Drug Addiction

In this paper, I identify an argument derived from the commitments of John Rawls’s liberalism for restricting the consumption of recreational drugs in a liberal society, but not because of a great passion for restriction at present. The argument can also be used to respond to Jonathan Quong’s example of an unresolvable disagreement between liberal citizens.

The opioid crisis has greatly increased the number of patients who are illegally injecting drugs while hospitalized for other conditions. Physicians face a difficult decision in these circumstances: when is it appropriate to involuntarily discharge or “fire” a patient with opioid use disorder for their continued nonmedical use of opioids? This commentary analyzes physicians’ responsibilities to their patients and argues that physicians should fire non-adherent patients only when every other option has been exhausted and the expected benefits of firing the (...) patient outweigh the expected harms. (shrink)

Disagreement about the nature of ‘addiction’, such as whether it is a brain disease, arises in part because the label is applied to a wide range of phenomena. This creates conceptual and definitional confusions and misunderstandings, often leading to researchers talking past one another. Ontologies have been successfully implemented in other fields to help solve these problems by creating unifying frameworks that can accommodate divergence while clarifying the basis for it. We argue that ontologies can help transform the way we (...) think and communicate about addiction as well, providing a basis for a shared understanding of the domain and a shared means for communicating and achieving that understanding. -/- We introduce the use of ontologies in science and medicine and show how they can unify differing perspectives on addiction. We also show how ontologies provide a practical tool for organizing our collective knowledge in this field, even, and especially, when that knowledge is garnered through distinct disciplinary approaches adopting disparate methodologies or perspectives (e.g., neurobiological, psychological, sociological, etc.). In the end, we believe that ontologies can help to avoid letting questions like “Is addiction a brain disease?” divide the field, hamper communication, or otherwise disrupt the ability to make meaningful progress. (shrink)

In this chapter we focus on the structure of close personal relations and diagnose how these relationships are disrupted by addiction. We draw upon Peter Strawson’s landmark paper ‘Freedom and Resentment’ (2008, first published 1962) to argue that loved ones of those with addiction veer between, (1) reactive attitudes of blame and resentment generated by disappointed expectations of goodwill and reciprocity, and (2) the detached objective stance from which the addicted person is seen as less blameworthy but also as less (...) fit for ordinary interpersonal relationships. We examine how these responses, in turn, shape the addicted person’s view of themselves, their character and their capacities, and provide a negative narrative trajectory that impedes recovery. We close with a consideration of how these effects might be mitigated by adopting less demanding variations of the participant stance. (shrink)

Research suggests that reducing rates of drug addiction requires a range of physical spaces where drug users and counselors can meet, build community, and work together. The efficacy of this ‘social infrastructure,’ however, depends not just on how its shared spaces facilitate access to social networks, but on how institutional rules and norms govern the social interaction that takes place in those spaces. I suggest that institutional norms nurture sobriety to the extent that the social arrangements they foster are (i) (...) discretionary, since individuals trying to re-establish sobriety have heterogeneous social preferences; (ii) unconditional, since individuals’ efforts to re-achieve sobriety frequently involve setbacks; and (iii) low-pressure, since individuals may find extraneous turmoil damaging to their renascent sobriety. To the extent that institutional norms facilitate contrary social arrangements, shared settings are liable to backfire—to undermine or at least fail to nurture sobriety—which I illustrate using the case of sobriety-oriented organizations in the Boston area. Critically, while the first two aspects are governed largely by intra-organizational norms, the third is governed by norms between multiple sobriety-oriented organizations. Upholding healthful local norms, then, demands commitment at both the organization and system levels. (shrink)

Addiction and certain varieties of interpersonal attachment share strikingly similar psycho-behavioral structures. Neuroscientists, psychologists, and philosophers have often adduced such similarities between addiction and attachment to argue that many typical cases of romantic love represent addictions to one’s partner and thus might be appropriate candidates for medical treatment. In this paper, I argue for the relatively neglected thesis that some paradigmatic cases of addiction are aptly characterized as emotional attachments to their objects. This has implications for how we should understand (...) the nature of addiction and for the ethics of attachment more broadly. (shrink)

E-cigarettes are a uniquely close substitute to combustible cigarettes. Close not just in nicotine content, but also in shape, taste and even inhalation and arm movement. Their availab...

