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

Calling addiction a disease may train our gaze on the individual — the implication something is wrong with them, deflecting attention from environment and life circumstances in which addiction flourishes. The gambling industry has actively used a disease label to deflect away from the fact it creates machines that hook people in and focus attention on personalities/vulnerabilities of people who have problems.

I appreciate that there’s summaries at the end of each chapter to tie together the discussion. This is a dense book for me right now!

The biggest thing against the “irresistibility” of drugs and that people are “compelled” no matter what, is that it denies people of their agency. It’s the thing that unites us all as humans.

Why do drug desires trend toward winning out over time? Sripada argues that loss of control is not due to irresistibility of desire, but the fallibility of the cognitive systems necessary for behavioural control. Exercising control is a multistage process susceptible to error. Drug desires may tend to win out because the more time, the more control must be exercised, the more errors.

Drug use in addiction is not compelled by irresistible desires but is flexible and goal directed—voluntary in an ordinary sense. Therefore, since drug use in addiction is not compulsive, compulsion cannot solve the puzzle of addiction.

Gotta keep in mind that this working explanation of addiction is behaviour based and not brain pathology based!

If we want to know whether a persons drug use is or is not good for them, there are 4 variables to consider:
1. The pattern of drug use with its consequences
2. The person’s sincerely professed values and conception of their own good
3. The person’s true values and conception of their good
4. What the person ought to value/what is truly good for them apart from values/conception of their good

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”.