A person suffering a mental illness or disorder may differ dramatically from his or her previous well self. Family and close friends who knew the person before the onset of illness tend to regard the illness as obscuring their loved one's true self and see the goal of treatment as the restoration of that self. ‘He is not really like this,’ they will say with increasing desperation. Treatment teams and others, who have no acquaintance with the person when well, respond (...) to what they see in front of them and do sometimes make harmful judgments of character based on the person's presentation when ill. (shrink)

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a “necessary” prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of “drug instrumentalization.” Psychoactive drugs are consumed for their effects on mental states. Humans are able to learn (...) that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific “instrumentalization goals” and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future. (shrink)

I offer an account of how ideals motivate us. My account suggests that although emulating an ideal is often rational, it can lead us to do irrational things. * This is the third in a series of four papers on narrative self-conceptions and their role in moral motivation. In the first paper, “The Self as Narrator” (to appear in Autonomy and the Challenges to Liberalism: New Essays, ed. Joel Anderson and John Christman), I explore the motivational role of narrative self-conceptions, (...) drawing on Daniel Dennett’s notion of the self as a “center of narrative gravity”. In the second paper, “Willing the Law” (in Practical Conflicts, ed. Monika Betzler and Peter Baumann [Cambridge: Cambridge University Press, forthcoming]), I explore the role of selfconceptions in Kantian “conflicts in the will”, drawing on Christine Korsgaard’s notion of “practical identities”. In a fourth paper, “A Sense of Self” (ms), I explore the role of narrative self-con-ceptions in Kantian “conflicts in conception”, drawing on the work of Thomas Nagel and John Perry on the self. (shrink)

There is an ongoing debate about loss of control in addiction: Some theorists say at least some addicts’ drug-directed desires are irresistible, while others insist that pursuing drugs is a choice. The debate is long-standing and has essentially reached a stalemate. This essay suggests a way forward. I propose an alternative model of loss of control in addiction, one based not on irresistibility, but rather fallibility. According to the model, on every occasion of use, self-control processes exhibit a low, but (...) non-zero, rate of failure due to error. When these processes confront highly recurrent drug-directed desires, the cumulative probability of a self-control lapse steadily grows. The model shows why the following statement—which has an air of paradox—can in fact be true: Each drug-directed desire the addict faces is fully resistible, but the addict nonetheless has significantly diminished control over eventually giving in. (shrink)

I argue that addiction is not a chronic, relapsing, neurobiological disease characterized by compulsive use of drugs or alcohol. Large-scale national survey data demonstrate that rates of substance dependence peak in adolescence and early adulthood and then decline steeply; addicts tend to “mature out” in their late twenties or early thirties. The exceptions are addicts who suffer from additional psychiatric disorders. I hypothesize that this difference in patterns of use and relapse between the general and psychiatric populations can be explained (...) by the purpose served by drugs and alcohol for patients. Drugs and alcohol alleviate the severe psychological distress typically experienced by patients with comorbid psychiatric disorders and associated problems. On this hypothesis, consumption is a chosen means to ends that are rational to desire: Use is not compulsive. The upshot of this explanation is that the orthodox view of addiction as a chronic, relapsing neurobiological disease is misguided. I delineate five folk psychological factors that together explain addiction as purposive action: strong and habitual desire; willpower; motivation; functional role; and decision and resolve. I conclude by drawing lessons for research and effective treatment. (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)

When philosophers want an example of a person who lacks the ability to do otherwise, they turn to psychopathology. Addicts, agoraphobics, kleptomaniacs, neurotics, obsessives, and even psychopathic serial murderers, are all purportedly subject to irresistible desires that compel the person to act: no alternative possibility is supposed to exist. I argue that this conception of psychopathology is false and offer an empirically and clinically informed understanding of disorders of agency which preserves the ability to do otherwise. First, I appeal to (...) standard clinical treatment for disorders of agency and argue that it undermines this conception of psychopathology. Second, I offer a detailed discussion of addiction, where our knowledge of the neurobiological mechanisms underpinning the disorder is relatively advanced. I argue that neurobiology notwithstanding, addiction is not a form of compulsion and I explain how addiction can impair behavioural control without extinguishing it. Third, I step back from addiction, and briefly sketch what the philosophical landscape more generally looks like without psychopathological compulsion: we lose our standard purported real-world example of psychologically determined action. I conclude by reflecting on the centrality of choice and free will to our concept of action, and their potency within clinical treatment for disorders of agency. (shrink)