Addiction theorists have often utilized the metaphor of the blind men and the elephant to illustrate the complex nature of addiction and the varied methodological approaches to studying it. A common purported upshot is skeptical in nature: due to these complexities, it is not possible to offer a unifying account of addiction. I think that this is a mistake. The elephant is real–there is a _there_ there. Here, I defend a dispositionalist account of addiction as _the systematic disposition to fail (...) to control one’s desires to engage in certain types of behaviors_. I explain this position, defend the inclusion of desires and impaired control, and flesh out the notion of _systematicity_ central to my account. I then illustrate how my dispositionalist framework can unify the disparate and seemingly incompatible accounts of addiction (and their respective methodological approaches). I close with a brief plan to extend and implement my account. (shrink)

This article describes a case of a teenager with early complex trauma due to chronic domestic violence. Cannabis use triggered auditory hallucinations, after which the teenager was diagnosed with an acute schizophrenia-like psychotic disorder. Antipsychotic medication did not fully resolve symptoms. Eventually the teenager chose to self-medicate with LSD in order to resolve a suicidal condition. The teenager carried out six unsupervised LSD sessions, followed by an extended period of almost daily use of inhaled low-dose DMT. Psychotic symptoms were mostly (...) resolved after approximately one year. Subsequent cannabis use caused a transient relapse. -/- While his psychosis may have been due to cannabis use in the presence of a genetic predisposition, LSD and DMT did not promote psychotic symptoms in this case, and resolved the suicidal condition in one session. Additional high-dose LSD sessions and low-dose DMT sessions appeared to resolve the symptoms related to the early complex trauma. Alternatively, if psychosis is understood as a massive defense system resulting from early complex trauma, and if his psychotic symptoms were partially due to such trauma, psychedelics appeared to transcend this defense system, providing access to traumatic memories in order to allow for an integrative treatment effect. -/- Information was acquired from medical record excerpts provided by the patient, a semi-structured retrospective video interview, and follow-up interviews a year later. The present case suggests a need for further studies on the relationship between psychedelics and psychotic disorders, the feasibility of supervised vs unsupervised settings for various situations, and alternative therapeutic models for utilizing the hyperaware-hypersensitive state induced by psychedelics. With regard to self-treatment, a harm reduction approach should be adopted. Low-risk psycholytic self-treatment protocols could be developed for future use in public health care systems. (shrink)

Charland's article suggests that we need to think more about whether decision-making capacity is impaired in severe addiction, working from the idea that drug dealers rely on this understanding of addiction to draw in their clients. Charland argues that it is possible to make a choice without being in control (to make decisions without having decision-making capacity). I argue in support of Charland's ideas by examining the reasons supporting a medical model of addiction and its importance. (For Charland's article and (...) the full set of commentaries, please see the Research Gate link). (shrink)

The debate for and against making e-cigarettes available to smokers is to a large extent empirical. We do not know the long-term health effects of vaping and we do not know how smokers will respond to e-cigarettes over time. In addition to these empirical uncertainties, however, there are difficult moral issues to consider. One such issue is that many smokers in some sense choose to smoke. Though smoking is addictive and though many start young, it does not seem impossible to (...) plan for and implement cessation. Yet many choose not to do so and we arguably have some reason to respect this choice. I propose that liberal opposition to strict tobacco control, based on respect for choice, is mitigated when e-cigarettes are available, since they are such a close substitute. Making e-cigarettes available to smokers might therefore not only enable switching in practice, but may make tougher tobacco control more justified. Another moral issue is that making e-cigarettes widely available might induce many people to vape, who would otherwise have neither vaped nor smoked. If this is so, the price of using e-cigarettes to accelerate smoking cessation may be a long-term vaping epidemic. Since vaping is less harmful than smoking, both individuals and society will have less reason to end this epidemic and so it may endure longer than the smoking epidemic would otherwise have done. This raises further questions around the weighing of reduced harm to current smokers against increased harm to future vapers. (shrink)

This study was carried out to determine the prevalence of, and reasons for the various forms of addictive use among the students of the University of Dire Dawa. The research system is used, cross-sectional, questionnairequestion. This study has been carried out, including the first-and second-year students at the University of Dire Dawa. The study included 164 students who have completed a structured questionnaire. The Data was analyzed on SPSS version 16. The prevalence of addictive use was 20.7%, with 64.7% of (...) the male students are dominating. It is the most common addiction among students was that the Chewing of Chat (38.2%), followed by cigarette smoking (23.5%), marijuana smoking (17.6%), shisha smoking (8.8%), alcohol (6%), and 5.9% were of other addiction. The most important factor appears to be the pleasure to compete and not being able to love. The vast majority of addictive users of the students (47.1%) were motivated by the friends of the start of an addiction. addictive usage among university students, even though they are well known about their dangers, a cause for concern. Education, training, counseling, and proper training can help prevent the dependency of prospective students, who are expected to serve the community. (shrink)

