I don’t mean to suggest that no one ever endorses the choice to do drugs. Indeed, as the philosopher Hanna Pickard has argued, addictive behavior is often initiated and maintained by the purposes it serves in someone’s life, often as self-medication for physical or psychological trauma. Nor am I saying that addictive behavior is compulsive, irresistible, or completely out of the person’s control. After all, many people manage to recover from addiction without the help of medication or even clinical intervention.
The messy truth about addiction is that it lies somewhere in between choice and compulsion. Addictive cravings work in much the same way as the cravings that everyone experiences — for Netflix or chips, say. They do not simply take over one’s muscles like an internal puppeteer. Instead, they pull one’s choices toward the craved object, like a psychological kind of gravity.
But as Berridge’s research suggests, the neurochemical effects of addictive drugs make the cravings addicts experience far, far stronger than those the rest of us have to contend with in our daily lives. It may not be impossible to resist these cravings, but it is extraordinarily difficult. And given how hard it is to resist cravings of normal strength — just think of those bottomless chips — we should not blame someone with addiction for failing to overcome her neurobiologically enhanced cravings.
This is why addiction is not a moral failure. The addicted person need not be shortsighted or selfish; she may have the very same priorities as anyone else. Nor need she be any worse at self-control than the rest of us are. She is just faced with cravings that are far harder to resist.
Seeing addiction this way also helps us think more clearly about treatment. Emphasizing the bad consequences of using, whether by pushing someone to rock bottom or by threatening her with prison, is ineffective because the part of the mind that drives addiction can overpower thoughts about consequences.
The problem is not that a person with addiction does not understand the consequences of her actions, but that she is unable to use this understanding to control her behavior. Thus, we should not be worried about “enabling” her addiction by protecting her from its worst effects — for example, by providing her with clean needles.
The paradigm shift is most dramatic for medication-assisted treatment. While the Socratic view paints these treatments as crutches that leave the basic problem unaddressed, the divided mind view shows this to be wrongheaded. If the source of addiction is overly strong automatic cravings, then the most direct way to treat addiction would be to weaken or satiate these cravings in a non-damaging way.
- People are dying because we misunderstand how those with addiction think
The messy truth about addiction is that it lies somewhere in between choice and compulsion. Addictive cravings work in much the same way as the cravings that everyone experiences — for Netflix or chips, say. They do not simply take over one’s muscles like an internal puppeteer. Instead, they pull one’s choices toward the craved object, like a psychological kind of gravity.
But as Berridge’s research suggests, the neurochemical effects of addictive drugs make the cravings addicts experience far, far stronger than those the rest of us have to contend with in our daily lives. It may not be impossible to resist these cravings, but it is extraordinarily difficult. And given how hard it is to resist cravings of normal strength — just think of those bottomless chips — we should not blame someone with addiction for failing to overcome her neurobiologically enhanced cravings.
This is why addiction is not a moral failure. The addicted person need not be shortsighted or selfish; she may have the very same priorities as anyone else. Nor need she be any worse at self-control than the rest of us are. She is just faced with cravings that are far harder to resist.
Seeing addiction this way also helps us think more clearly about treatment. Emphasizing the bad consequences of using, whether by pushing someone to rock bottom or by threatening her with prison, is ineffective because the part of the mind that drives addiction can overpower thoughts about consequences.
The problem is not that a person with addiction does not understand the consequences of her actions, but that she is unable to use this understanding to control her behavior. Thus, we should not be worried about “enabling” her addiction by protecting her from its worst effects — for example, by providing her with clean needles.
The paradigm shift is most dramatic for medication-assisted treatment. While the Socratic view paints these treatments as crutches that leave the basic problem unaddressed, the divided mind view shows this to be wrongheaded. If the source of addiction is overly strong automatic cravings, then the most direct way to treat addiction would be to weaken or satiate these cravings in a non-damaging way.
- People are dying because we misunderstand how those with addiction think
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