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)

The misuse of alcohol inflicts a major toll on individual users, their families, and the wider society. This includes disruptions of family life, violence, absenteeism and problems in the workplace, child neglect and abuse, and excess morbidity and mortality. The World Health Organization estimates that alcohol ranks eighth among global risk factors for death and is the third leading global risk factor for disease and disability. In the United States, alcohol dependence affects four to five percent (...) of the population at any given time. Alcohol dependence also exacts a significant financial toll.... (shrink)

Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association's (...) recent attempt to improve policy on alcohol in the UK by introducing strategies which have been shown to control drinking within populations still gives insufficient attention to alcohol dependence. This is because it fails accurately and consistently to characterize alcohol dependence and gives insufficient attention to the social challenges it presents. (shrink)

The psychopharmacology of alcohol dependence is today poised at interesting crossroads. Three major drugs Naltrexone, Disulfiram and Acamprosate have been tried and tested in various trials and have many meta-analyses each to support them. While Naltrexone may reduce craving, Acamprosate scores on cost effectiveness worldwide with Disulfiram being an alcohol deterrent drug. Studies support, refute and criticize the use of each of these drugs. Combining one or more of them is also a trend seen. The most important (...) factor in efficacy has been the combination of psychosocial treatment with medication. Studies from the early 1970s to date have been reviewed and the findings presented in a manner useful for the busy clinician to judge the best pharmacological option in the management of alcohol dependence. The role of depot disulfiram, naltrexone, and medications like Topiramate and SSRIs under research for alcohol dependence, are also addressed. (shrink)

The mental illness of substance dependence or addiction is responsible for major economic, social, and personal costs. If we are to elucidate its etiology, understand its mechanisms, and eventually bring it under control, scientific investigation is essential. Research in animals and humans has enhanced our understanding of this disease through examination of genetic, neurophysiological, biochemical, and behavioral factors. But because animals cannot verbalize their subjective responses to drugs and because significant symptoms of addiction cannot be observed in (...) non-drug-dependent humans, it is not surprising that certain investigations of substance dependence have required the participation of addicted or substance-dependent humans. (shrink)

Traditionally the doping debate has been dominated by those who want to see doping forbidden (the prohibitionist view) and those who want to see it permitted (the ban abolitionist view). In this article, the authors analyse a third position starting from the assertion that doping use is a symptom of the paradigm of highly competitive elite sports, in the same way as addictions reflect current social paradigms in wider society. Based upon a conceptual distinction between occasional use, habitual use and (...) addiction, and focusing on the physical and/or mental dependency caused by the addictive use of a certain drug, we argue that marihuana, stimulants and anabolic steroid abuse—the most frequently detected substances in doping tests—satisfies at least one, often both, of these conditions. A conclusion to be drawn from the authors' arguments is that the prohibitionist view is inappropriate for dealing with doping, as the severe sanctions attached to it will cut the doper off her/his social and professional environment, thereby risking reinforcing her/his addictive conduct. But the ban abolitionist view seems inappropriate as well. At first sight, it seems neither rational nor humane not to intervene when confronted with conduct which is highly harmful for the individual and upon which she has reduced or no control whatsoever. Instead the authors' proposal will be to contextualise dopers' conduct within sport healthcare and see it strictly in relation to each athlete's personal background. Developing preventive programmes—implemented through person-tailored counselling and eventually treatment, rather than severe sanctions or the mere lifting of the ban—seems to be a more reasonable, and probably more efficient, way of conducting ‘the war against doping’. (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)

Addiction is compulsive need for and use of a habit-forming substance. It is accepted as a mental illness in the diagnostic nomenclature and results in substantial health, social and economic problems. In the diagnostic nomenclature, addiction was originally included in the personality disorders along with other behaviours considered deviant. But it is now considered a clinical syndrome. Addiction is multifactorially determined, with substantial genetic influence. The development of addictions is also influenced by environmental factors, and an interplay (...) between the two. In the clinical context, addiction puts problem substance use on the agenda, and helps focus on the difficulties associated with drug use. But the concept of addiction is also used to distance the user from addicts, and in this way, may be counter-therapeutic. The addiction concept has also had a substantial influence on policy. The almost universal prohibition against drugs such as opiates, cocaine, cannabis and amphetamine has much support. But unfortunately, it has not been able to hinder the development of substance use problems. Optimism is fostered by the development of respectful ways of thinking about people with addictions, in particular, from advocates of motivational interviewing. (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)