In the present review we focus on what we take to be some remaining issues with the Behaviour Change Intervention Ontology (BCIO). We are in full agreement with the authors’ endorsement of the principles of best practice for ontology development In particular, we agree that an ontology should be “logically consistent and having a clear structures [sic], preferably a well-organised hierarchical structure,” and that “Maximising the new ontology’s interoperability with existing ontologies by reusing entities from existing ontologies where appropriate” is (...) critically important (Wright et al., 2020, p. 17). Our remaining concerns with BCIO relate directly to these two principles. First, we identify a number of issues with some of the classifications and definitions in BCIO that seem to be in tension with the just-mentioned principle . Second, we note some reservations about the reuse of certain classes in BCIO, namely from the Gazetteer (GAZ), the Ontology of Medically Related Social Entities (OMRSE), and the Information Artifact Ontology (IAO). While the latter principle of “reuse” is important, it is also important not to let the reuse of existing classes (or their corresponding definitions) compromise the logical integrity or the realist nature of one’s ontology. (shrink)

A dominant view of guilt and shame is that they have opposing action tendencies: guilt- prone people are more likely to avoid or overcome dysfunctional patterns of behaviour, making amends for past misdoings, whereas shame-prone people are more likely to persist in dysfunctional patterns of behaviour, avoiding responsibility for past misdoings and/or lashing out in defensive aggression. Some have suggested that addiction treatment should make use of these insights, tailoring therapy according to people’s degree of guilt-proneness versus shame-proneness. In this (...) paper, we challenge this dominant view, reviewing empirical findings from others as well as our own to question (1) whether shame and guilt can be so easily disentangled in the experience of people with addiction, and (2) whether shame and guilt have the opposing action tendencies standardly attributed to them. We recommend a shift in theoretical perspective that explains our main finding that both emotions can be either destructive or constructive for recovery, depending on how these emotions are managed. We argue such management depends in turn on a person’s quality of self-blame (retributive or ‘scaffolding’), impacting upon their attitude towards their own agency as someone with fixed and unchanging dispositions (shame and guilt destructive for recovery) or as someone capable of changing themselves (shame and guilt productive for recovery). With an eye to therapeutic intervention, we then explore how this shift in attitude towards the self can be accomplished. Specifically, we discuss empathy-driven affective and narratively-driven cognitive components of a process that allow individuals to move away from the register of retributive self-blame into a register of scaffolding ‘reproach’, thereby enabling them to manage their experiences of both shame and guilt in a more generative way. (shrink)

Opioid treatment agreements are written agreements between physicians and patients enumerating the risks associated with opioid medications along with the requirements that patients must meet to receive these medications on an ongoing basis. The choice to use such agreements goes beyond the standard informed consent process, and has a distinctive symbolic significance. Specifically, it suggests that physicians regard it as important to hold their patients accountable for adhering to various protocols regarding the use of their opioid medications. After laying out (...) a taxonomy of accountability relationships between physicians and patients, I argue that opioid treatment agreements are only justifiable for physicians to use in their provision of care if they improve public health outcomes, which has yet to be demonstrated. (shrink)

Mainstream addiction science is today widely marked by an antinomy between a neurologically determinist understanding of the human brain ‘hijacked’ by the biochemical allure of intoxicants and a liberal voluntarist conception of drug use as a free exercise of choice. Prominent defenders of both discourses strive, ultimately without complete success, to provide accounts that are both universal and value-neutral. This has resulted in a variety of conceptual problems and has undermined the utility of such research for those who seek to (...) therapeutically care for people presumed to suffer from addictions. This article contrasts these two contemporary discourses to two others that played vital historical roles in initiating both scientific and popular concern for addiction. These are the Puritan and civic republican discourses that dominated scholarly discussions of addiction in the early modern era. In each case, the place of values in these discussions is highlighted. By comparing them to their early modern historical antecedents, this article seeks to reflexively explore and develop more intellectually sound and therapeutically relevant alternatives to the troubled attempts at universality and value-neutrality now fettering debates in mainstream addiction science. (shrink)

In this essay I argue that a comprehensive understanding of addiction and its treatment should include an existential perspective. I provide a brief overview of an existential perspective of addiction and recovery, which will contextualize the remainder of the essay. I then present a case study of how the six-step philosophical practice method of Logic-Based Therapy can assist with issues that often arise in addiction treatment framed through an existential perspective.

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after (...) becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

Reprint of an article that first appeared in Monash Bioethics Review (2018).

