Dalrymple on Addiction
I have more than once in these pages protested against the absurd notion that tobacco is addictive — in a post on socially conscious investing for example — all the while granting that heroin and other substances are. Perhaps I need to take a step farther and question the very notion of addiction. To that end, Theodore Dalrymple's Romancing Opiates: Pharmacological Lies and the Addiction Bueaucracy appears to be the book to read:
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Posted by William F. Vallicella on
Saturday January 12, 2008 at 1:48pm
I've read Dalrymple's book on opiates and it is excellent. It's specifically addressed to the nature of opiate addiction (or non-addiction.) He doesn't deny that other substances may be genuinely chemically addicting.
Another great pharmacological book is Ronald Dworkin's Artificial Happiness, concerning how we have come to believe that an unhappy life is a medical condition to be treated with psychoactive drugs. I'd be interested in your take on both books.
Cheers,
David
If you get rid of the word 'addiction' as a description of what state people are in when dependent on nicotine, some close synonym needs to be suggested.
There is clearly something going wrong with someone that earnestly wants to stop but keeps failing. What should we call it? Weakness of will wrt nicotine? But on the other hand, there are clearly withdrawal symptoms when trying to quit, as I can stongly attest (headaches, irritability, anxiety, things I typically don't experience). Dalrymple (link below) suggests some of these symptoms are self-fulfilling prophecies. That is a tough thing to test: I can say they weren't, that I know myself well enough to see this. But I can't prove that. (Similar to arguments against atheism that even if you say you are an atheist, you really aren't: how is one to refute that?).
Perhaps he has some cross-cultural studies. Cultures where they have different lists of withdrawal symptoms, and some of which contradict one another, and you could study the extent to which people in the respective cultures adhere to the accepted list.
Here is Dalrymple's definition of addiction:
"Addiction is a condition in which people grow accustomed to a drug, need to take more of it to achieve the same effect, have withdrawal symptoms on ceasing to take it, and also have a psychological craving for the drug."
I lifted it from this interview.
That seems like a reasonable definition, including most of the standards (e.g., tolerance, withdrawal, craving, and usually they throw in 'life-damaging consequences).
I remember giving up cigarettes and it took an intense effort of will. This thing located in your throat that kept reminding you every three or four minutes that it was time for a fag. I'm very strongly against the legalisation of any currently illegal drugs.
Paradoxically, of course, I am against the current banning of smoking practically everywhere. Why, you ask. Don't know. I suppose we have learned to deal with smoking as a society, but clearly haven't with smack and crack cocaine and the other monstrosities.
On alcohol, which is destroying England at the moment, I would favour a return to the old licensing laws (lunchtime, and evenings until 10:30. English people simply can't cope with drinking, unlike our European friends.
Speaking of which I am on antibiotics for nearly two weeks and can't drink at all. Painful, but then it proves that addiction is real.
There is something going on here and we need a way to talk about it. If you don't like people to say that smoking is more addictive than alcohol, how should we describe this set of phenomena?
Perhaps this is explained by the need for just one addiction, and of the available addictions, smoking was seen as the least harmful.
I read William Burroughs' biography some years ago but was struck by the fact that both his father and grandfather were alcoholics. Also Burroughs' son, who was addicted to meth at one point, then turned to alcohol, which killed him. Burroughs lived until old age. Possible conclusions: 1. Perhaps heroin is indeed less harmful than alcohol, as some of its supporters would have it. That said, would I prefer my children tried heroin, or a glass of champagne, the answer is obvious. 2. Perhaps there is a genetic predisposition to addiction. I've lost count of the people I know who drink too much, whose parents also drink too much. 3. The drug of choice is not genetically predisposed. Any will do.
>>There is something going on here and we need a way to talk about it. If you don't like people to say that smoking is more addictive than alcohol, how should we describe this set of phenomena?
Addiction is philosophically challenging because it is a case of someone wanting to do something, but at the same time not wanting. Lots of different cases here. The case of someone who recognises the addiction is harmful, but doesn't care, just likes doing it and is happy with an informed balance, as they see it, between the good and the evil. Then there's the case of someone who 'genuinely' wants to stop but can't take the pain of the withdrawal symptoms (I take it everyone is agreed on the existence of 'withdrawal symptoms', which differ depending on the addiction but in most cases exist?). The latter case seems to present the most cogent one for illegalisation. Let's posit a hypothetical drug which is extremely pleasurable, but which when not taken causes the most agonising pain imaginable – let's say a pain comparable to that you would get if you immersed your hand in boiling water, but which continued indefinitely and without remission until the victim takes their own life.
The final case is the most problematic. Most heroin addicts report that the withdrawal symptoms, which last for a few days, are possible to endure. However, there persist symptoms called the 'monkey on the back' which consist of a nagging or craving to take the drug again, and which in many cases are impossible to resist. This is philosophically difficult. It seems like a return of one sort of 'will', which persists at the same time as the will to stay clean, which is the opposite will. But there clearly can't exist two equal and opposite wills. Or not? Plato portrayed it as the battle between the charioteer and the horses, who may be very strong. But then the 'will' is clearly the charioteer, the horses are simply forces opposed to that will, which for that very reason cannot be the charioteer's will.