I argue that denial plays a central but insufficiently recognized role in addiction. The puzzle inherent in addiction is why drug use persists despite negative consequences. The orthodox conception of addiction resolves this puzzle by appeal to compulsion; but there is increasing evidence that addicts are not compelled to use but retain choice and control over their consumption in many circumstances. Denial offers an alternative explanation: there is no puzzle as to why drug use persists despite negative consequences if these (...) consequences are not straightforwardly known. I describe the nature of the causal knowledge that one's drug use is causing negative consequences; map the conceptual landscape of denial and explain how it can block such knowledge; and explore some of the processes and mechanisms that have been studied by philosophy and the cognitive sciences and which may underpin denial in addiction, including well-established information-processing biases, motivational influences on belief formation and self-deception, and cognitive deficits with respect to insight and self-awareness. I conclude by suggesting that addiction is as much a disorder of cognition as a disorder of conation. (shrink)

Generic generalizations such as ‘mosquitoes carry the West Nile virus’ or ‘sharks attack bathers’ are often accepted by speakers despite the fact that very few members of the kinds in question have the predicated property. Previous work suggests that such low-prevalence generalizations may be accepted when the properties in question are dangerous, harmful, or appalling. This paper argues that the study of such generic generalizations sheds light on a particular class of prejudiced social beliefs, and points to new ways in (...) which those beliefs might be undermined and combatted. (shrink)

Five experiments provide evidence for a class of ‘dual character concepts.’ Dual character concepts characterize their members in terms of both (a) a set of concrete features and (b) the abstract values that these features serve to realize. As such, these concepts provide two bases for evaluating category members and two different criteria for category membership. Experiment 1 provides support for the notion that dual character concepts have two bases for evaluation. Experiments 2-4 explore the claim that dual character concepts (...) have two different criteria for category membership. The results show that when an object possesses the appropriate concrete features, but does not fulfill the appropriate abstract value, it is judged to be a category member in one sense but not in another. Finally, Experiment 5 uses the theory developed here to construct artificial dual character concepts and examines whether participants react to these artificial concepts in the same way as naturally occurring dual character concepts. The present studies serve to define the nature of dual character concepts and distinguish them from other types of concepts (e.g., natural kind concepts), which share some, but not all of the properties of dual character concepts. More broadly, these phenomena suggest a normative dimension in everyday conceptual representation. (shrink)

Chapter 51 focuses on the subjective side of alcoholism, specifically about what memoirs of alcoholism teach about alcoholism, and argue that a common theme in many memoirs is that drinking, sometimes heavy drinking, a prerequisite of addiction, was modelled, endorsed, and eventually achieved in a way that involves deep identification, and also argues that alcoholic memoirs, even assuming that they suffer from objectivity problems such as the latter, nonetheless serve an important function, and not just whatever cathartic function they serve (...) for the author. (shrink)

We aim to find a middle path between disease models of addiction, and those that treat addictive choices as choices like any other. We develop an account of the disease element by focussing on the idea that dopamine works primarily to lay down dispositional intrinsic desires. Addictive substances artifically boost the dopamine signal, and thereby lay down intrinsic desires for the substances that persist through withdrawal, and in the face of beliefs that they are worthless. The result is cravings that (...) are largely outside the control of the addict. But this does not mean that addicts are bound to act on such cravings, since they typically retain their faculty of self-control. The issue is one of difficulty not impossibility. Controlling an addictive craving is exceedingly demanding. (shrink)

Why do some addicted people chronically fail in their goal to recover, while others succeed? On one established view, recovery depends, in part, on efforts of intentional planning agency. This seems right, however, firsthand accounts of addiction suggest that the agent’s self-narrative also has an influence. This paper presents arguments for the view that self-narratives have independent, self-fulfilling momentum that can support or undermine self-governance. The self-narrative structures of addicted persons can entrench addiction and alienate the agent from practically feasible (...) recovery plans. Strategic re-narration can redirect narrative momentum and therefore support recovery in ways that intentional planning alone cannot. (shrink)

Popular and neurobiological accounts of addiction tend to treat it as a form of compulsion. This contrasts with personality disorder, where most problematic behaviours are treated as voluntary. But high levels of co-morbidity, overlapping diagnostic traits, and the effectiveness of a range of comparable clinical interventions for addiction and personality disorder suggest that this difference in treatment is unjustified. Drawing on this range of clinical interventions, we argue that addiction is not a form of compulsion. Rather, the misuse of drugs (...) and alcohol is like many of the problematic behaviours associated with personality disorder: it is typically a way of coping with psychological distress. We suggest that a satisfying explanation of why many addicts struggle to control their use can be given without departing from concepts employed in our basic folk psychological understanding of agency. In particular, we appeal to five rough-and-ready folk psychological factors to explain addiction: (i) strength of desire and habit; (ii) willpower; (iii) motivation; (iv) functional role; and (v) decision and resolve. (shrink)