It is largely unethical to sentence individuals who are addicted to drugs to prison. While substance use can be a crime, it must be treated differently from other crimes because addiction is a psychiatric disorder. Prisons are penal institutions. Legitimate goals of penal sanctions include retribution, deterrence, rehabilitation, and incapacitation.[i] Most of these goals do not speak to those with substance use disorder, and incarceration may be counterproductive given the wide availability of drugs and feeble rehabilitation efforts in prison. Further, (...) it may be the case that substance use disorder impairs an addict’s autonomy, calling into question his criminal culpability. Our understanding of substance use disorder has evolved and our prison sentencing practices must do the same. This paper will first provide background on substance use disorder as a psychiatric disorder. Then, the need to focus on rehabilitating rather than punishing those with substance use disorder who commit crimes will be explored. Finally, this paper will address whether an individual with substance use disorder can be considered culpable for any crime—regardless of severity—and whether that individual’s autonomy is impaired due to his addiction. I conclude that culpability should depend on whether the serious crime would have occurred in the absence of the drug addiction. In most cases, it is unethical to sentence an individual with substance use disorder to prison where other options such as home confinement are available. (shrink)

In this article I address the question of what makes addiction morally problematic, and seek to answer it by drawing on values salient in the sub-Saharan African philosophical tradition. Specifically, I appeal to life-force and communal relationship, each of which African philosophers have at times advanced as a foundational value, and spell out how addiction, or at least salient instances of it, could be viewed as unethical for flouting them. I do not seek to defend either vitality or community as (...) the best explanation of when and why addiction is immoral, instead arguing that each of these characteristically African values grounds an independent and plausible account of that. I conclude that both vitalism and communalism merit consideration as rivals to accounts that Western ethicists would typically make, according to which addiction is immoral insofar as it degrades rationality or autonomy, as per Kantianism, or causes pain or dissatisfaction, à la utilitarianism. (shrink)

Programs of drug testing welfare recipients are increasingly common in US states and have been considered elsewhere. Though often intensely debated, such programs are complicated to evaluate because their aims are ambiguous – aims like saving money may be in tension with aims like referring people to treatment. We assess such programs using a proportionality approach, which requires that for ethical acceptability a practice must be: reasonably likely to meet its aims, sufficiently important in purpose as to outweigh harms incurred, (...) and lower in costs than feasible alternatives. In the light of empirical findings, we argue that the programs fail the three requirements. Pursuing recreational drug users is not important in the light of costs incurred, while dependent users who may require referral are usually identifiable without testing and typically need a broader approach than one focussing on drugs. Drug testing of welfare recipients is therefore not ethically acceptable policy. (shrink)

Currently there is such a cornucopia of conflicting theories in the field of addiction studies that it has become exceedingly difficult for treatment providers, therapists, and policymakers to integrate this vast field of knowledge into effective treatment. Since such a chaotic overabundance of treatment theories, styles, and definitions cloud the field of addictionology, many therapists claim their field is in need of a paradigm shift. In the last 20 years an integrative and compound model has emerged known as the biopsychosocial (...) model, but without a solid and comprehensive meta-framework, syncretistic confusion can result when therapists pick and choose techniques without direction or an overall rationale. To address this problem, Guy du Plessis applies integral theory as a conceptual framework for understanding addiction, as well as a meta-therapeutic framework for therapists. The integral foundation of addiction outlined in this book provides researchers, academics, treatment providers, policy makers, and therapists with a conceptual architectonic of addiction and its treatment that is integrative, inclusive, and practical. An Integral Foundation for Addiction Treatment belongs on the shelf of every addiction treatment therapist, and anyone else who is impacted or influenced by the topic. (shrink)

This article addresses the ethics of betel nut use in Taiwan. It first presents scientific facts about the betel quid and its consumption and the generally accepted negative health consequences associated with its use: oral and esophageal cancer, coronary artery disease, metabolic diseases, and adverse effects in pregnancy. It then analyzes the cultural background and economic factors contributing to its popularity in Asia. The governmental and institutional attempts to curb betel nut cultivation, distribution, and sales are also described. Finally, the (...) article analyzes the bioethical implications of this often-ignored subject from the perspectives of human dignity, the good of health, vulnerable groups, cultural diversity, informed consent, and ethical blind spots. (shrink)

The ethics of betel nut use in Taiwan are examined in this article. It first presents scientific facts about the betel quid, its consumption and negative health consequences and then analyses the cultural background and economic factors contributing to its popularity in Asia. Governmental and institutional attempts to curb betel nut cultivation, distribution and sales are also described. Finally, the bioethical implications of this often ignored subject are considered.

