Addiction: Disease, Moral Failing, or something else?
In previous posts I’ve discussed a major challenge we face in today’s society, namely how to navigate the overwhelming access to easy short-lived pleasures that actually work against our long-term happiness. These choices often highjack our pursuit, pleasure and reward circuits in the brain and our bodies compensate through increased tolerance leading to diminished returns. This can consequently lead to forms of anxiety, depression, and general unease with our life. As a result, prominent and popular voices have surfaced to champion self-control, discipline, and choosing the difficult road. While these are helpful voices, in my second post I discuss the need for a deeper philosophical account that differentiates virtue from mere self-control. For Plato and Aristotle, they saw self-restraint not as the goal, but temperance, the formation of the person to not want things in excess. In this final discussion I want to consider what happens when our desires run out of control and lead to addictions. What is addiction and how should we think about treating it? (Note: with many of these topics, a short blog format like this cannot do full justice to a topic so complex and robust, the goal here is to bring awareness of how addiction has been looked at in the past, and give a helpful critique to think about a better way to consider it in light of psychological research as well as a clear philosophical account of the person).
The recognition of people struggling with addictions is nothing new, but due to a growing opiate addiction crisis in the US in the 1920’s people treating those using opiates began to conceptualize addiction as a disease. By the 1940’s that was the dominant way doctors approached addiction to heroine. From there it spread to treatment of all kinds of drugs and even into behaviors to the point where we now look at not only substance abuse but behaviors like video games, pornography, and sex in a similar way of addiction. Since then, doctors continue to evolve in their theories on addiction, bringing things like the “biopsychosocial model” which tries to account for more than simply materialistic and deterministic assumptions. Why is it, that some people continue to go back to behaviors time and time again despite (overwhelming in some cases) negative consequences? In past posts on this series, I discussed the role that dopamine plays in our decision making, leading us to want more. I also discussed a philosophical framework from Plato and Aristotle that gives a clear account of the person and differentiates self-control from the true human excellence, temperance. In this last post, I want to consider the nature of addiction and based off of these other considerations what insight we can glean in order to approach this problem from a more accurate and helpful way.
In Aristotle’s proposition of Akrasia, being weak-willed, one can simply interpret that addicts have weaker-wills than others, or that it is a moral failing. Certainly, an addict would fit the definition of being intemperate by virtue ethics standards, however that alone may not be an adequate account for what is happening in the person who is not being temperate. Intemperance is also not sufficient enough on its own because there are many people who are intemperate but not addicts. So addiction isn’t simply a moral failing, but neither should addiction simply be reduced to a materialistic explanation that leaves out our free will for purely a mechanistic and deterministic account. Many modern accounts in biology and medicine today operate from this perspective, combined with a reductionism that fails to account for the whole person. This is something I would argue that The Molecule of More falls into at times, trying to give an overarching account for human actions based on the molecule of dopamine which ignores other human capacities which is how some in the medical community conceptualize addictions. Our psychology is always rooted in a philosophical account of the human person, whether or not we acknowledge that. In many modern medical accounts, there is a deterministic and materialistic philosophical account of the person that is smuggled into the research through assumptions that should be challenged to incorporate a more robust, and explanatorily satisfying account of the person.
Addiction is a complex topic because as humans we have a variety of psychological and neurophysiological capacities. Whether we are talking about clinical addictions, or lesser behaviors and habits that are work against our good, we need to take a more holistic approach to the topic. Behavioralists want to simply look at the mechanisms of behavior, which is helpful but not the whole story, while others may look simply at neurological chemical imbalances that can be rectified through medications. Dr. Daniel De Haan, a philosopher and neuroscientist, has done extensive research into the relationship between philosophy, theology, and neuroscience and argues that addiction is not fundamentally a disease of the brain, reflexive behaviors, unstable emotions, moral failing, not knowing what the good actually is, or simply weakness of the will, but a kind of “disordered acquired drive”.
All psychology is rooted in a philosophy, and for Dr. De Haan, he follows in Aristotle’s footsteps with the argument that claims we are a hylomorphic being, comprised of body and soul which leads to a psychosomatic unity of the person. This means that when we see, think, or act, it is you the whole of you that does that, not simply the eye, or the neo-cortex in the your brain. As a unified person, psychology which starts from this point of view is able to acknowledge the chemical, biological, neurophysiological, and psychological may all have parts to explain the state of the overall person and their addiction. One additional distinction that Aristotle helps us understand is the difference between “a human action” and “the activations of a human”. Aristotle recognizes that when humans act in accordance with reason given our ability to be rational, that is a “human act”, whereas “activations of a human” happen to the person, they are not be freely chosen, such as the process of digestion, when your hair grows, or even a mindless scratch of an itch. Dr. de Haan describes the concept of human drives as various activations in the person that are directed towards a specific purpose or goal.
These drives are automatic and bring to our awareness a need to be fulfilled. This includes hunger, thirst, pain needing to be addressed and more. But while we often correctly interpret pain in the stomach as hunger, there are times we may misinterpret these drives. For instance, a person may continue to experience hunger pains even after eating a satiating meal, to which the person may believe that he still needs more food, while the reality is, he may actually be experiencing thirst not hunger. Now some of these drives we have are natural, such as hunger or fatigue, while acquired drives are the way we’ve been conditioned to think about and address those drives. This can be thought of as the nurture in the nature vs. nurture debate. We all have desires to satiate hunger, but our family, history, and culture influence how we address that drive. Addictions are acquired drives we have that have become dysordered, in that they don’t lead to the actual end of the drive (food for nourishment) and become difficult to overcome. So we end up with desires for real needs being met in ways that do not lead to the true goal of the drive and are hard to overcome or change.
While there isn’t time here to give a full account how to address addictions, I will highlight a few key takeaways as we conclude. First, in order to properly address addictions, we cannot reduce the issue to one aspect of the person, such as chemical imbalance, behaviors, or emotions. All areas of the person’s addiction must be addressed such as: one’s inner life/thoughts, behaviors, social interactions and environment, and neurophysiological dependency. Secondly, because the person is addicted, not just their brain, medications may be able to help in addressing the addiction, but one must also account for behaviors, one’s own belief of their hierarchy goods, and their social support systems. As Aristotle notes, it is significantly more difficult (if not impossible) to live a virtuous life apart from a supportive virtuous community. The same holds true here, as people working to get out of addiction need the support and modeling of friends and family and others. So, our understanding of what and how we become addicted also helps us understand the antidote, how we break free from the addiction to live a better life in which we are not compelled by our desires but free to choose things that to our flourishing and happiness.