I review the brain disease model of addiction promoted by medical, scientific, and clinical authorities in the US and elsewhere. I then show that the disease model is flawed because brain changes in addiction are similar to those generally observed when recurrent, highly motivated goal seeking results in the development of deep habits, Pavlovian learning, and prefrontal disengagement. This analysis relies on concepts of self-organization, neuroplasticity, personality development, and delay discounting. It also highlights neural and behavioral parallels between substance addictions, (...) behavioral addictions, normative compulsive behaviors, and falling in love. I note that the short duration of addictive rewards leads to negative emotions that accelerate the learning cycle, but cortical reconfiguration in recovery should also inform our understanding of addiction. I end by showing that the ethos of the disease model makes it difficult to reconcile with a developmental-learning orientation. (shrink)

This book provides a comprehensive, systematic theory of moral responsibility. The authors explore the conditions under which individuals are morally responsible for actions, omissions, consequences, and emotions. The leading idea in the book is that moral responsibility is based on 'guidance control'. This control has two components: the mechanism that issues in the relevant behavior must be the agent's own mechanism, and it must be appropriately responsive to reasons. The book develops an account of both components. The authors go on (...) to offer a sustained defense of the thesis that moral responsibility is compatible with causal determinism. (shrink)

The claim that addiction is a brain disease is almost universally accepted among scientists who work on addiction. The claim’s attraction rests on two grounds: the fact that addiction seems to be characterized by dysfunction in specific neural pathways and the fact that the claim seems to the compassionate response to people who are suffering. I argue that neural dysfunction is not sufficient for disease: something is a brain disease only when neural dysfunction is sufficient for impairment. I claim that (...) the neural dysfunction that is characteristic of addiction is not sufficient for impairment, because people who suffer from that dysfunction are impaired, sufficiently to count as diseased, only given certain features of their context. Hence addiction is not a brain disease (though it is often a disease, and it may always involve brain dysfunction). I argue that accepting that addiction is not a brain disease does not entail a moralizing attitude toward people who suffer as a result of addiction; if anything, it allows for a more compassionate, and more effective, response to addiction. (shrink)

Ordinarily, we take moral responsibility to come in degrees. Despite this commonplace, theories of moral responsibility have focused on the minimum threshold conditions under which agents are morally responsible. But this cannot account for our practices of holding agents to be more or less responsible. In this paper we remedy this omission. More specifically, we extend an account of reasons-responsiveness due to John Martin Fischer and Mark Ravizza according to which an agent is morally responsible only if she is appropriately (...) receptive to and reactive to reasons for action. Building on this, we claim that the degree to which an agent is responsible will depend on the degree to which she is able to recognize and react to reasons. To analyze this, we appeal to relations of comparative similarity between possible worlds, arguing that the degree to which an agent is reasons-reactive depends on the nearest possible world in which given sufficient reason to do otherwise, she does so. Similarly, we argue that the degree to which an agent is reasons-receptive will depend on the intelligibility of her patterned recognition of reasons. By extending an account of reasons-responsiveness in these ways, we are able to rationalize our practice of judging people to be more or less responsible. (shrink)

John Fischer and Mark Ravizza defend in this book a painstakingly constructed analysis of what they take to be a core condition of moral responsibility: the notion of guidance control. The volume usefully collects in one place ideas and arguments the authors have previously published in singly or jointly authored works on this and related topics, as well as various refinements to those views and some suggestive discussions that aim to show how their account of guidance control might fit into (...) a more comprehensive account of moral responsibility. (shrink)

This article reviews scientific advances in the prevention and treatment of substance-use disorder and related developments in public policy. In the past two decades, research has increasingly supported the view that addiction is a disease of the brain. Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned, perhaps because the aberrant, impulsive, and compulsive (...) behaviors that are characteristic of addiction have not been clearly tied to neurobiology. Here we review recent advances in the neurobiology of addiction to clarify the link between addiction and brain function and to broaden the understanding of addiction as a brain disease. (shrink)

ABSTRACT We frequently accuse heavy drinkers and drug users of self‐deception if they refuse to admit that they are addicted. However, given the ways in which we usually conceptualize it, acknowledging addiction merely involves swapping one form of self‐deception for another. We ask addicts to see themselves as in the grip of an irresistible desire, and to accept that addiction is an essentially physiological process. To the extent this is so, we, as much as the addicts, suffer from self‐deception, and (...) the responsibility for their state is in part ours. Conversely, since addicts are compelled to accept a self‐deceptive image of themselves, they are at least partially excused from blame for their self‐deception. (shrink)

