For the Love of Wisdom

The logic of iambic half-lines

Philip Seymour Hoffman and Addiction

How much of what we say about addiction is true?

Reading the various takes on Philip Seymour Hoffman’s death can be frustrating, because so much of it is wishful thinking on behalf of the commentator. When an addict dies, they lose their life, but also the kind of regard we'd give them if they were only still living.

The loss of an addict seems an opportunity for non-addicts to "speak wise" on all they know about life. But for a few reasons, this seems inappropriate. One such reason is that these critics of addicts (and Hoffman) do not seem to have a good sense of the research that has been done on addiction.

The views that seem inaccurate include ones that take addiction to be a matter of not loving one’s family.

The views that seem unhelpful include ones that suggest an addict is simply lesser than the rest of us (Hoffman was surely greater).

The views that seem cruel pile on by trying to shame an addict who already lost his life.

And with some exceptions, such as the frank writing from Russell Brand, the impression one gets is that we all feel comfortable chiming in with our pet theories on the cause of a person's addiction. (Brand takes on those who want to delve into Hoffman’s personal life, as if they think therein lies some mystery yet to be explained. No, he writes, it’s just that addiction will kill you.)

I’d like to point readers to the most comprehensive explanation of addiction I’ve yet found, that of neuroeconomist and philosopher Don Ross. He puts the phenomenon of addiction in a larger context, that of coming to understand rationality itself. But allow me to quote from one of his many papers, "Addictive, Compulsive, and Counter-Normative Consumption." The section from which I am quoting is titled “Drug addiction.”

If we are going to philosophize or moralize about addiction, it is hard to imagine any excuse for doing so without representing the matter in all of its complexity. Ross represents the complexity of addiction well. If we even want to pretend to care about the situation in which addicts find themselves, we should study work like Ross's. 

“This essential identification of addiction with dependence leads immediately to a puzzling confrontation with facts about the courses of most actual addictions, which involve repeated successful withdrawals and relapses into regular consumption (Heyman 2009). Even heroin addicts are not generally so averse to the miseries of withdrawal that they feel compelled to stick with their drug; most suffer through full cold-turkey experiences all the way to temporary success several times in their lives. It is of course implausible to attribute relapse by experienced addicts to ignorance of the risk of dependence. This pattern puts irrecoverable strain on the Becker-Murphy (1988) model of “rational” addiction mentioned above, at least as a specific model of addiction rather than a model of habit-forming consumption in a much more abstract and general sense. One could try to save the model by hypothesizing that addicts go through repeated withdrawal not in hopes of quitting for good, but to lower their tolerance so as to make their future drug consumption less expensive; but there is no empirical evidence at all for such an hypothesis. The disease model of addiction is better able to adapt to the common pattern of withdrawal and relapse. Discovery of a strong genetic and inherited basis of vulnerability to addiction (MacKillop et al 2010) leads naturally to the idea that the underlying disease is the vulnerability itself. The idea that drug addicts are helpless in the face of their dependence has been vigorously promoted by the ideology of so-called “12 steps” recovery groups such as Alcoholics Anonymous, which regards addicts who are currently abstaining as in “remission”, but denies that any addict can be regarded as “cured” or “recovered”.

Heyman (2009) vigorously criticizes the disease model on the grounds that addicts' consumption patterns are manifestly sensitive to incentives, most notablyprice changes (Chaloupka 1991; DeGrandpre et al 1992; Leung & Phelps 1993; Carroll 1996; Bickel et al 1998; Chaloupka et al 1999; Higgins et al 2004) and changes in career and life prospects (Heyman 2009, pp. 65-88). Indeed the evidence that addictive consumption is chosen in the economist’s sense as described in the previous section is overwhelming.

All this shows, however, is that disease models and choice models are not the incompatible alternatives they are often taken to be. Genetic and other physiological factors make it more likely that some people will choose addictive consumption, controlling for environmental triggers such as availability and social and legal sanctions, than others. Logically, there is no difference here from allowing that the following pair of uncontroversial statement simply no mutual contradiction: in consequence of an inherited condition, lactose tolerant people are more likely to quench their thirst with milk than are lactose-intolerant people; and everyone who drinks milk chooses to do so. The special tendency of addicts to relapse likely goes beyond their initial genetic vulnerability.

A good deal of evidence, both behavioural and based on neuroimaging, indicates that addictive drugs work by exploiting the reward valuation learning systems of the brain (Koob et al 1998; Koob & Le Moal 2000; Berke & Hyman 2000; Wise 2000; Martin-Soelch et al 2001; Everitt et al 2001; Robinson et al 2001; Goldstein & Volkow 2002; Ahmed 2004; Redish 2004; Everitt & Robbins 2005; Kalivas et al 2005; Koob 2006)."

Ross goes on to explain what we know about these reward valuation systems. I wouldn't want to summarize and lose the detail, which he puts forward very ably. But I would recommend the paper to anyone interested in "speaking wise" about addiction. 

As even this excerpt attests, addiction is not simple. The frameworks with which we commonly approach it are incomplete. So we cannot be breezy about it or pretend to have it figured out, and that goes for the addicts and the non-addicts among us. My hope, though, is that us non-addicts at least begin to recognize that an addict's experience is not the same as a means to congratulate ourselves in comparison.

Please read the rest of Ross's paper here: http://www.academia.edu/653384/Addictive_compulsive_and_other_counter-normative_consumption

Jennifer Baker, Ph.D., is an assistant professor of philosophy at the College of Charleston.

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