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)

Neuroscience has substantially advanced the understanding of how changes in brain biochemistry contribute to mechanisms of tolerance and physical dependence via exposure to addictive drugs. Many scientists and mental health advocates scaffold this emerging knowledge by adding the imprimatur of disease, arguing that conceptualizing addiction as a brain disease will reduce stigma amongst the folk. Promoting a brain disease concept is grounded in beneficent and utilitarian thinking: the language makes room for individuals living with addiction to receive (...) the same level of compassion and access to healthcare services as individuals living with other medical diseases, and promotes enlightened social and legal policies. However such claims may yield unintended consequences by fostering discrimination commonly associated with pathology. Specifically, the language of neuroscience used to describe addiction may reduce attitudes such as blame and responsibility while inadvertently identifying addicted persons as neurobiological others. In this paper, we examine the merits and limitations of adopting the language of neuroscience to describe addiction. We argue that the reframing of addiction in the language of neuroscience provides benefits such as the creation of empowered biosocial communities, but also creates a new set of risks, as descriptive neuroscience concepts are inseparable from historical attitudes and intuitions towards addiction and addicted persons. In particular, placing emphasis on the diseased brain may foster unintended harm by paradoxically increasing social distance towards the vulnerable group the term is intended to benefit. (shrink)

The psychopharmacology of alcohol dependence is today poised at interesting crossroads. Three major drugs Naltrexone, Disulfiram and Acamprosate have been tried and tested in various trials and have many meta-analyses each to support them. While Naltrexone may reduce craving, Acamprosate scores on cost effectiveness worldwide with Disulfiram being an alcohol deterrent drug. Studies support, refute and criticize the use of each of these drugs. Combining one or more of them is also a trend seen. The most important (...) factor in efficacy has been the combination of psychosocial treatment with medication. Studies from the early 1970s to date have been reviewed and the findings presented in a manner useful for the busy clinician to judge the best pharmacological option in the management of alcohol dependence. The role of depot disulfiram, naltrexone, and medications like Topiramate and SSRIs under research for alcohol dependence, are also addressed. (shrink)

Pickard (2012) claims that the neurobiological or disease model of addiction hinders the recovery of people because it undermines their feeling of self-efficacy and agency. Sub- stance users are “not aided by being treated as victims of a neurobiological disease, as opposed to agents of their own recovery” (40).Although Pickard acknowledges that claims of powerlessness or loss of agency can have a functional role in the self-narratives of substance users in excusing them from blame, she primarily focuses on the (...) negative effects of the diseasemodel on the recovery of substance users. Preliminary evidence from in-depth interviews with heroin-dependent participants in our current cohort study on addiction and moral identity supports Pickard’s claims in part: Substance users describe grades of control, psychological distress, and loss of options, and an ambivalent attitude toward their belief in self-efficacy. However the interviews also provide points of critique. While Pickard is right to dismiss the more extreme claims of proponents of the disease model—namely, that drug use in addicts is literally compelled—user responses suggest that an understanding of the neurobiology of addiction might in some respects support rather than undermine a sense of agency. Moreover, there is reason to suppose that the relation be- tween substance use and psychological distress is not as straightforward as Pickard claims. In this respect we believe the debate must become more nuanced and move beyond a simple opposition between the disease model and the rational choice model endorsed by Pickard. (shrink)

Over the years, many theories have been proposed to account for the aberrant behavior of drug dependent individuals. Heyman posits that the existing theories of drug dependence are inadequate to explain the complex processes inherent in human drug-taking. He proposes that incongruous behaviors that comprise addiction, such as continued drug use in spite of adverse consequences, can be explained by application of the matching law approach. While the matching law theory of addiction explains certain aspects of human (...) behavior, its application to the area of addiction must be subjected to experimental verification. (shrink)

ABSTRACT Clinicians, researchers and the informed public have come to view addiction as a brain disease. However, in nature even extreme events often reflect normal processes, for instance the principles of plate tectonics explain earthquakes as well as the gradual changes in the face of the earth. In the same way, excessive drug use is predicted by general principles of choice. One of the implications of this result is that drugs do not turn addicts into compulsive drug users; they (...) retain the capacity to say ?no?. In support of the logical implications of the choice theory approach to addiction, research reveals that most addicts quit using drugs by about age 30, that most quit without professional help, that the correlates of quitting are the correlates of decision making, and, according to the most recent epidemiological evidence, the probability of quitting remains constant over time and independent of the onset of dependence. This last result implies that, after an initial period of heavy drug use, remission is independent of any further exposure to drugs. In short, there is much empirical support for the claim that addiction emerges as a function of the rules of everyday choice. (shrink)

