Is addiction a behavioral pattern, or the underlying cause of a behavioral pattern? Both views are found in prominent accounts of addiction, but theorists generally do not notice that they are taking a controversial position, let alone justify it. A third possibility is that addiction consists in both addictive behavior and its causes, though this view is less obviously present in the literature. I argue that two important considerations favor the "cause view" over the "behavior" and "hybrid" (...) views. The first is that we want to be able to explain addictive behavior with reference to addiction. The second is that addiction seems to persist long after addictive behavior has ceased. Only the cause view can easily accommodate both data points. (shrink)

TikTok has one of the most advanced algorithm systems and is the most addictive as compared to other social media platforms. While research on social media addiction is abundant, we know much less about how the TikTok information system environment affects users’ internal states of enjoyment, concentration, and time distortion, which in turn influences their addiction behavior. To fill this gap, this study collects responses from 659 adolescents in China aged between 10 and 19 years old, and the (...) data is then analyzed using Partial Least Square. We find that the system quality has a stronger influence than information quality in determining adolescents’ experience with TikTok and that the flow experience has significant direct and indirect effects on TikTok addiction behavior. Notably, this study finds that TikTok addiction is determined by users’ mental concentration on the medium and its content. Several theoretical insights from the stimulus–organism–response model and the flow theory are used to explain the findings. (shrink)

Social psychologists have been in the forefront of the development of modern theories of cigarette smoking and obesity. These theories are reductionist: they account for behavior in purely physiological terms and regard cognitive, value, personality, and social class factors as secondary or irrelevant. Yet, from their beginnings, these theories have failed to account for major aspects of the behaviors under investigation, aspects apparently related to personal intention and social background. While it may seem suprising that work by social psychologists denies (...) social and psychological reality, the theories discussed here actually reflect broader trends in social psychology, trends with rather large implications for our ideas about individual and social efforts at change. (shrink)

There continues to be a debate on whether addiction is best understood as a brain disease or a moral condition. This debate, which may influence both the stigma attached to addiction and access to treatment, is often motivated by the question of whether and to what extent we can justly hold addicted individuals responsible for their actions. In fact, there is substantial evidence for a disease model, but the disease model per se does not resolve the question of (...) voluntary control. Recent research at the intersection of neuroscience and psychology suggests that addicted individuals have substantial impairments in cognitive control of behavior, but this "loss of control" is not complete or simple. Possible mechanisms and implications are briefly reviewed. (shrink)

There continues to be a debate on whether addiction is best understood as a brain disease or a moral condition. This debate, which may influence both the stigma attached to addiction and access to treatment, is often motivated by the question of whether and to what extent we can justly hold addicted individuals responsible for their actions. In fact, there is substantial evidence for a disease model, but the disease model per se does not resolve the question of (...) voluntary control. Recent research at the intersection of neuroscience and psychology suggests that addicted individuals have substantial impairments in cognitive control of behavior, but this “loss of control” is not complete or simple. Possible mechanisms and implications are briefly reviewed. (shrink)

In this article, I focus on possibly impaired self-determination in addiction. After some methodological reflections, I introduce a phenomenological description of the experience of being self-determined. I argue that being self-determined implies effectivity of agency regarding three different behavioural domains. Such self-referential agency shall be called ‘self-effectivity’ in this article. In a second step, I will use this phenomenological description to understand the impairments of self-determination in addiction. While addiction does not necessarily imply a basic lack (...) of control over one’s life, this can well be the case during certain periods of time or in special situations. Addiction is herein described as an embodied custom—highly effective with respect to changing one’s lived experience—which is learned and developed while becoming addicted. Such a repeatedly performed custom, called a ‘psychotropic technique’, implies deep changes in one’s personal identity and alters an agent’s ‘self-effectivity’. In the closing section, I discuss the possible implications of a phenomenological approach to personal responsibility. (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)

Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behaviour under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in (...) the brain structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behaviour. In this paper we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. -/- . (shrink)

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely (...) shared assumption in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted. -/- . (shrink)

Neil Levy argues that while addicts who believe they are not addicts are self-deceived, addicts who believe they are addicts are just as self-deceived. Such persons accept a false belief that their addictive behaviour involves a loss of control. This paper examines two implications of Levy's discussion: that accurate self-knowledge may be particularly difficult for addicts; and that an addict's self-deceived belief that they cannot control themselves may aid their attempts at self-control. I argue that the self-deceived beliefs of addicts (...) in denial and of self-described addicts differ in kind. Unlike the self-deception of an addict in denial, that of the self-described addict allows them to acknowledge their behaviour. As such, it may aid an addict to develop more self-control. A paradoxical implication is that this self-deception may allow an addict more self-knowledge. (shrink)

