Abstract
Marc Lewis argues that addiction is not a disease, it is instead a dysfunctional outcome of what plastic brains ordinarily do, given the adaptive processes of learning and development within environments where people are seeking happiness, or relief, or escape. They come to obsessively desire substances or activities that they believe will deliver happiness and so on, but this comes to corrupt the normal process of development when it escalates beyond a point of functionality. Such ‘deep learning’ emerges from consumptive habits, or ‘motivated repetition’, and although addiction is bad, it ferments out of the ordinary stuff underpinning any neural habit. Lewis gives us a convincing story about the process that leads from ordinary controlled consumption through to quite heavy addictive consumption, but I claim that in some extreme cases the eventual state of deep learning tips over into clinically significant impairment and (so) disorder. Addiction is an elastic concept, and although it develops through mild and moderate forms, the impairment we see in severe cases needs to be acknowledged. This impairment, I argue, consists in the chronic automatic consumption present in late stage addiction. In this condition, the desiring self largely drops out the picture, as the addicted individual begins to mindlessly consume. This impairment is clinically significant because the machinery of motivated rationality has become corrupted. To bolster this claim I compare what is going on in these extreme cases with what goes on in people who dissociate in cases of depersonalization disorder.
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Notes
I thank an anonymous referee for requesting clarification of the concept of the purely automatic.
I thank an anonymous referee for pushing me on this point.
But note of course that even during those periods his unchanging goal was to consume. It is an underrated criticism of choice models of addiction that the object of choice (in this case alcohol) remains constant. Drawing attention to the fact that an affected person is making lots of ‘local’ choices, the ones required to secure alcohol and so on, misses the main point that the important reflectively generated choice over what this person values always presents to them as one between their favored drug and something else they might like. Pointing to local choice-making behavior misses almost everything about a potential pathological state; until we have described the economy of choices of the agent in full, including their content, frequency, and the duress under which they are taken, we have not done a proper evaluation of what is really at stake in the disorder classification question. But I digress.
I choose depersonalization (just one of the dissociative disorders) in order to make some very specific comparisons, however, it is by no means the only mental disorder in which dissociative symptoms may be present, for example, consider OCD, or even BPD. As an anonymous referee helpfully points out, my argument would be strengthened by the inclusion of these other recognised conditions in case one was skeptical that depersonalization did not really count as a disorder, or not a severe disorder.
According to the UN World Drug Report [7], ‘Illicit drug use was estimated to be the cause of 0.8% of disability-adjusted life years worldwide in 2010…In comparison, tobacco smoking was the cause of an estimated 6.3% of global disability-adjusted life years.’
It is important to note that the automaticity in Johnny’s case develops as part of the volitional dissociation in addiction. This is to be distinguished from two other possibilities. First, there is no suggestion that he drank because of a pre-existing dissociative condition, which, so to say, drove him to it (a version of self-medication). So the case must not be confused with those in which this does happen (See [10]). And second, the automaticity is not to be confused with being a substance-induced artifact, a secondary effect emerging from some specific physiological response to alcohol. Indeed, there are cases of marijuana or hallucinogen consumption known to bring about the symptoms of depersonalization [11]. I am not talking about these cases.
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Acknowledgements
This research was supported via a study entitled ‘Addiction, Moral Identity and Moral Agency’, funded by the Australian Research Council (DP 1094144). It was also supported through funding from the Laurdel Foundation. I thank Anke Snoek, and an anonymous referee for helpful comments on an earlier draft.
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Matthews, S. Chronic Automaticity in Addiction: Why Extreme Addiction is a Disorder. Neuroethics 10, 199–209 (2017). https://doi.org/10.1007/s12152-017-9328-5
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DOI: https://doi.org/10.1007/s12152-017-9328-5