Getting Hooked

It's amazing, but the truth is that while there has been a huge amount of research into addiction, most of that research is at empirical social studies, rat behavior, genetics, and neurophysiology. Some of the most important aspects of the research, i.e., how to integrate these different sources of information, and what the implications are for morality, policy, and our self-understanding, have gone remarkably neglected, especially by philosophers and ethicists.

But there are signs of change. This may be largely due to the work of one person. Jon Elster has for a long time been one of the more thoughtful social scientists discussing human self-defeating behavior, and is especially well known for his work on forms of self control based on Ulysses and the Sirens. He has recently published a book on the rationality and emotion, Alchemies of the Mind, and another book on emotion and addiction, Strong Feelings. He has also co-edited a book with Ole-Jorgen Skog on rationality and addiction, titled Getting Hooked. This collection of 10 articles derives from the meetings of a group that met annually from 1992-1997. The contributors include three psychiatrists, a political scientist, a philosopher, two economists and two sociologists.

This is a useful set of papers, especially for those wanting an introduction to some of the recent literature in the social sciences on addiction. As it should be, the definition of addiction is a central issue. Especially important therefore is a paper by Eliot Gardner and James David on "The Neurobiology of Chemical Addiction.," which many of the authors, including himself, take to be of great importance. Elster ends his paper on "Gambling and Addiction," with the following paragraph:

Are compulsive gamblers addicts? A full answer must await more knowledge about the neurophysiology of addictions. We do not know whether gambling exhibits anything like the patters of neuroadaptation described in the chapter by Gardner and David. If gambling turns out to exhibit primary as well as secondary withdrawal symptoms, there is a strong case for classifying it as an addiction. If not, there will nevertheless remain a number of features that gambling has in common with the core addictions.

I have strong reservations about the methodology of basing our conception of addiction on "the core addictions," - i.e., the ones involving chemical substances - and then using the patterns of brain chemistry in those addictions as a paradigm to decide whether other forms of behavior should count as addiction. I don't believe that it is a method that is useful for social policy, nor does it help to pick out the morally relevant psychological features of addiction. But Elster's paper is important precisely because it sets out so clearly what methodology he favors, and thus helps to enable discussion of it.

Several authors focus on the explanation from the addict's point of view about why he or she continues to drink or take drugs when the bad effects of the behavior are obvious. Philosophy has since Plato discussed how it is possible that people can do what they themselves take to be bad, either for society or for themselves, and whether such behavior is irrational. Olav Gjelsvik gives a helpful discussion of the relation between the philosophical discussion on weakness of will and the more psychological discussion of relapse. The well known "attribution theorist" George Ainslie writes about how to explain addictive behavior on the (in my view dubious) supposition that people try to maximize their personal well being. He draws on the idea of dissociation in order to help explain the irrationality of addict's choices: if one agrees with his starting point, his suggestions will be very provocative. George Loewenstein gives an excellent discussion of his "visceral account" of addiction, which emphasizes the role of craving.

Of course, Getting Hooked does not provide a comprehensive discussion of all the issues, and as I have indicated, many of the assumptions of the contributors are controversial. Nevertheless, this is an excellent interdisciplinary book and I highly recommend it to those interested in finding an adequate explanation of the behavior of addicts.