The problem of addiction to psychoactive substances, such as alcohol and other drugs, has been addressed in psychiatry traditionally from the perspective of a mechanistic-reductionist epistemological model, whose main focus in clinical care is to avoid or suppress the use of these substances, rather than understanding the meaning of a treatment and the meaning of the alterations of consciousness produced by these addictive substances. This paper attempts to contribute towards overcoming this epistemological perspective from the perspective of phenomenological psychopathology. In (...) the first part of the article, the main characteristics of phenomenology and its incorporation into the field of mental health will be presented. Then the issue of addiction will be analysed from two ways of understanding it: the mechanistic-reductionist model and the phenomenological dialectical model. Finally, the pragmatic consequences of the dialectical perspective of phenomenology, called Dialectical Phenomenology (DPh), which seeks to enrich the diagnostic process in the mental health clinic, allowing scientific diagnoses to approach the complexities of clinical reality, will be presented. (shrink)

I clarify and defend the hypothesis that human belief formation is sensitive to social rewards and punishments, such that beliefs are sometimes formed based on unconscious expectations of their likely effects on other agents – agents who frequently reward us when we hold ungrounded beliefs and punish us when we hold reasonable ones. After clarifying this phenomenon and distinguishing it from other sources of bias in the psychological literature, I argue that the hypothesis is plausible on theoretical grounds and I (...) show how it illuminates and unifies a range of psychological phenomena, including confabulation and rationalisation, positive illusions, and identity-protective cognition. (shrink)

When the costs of acquiring knowledge outweigh the benefits of possessing it, ignorance is rational. In this paper I clarify and explore a related but more neglected phenomenon: cases in which ignorance is motivated by the anticipated costs of possessing knowledge, not acquiring it. The paper has four aims. First, I describe the psychological and social factors underlying this phenomenon of motivated ignorance. Second, I describe those conditions in which it is instrumentally rational. Third, I draw on evidence from the (...) social sciences to argue that this phenomenon of rational motivated ignorance plays an important but often unappreciated role in one of the most socially harmful forms of ignorance today: voter ignorance of societal risks such as climate change. Finally, I consider how to address the high social costs associated with rational motivated ignorance. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity (...) and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

The present paper proposes an integrative account of social forms of practical irrationality and corresponding disruptions of individual and group-level emotion regulation. I will especially focus on disruptions in emotion regulation by means of collaborative agential and doxastic akrasia. I begin by distinguishing mutual, communal and collaborative forms of akrasia. Such a taxonomy seems all the more needed as, rather surprisingly, in the face of huge philosophical interest in analysing the possibility, structure and mechanisms of individual practical irrationality, with very (...) little exception, there are no comparable accounts of social and collaborative cases. However, I believe that, if it is true that individual akrasia is, in the long run, harmful for those who entertain it, this is even more so in social contexts. I will illustrate this point by drawing on various small group settings, and explore a number of socio-psychological mechanisms underlying collaborative irrationality, in particular groupthink. Specifically, I suggest that in collaborative cases there is what I call a spiralling of practical irrationality at play. I will argue that this is typically correlated and indeed partly due to biases in individual members' affect control and eventually the group's with whom the members identify. (shrink)

The landscape of addiction is dominated by two rival models: a moral model and a model that characterizes addiction as a neurobiological disease of compulsion. Against both, I offer a scientifically and clinically informed alternative. Addiction is a highly heterogenous condition that is ill‐characterized as involving compulsive use. On the whole, drug consumption in addiction remains goal directed: people take drugs because drugs have tremendous value. This view has potential implications for the claim that addiction is, in all cases, a (...) brain disease. But more importantly, it has implications for clinical and policy interventions. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is not to cleave to the concept of compulsion but to fight moralism directly. (shrink)

