The Puzzle of Addiction (original) (raw)
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Journal of Humanistic Psychology, 2017
The Surgeon General's Report on Alcohol, Drugs, and Health authoritatively situated addiction as a brain disease and called for increased research into its underlying neurobiological mechanisms. While the Surgeon General's Report makes strides toward destigmatizing addiction and rightfully rejecting addiction-as-moral-weakness, it adopts addiction-as-disease as another oversimplified conceptualization of a complex human experience. Inspired by Eastern philosophy, we argue that addiction is a sane, protective response to suffering. We highlight evidence suggesting that so-called addictive substances are not powerful culprits that compel persons to action, as framed in the Report. Rather, we discuss addiction as a dysfunctional relationship with substances, developed out of sane attempts to escape the inevitable and universal truth of our own suffering. The compulsive use of a substance is the struggle of trying to escape pain, blame, shame, and loss. Rather than a choice between false dichotomies, then, addiction is normalized as part of the spectrum of human experience, enabled but not determined by either biology or so-called addictive substances. Viewing addiction as a process of the human experience, the therapeutic relationship remains the greatest
Addiction, Chronic Illness, and Responsibility.
Some theorists have argued that we should understand the notion of free will from a functional perspective: free will just is our ability to choose effectively and adaptively in an ever-changing environment. Although far from what many philosophers normally mean by free will, those who adopt this biological-evolutionary perspective can clearly define and defend a notion of personal responsibility. One consequence of this point of view is that addicts become responsible for their actions, for at each choice point, there is a real sense in which the addict could have elected not to use or abuse. As a result, it has been argued that addiction is not a disease, that addictive behavior is voluntary, and that sometimes it is even rational. This paper defends a different way of thinking about addiction, one that aligns it with other complex chronic illnesses. The perspective put forth here suggests that these discussions about responsibility and free will represent an over-simplified and neuropsychologically inaccurate portrait of basic human capacities for behavioral choice.
Frontiers in Psychiatry, 2013
Addiction is a person-level phenomenon that involves twin normative failures. A failure of normal rational effective agency or self-control with respect to the substance; and shame at both this failure, and the failure to live up to the standards for a good life that the addict himself acknowledges and aspires to. Feeling shame for addiction is not a mistake. It is part of the shape of addiction, part of the normal phenomenology of addiction, and often a source of motivation for the addict to heal. Like other recent attempts in the addiction literature to return normative concepts such as "choice" and "responsibility" to their rightful place in understanding and treating addiction, the twin normative failure model is fully compatible with investigation of genetic and neuroscientific causes of addiction. Furthermore, the model does not re-moralize addiction. There can be shame without blame.
Addiction is socially engineered exploitation of natural biological vulnerability
Interdisciplinary study of addiction is facilitated by relative unification of the concept. What should be sought is not formal unification through literal analytic definition, which would undermine practical flexibility within disciplines and intervention practices. However, leading controversies around whether addiction should be conceived as a 'disease', and over whether addiction is 'chosen' behavior, are made more difficult to resolve by failure to apply philosophical reflection on these general concepts. Such reflection should be sensitive to two kinds of constraint: coherence in description of empirical, including neuroscientific, observation, and utility in framing normative goals in treatment and policy design. Following review of various interpretations of addiction, disease, and choice across contributing disciplines, it is concluded that addiction is most plausibly viewed as a disease at the scale of public health research and policy, but not personal (e.g. clinical) management and intervention. Addicts must make choices to recover, and in that respect addiction is a 'disorder of choice'. However, it is concluded that the most relevant sense of 'disorder' arises at the social rather than the personal scale.
Philosophical Issues in the Addictions
2020
As this Handbook demonstrates, the phenomenon of addiction straddles a dizzying number of fields of enquiry; even at a very coarse disciplinary grain, it throws up biomedical, neurological, pharmacological, clinical, social, legal, political, and moral issues, among numerous others. So it is no surprise that the multitude of disciplinary perspectives, methodologies, terminologies, and research programs, all working at crosspurposes, should generate conceptual misunderstandings and disputes. Philosophy is, of course, dedicated as a field of study to the analysis and clarification of such conceptual quandaries, and many of the particular issues that have arisen in the course of the interdisciplinary study of addiction over the past few decades will be extremely familiar to ethicists, metaphysicians, and philosophers of science. Philosophers may address these problems directly; philosophical attention to them can also be hugely beneficial to researchers in the range of other “stakehold...
Drug Addiction: From Neuroscience to Ethics
Frontiers in Psychiatry
In the present paper, we suggest a potential new ethical analysis of addiction focusing on the relationship between aware and unaware processing in the brain. We take the case of the opioids epidemics to argue that a consideration of both aware and unaware processing provides a more comprehensive ethical framework to discuss the ethical issues raised by addiction. Finally, our hypothesis is that in addition to identified Central Nervous System's neuronal/neurochemical factors contributing to addictive dynamics, the socioeconomic status plays a causal role through epigenetic processes, originating the need for additional reward in the brain. This provides a strong base for a socio-political form of responsibility for preventing and managing addiction crisis.
Journal of Opioid Management , 2021
A growing number of individuals live with an Opioid Use Disorder (OUD). While many go on to recover from such disorders, certainly there will be individuals in palliative care at some point who still suffer with OUD . One of the major barriers to palliative care for individuals recovering and currently suffering from an OUD is the stigma related to having an OUD. Therefore, in the context of palliative care it is important to understand the relationship that exists between palliative care, OUDs, and how stereotypes related to substance use disorders affect patient engagement in palliative care. For this paper, the focus will be on how stereotypes affect pain management in palliative care for persons with an OUD. A review of current literature regarding OUDs and pain management indicates a need for care specific to the needs of those in palliative care who formerly and/or currently suffer from an OUD in order to avoid relapse or worsening of their affliction while still managing their pain. The striking lack of knowledge and resources regarding opioid use disorders and their treatment indicates a need to strengthen/increase resources for physicians to educate on treating OUDs as well as alternatives for pain management. This article presents dignity-enhancing care as a gateway to fairly treat individuals with an OUD and to get rid of the stigma associated with OUD patients.
Agency in Mental Disorder: Philosophical Dimensions (Matthew King and Joshua May, eds.)