Addiction is, of course, an extremely serious societal problem. It has destroyed families and communities, ended millions of lives prematurely, and in some cases, upset whole cultures and economies. About a hundred years ago here in the U.S. we had a national prohibition on alcoholic beverages, in no small part because alcoholism left whole towns of men unwilling or unable to work. In the ‘80s, the crack epidemic plagued black and brown communities across the nation, and in some places led to unprecedented violence in the streets. Now the ongoing U.S. Opioid Crisis—once driven by OxyContin, now by Fentanyl—is an era-defining public health issue, ending about half a million lives prematurely since 1999, and ruining many more.
As it happens, in addition to being an extremely serious societal problem, addiction raises fascinating, and sometimes pressing, philosophical questions. Some of these questions are social, political, and ethical, while others are metaphysical, epistemological, and psychological. What is addiction? Is it a ‘natural kind,’ or is the grouping together of different addictions merely conventional? Does addiction even exist, or might it just be a politicized myth? Considering its similarities to natural appetites, what makes it bad? Is it only bad vis-à-vis peculiar socially constructed institutions and values? In what sense do ‘unwilling’ addicts ‘want,’ ‘desire,’ or ‘value’ that to which they are addicted? What kind of self-conception or self-knowledge does addictive behavior reflect? Are addicts morally responsible for their addictive behavior, and should we hold them legally responsible? Philosophers have taken up all of these questions, among others.
How addiction affects self-control is perhaps the most pressing philosophical question about addiction. For one, the questions of moral and legal responsibility seem to hinge on it: If addictive behavior is out of the agent’s control, or ‘compulsive,’ then it seems they are not responsible for it, and should not be punished when it harms others or violates the law. In this way, what we might call ‘the question of freedom in addiction’ has particularly clear practical connections. But at a more basic level, people have radically divergent perceptions and intuitions about how addiction shapes behavior. On one hand, addictive behavior often looks like a paradigm of intentional action: it can be premeditated, carefully planned, and assiduously executed. On the other hand, when you consider that people struggle and fail to overcome their addictions, often repeatedly and despite sophisticated interventions, it can seem perfectly obvious that addiction compromises one’s basic ability to do what one really wants. This tension exists as much for addicted persons themselves, as for third parties; addiction can be a deeply perplexing experience that undermines one’s own sense of agency and personhood. What in the world does addiction do to us, as agents?
There have always been those who viewed what we now call addiction as a moral failing. On this picture, addicted persons are deeply committed to perverse values. They are lazy, selfish hedonists who care more about their drug use than their loved ones, their communities, and their jobs. They are not ‘out of control’ of their addiction at all—they are living exactly as they like. But the modern understanding of addiction, which tends to see it as a compulsion, is a medical (or at least ‘medicalized’) one. In a passage well-known to philosophers who study addiction, physician, Founding Father, and ‘father of American psychiatry’ Benjamin Rush recounts the following testimony from an alcoholic in his 1812 work Medical Inquiries And Observations Upon The Diseases of the Mind: “Were a keg of rum in one corner of the room, and were a cannon constantly discharging balls between me and it, I could not refrain from passing before that cannon, in order to get at the rum.” Medical practitioners, theorists, and laypeople had just started to think of what we now call “alcoholism” in terms of medical pathology, and compulsion, in 1812; and by the early 20th century, many kinds of substance addiction were predominantly understood in this way.
The view that addiction is a compulsive pathology, either of the brain or of the mind, is still the orthodoxy in psychiatry, neuroscience, and various treatment and support modalities (like Alcoholics Anonymous). But there is a lot of skepticism about this view now, particularly in psychology and philosophy. In the early ‘70s, philosophers like Joel Feinberg and A.M.C. Armstrong raised deep doubts about the concept of the psychological inability to do otherwise. Then, a wave of psychological studies commenced demonstrating that heavy drug users have at least some control over their consumption behavior. One kind of study has shown that certain incentive structures prove fairly effective at promoting abstinence; drug misuse seems especially responsive to financial incentives in particular. In a similar vein, Bruce Alexander’s now-famous ‘Rat Park’ experiments suggest that a lot of drug misuse is a response to adverse environmental conditions, and that when healthy socialization and recreation are available, they are usually preferred to even highly addictive substances. Empirical evidence from experimental psychology was reason enough for many psychologists and others—including philosophers—to doubt the orthodox view of addiction as a compulsive pathology. Now, there is even a neuroscientific argument, which centers on the view that addiction is primarily a matter of the reward learning (mesocorticolimbic) circuitry: Addiction is basically just a really ingrained habit. And behavior can seem more autonomous for being more deeply ingrained, not less.
This skepticism is much needed. The prevailing medical view of addiction lends itself too readily to convenient stereotypes of addicted persons as subhuman automata, or zombies—which, it should be clear, are incredibly stigmatizing and dangerous. Science just confirms the clear-eyed casual observation that a great deal of addictive behavior is chosen in a rather ordinary way. And philosophers like Gary Watson, Neil Levy, and Hanna Pickard have helped us to see that the traditional arguments for the view that addiction is a compulsion are not nearly as strong as once assumed. Obviously addiction is a disorder of agency, but it is important that we see that how it shapes behavior is not simple or uniform. Addiction is far slipperier than is often assumed, even by leading experts.
While most clinicians, neuroscientists, and health organizations still hold that addiction is a compulsive pathology, a new orthodoxy is forming among philosophers who study the issue. In the absence of good arguments for the received view, and the presence of empirical evidence of control in addiction, these philosophers increasingly agree that addictive behavior is always (or almost always) freely chosen. In general, addicted persons are able to abstain from their substance or behavior, hard though it may be. There may be less moral or legal responsibility for wrongs done in service of addiction, but this is not because addicted agents simply can’t do otherwise.
This is where my research comes in. Scientific and philosophical skepticism about addictive compulsivity have productively complicated our understanding of addiction. But there is still so much to learn that bears on the question of freedom in addiction, and so much science coming out all the time to be appraised and integrated. One thing I would like to draw attention to is that whether addiction is compulsive is really a matter of whether it compromises control over a pattern of behavior, and not just individual behaviors. An addicted person might have control over 99% of her addictive behaviors, but be out of control of her addiction because she cannot prevent herself from eventually relapsing. Another thing I want us to explore more is the role of emotion in addiction. Philosophers tend not to think of addiction as an emotional phenomenon, but a growing body of empirical research suggests that aversive emotions are a central part of any adequate theory of addiction. If strong aversive emotions can compromise behavioral control—as has often been held in philosophy—then there may be a way in which addiction compels that we have yet to properly appreciate. To be sure, addiction is not compulsive in the simplistic way we might have imagined; but the deeper theoretical question is far from settled.
Arthur Krieger
Arthur Krieger is a Ph.D. candidate in Philosophy at Temple University (Philadelphia, PA). His dissertation is about self-control in addiction, at the intersection of philosophical psychology and philosophy of action. His broader interest is ethics.
