I'm making good on my promise from last week to begin a discussion on addiction. It's a timely topic, given that the American Society of Addiction Medicine this week reopened the debate about the nature of addiction.
A good place to begin our investigation of the nature of addiction is with an appreciation of its variety and complexity.
We can be addicted to substances, like heroin, or coffee, or even food, and we can be addicted to activities, like gambling or sex or the Internet (maybe). However, merely using an addictive substance, or participating in an addictive activity — even habitually — does not an addict make: Many people who enjoy sex are not sex addicts, and most people who drink alcohol are not alcoholics.
What can all these different objects of addiction have in common? Perhaps only this: that they are capable of affording us pleasure or satisfaction.
But we can't say that a substance or activity is addictive just because it can give rise to pleasure or satisfaction. Just about anything can do that.
No, addiction is neither in the substance or activity, nor, in any straight forward sense, is it solely in the addict's behavior.
Consider: Two people might be identical in respect to a potentially addictive behavior — let us imagine each of them has a great quantity and variety of sex — while one is an addict and the other isn't.
How do we distinguish between addiction and mere enthusiasm?
The short answer: For the addict, the behavior is, well, bad. And not because of anything intrinsic to the behavior, but because of how it fits into the bigger picture. What makes it bad for the addict will have to do with the way he or she feels about what he or she is doing, and they way it influences his or her choices, relationships and other domains of his or her life. (Do the sexual urges feel out of control? Do you need more and more to feel any satisfaction at all? Are you forced to take risks you don't want to take?) I want to explore the idea that addiction is a perversion, or malformation — a caricature, to use a word that thinker and cultural historian William Irwin Thompson has used in this connection — of our unproblematic, nonaddictive pursuits of satisfaction.
Consider: We achieve our pleasures; we cultivate them in ourselves. We learn to perceive and take pleasure in art; we develop in ourselves the skills that are prerequisite for making sense of and loving watching a baseball game, or reading a book, or enjoying a meal, or making love. Pleasure is the correlate of learning and development. We take pleasure in things as we come to know the world better — as we come to be engaged in and at home in the world.
The hallmark of addiction is the tendency for this relationship between acting and finding satisfaction to unravel. In addiction, pleasure seems to come for free.
In normal circumstances, there is an internal relationship between what we do and the satisfactions that result. You achieve the pleasure; the satisfaction is a satisfaction in what you are doing. You read the book, and the pleasure results from reading itself; it is not a state imposed on you by having read.
With addiction, in contrast, the relationship between action and pleasure is external — mere cause and effect; you press the button, the elevator goes up. There is no such thing as learning to press the button well; there is no such thing as cultivating the relevant pleasure. It is really as if you short circuit the normal relationship between action and reward.
But the addict must act. He must find better ways to get access to the button. This may be very costly if the button is illegal or expensive or dangerous. But there is a more abiding cost. The addict must concern himself not with his pleasures, but with the mere means. The addict turns away from knowledge, self-cultivation, the world, and is truly like a rat pressing a lever for a reward.
Another hallmark of addiction is the way it tends to disrupt the natural give and take of our values and activities. The pleasures we achieve are, on the whole, integrated with other activities and values. We take pleasure in our work, let's say, and this leads us to take value in non-work — in play or sleep, for example. The pleasure of sleep has the effect of returning us to our desire to get up and take up work or play. We seek, and sometimes find, a balance between different, locally incompatible sources of pleasure: When I work, for example, I turn away from my family; but my work is no obstacle to developing and sustaining my family life.
Things are totally different with addiction. Addicts lie and cheat; they conceal the when, what and how much. No matter how they excel at pressing that button, this never adds up to an act of significance on a scale of values that includes and gets balanced against, well, any other values. So relationships fall apart, jobs are lost. These are terrible costs.
If we view addiction as a breakdown of the normal ways in which we find pleasure, then what are the implications for a range of other assumptions? What does that mean for the concept of addiction as a chronic disease — in particular, a disease of the brain? In the coming weeks, I want to explore that question, and I'll also review two new books on addiction.