“The addict” is a well-known figure in philosophy, but analytical attempts to define “addictive disorder” are rare. According to extant views, the “hallmark” of addiction lies in an individual’s inability or impaired ability to control the behavior the individual is addicted to doing. But how exactly are we to understand the relevant concept of (in)ability (or impaired ability) in the first place? Furthermore, what else is necessary for an individual to have an addictive disorder? I argue for a definition (...) of “addictive disorder” in terms of desire, tolerance and withdrawal, inability, and harm. The main focus of this paper is on the concept of ability. The view I propose integrates insights from the literature on abilities and develops them further as they are relevant to addiction. The resulting view offers a more differentiated perspective on questions about what individuals with an addictive disorder can and cannot do. (shrink)

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to (...) go a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

How should addictive behavior be explained? In terms of neurobiological illness and compulsion, or as a choice made freely, even rationally, in the face of harmful social or psychological circumstances? Some of the disagreement between proponents of the prevailing medical models and choice models in the science of addiction centres on the notion of “loss of control” as a normative characterization of addiction. In this article I examine two of the standard interpretations of loss of control in (...) class='Hi'>addiction, one according to which addicts have lost free will, the other according to which their will is weak. I argue that both interpretations are mistaken and propose therefore an alternative based on a dual-process approach. This alternative neither rules out a capacity in addicts to rationally choose to engage in drug-oriented behavior, nor the possibility that addictive behavior can be compulsive and depend upon harmful changes in their brains caused by the regular use of drugs. (shrink)

Defining brain mechanisms that control and adapt motivated behavior will not only advance addiction treatment. It will help society see that addiction is a disease that erodes free will, rather than representing a free will that asks for or deserves consequences of drug-use choices. This science has important implications for understanding addiction's comorbidity in mental illness and reducing associated public health and criminal justice burdens.

It is often claimed that the autonomy of heroin addicts is compromised when they are choosing between taking their drug of addiction and abstaining. This is the basis of claims that they are incompetent to give consent to be prescribed heroin. We reject these claims on a number of empirical and theoretical grounds. First we argue that addicts are likely to be sober, and thus capable of rational thought, when approaching researchers to participate in research. We reject behavioural (...) evidence purported to establish that addicts lack autonomy. We present an argument that extrinsic forces must be irresistible in order to make a choice non-autonomous. We argue that heroin does not present such an irresistible force. We make a case that drug-oriented desires are strong regular appetitive desires, which do not compromise consent. Finally we argue that an addict’s apparent desire to engage in a harmful act cannot be construed as evidence of irrational or compulsive thought. On these arguments, a sober heroin addict must be considered competent, autonomous and capable of giving consent. More generally, any argument against legalisation of drugs or supporting infringement of the liberty of those desiring to take drugs of addiction must be based on considerations of harm and paternalism, and not on false claims that addicts lack freedom of the will. (shrink)

Based on brain imaging findings, we present a model according to which addiction emerges as an imbalance in the information processing and integration among various brain circuits and functions. The dysfunctions reflect (a) decreased sensitivity of reward circuits, (b) enhanced sensitivity of memory circuits to conditioned expectations to drugs and drug cues, stress reactivity, and (c) negative mood, and a weakened control circuit. Although initial experimentation with a drug of abuse is largely a voluntary behavior, continued drug use can (...) eventually impair neuronal circuits in the brain that are involved in free will, turning drug use into an automatic compulsive behavior. The ability of addictive drugs to co‐opt neurotransmitter signals between neurons (including dopamine, glutamate, and GABA) modifies the function of different neuronal circuits, which begin to falter at different stages of an addiction trajectory. Upon exposure to the drug, drug cues or stress this results in unrestrained hyperactivation of the motivation/drive circuit that results in the compulsive drug intake that characterizes addiction. (shrink)

An issue that affects the academic engagement, performance, health and wellbeing of university undergraduates is bullying. Substantial literature has examined the predictors of bullying perpetration, but there is little research on the contributions of internet-related factors and the propensity to take risks in bullying. We examined the roles of IGD, risk-taking behavior, and internet addiction in social bullying. Four instruments were used for data collection, namely: Young Adult Social Behavior Scale, the Internet Gaming Disorder Scale, Domain-Specific Risk-Taking Scale, and (...) the Internet Addiction Test Scale. Participants were 552 undergraduate students from the University of Nigeria, Nsukka consisting of 143 males and 409 females. Results of regression analysis showed that gaming disorder and risk-taking behavior had positive associations with social bullying. Thus, the more people grow addicted to internet gaming and takes more risks, the more they are likely to become bullies. Internet addiction had no significant association with social bullying. Efforts should be made to minimize the rate of dysfunctional internet use, GD and risk-taking behaviors of undergraduates in order to curtail bullying perpetration. (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)

Chapter 1 Disordered Appetites: Addiction, Compulsion, and Dependence Gary Watson In both popular and technical discussion, addictive behavior is said to be ...