Drug use and drug addiction are severely stigmatised around the world. Marc Lewis does not frame his learning model of addiction as a choice model out of concern that to do so further encourages stigma and blame. Yet the evidence in support of a choice model is increasingly strong as well as consonant with core elements of his learning model. I offer a responsibility without blame framework that derives from reflection on forms of clinical practice that support change and recovery (...) in patients who cause harm to themselves and others. This framework can be used to interrogate our own attitudes and responses, so that we can better see how to acknowledge the truth about choice and agency in addiction, while avoiding stigma and blame, and instead maintaining care and compassion alongside a commitment to working for social justice and good. (shrink)

Addiction is standardly characterized as a neurobiological disease of compulsion. Against this characterization, I argue that many cases of addiction cannot be explained without recognizing the value of drugs to those who are addicted; and I explore in detail an insufficiently recognized source of value, namely, a sense of self and social identity as an addict. For people who lack a genuine alternative sense of self and social identity, recovery represents an existential threat. Given that an addict identification carries expectations (...) of continued consumption despite negative consequences, there is therefore a parsimonious explanation of why people who identify as addicts continue to use drugs despite these consequences: they self‐identify as addicts and that is what addicts are supposed to do. I conclude by considering how it is nonetheless possible to overcome addiction despite this identity, in part by imagining and enacting a new one. Importantly, this possibility requires the availability of social support and material resources that are all too frequently absent in the lives of those who struggle with addiction. (shrink)

In this article I address the question of what makes addiction morally problematic, and seek to answer it by drawing on values salient in the sub-Saharan African philosophical tradition. Specifically, I appeal to life-force and communal relationship, each of which African philosophers have at times advanced as a foundational value, and spell out how addiction, or at least salient instances of it, could be viewed as unethical for flouting them. I do not seek to defend either vitality or community as (...) the best explanation of when and why addiction is immoral, instead arguing that each of these characteristically African values grounds an independent and plausible account of that. I conclude that both vitalism and communalism merit consideration as rivals to accounts that Western ethicists would typically make, according to which addiction is immoral insofar as it degrades rationality or autonomy, as per Kantianism, or causes pain or dissatisfaction, à la utilitarianism. (shrink)

Rationalist accounts of self-knowledge are motivated in important part by the claim that only by looking to our reasons to discover our beliefs and desires are we active in relation to them and only thereby do we take responsibility for them. These kinds of account seem to predict that self-knowledge generated using third-personal methods or analogues of these methods will tend to undermine the capacity to exercise self-control. In this light, the insistence by treatment programs that addicts acknowledge that they (...) are addicts seems puzzling. I argue that because addicts—and perhaps ordinary akratics, to some extent at least, too—are vulnerable to losing control of their actions via losing control over their beliefs, advising them to look to their reasons for actions is counterproductive and facilitates loss of control. In contrast, an insistence on what I call impersonal self-knowledge, knowledge of some of one's states and dispositions generated by third-personal means, may help to reestablish control. (shrink)

Addiction is widely taken to involve a profound loss of self-control. Addictive motivation is extremely forceful, and it is remarkably hard to abstain from addictive behaviors. Theories of addiction have sought to explain how self-control is undermined in addiction. However, an important explanatory factor in addictive motivation and behaviors has so far been underexamined: emotion. This paper examines the link between emotion and loss of control in addiction. I use the concept of affective scaffolding to argue that drug use functions (...) as a form of emotion regulation that, especially in certain psycho-socioeconomic conditions, can escalate into what I term addictive affective dependence. Addictive affective dependence is extremely motivating of drug use, and in this way contributes to the agent losing control. An upshot of the paper is that it predicts something that is known to be true about addiction treatment and recovery: strategies that address psycho-socioeconomic conditions are particularly successful in bolstering agency in addiction. Furthermore, my view explains why these strategies work. Thus, the view provides a conceptual framework for existing effective methods of addressing addiction. (shrink)

Addicts may simply deny that they are addicted; or they may use self-signalling to try to provide evidence that giving up is not worthwhile. I provide an account that shows how easy it is to provide apparent evidence either that the addiction is so bad that it cannot be escaped; or that there is no real addiction, and hence nothing to escape. I suggest that the most effective way of avoiding this is to avoid self-signalling altogether.