L’ouverture en juin 2010 des paris sportifs, hippiques et de poker en ligne constituait une véritable révolution culturelle auprès des joueurs et des professionnels du secteur. Il s’agissait essentiellement d’encadrer et de réguler en France les jeux d’argent et de hasard sur Internet, notamment par la création de l’Arjel , lutter contre les sites illégaux basés à l’étranger et protéger les joueurs du risque de dépendance. De très fortes retombées financières étaient également attendues par l’État. Au-delà de ces attentes économiques, (...) pas toujours tenues, un an et demi plus tard, le gouvernement semble hésiter sur sa politique de gestion de la cyberdépendance. D’un côté, en légalisant les jeux d’argent en ligne, l’État français incite implicitement les joueurs-parieurs à se connecter et à miser sur Internet massivement. Dans le même temps, les responsables politiques créent des organismes de sensibilisation face au danger que représente la dépendance informatique, fortement relayée par des médias, volontiers alarmistes. Ce paradoxe communicationnel s’inscrit alors dans l’analyse d’un double discours fortement controversé, incitant et diabolisant simultanément auprès des joueurs la pratique des jeux d’argent en ligne.The launch of online poker and betting on sports and horse-racing in June 2010 was a real cultural revolution for punters and professionals in the gambling sector. The aim was essentially to control and regulate online betting and gambling, especially with the introduction of ARJEL , to take action against illegal sites based abroad and to protect gamblers from the risk of addiction. The State also anticipated very substantial tax revenues. But over and above these financial expectations, not all of which had been realised a year and a half later, the government seems to be hesitating on its policy for managing cyber-addiction. On the one hand, by legalising online gambling, the French State is implicitly encouraging gamblers to log on and place bets on a massive scale. But at the same time, the authorities are setting up agencies to raise awareness on the dangers of Internet addiction, to a chorus of often alarmist media attention. This communicational paradox is therefore directly relevant to the analysis of a dual and highly controversial discourse that encourages online gambling while simultaneously demonising the practice. (shrink)

This article introduces the Bishri Hafi Effect, a distinctive psycho-spiritual phenomenon that appears to hinder the recovery journey of individuals struggling with alcohol and substance addiction. This effect is characterized by the belief held by addicts that their recovery is contingent upon an external (supernatural) force, rather than their own agency, thereby creating a significant hurdle in their path to overcoming addiction. The phenomenon emerged as a byproduct of a larger study involving 10 individuals undergoing treatment for (...) alcohol and substance addiction at various Green Crescent (Yeşilay) Consultancy Center branches in Istanbul between 2019 and 2021. Employing phenomenological analysis, this effect was identified and examined within the broader context of the study. During spiritual counseling sessions that incorporates Islamic tradition, it became apparent that some individuals, when presented with the recovery story of Bishri Hafi—a key figure in Islamic tradition symbolizing alcohol addiction—tended to idealize his narrative, often to the point of overlooking their own personal progress. The story of Bishri Hafi triggered an outlook wherein recovery was anticipated as a miraculous event. This article aims to introduce and shed light on this unique phenomenon, highlighting its unexpected impact within the realm of spirituality in addiction treatment. (shrink)

Alcohol addiction can lead to health and social problems. It can also affect people's emotions. Emotion plays a key role in human communications. It is important to recognize the people's emotions at the court and infer the association between the people's emotions and the alcohol addiction. However, it is challenging to recognize people's emotions efficiently in the courtroom. Furthermore, to the best of our knowledge, no existing work is about the association between alcohol addiction (...) and people's emotions at court. In this paper, we propose a deep learning framework for predicting people's emotions based on sound perception, named ResCNN-SER. The proposed model combines several neural network-based components to extract the features of the speech signals and predict the emotions. The evaluation shows that the proposed model performs better than existing methods. By applying ResCNN-SER for emotion recognition based on people's voices at court, we infer the association between alcohol addiction and the defendant's emotion at court. Based on the sound source data from 54 trial records, we found that the defendants with alcohol addiction tend to get angry or fearful more easily at court comparing with defendants without alcohol addiction. (shrink)