Since the dawn of the internet, pornography has effectively become ubiquitous, pervasive, and increasingly normalised. Study findings show remarkable similarities in how the brain reacts to pornography, and other known addictive substances, and indicate that consuming pornography is comparable to consuming other known addictive substances. Moreover, two of the biggest risk factors for addiction are the substance’s availability and its easy accessibility, particularly in the case of younger persons. To date, pornography addiction has been conceptualised as a (...) class='Hi'>behavioural addiction. However, the body of research data on pornography addiction does not provide conclusive support for behavioural addiction. The aim of this thesis is to put forward the idea that pornography can, and should, be conceptualised as an addictive substance, and, that when pornography is consumed, an addictive substance is consumed. In order to support this claim, there are many factors that must be addressed. I first clarify what pornography entails by exploring how it is conceptualised, what pornography ‘does’, and what it means to be a pornography consumer. Secondly, I examine the conceptualisations of substances, substance consumption and addiction, respectively, as well as the subsequent difference between substance and behavioural addiction. Thirdly, I give an inclusive overview of pornography addiction by not only examining the most recent perspectives of researchers, but also of pornography consumers. I conclude by suggesting how we should go about conceptualising pornography addiction, and then propose how the set of diagnostic criteria for pornography use disorder should be formulated for a future iteration of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. I argue that, given the abundance of academic research on substance addiction, compared to the scarcity of research on behavioural addiction, conceptualising pornography as an addictive substance is more likely to create a sense of urgency for the future research of pornography addiction than would be the case if it is considered a potential behavioural addiction. Furthermore, I argue that the classification of pornography as an addictive substance, and the inclusion of pornography use disorder in a future iteration of the DSM, will raise awareness of the potential adverse effects of pornography consumption and, therefore, the harmful consequences of pornography use disorder. (shrink)

