Brain, Behavior, and Addiction

Is addiction a brain disease that forces people to use drugs, even when the drugs in question are bad for them? Or are people who are addicted to drugs choosing to use them? Most neuroscientists would probably say the former. They might point out how addiction changes the way the brain’s dopamine system functions; they might also note that there are medications for some addictions, and those medications work because addiction is a disease.

We might also talk about the almost overwhelming power of cravings, which seem to drive behavior that goes against our best judgment and deepest preferences. We eat that fifteenth gummy bear, for example, or watch that nineteenth episode in a row, in spite of our firm intention to do something else. We may even feel disappointed in ourselves, impatient with ourselves, angry at ourselves.

But does that assessment ignore the fact that users are still making a choice? Imagine someone walking into a bar and poisoning a gin & tonic, right in front of its owner’s face. The owner of the poisoned G&T isn’t going to drink it, no matter how addicted they are. And this shows that addicts aren’t mindless automata but instead are people with willpower. If addiction were just a disease that made us totally powerless to resist, we would reach out, grab that poisoned gin & tonic, and pour it right into our mouth.

This goes along with something the existentialists would say. Sartre or Beauvoir would say that human beings always have choices to make, even in the face of overwhelming impulses. We can always choose against our feelings, motivations, and past decisions. We don’t have to give in to those cravings. And if we don’t, we’ll be helping both ourselves and other people.

All of this generates a difficult dilemma. On the one hand it seems like we should recognize a space for agency, even within addiction; on the other hand, it is surely callous to suggest or imply that someone’s addiction is a character flaw, and all they need to do is make better choices, as though making better choices is a trivially easy thing. That seems pretty heartless.

One compromise solution might be to say that while addiction is in part a matter of character, character itself is not something we can be blamed for. Character is formed by all kinds of factors that are outside of our control: how our parents treated us, what resources society has given us, even our brain chemistry and DNA. But once we have that character, we are still responsible for what we do with it. We shouldn’t be blamed for a problem of character that isn’t our fault. But we should perhaps be encouraged to take the steps that lie within our power.

Is that a good compromise, or is it still too condescending? Does it involve too much responsibility, too little responsibility, or just enough? Our guest will have plenty to tell us about the value of avoiding blame when it comes to actually helping addicts; she has fascinating suggestions for better ways of conceptualizing and treating addiction. It’s Hanna Pickard from Johns Hopkins University, whose new book is What Would You Do Alone in a Cage with Nothing but Cocaine? A Philosophy of Addiction.