Social media companies commonly design their platforms in a way that renders them addictive. Some governments have declared internet addiction a major public health concern, and the World Health Organization has characterized excessive internet use as a growing problem. Our article shows why scholars, policy makers, and the managers of social media companies should treat social media addiction as a serious moral problem. While the benefits of social media are not negligible, we argue that social media addiction (...) raises unique ethical concerns not raised by other, more familiar addictive products, such as alcohol and cigarettes. In particular, we argue that addicting users to social media is impermissible because it unjustifiably harms users in a way that is both demeaning and objectionably exploitative. Importantly, the attention-economy business model of social media companies strongly incentivizes them to perpetrate this wrongdoing. (shrink)

Variation in addiction suggests that a good definition will be précising: it should serve a purpose. The authors canvass the various purposes served by a definition of addiction in psychiatric, social, legal, economic, interpersonal and scientific contexts. They argue that addiction is a strong and habitual want that significantly reduces control and leads to significant harm. What counts as significant varies relative to purpose and context. The authors offer a basic account of the nature of control and (...) how and why it can be reduced. The chapter explores the nature of harm and why it is part of the definition. And it concludes by suggesting that progress in understanding addiction depends on bearing in mind the various purposes and contexts of enquiry, together with the common-sense but often neglected point that both control and harm come in degrees. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Can't Say "No" to That!(A "Difficult Patient" Story)Ingrid BergAs a sequela of COVID-19, my rural Wisconsin hospital has been jam-packed for months with patients for whom we routinely provide care and many for whom we do not. An exodus of health care workers and other constraints have made the transfer of critically ill patients very difficult. In this disquieting "new-normal" of our work life, we routinely must call (...) bigger cities throughout our state to find beds for complex patients.So, it was not surprising when a young patient, an IV drug user in sepsis from a heart infection, was admitted to me in the middle of the night. In less disheartening times, before the pandemic, this patient would have been transferred promptly to the big-city hospital. Now, though, the possibility of finding an open bed is next to impossible. Resigned, I placed admission orders, continued antibiotics and fluids, and crossed my fingers. Then the unexpected happened: a bed opened up, and we could send her at once!The patient had a harsh heart murmur. It was likely that a "vegetation" was clinging to the valve, between the right upper and lower chambers of her heart. A vegetation is a clump of debris, such as platelets, clotting proteins, and bacteria that is a menace to the body. Her chest imaging looked like her infection had already spread to her lungs.A definitive diagnosis for endocarditis requires a special ultrasound with a probe that goes down through the esophagus, a procedure performed by cardiologists. It's a serious infection, one that requires weeks of IV antibiotics and is best monitored by infectious disease specialists. Sometimes, cardiothoracic surgeons are called upon to strip away the infection at the site, depending on how badly the valve has been slayed or the size of the vegetation. My only recommendation for a young, otherwise healthy patient in this scenario, is transfer.All of these reasons for transfer were lolling around in my tired head when the night-time [End Page 14] nursing supervisor approached me and said, "We have a problem." When the patient was updated about the transfer, she balked: "She says she is tired and refusing to go," the supervisor began. "She doesn't feel like getting into an ambulance in the middle of the night and she doesn't care if her condition is life-threatening. She knows we can't force her to go and she will only talk about it again in the morning."The cartoon version of myself at that moment had bugged-out eyes, a dropped jaw, fists tight and clenched at my sides, and steam coming out of my head. I can look past a patient's self-neglect, poor medication adherence, abysmal communication, alcohol and drug addiction, and other crimes. But saying no to a bed at a tertiary care facility? Unacceptable!I marched down the quiet hallway and into her room. She was lying on her side, facing the door, one IV in a thin arm. I was confident I could reason with her once I explained the scarcity of beds and the medical necessity of transfer. But she was having none of it. I was calm until I could no longer maintain my cool: "You can't give up this bed!""Maybe in the morning," she insisted, yawning. "But not now. I am tired and want to rest!""But there might not be a bed in the morning," I countered. "And your infection can be life-threatening." (This is true, but we both knew she wasn't dying at this very moment.)"I am not going anywhere!" She raised her voice and then closed her eyes.And she was right. I had no choice but to keep her. I could not kick her out of the hospital because she was making a poor choice, and I was frustrated for having to manage the fallout of that decision. Giving her antibiotics and fluid boluses to bolster her blood pressure was certainly within my scope of practice. And fretting. Fretting is always within my scope of practice; not that my scope of practice matters when all the big... (shrink)