Addiction: A Philosophical Approach CHAPTER ABSTRACTS “Introduction: Dismantling the Catchphrase” by Candice Shelby Shelby dismantles the catchphrase “disease of addiction.” The characterization of addiction as a disease permeates both research and treatment, but that understanding fails to get at the complexity involved in human addiction. Shelby introduces another way of thinking about addiction, one that implies that is properly understood neither as a disease nor merely as a choice, or set of choices. Addiction is (...) a phenomenon emergent from a complex dynamic system that is at once physical, psychological, social, and more. “A Philosophical Analysis of Addiction” by Candice Shelby Shelby brings much-needed clarity to the discourse surrounding the topic of addiction. Arguing that addiction can neither properly be understood as a disease nor as merely a set of choices, Shelby exposes the weaknesses of both approaches. She shows that addicted persons do not exhibit the elements characteristic of compulsion, nor does an account of addiction in terms of weakness of will, or irrational choosing, provide a satisfying explanation. Instead, by replacing traditional substance ontology with process ontology, and accepting the reality of emergent entities, a coherent account of persons, minds, and addiction can be provided. A fundamental philosophical shift is necessary to see that bodies, minds, values, and addictions are all part of the natural world. “Addiction at the Individual Level” by Candice Shelby Shelby discusses the most influential accounts of addiction as it is understood at the purely individual level. From hedonic theories to incentive sensitization, to habit theories of addiction, to behavioral theories and the ego depletion theory, Shelby considers a variety of approaches to understanding addiction in individuals, as framed in both psychological and in neuroscientific terms. She notes some important caveats that should be considered before accepting the research regarding addiction at the individual level, namely that the scanning studies that are so popularly used to characterize addiction in neurobiological terms are ambiguous, and rely on numerous assumptions that may be false, and that certainly mislead. Shelby provides much-needed critique of both disease and choices models as they characterize addiction at the individual level. “Addiction and the Local Environment” by Candice Shelby Shelby argues that human addiction cannot be understood without serious consideration of the individual’s local environment, her home and family. From the gestational environment to interactions with caregivers during post-natal development to the adult environment in which people become addicted, Shelby shows that no one becomes an addict in a vacuum. Stress is a major influence in the environment throughout life, and has serious consequences for addictive vulnerability. Genetic influences as well are important to addictive vulnerability, but genes always express in interaction with their environment. Social acceptance or rejection is another particularly important factor in the local environment with respect to both coming to be addicted and transitioning out of it. “The Relation Between Addiction and Culture” by Candice Shelby Shelby provides a groundbreaking analysis of the relation between addicts and the cultures that breed them. In this cultural critique, Shelby shows that addictions to certain substances have historically been both the solution to the problem of how to grow economies and control people, and a problem for economic productivity and controlling citizens. Not all cultures have even the concept of addiction, while others, such as the contemporary Western world, and the U.S. in particular, seem to foster it. Shelby shows that addiction is both a cultural construct and, from another way of thinking about it, the result of conditions created by particular cultures. Social inequities, alienation, driving capitalism, and in particular the power of pharmaceutical companies, all contribute to the spiraling endemic of addiction. “Addiction and Meaning” by Candice Shelby Shelby provides a unique argument that understanding how meanings work is essential to a complete analysis of addiction. Individuals experiencing addiction and those who care about and for them often utterly fail to communicate. This is because their respective systems of meanings come to be significantly different. Meanings are not, Shelby argues, best understood in the symbolic terms that characterized the theory of language in the 20th century, but are better apprehended as emotion-rich prototypes carved from repeated interaction with the world. Becoming addicted essentially changes one’s entire system of meanings. Requisite to transitioning out of addiction is a Gestalt-type shift in one’s system of meanings. This holistic way of understanding meanings also provides one level of explanation of what happens when an addict relapses. “The Phenomenology of Addiction and its Implications” by Candice Shelby One way of judging theories of addiction is by how well they capture the phenomenal descriptions that addicts give of their own experiences. Shelby considers variations on 5 basic patterns of addictive experience through the eyes of particular individuals who lived through addictive periods, and shows how even the most influential theories of addiction fail to capture all of them. She argues that an important implication of taking the details of individuals’ addictive stories seriously is that addiction must be understood as a personal phenomenon emergent from a particular complex dynamic system. As her theory of addiction would lead one to expect, no two addicts are the same, and no single-focus theory can explain why not. “Possibilities for Transitioning Out of Addiction” by Candice Shelby Shelby provides numerous strategies for transitioning out of addiction. Given that the vast majority of addiction treatment programs currently available are 12-step based and only successful about 5-8% of the time, it is essential that other approaches be undertaken. Shelby canvasses a variety of options for helping addicted individuals to make the transition out of their troubled pattern of thinking and behaving. From direct brain interventions to drugs to trauma therapy to exercise and nutrition to habit reformation to use of narrative and changing one’s social context as ways of redefining the self, Shelby shows that the possibilities for transitioning out of addiction are legion. Perhaps the best approach is to understand addiction treatment in terms of providing physical, psychological, and social tool kits. “Addiction Emerges from a Complex Dynamic System” by Candice Shelby Shelby considers whether there truly exists such a thing as “an addict” or “addictive thinking” in the universal sense. She concludes that within the context of disruptive substance use or repetitive engagement in certain activities, ordinary human cognitive biases and behavior patterns are categorized as addictive. Addiction, she argues, is best understood as an irreducible human reality, emergent from a sufficiently complex dynamic system (an organism with self-awareness, within a particular cultural milieu) that is both shaped by and contributes to the shaping of its environment. Attempts to simplify addiction into one or a few dimensions may create a solvable problem, but by doing so they fail to solve the real one. (shrink)

The author comments on the article “The neurobiology of addiction: Implications for voluntary control of behavior,‘ by S. E. Hyman. Hyman presents that addiction is a brain disease or a moral condition. The authors present that addiction is a strong preference, similar to appetitive preferences. They state that addiction is merely a form of pleasure-seeking. The authors conclude that the problem of addiction is the problem of the management of pleasure, not treatment of a disease. (...) Accession Number: 24077914; Authors: Foddy, Bennett 1; Email Address: [email protected] Savulescu, Julian 2; Affiliations: 1: University of Melbourne, Monash University, Australia; 2: University of Oxford; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: HYMAN, S. E.; Subject: BRAIN -- Diseases; Subject: PLEASURE; Subject: NEUROBIOLOGY; Subject: BEHAVIOR; Number of Pages: 4p. (shrink)