Lewis ascribes the stubborn persistence of addictions to habit, itself a normal process that does not imply lack of responsiveness to motivation. However, he suggests that more dynamic processes may be involved, for instance that “our recurrently focused brains inevitably self-organize.” Given hyperbolic delay discounting, a reward-seeking internal marketplace model describes two processes, also normal in themselves, that may give rise to the “deep attachment” to addictive activities that he describes: People learn to interpret current choices as test cases for (...) how they can expect to choose in the future, thus recruiting additional incentive against a universal tendency to temporarily prefer smaller, sooner to larger, later rewards. However, when this incentive is not enough, the same interpretation creates incentive to abandon the failed area, leading to the abstinence violation effect and a localized weak will. Normal human value does not come entirely, or even mainly, from expectation of external rewards, but is generated endogenously in imagination. Hyperbolic discounting provides an account of how we learn to cultivate the hedonic importance of occasions for endogenous reward by building appetite. In this account, expectations of the far future have to be rewarded endogenously if they are be as important as currently rewarded alternatives; and this importance is prone to collapse. Both will and hedonic importance are recursive and thus hard to study by controlled experiment, but do represent modelable, reward-based hypotheses about the dynamic nature of habit. (shrink)

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible (...) recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot. (shrink)

Addiction: A Philosophical Approach CHAPTER ABSTRACTS “Introduction: Dismantling the Catchphrase” by Candice Shelby Shelby dismantles the catchphrase “disease of addiction.” The characterization of addiction as a disease permeates both research and treatment, but that understanding fails to get at the complexity involved in human addiction. Shelby introduces another way of thinking about addiction, one that implies that is properly understood neither as a disease nor merely as a choice, or set of choices. Addiction is a phenomenon emergent from a complex (...) dynamic system that is at once physical, psychological, social, and more. “A Philosophical Analysis of Addiction” by Candice Shelby Shelby brings much-needed clarity to the discourse surrounding the topic of addiction. Arguing that addiction can neither properly be understood as a disease nor as merely a set of choices, Shelby exposes the weaknesses of both approaches. She shows that addicted persons do not exhibit the elements characteristic of compulsion, nor does an account of addiction in terms of weakness of will, or irrational choosing, provide a satisfying explanation. Instead, by replacing traditional substance ontology with process ontology, and accepting the reality of emergent entities, a coherent account of persons, minds, and addiction can be provided. A fundamental philosophical shift is necessary to see that bodies, minds, values, and addictions are all part of the natural world. “Addiction at the Individual Level” by Candice Shelby Shelby discusses the most influential accounts of addiction as it is understood at the purely individual level. From hedonic theories to incentive sensitization, to habit theories of addiction, to behavioral theories and the ego depletion theory, Shelby considers a variety of approaches to understanding addiction in individuals, as framed in both psychological and in neuroscientific terms. She notes some important caveats that should be considered before accepting the research regarding addiction at the individual level, namely that the scanning studies that are so popularly used to characterize addiction in neurobiological terms are ambiguous, and rely on numerous assumptions that may be false, and that certainly mislead. Shelby provides much-needed critique of both disease and choices models as they characterize addiction at the individual level. “Addiction and the Local Environment” by Candice Shelby Shelby argues that human addiction cannot be understood without serious consideration of the individual’s local environment, her home and family. From the gestational environment to interactions with caregivers during post-natal development to the adult environment in which people become addicted, Shelby shows that no one becomes an addict in a vacuum. Stress is a major influence in the environment throughout life, and has serious consequences for addictive vulnerability. Genetic influences as well are important to addictive vulnerability, but genes always express in interaction with their environment. Social acceptance or rejection is another particularly important factor in the local environment with respect to both coming to be addicted and transitioning out of it. “The Relation Between Addiction and Culture” by Candice Shelby Shelby provides a groundbreaking analysis of the relation between addicts and the cultures that breed them. In this cultural critique, Shelby shows that addictions to certain substances have historically been both the solution to the problem of how to grow economies and control people, and a problem for economic productivity and controlling citizens. Not all cultures have even the concept of addiction, while others, such as the contemporary Western world, and the U.S. in particular, seem to foster it. Shelby shows that addiction is both a cultural construct and, from another way of thinking about it, the result of conditions created by particular cultures. Social inequities, alienation, driving capitalism, and in particular the power of pharmaceutical companies, all contribute to the spiraling endemic of addiction. “Addiction and Meaning” by Candice Shelby Shelby provides a unique argument that understanding how meanings work is essential to a complete analysis of addiction. Individuals experiencing addiction and those who care about and for them often utterly fail to communicate. This is because their respective systems of meanings come to be significantly different. Meanings are not, Shelby argues, best understood in the symbolic terms that characterized the theory of language in the 20th century, but are better apprehended as emotion-rich prototypes carved from repeated interaction with the world. Becoming addicted essentially changes one’s entire system of meanings. Requisite to transitioning out of addiction is a Gestalt-type shift in one’s system of meanings. This holistic way of understanding meanings also provides one level of explanation of what happens when an addict relapses. “The Phenomenology of Addiction and its Implications” by Candice Shelby One way of judging theories of addiction is by how well they capture the phenomenal descriptions that addicts give of their own experiences. Shelby considers variations on 5 basic patterns of addictive experience through the eyes of particular individuals who lived through addictive periods, and shows how even the most influential theories of addiction fail to capture all of them. She argues that an important implication of taking the details of individuals’ addictive stories seriously is that addiction must be understood as a personal phenomenon emergent from a particular complex dynamic system. As her theory of addiction would lead one to expect, no two addicts are the same, and no single-focus theory can explain why not. “Possibilities for Transitioning Out of Addiction” by Candice Shelby Shelby provides numerous strategies for transitioning out of addiction. Given that the vast majority of addiction treatment programs currently available are 12-step based and only successful about 5-8% of the time, it is essential that other approaches be undertaken. Shelby canvasses a variety of options for helping addicted individuals to make the transition out of their troubled pattern of thinking and behaving. From direct brain interventions to drugs to trauma therapy to exercise and nutrition to habit reformation to use of narrative and changing one’s social context as ways of redefining the self, Shelby shows that the possibilities for transitioning out of addiction are legion. Perhaps the best approach is to understand addiction treatment in terms of providing physical, psychological, and social tool kits. “Addiction Emerges from a Complex Dynamic System” by Candice Shelby Shelby considers whether there truly exists such a thing as “an addict” or “addictive thinking” in the universal sense. She concludes that within the context of disruptive substance use or repetitive engagement in certain activities, ordinary human cognitive biases and behavior patterns are categorized as addictive. Addiction, she argues, is best understood as an irreducible human reality, emergent from a sufficiently complex dynamic system (an organism with self-awareness, within a particular cultural milieu) that is both shaped by and contributes to the shaping of its environment. Attempts to simplify addiction into one or a few dimensions may create a solvable problem, but by doing so they fail to solve the real one. (shrink)

