The Purpose in Chronic Addiction

Abstract

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to "mature out" in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations can be explained by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment.

Explaining Irrational Actions

“…Feinberg 1970;Korsgaard 1997;Pickard 2012;Watson 2004). The common argument goes something like this: if a desire were literally irresistible, then there could be no cases in which the person resists the desire successfully.…”

The libidinal economy of revanchism: Illicit drugs, harm reduction, and the problem of enjoyment

“…As critical drug scholars have repeatedly pointed out, every year, huge numbers of hospital patients are prescribed opioids in quantities sufficient to develop physical tolerances to them, yet only a tiny fraction become addicted (Maté, 2009: 141). Drug use, whether licit or illicit, only becomes addiction when it also serves a psychological purpose for the addict-a purpose that is so important to them that it supersedes other concerns (Alexander, 2010;Dodes and Dodes, 2014;Hari, 2015: 227;Peele, 1985;Pickard, 2012;Proudfoot, 2017).…”

Self-harm as violence: when victim and perpetrator are one

“…4 . For further discussion of this form of argument, especially in relation to the nature of addiction on the one hand, and personality disorder, and criminal law on the other, see Pickard 2012Pickard , 2013aPickard , 2013bPickard , and 2015 6 . Note that a history of childhood physical abuse is associated with otherdirected violence in men, while a history of childhood sexual abuse is associated with self-directed violence in women (Waxman et al 2013 ' (1984, 181).…”