Philosophy and Addiction: Understanding and Transforming Suffering
My venture into what we now call “field philosophy” was and remains a consequence of my abiding commitment to the transformative potential of philosophy, which requires access to be democratized. Philosophy belongs just as much in the streets as it does in the academic halls. My field philosophy has taken place in academic conferences, community education programs, treatment centers, high schools, senior luncheons, and church basements. Philosophy belongs in op-ed pieces, blogs, podcasts, and whatever else people are reading, watching, or listening. As Wittgenstein noted to a young student, a philosopher who is not taking part in discussions is like a boxer who never goes into the ring (Drury 2017, 106). This volume explores some of the rings into which philosophers have stepped. I’ve stepped into the ring of addiction, both as a philosopher and as a person in recovery.
The structure my of essay is primarily chronological. I offer a description of the trajectory of my work on addiction, make some suggestions, and reflect on some of the lessons I have learned. My experience over the last eight years working with different publics on concerns about addiction prompts me to offer the following suggestions:
I believe these suggestions and lessons learned are generalizable and useful to others embarking on the rewarding work of field philosophy. Such work can benefit both the fields in which we are working and the discipline of philosophy itself.
Survey the Field
What is addiction? For centuries, addiction was regarded as the moral failure of an individual; it was the quintessential character defect. An addict was one who lacked the will or the courage to stop drinking or using drugs. With the advent of the discipline of psychology, the dominant explanation is that people drink or use mood-altering substances because we are unstable or troubled in deep and abiding ways. According to this explanation, it is the unresolved tumult of our inner lives that causes us to drink or use drugs to excess—even perhaps to the point of total annihilation. Risking such loss while leaving a path of destruction surely must be a kind of irrationality or insanity best addressed in a therapeutic setting. In contrast, most psychologists and psychiatrists treat addiction as a disease that has biopsychosocial influences, acknowledging genetic components but seeing these as only part of the story.
Recent studies in neuroscience have explored the relationship between brain chemistry and addiction. Addiction, these studies suggest, may be a consequence of a combination of genes and neurotransmitters. The move is to treat addiction as a chronic physical condition, one that needs regular monitoring and management, much like diabetes or asthma. The National Institute on Drug Abuse (NIDA), part of the National Institute of Health of the United States, defines addiction as
a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs.
(National Institute on Drug Abuse 2018)
It is important that these biological considerations be explored vigorously and carefully. At the same time, it is imperative that advances from other medical and nonmedical fields are not summarily rejected. As many feminists have chronicled for decades across many disciplines, once a condition or experience becomes medicalized, it becomes legitimized (Varney and Thompson 2015). The legitimacy often creates a new category of “experts,” and those who have long-term familiarity with and knowledge about that situation are suddenly cast in the role of perhaps well-meaning but ultimately uninformed witnesses, dabblers, or in the worst case, interlopers.
In the field of addiction studies, psychiatrists and psychologists who once held epistemic authority are now finding themselves marginalized. Marginalized at least as much, if not more, are recovered addicts and any sort of treatment practitioner working from a 12-step model or other self- and mutual-help principles. By shifting the legitimacy away from those with personal and clinical experience, the medicalization of addiction may produce epistemic injustices, which in turn may affect the range of possibilities available for recovery or remission.
This is especially evident when it comes to medication assisted treatment (MAT) and is cause for great concern. Those struggling with opioid addiction may be caught in a catch-22 situation when it comes to MAT. Someone who expresses a desire or willingness to be treated with MAT may be accused of drag seeking. The person who is unwilling to use MAT may be accused of not taking their sobriety seriously (O’Connor 2018).
Another concern with these new studies—granting that most of them spring from very good intentions on behalf of the researchers—is that they first assume and then claim to prove that addiction is a problem of an individual’s biology rather than the social environment they inhabit. More specifically, addiction is conceptualized as a problem in or with some people’s brains. This obscures many of the very real environmental reasons why people start to drink or use drags in ways that may begin casually but eventually progress to abuse and then dependence. Why do some people use and continue to use when consequences ranging from the undesirable to the catastrophic ensue? Why can’t people just stop using or, to borrow a phrase from Nancy Reagan, just say no to drags?
These “whys” are absolutely crucial both to understanding the trajectories of addiction and the possibilities of recover)' or remission. Neither the social sciences nor the natural sciences alone are able to address them. I agree with Wittgenstein (2001, 6.52), who notes, “We feel as if even if all possible scientific questions be answered, the problem of life will not have been touched at all.” Addiction most certainly is a problem of life. Philosophy has a long history of addressing problems of life; its possible contributions seemed obvious to me.