ABSTRACT I examine the impact of addiction on autonomy in terms of the standard literature on addiction – referred to also as ‘substance dependence.’1 Then in terms of the criteria for substance dependence, by developing a set of practical strategies to help people with addictions think more clearly, I test the idea whether addicts can be helped to become more autonomous. Given that unsuccessful attempts to quit constitute part of the criteria of substance dependence, I (...) look at what goes wrong when people try to quit using a substance. The subjective experience of addiction is an important aid in understanding addiction and first person accounts and literary characterisations of addiction provide insight into the addict's mind and assist us in deciding whether addicts can be helped to become more autonomous. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Surrender Versus Control:How Best Not to DrinkMark D. Rego (bio)Keywordsaddiction, Alcoholics Anonymous, will, St. AugustineI recall as a teenager noticing that some people modified nouns in, what sounded to me, a peculiar way. A friend's mother who was taking an automotive repair course said, " We're going to learn to fix the brakes next week." The same folks would also use the possessive for common nouns in phrases like: (...) "I'll be ready after I take my shower." Although not incorrect, I believe this type of usage reflected a different attitude about brakes, showers, and other things. These tended to be more hands-on people and thus, in my understanding at least, had a more particular relationship with things in their world than others for whom objects were examples of types of things.This brief vignette serves as an introduction to my qualified enthusiasm for the project taken up by Allison Mitchell in her paper, "Taking Mentality Seriously: A Philosophical Inquiry into the Language of Addiction and Recovery" (Mitchell, 2006). Indeed, as a practicing psychiatrist I would be hard pressed not to endorse the use of language as a key to deeper aspects of experience.My following remarks are mostly contra Mitchell's hypothesis, but before beginning I name one more reason I think this project is worthwhile. In spite of much research and recitations of the motto "treatment works," we do not presently have a reliable treatment for addiction. The linguistic portrait painted by Mitchell allows us to view our treatments in vivo and reflect upon what we see. (For the purpose of this commentary, I consider alcoholism and Alcoholics Anonymous [AA] as a general example of addiction and treatment.)Medication treatment remains almost inconsequential except when applied for comorbid psychiatric disorders rather than the primary addiction. Even then it rarely serves to undo some form of self-medication, but instead only offers an important leg up in battling the addiction.Research and much experience has shown AA to be the single best treatment for alcoholism (Vaillant and Hiller-Sturmhofel 1996). Some investigators have proposed underlying mechanisms for its efficacy (some, like "creating dependency" run very counter to Mitchell) (Vaillant 2005). AA's success is highly dependent upon attendance (McCrady et al. 2004), which can of course be a marker for getting better in the first place and not solely a cause of improvement (i.e., people who are doing better attend more meetings not vice- versa). Even within AA, the dropout rate is quite high (Martin et al. 1996). Workers in this area [End Page 223] have raised questions about AA's approach and have proposed other avenues to sobriety, including interpersonal, cognitive–behavioral, and relapse prevention programs (Witkiewitz and Marlatt 2005, 2004; O'Dwyer 2006). Lamentably, some very large studies failed to show any effective ability to match up alcoholics with a particular treatment modality (Church 2004; Read 2004).Given the lack of clarity with which we still work, I think an approach like Mitchell's is a welcome call for serious reflection. The limitations of a linguistic analysis place an unfortunate constriction on implications to be drawn.Mitchell's chief concern is that the language of recovery, as reflected in twelve-step programs, betrays and even fosters a degree of passivity, which leaves the addict without an adequate sense of agency and autonomy with which to combat addiction. From a more philosophical perspective, Mitchell believes this is due to an incomplete philosophical materialism; one that lacks "mentality" (i.e., the sense that part of our physical being is made up of mental activities such as emotions, motivations, beliefs, etc.). This attitude is manifest in a "pretheoretic conception of the self" that leaves the addict with a dearth of self-awareness as a mental agent of action and change.In place of the standard recovery model in use today, Mitchell suggests cultivating a sense of self that values and fosters engaged agency that is both capable of self-control and responsive to external obligations.A Few ConcernsFirst, I will offer a few concerns about premises at work within the paper. Then, I outline an attempt to make sense of the... (shrink)