If one believes that the brain is, in some as yet unspecified way, the organ of mind and behaviour, then all human behaviour has a neurobiological basis. Neuroscience research over the past several decades has provided more specific reasons for believing that many addictive phenomena have a neurobiological basis. The major psychoactive drugs of dependence have been shown to act on neurotransmitter systems in the brain (Nutt 1997; Koob 2000); common neurochemical mechanisms underlie many of the rewarding effects of these (...) drugs and the phenomena of tolerance and withdrawal symptoms (Hyman & Malenka 2001; Koob 2000), and there is evidence for a genetic vulnerability to addiction (Nestler 2001; Uhl 1999) that is mediated by genes that regulate the metabolism of psychoactive drugs and the brain neurotransmitter systems on which they act (Uhl 1999). (shrink)

Addicts often are portrayed as agents driven by irresistible desires in the philosophical literature on free will. Although this portrayal is faithful to a popular conception of addiction, that conception has encountered opposition from a variety of quarters (e.g., Bakalar & Grinspoon, 1984; Becker & Murphy, 1988; Peele, 1985 and 1989; Szasz, 1974). My concern here is some theoretical issues surrounding a strategy for self-control of potential use to addicts on the assumption that their pertinent desires fall short of (...) irresistibility. I offer no defense of this assumption; rather, I treat it as a point of departure for one approach to understanding addiction in action. I begin by sketching some conceptual and theoretical background and then turn to a proposal of George Ainslie's (1992) about temptation and self-control and to some reservations that Michael Bratman (1966) has expressed about it. I will argue that in some scenarios typical of addicts, Ainslie's proposal survives Bratman's objections. My guiding question is this: How can behavior exhibiting self-control or its contrary in addicts who are concerned to resist relevant temptations be accommodated in a general theory of human action that features a broad array of so-called "intentional attitudes" as important explanatory items? The attitudes that primarily concern me here are desire, intention, belief, and a species of evaluative judgment. (shrink)

This chapter contains sections titled: References Further reading.

It is common to think of addiction as involving behavior which in some sense is ?out of control.? But does this mean addictive actions occur because of compulsion or because of ordinary weakness of will? Many philosophers argue that addictive actions occur because of weakness of will, since there is plenty of evidence suggesting that they are not caused by irresistible desires. In fact, addicts seem, in general, to perform these actions freely in the sense of having the ability (...) to refrain from doing so. In this paper I argue, first, that it is not the addiction-as-compulsion view that is mistaken, but rather the view that irresistible desires are a defining feature of compulsion. Second, drawing on some results in addiction neuroscience, I construct and defend a new analysis of compulsivity that distinguishes addictive from weak-willed actions in a way that is consistent with the view that addictive actions are performed freely. (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)

Concepts We thank all three commentators for extremely constructive, insightful, and gracious commentaries. We cannot address all their valuable points. In this response, we elucidate and relate the concepts of addiction, disease, disability, autonomy, and well-being. We examine some of the implications of these relationships in the context of the helpful responses made by our commentators. We begin with the definitions of the relevant concepts which we employ: ¥? ? ? Addiction (Liberal Concept): An addiction is a (...) strong appetite. ¥? ? ? Appetites: An appetite is a disposition that generates desires that are urgent, oriented toward some rewarding behavior, periodically recurring, often in predictable circumstances, sated temporarily by their fulfillment, and generally provide pleasure. ¥? ? ? Disease (Naturalistic Concept): A disease is some biological or psychological state that results in subfunctioning of the organism in a given set of environmental and social circumstances, C. The reference class is a natural class of organisms of uniform functional design; specifically, an age group of a sex of a species. A normal function is a part or process within members of the reference class and is a statistically typical contribution by it to their individual survival and reproduction (Boorse 1977, 1997). ¥? ? ? Disability (Welfarist Concept): A disability is a relatively stable biological or psychological state that tends to reduce the amount of well-being that this person will enjoy in a given set of environmental and social circumstances (Savulescu and Kahane 2009; Kahane and Savulescu, 2009). ¥? ? ? Autonomy (Rationalist Concept): A person rationally desires or values some state of affairs if and only if he or she desires that state of affairs while (1) being in possession of all relevant. (shrink)

Addiction is increasingly described as a “chronic and relapsing brain disease”. The potential impact of the brain disease model on the treatment of addiction or addicted individuals’ treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour. Thirty-one Australian addiction (...) neuroscientists and clinicians (10 females and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about “diseased brains” will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons. (shrink)