On what is more addictive than what, also a difficult question. In the case of drugs whose removal presents extreme physical pain, there is no problem. The difficulty is drugs with the 'monkey on the back', and the extent to which the monkey represents real choice, or whether it is a 'will' artificially created by the drug.
>>There is something going on here and we need a way to talk about it. If you don't like people to say that smoking is more addictive than alcohol, how should we describe this set of phenomena?
Addiction is philosophically challenging because it is a case of someone wanting to do something, but at the same time not wanting. Lots of different cases here. The case of someone who recognises the addiction is harmful, but doesn't care, just likes doing it and is happy with an informed balance, as they see it, between the good and the evil. Then there's the case of someone who 'genuinely' wants to stop but can't take the pain of the withdrawal symptoms (I take it everyone is agreed on the existence of 'withdrawal symptoms', which differ depending on the addiction but in most cases exist?). The latter case seems to present the most cogent one for illegalisation. Let's posit a hypothetical drug which is extremely pleasurable, but which when not taken causes the most agonising pain imaginable – let's say a pain comparable to that you would get if you immersed your hand in boiling water, but which continued indefinitely and without remission until the victim takes their own life.
The final case is the most problematic. Most heroin addicts report that the withdrawal symptoms, which last for a few days, are possible to endure. However, there persist symptoms called the 'monkey on the back' which consist of a nagging or craving to take the drug again, and which in many cases are impossible to resist. This is philosophically difficult. It seems like a return of one sort of 'will', which persists at the same time as the will to stay clean, which is the opposite will. But there clearly can't exist two equal and opposite wills. Or not? Plato portrayed it as the battle between the charioteer and the horses, who may be very strong. But then the 'will' is clearly the charioteer, the horses are simply forces opposed to that will, which for that very reason cannot be the charioteer's will.
On what is more addictive than what, also a difficult question. In the case of drugs whose removal presents extreme physical pain, there is no problem. The difficulty is drugs with the 'monkey on the back', and the extent to which the monkey represents real choice, or whether it is a 'will' artificially created by the drug.
Well, I had no trouble stopping smoking.
Well, for me (and my friend's Uncle) it was very hard!
And on and on.
While I suppose there are substances that when ingested cause a person to uncontrollably desire more and more of the substance to his detriment, I honestly don't see how so-called addiction differs from a bad habit other than in degree.
Regards, Bill T.
Thanks for informing me of Dworkin's book. I'll look out for it.
As for defining addiction, here is what I suggested:
Addiction, if it means anything, has to involve (i) a physiological dependence (ii) on something harmful to the body (iii) removal of which would induce serious withdrawal symptoms. One cannot be addicted to nose-picking, to running, to breathing, or to caffeine. Furthermore, (iv) it is a misuse of language to call a substance addictive when only a relatively small number of its users develop — over a sufficient period of time with sufficient frequency of use — a physical craving for it that cannot be broken without severe withdrawal symptoms. Heroin is addictive; nicotine is not. To think otherwise is to use ‘addiction’ in an unconscionably loose way.
Liberals and leftists engage in this loose talk for at least two reasons. First, it aids them in their denial of individual responsibility. They would divest individuals of responsibility for their actions, displacing it onto factors, such as ‘addictive’ substances, external to the agent. Their motive is to grab more power for themselves by increasing the size and scope of government: the
less self-reliant and responsible individuals are, the more they need the nanny state and people like Hillary, who gives some evidence of aspiring to be Nanny-in-Chief. Second, loose talk of ‘addiction’ fits in nicely with what I call their misplaced moral enthusiasm. Incapable of appreciating a genuine issue such as partial-birth abortion, they invest their moral energy in pseudo-issues.
"I remember giving up cigarettes and it took an intense effort of will." That, in part, is my point. You did it by an exercise of free will. You and countless others without a bunch of liberals holding your hands and presumably also without 'patches' and other drugs. You just did it. So calling nicotine addictive is a wild semantic stretch.
Dave,
How can you call a substance addictive when countless people quit by themselves? Remember Everett Koop the surgeon general a few years back? He actually claimed that nicotine is as addictive as heroin. That is preposterous.
I find the demonization of tobacco a very strange phenomenon. No, I do not smoke cigarettes, not do I work for a tobacco company.
Your Plato reference is to the Phaedrus. It was not the charioteer versus the horses. He was trying to control two horses, one unruly and one ruly (if that's a word). The latter aspired upward, towards the Froms, the former downward into the maelstrom of the mundus sensibilis.
You say that addiction differs from a bad habit only by degree. To repeat and simplify my stab at a definition above:
Addiction has to involve (i) a physiological dependence (ii) on something harmful to the body (iii) removal of which would induce serious withdrawal symptoms. (NOT the headache a coffee drinker may get if he stops drinking the stuff.) Furthermore, (iv) it is a misuse of language to call a substance addictive when only a relatively small number of its users develop — over a sufficient period of time with sufficient frequency of use — a physical craving for it that cannot be broken without severe withdrawal symptoms.
