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What Would You Do Alone in a Cage with Nothing but Cocaine?: A Philosophy of Addiction
A revolutionary new paradigm for understanding addiction
Why do people with addiction use drugs self-destructively? Why don’t they quit out of self-concern? Why does the rat in the experiment, alone in a cage, press the lever again and again for cocaine—to the point of death? In this pathbreaking book, Hanna Pickard proposes a new paradigm for understanding the puzzle of addiction. For too long, our thinking has been hostage to a false either addiction is a brain disease, or it is a moral failing. Pickard argues that it is neither, and that both models stifle addiction research and fail people who need help.
Drawing on her expertise as an academic philosopher and her clinical work in a therapeutic community, Pickard explores the meaning of drugs for people with addiction and the diverse factors that keep them using despite the costs. People use drugs to cope with suffering—but also to self-harm, or even to die. Some identify as “addicts," while others are in denial or struggle with cravings and self-control. Social, cultural, and economic circumstances are crucial to explaining addiction—but brain pathology may also matter. By integrating addiction science with philosophy, clinical practice, and the psychology and voices of people with addiction themselves, Pickard shows why there is no one-size-fits-all theory or ethics of addiction. The result is a heterogeneous and humanistic paradigm for understanding and treating addiction, and a fresh way of thinking about responsibility, blame, and relationships with people who use drugs.
Why do people with addiction use drugs self-destructively? Why don’t they quit out of self-concern? Why does the rat in the experiment, alone in a cage, press the lever again and again for cocaine—to the point of death? In this pathbreaking book, Hanna Pickard proposes a new paradigm for understanding the puzzle of addiction. For too long, our thinking has been hostage to a false either addiction is a brain disease, or it is a moral failing. Pickard argues that it is neither, and that both models stifle addiction research and fail people who need help.
Drawing on her expertise as an academic philosopher and her clinical work in a therapeutic community, Pickard explores the meaning of drugs for people with addiction and the diverse factors that keep them using despite the costs. People use drugs to cope with suffering—but also to self-harm, or even to die. Some identify as “addicts," while others are in denial or struggle with cravings and self-control. Social, cultural, and economic circumstances are crucial to explaining addiction—but brain pathology may also matter. By integrating addiction science with philosophy, clinical practice, and the psychology and voices of people with addiction themselves, Pickard shows why there is no one-size-fits-all theory or ethics of addiction. The result is a heterogeneous and humanistic paradigm for understanding and treating addiction, and a fresh way of thinking about responsibility, blame, and relationships with people who use drugs.
352 pages, Hardcover
Published January 6, 2026
41 people are currently reading
1704 people want to read
About the author
Hanna Pickard
4 books4 followersProfessor in Philosophy of Psychology at the University of Birmingham. On leave (2017-2019) to visit Princeton University as a Research Scholar to the Program in Cognitive Science.
Worked in a NHS Specialist Service (2007-2017) for people with personality disorder and complex needs. Was also a fellow of All Souls College, Oxford from 1997-2017.
Worked in a NHS Specialist Service (2007-2017) for people with personality disorder and complex needs. Was also a fellow of All Souls College, Oxford from 1997-2017.
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Displaying 1 - 8 of 8 reviews
January 25, 2026
4⭐️
heavy on the philosophy, heavy on the academia, but overall very informative and interesting look at how cultural beliefs can seep into medical and scientific approaches and vice versa. if you can’t handle the very detailed and lengthy sections on the semantics of “addiction” and “drugs” then i would suggest, as the author does in her introduction, to at least skip to the final part and read the sections on ethics, relationships, responsibility, and blame. those were my favorite in the book and they contain information that i think is useful and important to everyone, not just people who are currently affected by addiction in some way.
heavy on the philosophy, heavy on the academia, but overall very informative and interesting look at how cultural beliefs can seep into medical and scientific approaches and vice versa. if you can’t handle the very detailed and lengthy sections on the semantics of “addiction” and “drugs” then i would suggest, as the author does in her introduction, to at least skip to the final part and read the sections on ethics, relationships, responsibility, and blame. those were my favorite in the book and they contain information that i think is useful and important to everyone, not just people who are currently affected by addiction in some way.
January 3, 2026
In What Would You Do Alone in a Cage with Nothing but Cocaine?, Hanna Pickard presents a thoughtful and humanistic examination of addiction that challenges the idea that it is either a brain disease or a moral failing. Drawing on her work as both a philosopher and clinician, she offers a nuanced framework that reflects the real complexity of addiction.
Pickard explores the many reasons people continue to use substances despite harmful consequences, emphasizing that motivations, internal drives, and readiness to quit vary widely. Through engaging studies and real-world insights, she shows how addiction is shaped by psychological, social, cultural, and economic factors, while still acknowledging the possible role of brain pathology. One of the book’s greatest strengths is how effectively it captures the complexity of addiction without losing clarity or compassion with many of the examples feeling broadly applicable to human behaviour beyond addiction itself.
The book is informative and engaging, holding my interest throughout. It helped me better understand the diverse motivations behind addiction and offered a compassionate, flexible way of thinking about responsibility and recovery. This is a valuable read for anyone interested in addiction, psychology, or more ethical and realistic approaches to care.