Mortality rates for middle-aged whites in the U.S. are rising due to drugs, alcohol, and depression. Unique to our country, these “deaths of despair” disproportionately occur among the under-educated, who are at particular risk for dying young. At one time, less-educated persons aspired to work in the same factory as their parents, at union wages, with benefits. Those jobs, and the sense of community and prosperity and security they allowed, are evaporating. Many former workers suffer from chronic pain, which (...) underlies America's ongoing opioid overdose epidemic. The pain is not only physical. It is psychic, spiritual, and economic. (shrink)

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)

Decision-making is a complex activity for which emotions and affects are essential. Maladaptive choices depend on negative affects. Vulnerabilities to drug or non-drug objects depend on previous psychopathological comorbidities. Premorbid individual characteristics allow us to understand why some individuals enter into the addiction cycle. Moreover, plasticity of reward neurocircuitry is, at least in past, responsible for these vulnerabilities leading to compulsive drug use.

Objective: We aimed to analyze the characteristics and psychological mechanism of depressive symptoms in elderly patients with alcohol dependence under the COVID-19 epidemic and to observe the effect of acupuncture combined with emotional therapy of Chinese medicine treatment on depressive symptoms in elderly patients with alcohol dependence.Methods: Sixty patients were randomly divided into two groups. One group was treated by a set of emotional therapy of Chinese medicine treatment for 12 weeks. One group was treated by (...) a set of acupuncture combined with emotional therapy of Chinese medicine treatment for 12 weeks. We compared the curative effect between the control group and the treatment group, the mean alcohol consumption, the SF-36 scores before and after treatment, and the scores of Hamilton Depression Scale before and after treatment of 3, 6, and 9 weeks.Results: Based on the cognitive behavior model, the characteristics and psychological mechanism of depression in elderly patients with alcohol dependence under the COVID-19 epidemic situation were summarized. The total effective rate of the control group was 60%, and that of the treatment group was 100%. After 12 weeks of treatment, there were significant differences in PF, RF, physical pain, general health status, energy, and mental health between the treatment group and the control group. Before and after treatment, there were significant differences in PF, RF, physical pain, general health, energy, emotional function, and mental health of the treatment group. The PF, energy, and mental health of the control group were significantly different before and after treatment. There was no significant difference between the treatment group and the control group in the scores of Hamilton Depression Scale before treatment. There was significant difference between the treatment group and the control group in the scores of Hamilton Depression Scale at 3, 6, and 9 weeks after treatment.Conclusion: Attention, cognition, emotion, behavior, and physical response reinforce each other, creating a vicious cycle that reinforces and sustains the depressive symptoms of elderly alcohol dependence under the COVID-19 epidemic, and acupuncture combined with emotional therapy of Chinese medicine treatment for improving the depressive symptoms of elderly alcohol dependence during the epidemic period of COVID-19 has a brilliant therapeutic effect. (shrink)

The concept of addiction is historically and culturally specific, becoming a common way of understanding experience first in early nineteenth-century America, This paper considers the relation to the concept of elements in current professional definitions of addiction (as dependence). Addiction concepts have become a commonplace in storytelling, offering a secular equivalent for possession as an explanation of how a good person can behave badly, and as an inner demon over which a hero can triumph.

Les mondes virtuels sont issus des MMORPG, Massively Multiplayer Online Role-Playing Games qui sont eux-mêmes issus du monde du jeu vidéo. À ce titre, il existe une filiation « ludique » entre ces différents dispositifs. Les travaux de Steinkuehler suggèrent que les mécanismes de l’apprentissage générés par les jeux issus des mondes virtuels dépendent « certes de la nature du jeu mais aussi des pratiques sociales qu’ils engendrent ». Dans cette continuité, nous avons démontré dans nos travaux que ces environnements (...) immersifs permettaient de créer du lien social et donnaient lieu à des formes de rites numériques entre sphère privée et publique. Dans cet article nous nous intéressons aux controverses des environnements immer- sifs en questionnant la place du corps virtuel au sein de ces dispositifs qui pourraient se situer selon nous, entre lieux de spectacle, de loisir et d’apprentissage médiatisé. Le cas des serious games sera évoqué à titre d’illustration.Virtual worlds started with the MMORPG who emerged from the video gaming world, thus indicating their play-related origins. Steinkuehler’s work suggests that the learning mechanisms triggered by games in the virtual world depend “on the nature of the game obviously, but also on the social practices they give rise to”. Continuing this line of study, our work shows that these immersive environments actually forge social ties and generate digital rites of various kinds between the public and private spheres. In this article, we explore the controversies around immersive environments through an investigation of the virtual body within these systems, which we believe function as venues partly for entertainment, partly for leisure and partly as mediated learning spaces. The case of “serious games” is discussed here as an illustration. (shrink)