It is both common and natural to think of addiction as a kind of defect of the will. Addicts, we tend to suppose, are subject to impulses or cravings that are peculiarly unresponsive to their evaluative reflection about what there is reason for them to do. As a result of this unresponsiveness, we further suppose, addicts are typically impaired in their ability to act in accordance with their own deliberative conclusions. My question in this paper is whether we can make (...) adequate sense of this conception of addiction as a volitional defect. In particular, I want to focus on some philosophical assumptions, from the theory of action, that bear directly on the very idea that addiction might impair the agent’s volitional capacities. Understanding this idea, I shall argue, requires that we start out with an adequate conception of the human will. Only if we appreciate the kinds of volitional capacities characteristic of normal agents can we conceptualize properly the impairment of those capacities represented by addiction, and assess the implications of such impairment for questions of responsibility. (shrink)

Addictive behavior threatens not just the addict's happiness and health but also the welfare and well-being of others. It represents a loss of self-control and a variety of other cognitive impairments and behavioral deficits. An addict may say, "I couldn't help myself." But questions arise: are we responsible for our addictions? And what responsibilities do others have to help us? This volume offers a range of perspectives on addiction and responsibility and how the two are bound together. Distinguished contributors -- (...) from theorists to clinicians, from neuroscientists and psychologists to philosophers and legal scholars -- discuss these questions in essays using a variety of conceptual and investigative tools. Some contributors offer models of addiction-related phenomena, including theories of incentive sensitization, ego-depletion, and pathological affect; others address such traditional philosophical questions as free will and agency, mind-body, and other minds. Two essays, written by scholars who were themselves addicts, attempt to integrate first-person phenomenological accounts with the third-person perspective of the sciences. Contributors distinguish among moral responsibility, legal responsibility, and the ethical responsibility of clinicians and researchers. Taken together, the essays offer a forceful argument that we cannot fully understand addiction if we do not also understand responsibility. (shrink)

This book brings cutting edge neuroscience and psychology into dialogue with philosophical reflection to illuminate the loss of control experienced by addicts, and thereby cast light on ordinary agency and the way in which it sometimes goes wrong.

There is a remedy available for many of our ailments: Psychopharmacology promises to alleviate unsatisfying memory, bad moods, and low self-esteem. Bioethicists have long discussed the ethical implications of enhancement interventions. However, they have not considered relevant evidence from psychology and economics. The growth in autonomy in many areas of life is publicized as progress for the individual. However, the broadening of areas at one’s disposal together with the increasing individualization of value systems leads to situations in which the range (...) of options asks too much of the individual. I scrutinize whether increased self-determination and unbound possibilities are really in a person’s best interests. Evidence from psychology and economics challenges the assumption that unlimited autonomy is best in all cases. The responsibility for autonomous self-formation that comes with possibilities provided by neuro-enhancement developments can be a burden. To guarantee quality of life I suggest a balance of beneficence, support, and respect for autonomy. (shrink)

Addiction is almost universally held to be characterized by a loss of control over drug-seeking and consuming behavior. But the actions of addicts, even of those who seem to want to abstain from drugs, seem to be guided by reasons. In this paper, I argue that we can explain this fact, consistent with continuing to maintain that addiction involves a loss of control, by understanding addiction as involving an oscillation between conflicting judgments. I argue that the dysfunction of the mesolimbic (...) dopamine system that typifies addictions causes the generation of a mismatch between the top-down model of the world that reflects the judgment that the addict ought to refrain from drugs, and bottom-up input caused by cues predictive of drug availability. This constitutes a powerful pressure toward revising the judgment and thereby attenuating the prediction error. But the new model is not stable, and shifts under the pressure of bottom-up inputs in different contexts; hence the oscillation of all-things-considered judgment. Evidence from social psychology is adduced, to suggest that a similar process may be involved in ordinary cases of weakness of will. (shrink)

What is the role and value of pleasure in addiction? Foddy and Savulescu have claimed that substance use is just pleasure-oriented behavior. They describe addiction as "strong appetites toward pleasure" and argue that addicts suffer in significant part because of strong social and moral disapproval of lives dominated by pleasure seeking. But such lives, they claim, can be autonomous and rational. The view they offer is largely in line with the choice model and opposed to a disease model of addiction. (...) Foddy and Savulescu are sceptical of self-reports that emphasize the ill effects of addiction such as loss of family and possessions, or that claim an absence of pleasure after tolerance sets in. Such reports they think are shaped by social stigma which makes available a limited set of socially approved addiction narratives. We will not question the claim that a life devoted to pleasure can be autonomously chosen. Nor do we question the claim that the social stigma attached to the use of certain drugs increases the harm suffered by the user. However our interviews with addicts reveal a genuinely ambivalent and complex relationship between addiction, value, and pleasure. Our subjects did not shy away from discussing pleasure and its role in use. But though they usually valued the pleasurable properties of substances, and this played that did not mean that they valued an addictive life. Our interviews distinguished changing attitudes towards drug related pleasures across the course of substance use, including diminishing pleasure from use over time and increasing resentment at the effects of substance use on other valued activities. In this paper we consider the implications of what drug users say about pleasure and value over the course of addiction for models of addiction. Well don't get me wrong, I love using mate. If I could use successfully I would. I'd still be using. I love using. I just don't like the shit that comes with it. (shrink)