An important international discussion began because of some pioneer studies carried out by Young (1996a) on the internet addiction disorder (IAD). In the fifth and most recent version of the Diagnostic, and Statistical Manual of Mental Disorders (DSM) there is no mention of this disorder and among researchers there are basically two opposite positions. Those who are in favor of a specific diagnosis and those who are claiming the importance of specific criteria characterizing this behavior and the precise role (...) it has in the patient’s life. The aim of the present paper is to answer the question whether it is possible or not to formulate diagnoses of internet-related disorders. We revised literature on the history of diagnostic criteria, on neurocognitive evidence, on the topic debate and on IAD instrumental measures. We found that the disorder was not univocally defined and that the construct was somehow too broad and generic to be explicative for a diagnosis. Indeed, the models are borrowed from other addiction pathologies and they are often formulated before the development of internet as intended in current society. In conclusion, we think we need a more innovative, integrated and comprehensive model for an IAD diagnosis. (shrink)

ObjectiveIntimate partner violence has been related to emotional dependence and addictive disorders. This study aims to provide a global approach to analyse the relationship between these variables and to determine the factors underlying permanence in violent relationships.MethodsIt is a non-experimental, cross-sectional correlational design study. Participants had to have at least one dating relationship for at least 1 month to complete the questionnaire, which included the following instruments: emotional dependence scale, scale of violence in dating relationships and impulse control disorders scale.ResultsThe (...) sample consisted of 1.533 adolescents, 53.9% were male and 46.1% female, between 14 and 18 years. Emotional dependence correlated significantly with received violence. Compulsive spending is strongly associated with emotional dependence, whereas sex addiction is associated with received violence to a greater extent. Received violence mediates on emotional dependence and addictions.ConclusionIPV is a risk factor for the perpetuation of addictive behaviours. It is advisable to promote affective education for developing resilience and adequate coping. (shrink)

Philosophers and psychologists have been attracted to two differing accounts of addictive motivation. In this paper, we investigate these two accounts and challenge their mutual claim that addictions compromise a person’s self-control. First, we identify some incompatibilities between this claim of reduced self-control and the available evidence from various disciplines. A critical assessment of the evidence weakens the empirical argument for reduced autonomy. Second, we identify sources of unwarranted normative bias in the popular theories of addiction that introduce systematic (...) errors in interpreting the evidence. By eliminating these errors, we are able to generate a minimal, but correct account, of addiction that presumes addicts to be autonomous in their addictive behavior, absent further evidence to the contrary. Finally, we explore some of the implications of this minimal, correct view. (shrink)

Purpose This study aims to explore the association between internet addiction and problem behaviours on social networking sites using the general strain theory. Design/methodology/approach Using the purposive sampling method, a survey was conducted, which collected data from 414 college students studying in two public universities in South Australia. The Delphi method was used to develop the questionnaire used for the survey. Findings 'Results of this research indicated a significant association between internet addiction and problem behaviours on SNS. Respondents (...) who had engaged in problem behaviours on SNS had high internet addiction test scores. On the basis of this finding, the present research argues that the general strains associated with the suffering of newly emerging challenges such as internet addiction might contribute to victimisation and deviant and problem behaviours on SNS in specific and possibly in cyberspace in general. Research limitations/implications Results of the present study need to be interpreted cautiously due to many limitations it has. This research is a cross-sectional study, which might not adequately explain the associations between internet addiction and problem behaviours on SNS. Longitudinal studies involving larger samples might have added significant value to this study. The present study uses purposive sampling technique, which has limited its generalizability, and its findings may not be generalised to large populations. Originality/value Limited information is available pertaining to the association between problem behaviours on SNS and internet addiction. The present study is a pioneering effort, which argues that rapid popularity of SNS is likely to increase internet addiction and the frustration of not getting proper treatment for their internet addiction might lead to deviant behaviours on SNS. (shrink)

Addicts sometimes engage in such spectacularly self-destructive behavior that they seem to act under compulsion. I briefly review the claim that addiction is not compulsive at all. I then consider recent accounts of addiction by Holton and Schroeder, which characterize addiction in terms of abnormally strong motivations. However, this account can only explain the apparent compulsivity of addiction if we assume—contrary to what we know about addicts—that the desires are so strong as to be irresistible. I (...) then consider accounts that invoke the phenomenon of “ego depletion,” according to which a person can resist temptation for a while, but not indefinitely. Implicit in this account is the assumption that addiction-related desires persist long enough to deplete the addict’s willpower. The balance of the paper argues that the persistence of the desire to consume drugs is a significant form of dysfunction in its own right, and that it makes an important and independent contribution to the compulsivity of addiction. I argue that addiction involves dysfunction in a mechanism that normally prevents a person from being tempted to do something that would invite disaster. (shrink)

