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Addiction Doesn’t Exist, But it is Bad for You

A Letter to this article was published on 01 April 2017


There is a debate about the nature of addiction, whether it is a result of brain damage, brain dysfunction, or normal brain changes that result from habit acquisition, and about whether it is a disease. I argue that the debate about whether addiction is a disease is much ado about nothing, since all parties agree it is “unquestionably destructive.” Furthermore, the term ‘addiction’ has disappeared from recent DSM’s in favor of a spectrum of ‘abuse’ disorders. This may be a good thing indicating more nuance in typing the heterogeneous phenomena we used to call ‘addiction’.

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  1. In my experience, when AA members speak of addiction as a disease (or, as often, as like a disease), Type 2 diabetes is the favored analogy. Type 2 diabetes is acquired – sometimes by bad intentional or inadvertent lifestyle choices – but also requires the agent’s diligence in recovery.

  2. Levy (2013) and Flanagan (2017) show that brain dysfunction is not sufficient for ascribing addiction [8, 13]. Lewis should agree since addiction on his view is not in the head; it refers to a normative mismatch between the agent’s habit, their own ends, and their social world.

  3. Lewis says correctly that calling addiction destructive is not the same as saying it is a disease. His example is violence, which is destructive but not a disease. True. In ordinary language all diseases are destructive or potentially destructive, but not all destructive phenomena are diseases.

  4. Disequilibria come in various kinds. One kind is variation from normal internal functional relations where area α gets the upper-hand over area β or loses control over β when the normal state is to cooperate and balance each other or for α to control β. Imagine a small stroke that temporarily produces difficultly in communication with the motor areas that subserve speech or moving the hand. Here the problem is that intention cannot execute speech or motor movement in a normal way due to an internal disequilibria. Another kind of disequilibrium is between a whole person and the world. In Jeet Thayil’s novel Narcopolis (2012), we go inside Bombay’s opium dens where no one judges anyone else’s opium habit as abnormal or addictive or destructive. Those normative concepts are not in play. It is in the outside world where the mismatch between the opium habit and normal productive life occurs. The problem is completely outside-the-head. Addiction may – it likely does – involve both kinds of disequilibria.

  5. Consider: once one learns to swim or ride a bike, one can do so with 10, 15, 25 year gaps between practice. These are habits, kinds of “know how” that could be said to satisfy the “chronic, relapsing condition” but in a good way.

  6. One reason that the dialectic can seem stuck or frozen is that we demand a phrase or a motto to capture the phenomenon, a definition of something that is complex and resists definition in terms of necessary and sufficient conditions. Lewis makes a lot over the fact that brain changes in passionate love and sports fandom [1, p.26; p.163] are like those in addiction and thus that there is no “line in the sand” (brain-wise) that allows us to call addiction a disease and love or rooting for the Red Sox normal and healthy. Suppose this -- the brain similarity part – were true. At most it would show that brain differences of a certain sort (similar dopaminergic surges) are not sufficient to judge addiction a disease. It is not clear NIDA would say it is. Note: even in NIDA’s little advertisement for a theory, it says that the disease is “characterized by compulsive drug seeking and use, despite harmful consequences.” The romantic love and passion for Red Sox’s baseball cases do not have these characteristics.

  7. Consider: some conditions have reliable genetic causes: Sickle cell anemia, Huntington’s disease, and Tay-Sacks disease are good examples. They can and do appear perfectly sensibly in genetic textbooks as genetic diseases or genetic disorders, and there are researchers who sensibly hope for cures at the level of genes. In hematology and neurology textbooks, these same diseases are characterized as diseases of blood cells or nerve cells, and interventions and cures are sought at these upstream locations.

  8. Imagine that NIDA compiles an encyclopedia of all the usual brain changes that characterize substance addictions, and Lewis has done the same for the canals and “ruts” that deep learning creates in brain tissue. Next an otherwise paradigm case alcoholic or addict shows up without any of those brain changes. Both NIDA and Lewis have the same three choices: say that the definition doesn’t stipulate necessary conditions, only usual or typical ones; say that the individual is not an alcoholic or addict; or say that the individual belongs to a new kind, or class, or subclass of alcoholic or addict. The last case would be akin to this: A mammal gives birth to live born babies. The platypus lays eggs; it belongs to the subclass of mammals called monotremes that lay eggs. Members of the genus mammal, now speaking more precisely, normally give live birth, but some subclasses – monotremes and marsupials – don’t. They (monotremes) lay eggs or (marsupials) grow newborns partly inside the body and partly outside in pouches.

  9. There is one exception and it is good for Lewis’s case: the term addiction still occurs for gambling, but not any longer for any substance abuse problem.

  10. I took the diagnostic test answering from vivid memories of what my life was like when I had a substance use disorder, and answered yes to every question. That’s severe, which sounds right. In AA we call souls like me “low bottom drunks.”

  11. There is a type of case where the substance abusers or misusers themselves might well still prefer to call themselves alcoholics, addicts, junkies, or dope fiend. These are cases where the addiction is identity-constitutive, an existentially consuming lifestyle, and not just an odd dosing regimen with respect to some substance. Personally, it trivializes what I once was to say that I was only an extreme substance abuser or substance misuser. It was more than that, and worse than that [14].


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Correspondence to Owen Flanagan.

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Flanagan, O. Addiction Doesn’t Exist, But it is Bad for You. Neuroethics 10, 91–98 (2017).

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  • Addiction
  • Addict
  • Deep learning
  • DSM-5
  • Lewis
  • NIDA
  • Volkow