Pickard explores the many reasons people continue to use substances despite harmful consequences, emphasizing that motivations, internal drives, and readiness to quit vary widely. Through engaging studies and real-world insights, she shows how addiction is shaped by psychological, social, cultural, and economic factors, while still acknowledging the possible role of brain pathology. One of the book’s greatest strengths is how effectively it captures the complexity of addiction without losing clarity or compassion with many of the examples feeling broadly applicable to human behaviour beyond addiction itself.
The book is informative and engaging, holding my interest throughout. It helped me better understand the diverse motivations behind addiction and offered a compassionate, flexible way of thinking about responsibility and recovery. This is a valuable read for anyone interested in addiction, psychology, or more ethical and realistic approaches to care.
February 6, 2026
[3.5 stars rounded down]
Let’s say that you live with chronic pain and are nearly bedridden most days with a physical or mental disability. Let’s say that you work two full time jobs and spend nearly all the time outside of those two jobs either sleeping or eating. Let’s say that your entire social circle is centered around going to the bar and you don’t know anyone outside of this group of friends and can’t seem to meet anyone new. Let’s say you were alone in a cage with nothing but cocaine.
This is an extremely academic book. As in, it is one of those books that creates a very specific definition of something (in this case: addiction: a pattern) and then defines several bullet points further defining this explication. It is dense and repetitive in that way that many long, non-pop-nonfiction texts are. This is not at all a bad thing for a book to be, but it just shrinks your audience to those who are used to reading academic texts. The vocabulary and referenced ideas are not too advanced or specific and Pickard is sure to explain or define anything when it is brought up, so it’s not academic in that sense it is more so the formatting that is academic in nature.
Despite me saying that, I don’t think that this is too inaccessible of a book even if you are not familiar with academic writing (I myself only hold an Associates and never got far enough anywhere to begin to read these texts). I am ultimately glad that I have read this book and will carry many of its words with me in the future when discussing substance addiction. It is just very repetitive. It felt like there were multiple points every chapter where the author would finish describing something and then go back to either her main definition of addiction or another specification from an earlier chapter. It is hard to critique this because this is how academic writing that I have encountered always works (I have never read any philosophy academic works before, but I assume it is also common in those), but expectations should be set before going in. All of this to say: it is good research and academic writing but might be way too dry and repetitive if you are just looking for a book about addiction and communicating with those living with addiction.
Pickard explicates addiction as: “a pattern of drug use that persists despite evident and severe costs such that it counts profoundly against a person’s own good”. Primarily, she explores the reasons that people may become addicted to a substance (self-medication, self harm, a person’s social, cultural, and economic status, etc.) as well as why they continue to choose to use drugs despite their “evident and severe costs”. My use of the word “choose” there is intentional as Pickard is clear throughout the book that she does not see addiction as a explicitly a brain disease and instead as a pattern of behaviors influenced by the prior mentioned areas (she acknowledges that some cases of addiction do seem to be influenced by brain changes from drug use but argues that those cases do not define addiction as a whole).
I enjoyed Pickard's arguments and explanations a lot. I had this thought throughout the majority of the book that everything she was describing was common sense and decency but, looking back after the conclusion, I felt instead that Pickard just has a gift for making the complex become simple. Despite me having never read a book about addiction before and only encountering it through a few early psychology courses and social media, I was never confused or lost in either her explanations or her arguments. She is clearly a very skillful academic writer and I am very impressed looking back at how she laid out her arguments and explanations using a mixture of research (both modern and older), memoirs by people who have dealt with addiction, and some of her own experiences working in a group therapy model for people with BPD - many of whom dealt with addiction.
I’m frustrated with myself for only giving this book 3 stars, but I considered DNF-ing it many times throughout solely because of the academic nature of it. I got very bored at points (especially early), I will admit. I very strongly recommend this book if you are looking for a breath of fresh air from a skilled writer about addiction and are fine reading the academic formatting. Genuinely, there are full perspective shifting moments throughout the entire book.
Let’s say that you live with chronic pain and are nearly bedridden most days with a physical or mental disability. Let’s say that you work two full time jobs and spend nearly all the time outside of those two jobs either sleeping or eating. Let’s say that your entire social circle is centered around going to the bar and you don’t know anyone outside of this group of friends and can’t seem to meet anyone new. Let’s say you were alone in a cage with nothing but cocaine.
This is an extremely academic book. As in, it is one of those books that creates a very specific definition of something (in this case: addiction: a pattern) and then defines several bullet points further defining this explication. It is dense and repetitive in that way that many long, non-pop-nonfiction texts are. This is not at all a bad thing for a book to be, but it just shrinks your audience to those who are used to reading academic texts. The vocabulary and referenced ideas are not too advanced or specific and Pickard is sure to explain or define anything when it is brought up, so it’s not academic in that sense it is more so the formatting that is academic in nature.