“A Liberal Account of Addiction‘ is a major contribution to the discussion of addiction, its treatment, and the social and policy issues which arise from it. Questioning as it does many generally accepted assumptions about addictive behavior, particularly the use of hard drugs, it will provoke even those who do not agree with it to rethink their positions. Many of its suggestions are relevant also, in my opinion, to thinking about other areas of psychiatric interest. Nevertheless, I want (...) to argue that its authors have perhaps not freed themselves sufficiently from some common assumptions, in particular about the nature of mental disorder, and that their argument might benefit from such liberation. The central assumption that I have in mind is that understanding human actions is nothing but understanding the brain activity that accompanies them. If so, then a pattern of behavior can count as a ’mental disorder’ in any clinically or legally relevant sense only if it is the result of a brain disease, causing a breakdown in normal brain functioning. Starting from this assumption, the authors seek to show, by means of evidence from neuroscience, that addiction to drugs does not have a unique ’neural substrate,’ distinct from that of any other kind of pleasure-seeking behavior. When we have a pleasurable experience of any kind, as they point out, dopamine is normally released within the brain. This, they say, activates the ’reward’ pathways, making the person more likely to repeat the behavior that gives rise to the pleasurable experience in questionÑwhether it is eating, sex, or injecting heroin. Addiction, they argue, is therefore just a tendency to repeat an intensely pleasurable experience, whatever the nature of that experience might be. The particular chemistry of the substance involved in this particular form of pleasure is, they argue, irrelevantÑall that matters is that the experience it gives someone is pleasant. Addiction, they. (shrink)

There are many ways of interpreting the behaviours related to substance misuse and addiction, which can be sort out as three basic models: biomedical, legal, and social. They are corresponding to approaches built in different epistemic and professional frameworks, such as medicine, law, and social work. Confronted with the experience of addiction, these models appear as pre-determined by a specific scientific or professional ideology; they presuppose a pre-understanding of the phenomena. I directed, therefore, my investigation on those phenomenological (...) paths that might lead to, and circumscribe the experience of addiction and I propose an analytical framework based on three major phenomenological perspectives: descriptive, genetic, and inter-relational. This paper argues in favour of defining addiction without making reference to a form of failure, psycho-somatic or existential. On the contrary, it concludes that there is a need to adopt a definition of addiction which holds at its core the idea of empowering addicted persons, of re-constructing their capacity to take decisions about their own lives. (shrink)

ABSTRACT Choice theorists such as George Ainslie and Gene Heyman argue that the drug-seeking behaviour of addicts is best understood in the same terms that explain everyday choices. Everyday choices, they claim, aim to maximise the reward from available incentives. Continuing drug-use is, therefore, what addicts most want given the incentives they are aware of but they will change their behaviour if and when better incentives become available. This model might explain many typical cases of addiction, but there are (...) hard cases that pose a problem. In these hard cases the addicted individual does not cease using drugs in the face of consequences that are so adverse it is implausible that they are unaware of more rewarding paths of action. These cases force the choice theorist into a dilemma: either these addicts? drug use does not count as action and so is best described by a neurobiological model, or reference to ?reward? in these cases means merely ?motivated? and so provides no explanatory power. We propose a different model of motivation that takes self-conception into account. We show how that can better explain the hard cases of addiction and also inform our understanding of recovery and self-control. (shrink)

The author comments on several articles on addiction. Recent developments in neuroscience suggest that addicted individuals have substantial impairments in the cognitive control of voluntary behavior. The author differs on the observations that addicts either act on desires that are not conducive to rational action. The author also states that addiction seems to be a prime manifestation of akrasia, in which one fails to be motivated to act in accordance with what one judges ought to be done. Accession (...) Number: 24077920; Authors: Viens, A. M. 1; Email Address: [email protected]; Affiliations: 1: University of Oxford, Hertford College, Oxford, United Kingdom; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: COGNITION; Subject: DECISION making; Subject: AKRASIA; Subject: NEUROSCIENCES; Number of Pages: 3p. (shrink)