Now a bad habit need not bring about any physiological dependence. Nose-picking, nail-biting, thumb-sucking, masturbation count as bad habits but physiological dependence does not result. Suppone one picks and eats his nasal effluvia. It is an empirical question, but I rather doubt that anyone has ever become physiologically dependent on ingestion of his own nasal effluvia, or suffered withdrwawal symptoms when you couldn't get his 'fix.'
Second, a bad habit need not be harmful to the body.
I think that clauses (i) and (iii) of your definition are what's essential. About clause (ii) I have doubts. And even with clause (iii), I don't know what standard of "seriousness" must be met before withdrawal symptoms indicate that a substance is addictive. Why not say that some addictive substances produce very severe withdrawal symptoms and others (perhaps including nicotine?) produce withdrawal symptoms that are not so severe?
yes you are right.
Now a bad habit need not bring about any physiological dependence. ... a bad habit need not be harmful to the body.
Agreed. I would say addiction is a species of bad habit, because it is still a matter of will (withdrawal symptons or not) to break the habit.
Regards, Bill T
Physiological dependence I would equate with harmful or painful symptoms on withdrawal.
To which I added earlier 'psychological dependence' or 'monkey on the back' which all addicts reports as being much more difficult to cope with than withdrawal.
It is as if the drug affected the user's will in a way that causes them to do what they previously did not want to do. But not quite, for as I pointed out, the oddity of addiction is that a user may well want to give up, but can't, and not because of the painful effects of withdrawal, but because the drug is like another person or other will inside them which has tremendous power and influence.
Often the will is personnified (or creature-fied) as with the monkey, or the dragon. Or a cocaine badger, as in a recent film.
Ergo, there is philosophical interest here. How can we want to do something (give up) but not want to (want to keep using).
Ergo, there is philosophical interest here. How can we want to do something (give up) but not want to (want to keep using).
Interesting question. We all have appetites. We also have the will to choose whether or not to act upon an appetite. We are all familiar with deferring the gratification of an appetite in the pursuit of higher things.
So we all have the experience of desires we choose not to fulfill -- i.e., to crave while not acting upon that craving. This is the conflict you put forth in your question. It is inherent in human nature, and learning to control that conflict is how we mature from the clever beasts of childhood to the moral beings of adulthood.
Of course, a severely disordered appetite, say a heroin addiction, is no easy thing to defer. No question that the conflict between wanting to satisfy a harmful appetite and wanting to repress it can be intense. But satisfaction and repression are both acts of will. The addict must choose one way or another.
This is why I say addiction is a species of bad habit (i.e., a matter of will), even though an addiction may give rise to intense conflict and make the choice of resistance most difficult.
Regards, Bill T
There is much to what you say here. The original question posed by Gudemann was whether we can quantify the disorder caused by the drug. Are some drugs more intrinsically addictive than others? Hard to say.
We can objectively observe the disordered appetite that some drugs can cause by means of its external effects -- e.g., symptons -- upon the addict, but I would say the disorder cannot be quantified for three reasons.
First, those external effects do not readily submit themselves to rigorous measurement, if it all. At best, only statistical comparisons of effects are possible, which like so much involving drugs makes their study an art and not a science.
Second, the qualia of the addiction, its most important aspect, is strictly subjective and eludes analysis -- i.e., study by delimitation, enumeration, and reduction.
Third, if I am correct in my previous comment, then addiction is a function of will, which in turn is entirely a function of mind. As the mind is a mental and not a physical entity, no quantification of its operation is possible.
So I agree that, in the absence of sufficient physicality of the phenomenon of addiction (and so not permitting quantification and analysis), it is hard to say if some drugs are by nature more addictive than others, at least scientifically.
Regards, Bill T
This topic is interesting, I think, because it reveals problems with our notion of 'will'. Ockham wonders if there can exist equal and opposite wills; Bills T and V emphasise that ridding oneself of an addiction is an act of will, which, though true, does not take us very far. After years of observing my own will formation I've reached the view that my will is the outcome of competing desires. I always seem to do what I most desire, almost by definition. The psychiatrist George Ainslie, in his Breakdown of Will (NDPR review here), has an impressively well-worked out model of this which accounts for addiction, procrastination, and other irrational behaviours. One problem for the addict is that his valuation of a desired drug-free state some time in the future is heavily discounted in comparison to the pain of withdrawal, the delights of the next hit, and the nagging of Ockham's monkey, all in the here and now. Ainslie calls this 'inter-temporal bargaining'. Unless his valuation of a drug-free future is raised, or his future discounting rate reduced, or the withdrawal pains, etc, reduced, the addict is unlikely to break his habit.
There is an interesting parallel here with the earlier discussion on doxastic voluntarism. Just as my will seems to emerge 'bottom-up' from my desires, so too my beliefs seem to emerge bottom-up from the evidence presented to me. I can't make myself believe P or not-P on the basis of the toss of a coin. Nor, if I have a desire to do A, will I submit myself to doing A or not-A on the same basis. In other words, I'm not likely to 'will' myself to reject my desire. Much depends, of course, on the strength of the desire.