The Nature of Addiction
Addictions are heterogeneous. The patterns picked out as addictive are only more or less generalizable, and there may be different aspects of a pattern that help to assign a person to the category of being addicted.
Consider the example we are using—a case of addiction to alcohol (a drug, a substance). There are many varieties of drug-related addictive behavior, depending on the drug of choice (DoC), the individual person, the social and cultural contexts within which the addiction progresses, and the person and social practices involving the consumption of the DoC. Often personal preoccupation with the “release” and relief that comes after using the DoC or with craving the DoC when the drug is absent are parts of addictive behaviors—parts but not essential or necessary parts. Addiction can occur without craving or felt release from craving (West 2006). But for purposes of this paper, let’s assume craving and release/relief to be elements of addiction (again, of the unwilling addict). Based on characteristics such as craving and release and noting the recent advances in understanding the neural correlates of motivation, decision-making, pleasure seeking, and inhibitory control, some theorists argue that addiction is “a disorder of the brain’s reward system” (Gastfriend 2005: 1514). That is not our belief.
No addiction bypasses the brain, to be sure, but whether the brain is not functioning as it should or is ill, diseased or disordered is not to be judged by whether it supports personally harmful or unwanted behavior. Nature did not design the human nervous system to guarantee personal prudence. Learning on a variable ratio schedule of reinforcement (as the brain does) is certainly fitness-enhancing. It kept our ancestors pursuing prey, despite numerous failures and attempts to capture them with unpredictable outcomes. But subjecting oneself to the very same ratio of reinforcement at a racetrack or casino can lead to significant imprudent harm. Drinking liquids is also fitness-enhancing to be sure. Without doing so we would shrivel up and die. But no respected evolutionary biologist who thinks that brains were designed, in part, to control hydration also thinks that it was designed to support drinking too much scotch too often in a bar in Brooklyn or the Bronx. Alcoholism comes like a booby prize for drinking the wrong stuff too often. True, eventually alcohol consumption may harm the brain, when, say, damage to the dopaminergic system or akinesia sets in. But the brain of someone with alcoholism is not disordered or diseased just because it is the brain of someone with alcoholism. Neither is it relevant for whether the brain is disordered that an alcoholic may feel that they have lost control over their drinking. The brain also is designed to entrain motor movements and actions that can proceed with minimal deliberate control after learning. Failing to pay full attention to one’s heavy bias to drink is often a prelude to relapse on the part of an otherwise unwilling addict, but these behaviors can be explained without assuming that the brain is broken.
Addictive patterns are formed by an inability to resist impulses that lead to significant harm. A fuller account of the “cognitive-motivational dynamics of addiction” requires an explanation of the “impairment in taking evaluative stock of oneself and of exerting reason-responsive control” (Graham 2013: 181). Developing this fuller and normatively infused account requires thinking of persons as reason- responsive, normative, and self-interpreting agents. Neither brains nor genes, for that matter, are the basic, root or sole cause of addiction; it is not brains or genes that become addicted, it is persons who get addicted (Flanagan 2013a, b; Graham 2013; Tekin 2013b).
An addict (of the unwilling sort) fails to execute normal powers of effective rational agency, according to the twin normative failure model of addiction. She decides not to use the DoC but uses anyway. She assesses her addictive behavior as a rational agent and judges that she does not want to continue, yet her self-assessment does not produce the outcome of effectively and permanently ending her use of the DoC. In a normative sense, the individual “fails to live up to the hopes, expectations, standards, and ideals she has for a good life for herself because of her addiction” (Flanagan 2013a: 1). She believes that life without addiction is a better life, a life in which she can flourish. Still she fails to act in accordance with her belief.
The model that asks us to conceive of the person as a narrative being who comes to exhibit, and often to recognize, that she suffers twin normative failures enriches our understanding of the depth, clinical presentation, and phenomenology of addiction. Nonetheless, some might argue that the model is not scientifically useful, as it makes the concept of the self central to understanding addiction by engaging with the reason responsiveness of the self, self-interpretation, self-assessment, and other self-related feelings and attitudes. This self, it may be objected, is neither empirically tractable nor easily describable; thus, it is not a useful scientific focus if we want to understand and address addiction. In fact, the concept of the self was omitted from the Diagnostic and Statistical Manual of Mental Disorders (DSM), the primary manual of mental disorders used for research and clinical purposes, starting with its third edition (1980), precisely because it was considered an unscientific concept reminiscent of Freudian psychoanalytic approaches to mental disorders (for more on this topic, see Tekin 2014a, b, c, 2015; Parnas et al. in press; Schaffner and Tabb in press).
But let’s not get entangled in Freudianism. Yes, the word “self’ is ambiguous. Sometimes it just refers to each and every person him or herself. I am myself. You are yourself. My self is none other than me. Your self is none other than you. Sometimes it refers to an internal subject of awareness, a homunculus, separate from the body. What follows gives a detailed explanation of what we refer to when we write of the self.