This article reviews scientific advances in the prevention and treatment of substance-use disorder and related developments in public policy. In the past two decades, research has increasingly supported the view that addiction is a disease of the brain. Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned, perhaps because the aberrant, impulsive, and compulsive (...) behaviors that are characteristic of addiction have not been clearly tied to neurobiology. Here we review recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease. (shrink)

Patients’ admission to modern substance use disorder treatment comes with the attendant risk of being discharged from treatment— a widespread practice. This article describes the three mainstream theories of addiction that operate as a reference point for clinicians in reasoning about a decision to discharge a patient from treatment. The extant literature is reviewed to highlight the pathways that patients follow after administrative discharge. Little scientific research has been done to investigate claims and hypotheses about the therapeutic function of AD, (...) which points to the need for empirical ethics to inform clinical addictions practice. (shrink)

Despite recent increasing support for the brain disease model of alcohol and drug addiction, the extent to which the model may clinically impact addiction treatment and client behaviour remains unclear. This qualitative study explored the views of community-based clinicians in Australia and examined: whether Australian community-based clinicians support the BDM of addiction; their attitudes on the impact the model may have on clinical treatment; and their views on how framing addiction as a brain disease may impact addicted clients’ behaviour. Six (...) Australian community-based clinicians participated in semi-structured in-depth interviews that were analysed using thematic analysis. Whilst the BDM was not fully supported by this purposive sample of Australian community-based clinicians, there was acceptance that addiction neuroscience formed a key part of a wider addiction framework. Participants believed the BDM ignored key social, psychological and environmental factors important for successful treatment. The BDM was seen as potentially irrelevant for certain client types, however the model was believed to integrate with particular therapies. Participants believed that for clients viewing their addiction in terms of a brain disease, there were potential positive and negative impacts on client behaviour. Implications for addiction treatment practice and public health policy are discussed. (shrink)

