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Towards a dispositionalist (and unifying) account of addiction

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Abstract

Addiction theorists have often utilized the metaphor of the blind men and the elephant to illustrate the complex nature of addiction and the varied methodological approaches to studying it. A common purported upshot is skeptical in nature: due to these complexities, it is not possible to offer a unifying account of addiction. I think that this is a mistake. The elephant is real–there is a there there. Here, I defend a dispositionalist account of addiction as the systematic disposition to fail to control one’s desires to engage in certain types of behaviors. I explain this position, defend the inclusion of desires and impaired control, and flesh out the notion of systematicity central to my account. I then illustrate how my dispositionalist framework can unify the disparate and seemingly incompatible accounts of addiction (and their respective methodological approaches). I close with a brief plan to extend and implement my account.

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Notes

  1. Examples of substantive unification in the history of science include Newton’s “first great unification” with his theory of gravity and Maxwell’s “second great unification” with his theory of electromagnetism [31, 32]. An example in the philosophical literature is Michael Bishop’s attempt to unify theories of well-being with his “network theory of well-being” [33].

  2. I follow Barry Smith [16] and Neil Williams [34] in my general understanding of dispositions. There are some divergences in the details of their views, but these will not matter to the arguments here. Moreover, while I favor the neo-Aristotelian powers theorist interpretation of the nature of dispositions defended by Williams, this detail can also be set aside for our purposes.

  3. That said, I favor the reward theory of desire defended by Nomy Arpaly and Timothy Schroeder [47, 48]. Their co-authorerd work provides fuller explanations of the many complexities involved in reward learning and desiring [47, Ch. 6]. Additionally, Schroeder’s work provides more detailed, and predominately neuroscientific, explanations of and arguments for the reward theory of learning and the reward theory of desire that rests on it [48].

  4. But compare the so-called ‘moral model’ [12, 44, 49]. Still, the moral model is very much an outlier view.

  5. I borrow the term from David Limbaugh. He introduces this notion in the context of dysfunctions and disorders, where he argues that his “harm in the damage sense” helps Wakefield’s harmful dysfunction account of medical disorder avoid a series of objections [56].

  6. But compare [42, 43, 57,58,59]. While these authors claim that there is no difference in kind between akrasia and addiction, there is nonetheless room for impaired control. Moreover, they identify differences in terms of frequency, strength, stability, or some other such thing, suggesting that the difference comes to something akin to being disposed in a certain kind of way. This idea is what I try to capture with systematicity.

  7. Note that, while I invoke the term ‘addiction’ to explain societally relevant circumstance, this is only for ease of explanation and does not make the analysis circular. We can substitute ‘addiction-relevant choices’ for ‘choices relevant to alcohol consumption’, ‘choices relevant to heroin consumption’, ‘choices relevant to gambling’, and the like.

  8. Thanks to an anonymous referee for pushing me on the need to include this kind of theory as distinct from the environment-based and biopsychosocial models of Pickard, Alexander, Buckner, and so on. Hartogsohn also provides a review of the history and evolution of this sort of theory of addiction [66].

  9. As an anonymous reviewer pointed out, one of those interesting and instructive differences is the lifeworld account’s ability to provide a better integration of third- and first-person perspectives than other accounts. This, in turn, can be extremely important for therapeutic purposes.

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Acknowledgements

Special thanks to David Limbaugh for many helpful discussions of the ideas that ultimately became this paper, and in particular for his help in applying his notion of systematicity to my account of addiction. I also owe a great deal of thanks to friends and fellows of the Romanell Center for Clinical Ethics and the Philosophy of Medicine at the University at Buffalo for their extremely helpful comments, questions, and discussion about the ideas in this paper and my account of addiction in general, both at the Fall 2020 Virtual Lecture Series and many other previous workshops and conferences: Harvey Berman, Patrick Daly, Jim Delaney, Neil Feit, Jack Freer, Shane Hemmer, David Hershenov, John Keller, Stephen Kershnar, David Limbaugh, John Lizza, Eric Merrell, Jake Monaghan, Catherine Nolan, Phil Reed, Barry Smith, Adam Taylor, Jerry Wakefield, and Jonathan Vajda. Special thanks to Harvey Berman, Neil Feit, Stephen Kershnar, and Phil Reed for providing comments on an earlier draft of this paper. Thanks to Neil Williams for many helpful conversations about the nature of dispositions.

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  1. Department of Philosophy, Bakersfield College, Bakersfield, CA, USA

    Robert Kelly

  2. Romanell Center for Clinical Ethics and Philosophy of Medicine, University at Buffalo, Buffalo, NY, USA

    Robert Kelly

  3. National Center for Ontological Research Lab, University at Buffalo, Buffalo, NY, USA

    Robert Kelly

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Kelly, R. Towards a dispositionalist (and unifying) account of addiction. Theor Med Bioeth 44, 21–40 (2023). https://doi.org/10.1007/s11017-022-09596-x

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