ABSTRACT The list of proposed addictions has recently grown to include television, videogames, shopping, day trading, kleptomania, and use of the Internet. These activities share with a more established entry, gambling, the property that they require no delivery of a biological stimulus that might be thought to unlock a hardwired brain process. I propose a framework for analyzing that class of incentives that do not depend on the prediction of physically privileged environmental events: people have a great capacity to coin (...) endogenous reward; we learn to cultivate it, and, where it is entrapping, to minimize it, by managing internally generated appetites for it. The basic method of cultivating endogenous reward is to learn cues that predict when best to harvest the reward that has been made possible by the growth of these appetites. This hedonic management occurs in the same motivational marketplace as the instrumental planning that seeks environmental goods in the conventional manner, and presumably obeys the same laws of temporal difference learning; but these laws are no longer limiting. Furthermore, instrumental contingencies often provide the most productive structure for hedonic management as well, for reasons that I discuss; but the needs of hedonic management create incentives both to pursue instrumental goals in a suboptimal manner and to avoid noticing how the hedonic incentive affects this pursuit. The result is the apparent irrationality that is often observed in process addictions. (shrink)

Heyman's target article contributes to our understanding of addictions by offering solutions to several paradoxes and by recognizing the stable nature of addictive behavior. Previous classical and operant conditioning models have emphasized molecular processes, such as acquisition and extinction, and have failed to address the aggregate effects of long-term exposure to the contingencies of drug and alcohol use.

In lieu of an abstract, here is a brief excerpt of the content:The Truth Will Set You Free, or How a Troubled Philosophical Theory May Help to Understand How People Talk About Their AddictionPatricia A. Ross (bio)Keywordsveridicality of narrative, contingency of theories, belief-behavior, causal connectionConsider the following proposition: If one were to recognize the unsatisfactory implications of maintaining a certain theoretical position, one would thereby be motivated to accept a more adequate theory, which would alter one's beliefs and, in turn, (...) alter the behaviors that are based upon those beliefs. Faith in this proposition is what motivates many of us to teach. But, alas...Allison Mitchell's argument for rethinking addiction intervention—in particular, rethinking twelve-step programs—is premised on this proposition. According to her argument, addicts function with an impoverished sense of self that is reflective of a grossly simplified form of philosophical materialism. By recognizing the limitations of this philosophically unconvincing view, and by, in effect, accepting a better, more complete materialism, addicts can come to modify their self-conception. This modification is instrumental to recovery.A careful consideration of the chain of events being proposed, and the problems with it, is helpful for understanding the limitations of her argument. There are four points that I consider in turn: (1) considering narratives can tell us something about the self-conception of addicts, (2) philosophical materialism can help us to understand and explain something about an addict's self-conception and how it is inadequate, (3) this sense of self is distinct from nonusers and the way in which it is distinct helps to understand the problem of addiction, and (4) a change in self-conception with respect to materialism helps recovery and, thus, our best intervention is one based on having addicts accept a full materialist theory of the self and not a pretheoretic one. [End Page 227]With respect to the first point, it should be noted that Mitchell's overall argument does not depend on whether or not it is true that narratives of addiction tell us something veridical about the self-conception of addicts. Such narratives may simply provide us with a potential theory—a possible worlds scenario—of how addicts conceive of themselves. Mitchell points this out herself. The narratives and the interpretation that she provides of these narrative, "are meant only to highlight a certain pattern of self-expression and conception that may in fact be common in persons who use mind-altering substances; the readings do not establish any empirical matters of fact or philosophical truths, nor do they prove any conclusions about how such persons (must) express themselves or conceive their nature" (Mitchell 2006, 214).Thus, what the argument is actually concerned with are the theoretical claims about the self-conception of addicts that are garnered from these narratives. Nevertheless, because the narratives provide the starting point for Mitchell's argument, it is worth thinking carefully about the epistemic status of this body of literature. In particular, could a consideration of such literature lead us astray in our endeavors to understand how addicts might misconceive of themselves and, if so, in what way? What sort of epistemic status does this information hold?Mitchell is motivated by Wittgensteinian analyses of the relationship between thought and language. The particular idea that she employs from Wittgenstein is that every act of self-expression, whether it is verbal or written narrative, reveals something about the conceptual framework with which the author is working. Thus, one can learn about the author of a narrative—one can acquire a sense of how that individual conceives of him- or herself—by looking at the language that is employed to talk about and describe him- or herself.Mitchell enumerates some problems with this approach. She mentions that the author may fail to make his or her intended sense clear to readers; that the reader's narrative expectations determine the interpretation given to the narrative; that literary narrative may be less direct, less ordinary than everyday uses of language; and that interpreting such narrative via philosophical framework may ascribe to people positions that are more precise and sophisticated than they actually intend (p. 213).Aside from these quite serious problems, it is necessary to recognize... (shrink)

