Kimberly T’s Reviews > What Would You Do Alone in a Cage with Nothing but Cocaine?: A Philosophy of Addiction > Status Update

The brain disease model therefore does more than redefine addiction in such a way as to create disagreement and limit the range of possible explanations. It also relocates it — removing addiction from the realm of behaviour and lodging it within the brain.

Addiction occurs precisely when drug use is psychologically unintelligible to us, by contrast with ordinary drug use. why is this person continuing to use drugs when the costs appear so severe, so profoundly counter to their own good?

People use drugs because they have tremendous value. But now suppose we ask: why do people use drugs despite costs such as their lives, jobs, etc? Whatever benefits of drug use remain in addiction, these costs are so evident and so severe that using seems in no way worth it - and yet, people with addiction persist.

This is Pickard’s “puzzle of addiction”.

As a species, we have always used drugs, and most drug use does not lead to addiction. Yet, all addiction originates with ordinary drug use.

Ex: drinking must precede alcoholism. Equally obvious but not always considered is the fact that drinking is not necessarily followed by alcoholism.

Addiction stigma comes from us.

In characterizing drug use as compulsive, the brain disease model undermines what is arguably a plank of all successful treatment, namely a sense of once’s own agency and ability to do things differently. That is, the ability to change one’s relationship to drugs and construct a life/identity where they play a less significant role.

Relinquishing the idea of a universal explanation or underlying essence that makes addiction what it is, and which every case of addiction must have, and no case of addiction can lack. The brain disease model is committed to such an essence, namely brain pathology.

Psychology and psychological explanation are inextricably linked with life circumstances. This is why pointing out a rat is literally alone in a cage with nothing but cocaine can be explanatory of why the rat/person might take a lot of drugs. We imagine the psychological impact of being trapped in isolation and emptiness.. misery and suffering. There is only 1 thing that offers any relief. Cocaine.

“The current dominant scientific paradigm for addiction is broken. It is time for heresy.”

It’s time. Give it to me!

“When given a choice between a lever for meth or heroin or one minute of playtime with another rat, almost 100% of rats including those who showed every indication of addiction like behaviour and none of whom was socially deprived - chose to press for playtime, forgoing the drug.”