Research findings on addiction are contradictory. According to biographical records and widely used diagnostic manuals, addicts use drugs compulsively, meaning that drug use is out of control and independent of its aversive consequences. This account is supported by studies that show significant heritabilities for alcoholism and other addictions and by laboratory experiments in which repeated administration of addictive drugs caused changes in neural substrates associated with reward. Epidemiological and experimental data, however, show that the consequences of drug consumption can (...) significantly modify drug intake in addicts. The disease model can account for the compulsive features of addiction, but not occasions in which price and punishment reduced drug consumption in addicts. Conversely, learning models of addiction can account for the influence of price and punishment, but not compulsive drug taking. The occasion for this target article is that recent developments in behavioral choice theory resolve the apparent contradictions in the addiction literature. The basic argument includes the following four statements: First, repeated consumption of an addictive drug decreases its future value and the future value of competing activities. Second, the frequency of an activity is a function of its relative (not absolute) value. This implies that an activity that reduces the values of competing behaviors can increase in frequency even if its own value also declines. Third, a recent experiment (Heyman & Tanz 1995) shows that the effective reinforcement contingencies are relative to a frame of reference, and this frame of reference can change so as to favor optimal or suboptimal choice. Fourth, if the frame of reference is local, reinforcement contingencies will favor excessive drug use, but if the frame of reference is global, the reinforcement contingencies will favor controlled drug use. The transition from a global to a local frame of reference explains relapse and other compulsive features of addiction. (shrink)

The Internet appears to have become an ever-increasing part in many areas of people’s day-to-day lives. One area that deserves further examination surrounds sex addiction and its relationship with excessive Internet usage. It has been alleged by some academics that social pathologies are beginning to surface in cyberspace and have been referred to as “technological addictions.” This article examines the concept of “Internet addiction” in relation to excessive sexual behavior. It contains discussions of the concept of sexual (...) class='Hi'>addiction and whether the whole concept is viable. This is done through the evaluation of the small amount of empirical data available. It is concluded that Internet sex is a new medium of expression that may increase participation because of the perceived anonymity and disinhibition factors. It is also argued that although the amount of empirical data is small, Internet sex addiction exists and that there are many opportunities for future research. These are explicitly outlined. (shrink)

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity (...) is a disease in the same sense as addiction is usually claimed to be a disease—that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction. (shrink)

The predominant narratives of addiction—Disease and Choice narratives—frame addiction as a personal problem to be addressed by controlling an individual’s behavior. By analyzing the epistemic function of narratives of addiction, this paper shows that these narratives construct a story about the nature of addiction by assuming simplistic views about human agency, leading to drug policies that narrowly focus on individual behavior. Assumptions embedded within narratives must be made transparent so that the partial, perspectival, and situated nature (...) of the knowledge that narratives convey is made evident and can be evaluated. As a result of their over-simplistic assumptions about human agency, Disease and Choice narratives neglect a significant factor in addiction: the social context which informs and sets limits on the reasons and values that enter into decision-making. This paper argues for the adoption of Social Constraint narratives, which would require policy agendas to focus on the social contexts that make drug use so appealing. As a result, agencies dealing with drug policy would need to collaborate with other agencies focusing on relevant social issues in order to create structural change, thus affecting the social environment and not merely the individual. (shrink)

The Diagnostic Statistical Manual of the American Psychiatric Association defines substance dependence, more commonly known as “drug addiction,” as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior.” If drug addiction is a matter of compulsion, as this definition suggests, then is it correct to say that a drug addict (...) chooses to take their drug of choice? Similarly, does it make sense to say that a person in the grip of fear really chooses to flee from what frightens them? In this book, Jon Elster argues that in general drug addicts and people subject to powerful emotions should be interpreted as making choices. Although there is a compulsion to choose, there is choice nonetheless. This is different from cases where there is a compulsion to act but no choice. But what kind of choice is this? And are such choices rational or not? These are among the central questions addressed in this book. (shrink)

Older people enter the final phases of their lives with well‐established habits and rituals, some of which might be or become substance abuse. This inquiry focused on the relationship between habits, rituals, and the compulsive addictive behaviours evident in older persons' substance abuse. Habits and rituals, examined as adaptive and limiting functions in older persons, revealed changes in autonomy, social inclusion, and emotional responses to such changes as older persons experience declining energy reserves and physical debilities. Older persons' ebbing sense (...) of control and passionate responses to change illustrate the perennial struggle between the will and emotions when habits and rituals transform to compulsive addictive behaviours. Two concepts, germane to this struggle both in older persons' addictive behaviours and nurses' response, emerged from this inquiry: temperance, a balance between the will's freely chosen actions and passionate desire, and discipline, the means to achieve such balance. The focused attention demanded in discipline can be realized in spiritual exercises and daily care of the soul. Disciplined actions engage the older persons' imaginative capacities to manage and abandon the self in goals consistent with end‐of‐life issues: meaningful fulfillment of human potential and the need for daily joy and pleasure in living the final years. (shrink)