Despite me saying that, I don’t think that this is too inaccessible of a book even if you are not familiar with academic writing (I myself only hold an Associates and never got far enough anywhere to begin to read these texts). I am ultimately glad that I have read this book and will carry many of its words with me in the future when discussing substance addiction. It is just very repetitive. It felt like there were multiple points every chapter where the author would finish describing something and then go back to either her main definition of addiction or another specification from an earlier chapter. It is hard to critique this because this is how academic writing that I have encountered always works (I have never read any philosophy academic works before, but I assume it is also common in those), but expectations should be set before going in. All of this to say: it is good research and academic writing but might be way too dry and repetitive if you are just looking for a book about addiction and communicating with those living with addiction.
Pickard explicates addiction as: “a pattern of drug use that persists despite evident and severe costs such that it counts profoundly against a person’s own good”. Primarily, she explores the reasons that people may become addicted to a substance (self-medication, self harm, a person’s social, cultural, and economic status, etc.) as well as why they continue to choose to use drugs despite their “evident and severe costs”. My use of the word “choose” there is intentional as Pickard is clear throughout the book that she does not see addiction as a explicitly a brain disease and instead as a pattern of behaviors influenced by the prior mentioned areas (she acknowledges that some cases of addiction do seem to be influenced by brain changes from drug use but argues that those cases do not define addiction as a whole).
I enjoyed Pickard's arguments and explanations a lot. I had this thought throughout the majority of the book that everything she was describing was common sense and decency but, looking back after the conclusion, I felt instead that Pickard just has a gift for making the complex become simple. Despite me having never read a book about addiction before and only encountering it through a few early psychology courses and social media, I was never confused or lost in either her explanations or her arguments. She is clearly a very skillful academic writer and I am very impressed looking back at how she laid out her arguments and explanations using a mixture of research (both modern and older), memoirs by people who have dealt with addiction, and some of her own experiences working in a group therapy model for people with BPD - many of whom dealt with addiction.
I’m frustrated with myself for only giving this book 3 stars, but I considered DNF-ing it many times throughout solely because of the academic nature of it. I got very bored at points (especially early), I will admit. I very strongly recommend this book if you are looking for a breath of fresh air from a skilled writer about addiction and are fine reading the academic formatting. Genuinely, there are full perspective shifting moments throughout the entire book.
January 20, 2026
Thanks to NetGalley for the review copy.
First, the good. I thoroughly agree with the author there needs to be another model for the disease descriptor of addiction: Loss of control, compulsion, inability to abstain, or security attachment with the drug.
The bad. Anytime a book has the word philosophy in the title. It is a 45/45 split on whether it will be campy or way too serious (read boring). Very few make the final 10% of having the intellectual chops to be both stimulating and relevant. Sadly, this one falls in the serious and boring category. It doesn’t help the narrator drags.
Lastly, the material presented within regarding addiction is potent and needs rigorous, national, collaborative discussions to move it into a larger framework beyond the disease model. I hope I’m not too critical of this work because it will be useful in formulating the next conversation; however, this material needs further exploration before arriving at a formal philosophical place.
First, the good. I thoroughly agree with the author there needs to be another model for the disease descriptor of addiction: Loss of control, compulsion, inability to abstain, or security attachment with the drug.
The bad. Anytime a book has the word philosophy in the title. It is a 45/45 split on whether it will be campy or way too serious (read boring). Very few make the final 10% of having the intellectual chops to be both stimulating and relevant. Sadly, this one falls in the serious and boring category. It doesn’t help the narrator drags.
Lastly, the material presented within regarding addiction is potent and needs rigorous, national, collaborative discussions to move it into a larger framework beyond the disease model. I hope I’m not too critical of this work because it will be useful in formulating the next conversation; however, this material needs further exploration before arriving at a formal philosophical place.
February 8, 2026
Este fue un libro denso, muy filosófico, pero con una aproximación "práctica". La autora pone mucho de sí para desmenuzar el tema de manera eficiente, con ejemplos, abstracciones y reflexiones que van no solo desde lo filosófico, sino lo clínico, psicológico, social y neurológico. Creo que es una exploración demasiado compleja sobre la adicción. La autora construye y desarrolla un paradigma de la adicción no solo muy completo, pero también interesado en como aportar, como generar transformaciones en como las políticas y las intervenciones a las personas con adicciones, adicciones a las drogas para ser específicos.
Es un poco pesado y lento pero en ningún momento tedioso.
Es un poco pesado y lento pero en ningún momento tedioso.
January 31, 2026
This book was a heavy read; it took me a while to get through it, but I'm glad I did. It was very informative, very interesting. Brought to light the need for nuanced approaches regarding addiction. It made me question a lot of things and made me think a lot. The repetition and summaries of what was to come annoyed me but it's expected in a more academic book.
Thank you, Netgalley and Highbridge Audio, for providing me with an ARC in exchange for an honest review
Thank you, Netgalley and Highbridge Audio, for providing me with an ARC in exchange for an honest review
January 9, 2026
This well written book offers a nuanced look at addiction that might help move your thinking beyond the traditional binary way of talking about addiction.
February 10, 2026
Audio. Work book. Big picture of addiction considering all elements. Informative.
Displaying 1 - 8 of 8 reviews