The concepts of ‘biopolitics’ and ‘naked life’ have become increasingly relevant in the debate on substance dependency due to the growing prominence of neuroscience in defining the nature of addiction1 and its threat to agency. However, these concepts are not necessarily well understood, and therefore may lead to oversight rather than insight. In this article we review the literature on Italian philosopher Giorgio Agamben, whose founding works on both concepts shed a different light on addiction. We argue that the current (...) debate is missing a key insight from Agamben's work: the idea of agency past the subject, of agency past identity. We will illustrate how this can be an important form of agency against the stigmatization of users, making use of empirical data from our ongoing work on addiction and agency. (shrink)

Addiction is a significant issue in many aspects but no explanatory closure has been attained. The overemphasis on the brain disease paradigm upheld by the National Institute on Drug Abuse may run serious risks, and the present study intends to counteract this partiality. Drawing on Ludwik Fleck’s notion of thought collectives, this article offers a close reading of the works of sociologists Bingham Dai and Alfred R. Lindesmith vis-à-vis other coeval biomedical approaches. Individuals within the same thought collective, such as (...) Dai and Lindesmith, have different views although they share certain thought styles. As noted in this study, inter-collective communication is not typically antagonistic and may form some liaison under certain circumstances. These findings imply that communication among collectives may facilitate creative liaison, as suggested by Fleck. This study aims to enrich the understanding of addiction by coordinating biomedical and sociological sciences through minimizing, if not erasing, their intellectual antagonism and social distance. (shrink)

I show that Pickard’s argument against the irresistibility of addiction fails because her proposed dilemma, according to which either drug-seeking does not count as action or addiction is resistible, is flawed; and that is the case whether or not one endorses Pickard’s controversial definition of action. Briefly, we can easily imagine cases in which drug-seeking meets Pickard’s conditions for agency without thereby implying that the addiction was not irresistible, as when the drug addict may take more than one route to (...) go meet her dealer. (shrink)

In this paper, we contend that the psychology of addiction is similar to the psychology of ordinary, non-addictive temptation in important respects, and explore the ways in which these parallels can illuminate both addiction and ordinary action. The incentive salience account of addiction proposed by Robinson and Berridge (1993; 2001; 2008) entails that addictive desires are not in their nature different from many of the desires had by non-addicts; what is different is rather the way that addictive desires are acquired, (...) which in turn affects their strength. We examine these “incentive salience” desires, both in addicts and non-addicts, contrasting them with more cognitive desires. On this account, the self-control challenge faced by addicted agents is not different in kind from that faced by non-addicted agents – though the two may, of course, differ greatly in degree of difficulty. We explore a general model of self-control for both the addict and the non-addict, stressing that self-control may be employed at three different stages, and examining the ways in which it might be strengthened. This helps elucidate a general model of intentional action. (shrink)

ABSTRACT In previous work I explored how Integral Theory can be applied as a metatheoretical and transdisciplinary framework, in an attempt to arrive at an integrally informed metatheory of addiction. There was an overemphasis on Integral Methodological Pluralism in that thread of research, without clarifying the ontological pluralism of addiction as a multiple object enacted by various methodologies. To arrive at a comprehensive integral metatheory and integral ontology of addiction, I believe it is necessary to include the conception of Integral (...) Pluralism and Integral Enactment Theory as posited by Sean Esbjörn-Hargens. Integral Enactment Theory highlights the phenomenon of addiction as a multiple and dynamic object arising along a continuum of ontological complexity; it adeptly points out how etiological models “co-arise” in relation to methodology (methodological pluralism) to enact a particular reality of addiction (ontological pluralism) while being mediated by the worldview of the subject (epistemological pluralism) applying the method. This article briefly explores the significance of including Integral Pluralism and Integral Enactment Theory in the quest of an integral metatheory and integral ontology of addiction. (shrink)

Addiction is one of the most significant problems facing contemporary society. Consequently many scholars, institutions and clinicians have sought to understand this complex phenomenon, as is evident in the abundance of etiological models of addiction in existence today. A literature review pointed that there is little consensus regarding the nature and etiopathogenesis of addiction, and integrative models have not yet been able to provide the sought-after integration. In addressing this problem, this study offers a theoretical analysis of the paradigmatic and (...) meta-paradigmatic suitability of Integral Theory in the design of an integrated metatheory of addiction. The data consisted of the most prominent etiological theories and models of addiction. The study focused on several essential features constituting the architectonic of any metatheory that attempts to provide conceptual scaffolding for the construction of a comprehensive metatheory of addiction. The criteria for the construction of a metatheory were conceptual integration, ontological span, ontological depth, empirical validity and internal consistency. Integral Theory was critically assessed in terms of each of the abovementioned criteria. The study suggests that Integral Theory is eminently suitable as a philosophical foundation for the development of an integrated metatheory of addiction. (shrink)