Orthodoxy holds that the difference between weakness of will and compulsion is a matter of the resistibility of an agent's effective motivation, which makes control-based views of agency especially well equipped to distinguish blameworthy weak-willed acts from non-blameworthy compulsive acts. I defend an alternative view that the difference between weakness and compulsion instead lies in the fact that agents would upon reflection give some conative weight to acting on their weak-willed desires for some aim other than to extinguish them, but (...) not to their compulsive desires. This view allows identificationist theorists of moral responsibility to explain why weak-willed actions, but not compulsive actions, are attributable to agents such that they can, in theory, be praised or blamed for them. After motivating and presenting the view in detail, I show how it has unique resources for explaining the ethics of managing one's compulsions. (shrink)

Two epistemic principles are Knowledge Exclusion and Belief Exclusion. Knowledge Exclusion says that it is necessarily the case that if an agent knows that p, then she does not believe that ∼p, and Belief Exclusion says that it is necessarily the case that if an agent believes that q, then she does not believe that ∼q. Many epistemologists find it reasonable to reject the latter principle and accept the former. I argue that this is in fact not reasonable by proposing (...) a case in which an agent can use that she has contradictory beliefs towards a proposition as decisive evidence for that proposition. A natural response is that this case conflicts with common assumptions about the relation between knowledge, contradictory beliefs and rationality. I reply by drawing ideas from Lasonen-Aarnio’s remarks on unreasonable knowledge to explain why these common assumptions do not threaten my argument. (shrink)

A restrictive view of self-control identifies exercises of self-control with synchronic intrapsychic processes, and pictures diachronic and externally-scaffolded strategies not as proper instances of self-control, but as clever ways of avoiding the need to exercise that ability. In turn, defenders of an inclusive view of self-control typically argue that we should construe self-control as more than effortful inhibition, and that, on grounds of functional equivalence, all these diverse strategies might be properly described as instances of self-control. In this paper, I (...) take a fresh look at this debate by focusing on cases of addiction. I argue that addicted agents face a paradigmatic sort of self-control challenge, which makes addiction an important test case for theories of self-control. And I discuss evidence that highlights both the unreliability of synchronic intrapsychic strategies and the crucial role that is played by diachronic and externally-scaffolded strategies in successful attempts at achieving abstinence by addicted individuals. Abstaining addicts are a paradigmatic case of agents who successfully exercise self-control, and they mostly do so by relying on diachronic and externally-scaffolded strategies. This, I argue, lends further support to an inclusive view of self-control. (shrink)

The addiction literature is fraught with conceptual confusions, stalled debates, and an unfortunate lack of clear and careful attempts to delineate the phenomenon of addiction in a way that might lead to consensus. My dissertation has two overarching aims, one metaphysical and one practical. -/- The first aim is to defend an account of addiction as the systematic disposition to fail to control one’s desires to engage in certain types of behaviors. I defend the inclusion of desires and impaired control (...) in the definition, and I flesh out the notion of systematicity central to my dispositionalist framework. I engage the so-called ‘disease vs. choice’ debate, criticizing its presupposition that we are dealing here with a dichotomy and arguing that the movement towards a middle ground is the right track to take. I explain how the dispositionalist account can capture this middle ground and how it serves to expand upon existing views, in particular by filling in the metaphysical details. -/- The second aim is to show how the account I defend can help to unify the extant views and disciplinary perspectives in the literature. Both the dispositionalist aspect of my framework and the methodology adopted (applied ontology and systematic metaphysics) can move the literature towards both substantive and methodological unification. This will help to clear up conceptual confusions, resolve (or sometimes dissolve) apparently intractable disputes, situate different research perspectives with respect to each other, facilitate interdisciplinary dialogue, and help to frame important questions about addiction. Finally, I offer the beginnings of an ontology of addiction, which will provide a terminologically well-structured guide to the addiction literature in a way that will facilitate more effective and efficient communication and data management across disciplines. (shrink)