Providing heroin to heroin addicts taking part in medical trials to assess the effectiveness of the drug as a treatment alternative, breaches ethical research standards, some ethicists maintain. Heroin addicts, they say, are unable to consent voluntarily to take part in these trials. Other ethicists disagree. In our view, both sides of the debate have an inadequate understanding of voluntariness. In this article we therefore offer a fuller conception, one which allows for a more flexible, case-to-case approach in which some (...) heroin addicts are considered capable of consenting voluntarily, others not. An advantage of this approach, it is argued, is that it provides a safety net to minimize the risk of inflicting harm on trial participants. (shrink)

Addiction is almost universally held to be characterized by a loss of control over drug-seeking and consuming behavior. But the actions of addicts, even of those who seem to want to abstain from drugs, seem to be guided by reasons. In this paper, I argue that we can explain this fact, consistent with continuing to maintain that addiction involves a loss of control, by understanding addiction as involving an oscillation between conflicting judgments. I argue that the dysfunction of the mesolimbic (...) dopamine system that typifies addictions causes the generation of a mismatch between the top-down model of the world that reflects the judgment that the addict ought to refrain from drugs, and bottom-up input caused by cues predictive of drug availability. This constitutes a powerful pressure toward revising the judgment and thereby attenuating the prediction error. But the new model is not stable, and shifts under the pressure of bottom-up inputs in different contexts; hence the oscillation of all-things-considered judgment. Evidence from social psychology is adduced, to suggest that a similar process may be involved in ordinary cases of weakness of will. (shrink)

The literature of Twelve Step groups such as Alcoholics Anonymous contains apparently contradictory implications regarding powerlessness and personal responsibility. In this essay I examine the treatment of these concepts in Twelve Step literature and their implications for the self-conception of people in these programs. In the first section, I examine the literature to demonstrate that addicts are presented as powerless over, yet responsible for, their addictive behaviors. In the second section, I outline two potential ways people in Twelve Step programs (...) might reconcile this contradiction within their self-conception, but I argue that neither is satisfactory. In the third section, I draw on Paul Ricoeur's theory of narrative identity to develop an account of how someone ni a Twelve Step group could coherently understand herself as both powerless and responsible. (shrink)

Joining the debate over the roles of reason and appetite in the moral mind, In Praise of Desire takes the side of appetite. Acting for moral reasons, acting in a praiseworthy manner, and acting out of virtue are simply acting out of intrinsic desires for the right or the good.

I argue that addiction is not an appropriate category to support generalizations for the purposes of scientific prediction. That is, addiction is not a natural kind. I discuss the Homeostatic Property Cluster (HPC) theory of kinds, according to which members of a kind share a cluster of properties generated by a common mechanism or set of mechanisms. Leading accounts of addiction in literature fail to offer a mechanism that explains addiction across substances. I discuss popular variants of the disease conception (...) and demonstrate that at least one class of substances that fails to confirm a major prediction of each account. When no mechanism can be found to explain the occurrence of the relevant properties in members of a category, the HPC view suggests that we revise our categories. I discuss options offered by the HPC view, including category revision and category replacement. I then conclude that talk of addiction as a prediction-supporting category should be replaced with categories such as “S-addiction” and “T-addiction,” where S and T are substances or sets of substances of abuse, as these categories are genuine natural kinds. (shrink)

Abstract This article proposes and outlines an integrally informed 12 Step-based therapy that is adapted for treating addicted populations. Integrated Recovery Therapy (IRT) as a therapeutic orientation is an Integral Methodological Pluralism to therapy for treating addiction. Its two main features are paradigmatic and meta-paradigmatic. The paradigmatic aspect refers to the recognition, compilation and implementation of various methodologies in a comprehensive and inclusive manner. The meta-paradigmatic aspect refers to IRT’s capacity to weave together, relate and integrate the various paradigmatic practices. (...) IRT is a meta-therapy derived from the Integrated Recovery Model, which is a comprehensive, balanced, multi-phased and multi-disciplinary clinical model designed for in-patient addiction treatment. As with the Integrated Recovery Model, IRT’s philosophy is derived from an integration of the 12-step abstinence-based philosophy, mindfulness, positive psychology, and Integral theory. It is suggested here that the application of IRT as a meta-therapy provides a truly comprehensive and integrated therapeutic orientation for therapists who treat addicted populations. -/- Keywords: Integrated Recovery Therapy, Integrated Recovery model; 12 Steps; mindfulness; Integral theory; positive psycholog. (shrink)