Research suggests that reducing rates of drug addiction requires a range of physical spaces where drug users and counselors can meet, build community, and work together. The efficacy of this ‘social infrastructure,’ however, depends not just on how its shared spaces facilitate access to social networks, but on how institutional rules and norms govern the social interaction that takes place in those spaces. I suggest that institutional norms nurture sobriety to the extent that the social arrangements they foster are (...) (i) discretionary, since individuals trying to re-establish sobriety have heterogeneous social preferences; (ii) unconditional, since individuals’ efforts to re-achieve sobriety frequently involve setbacks; and (iii) low-pressure, since individuals may find extraneous turmoil damaging to their renascent sobriety. To the extent that institutional norms facilitate contrary social arrangements, shared settings are liable to backfire—to undermine or at least fail to nurture sobriety—which I illustrate using the case of sobriety-oriented organizations in the Boston area. Critically, while the first two aspects are governed largely by intra-organizational norms, the third is governed by norms between multiple sobriety-oriented organizations. Upholding healthful local norms, then, demands commitment at both the organization and system levels. (shrink)

When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of the (...) data, and how the data is presented to the scientific and wider societal community. Highly stigmatized research subjects, like substance‐dependent parents, are especially at risk of encountering indirect harm, because the prejudice against them is so persistent. In this paper we discuss two forms of indirect harm. First, researchers have to be aware how their results will be preceived by society. Even when subjects are presented in an objective way, further, out of porportion stigmatization can occur. Researchers sometimes try to counteract this by whitewashing their results, at the risk of downplaying their respondents’ problems. The second risk researchers face is that their own normative judgements influence how they question such parents, report results and interpret statements. Researchers’ own normative judgements may influence the way they present their subjects. This article reviews a broad range of research that exhibits such indirect harms, discussing how and why indirect harms occur and formulating corresponding recommendations on how to prevent them. (shrink)

ObjectiveTo investigate the effects of cell phone dependence on mental health among undergraduates during the COVID-19 pandemic and further identify the determinants that may affect their mental health in China.MethodsThe data were collected from 602 students at a medical school in Shanghai via an online survey conducted from December 2021 to February 2022. The Mobile Phone Addiction Index and Depression Anxiety Stress Scale were applied to evaluate CPD and mental health, respectively. Independent sample t-test and one-way analysis of (...) variance were employed to compare the means of continuous variables among categorical groups. Correlations between continuous variables were detected using Pearson's correlation analysis. Univariable and multivariable logistic regressions were employed to identify the determinants of mental health.ResultsAmong the 402 eligible students, 73.88% were women with an average age of 20.19 ± 2.36 years. On average, the DASS score was 32.20 ± 11.07, the CPD score was 36.23 ± 11.89, and the cell phone use duration was 7.67 ± 3.61 h/day. CPD was found to have a negative effect on mental health among college students in Shanghai. Additionally, cell phone use duration, age, being senior students, faculty-student relationship, insomnia, tobacco use, obesity, and life satisfaction were clarified as contributing factors to mental health among college students.ConclusionHigh degree of CPD could have a negative effect on college students' mental health, which might lead to some psychological problems. Appropriate actions and effective interventions are highly needed to prevent severe psychological injuries among college students in China. (shrink)

One can find from a survey of the work of three prominent philosophers of technology in the late twentieth century, a very different kind of metaphor for describing the powerful, but not fully determinative influence that technology has on our lives. These three theories each centre on a concept I call "technological dependency." The most prominent exponents of technological dependency are Marshall McLuhan, Herbert Marcuse and Jacques Ellul. Although there are similarities between their descriptions of the phenomenon of dependency, their (...) discussions of this phenomenon are focused around very different sub-metaphors for describing the nature of the dependency. McLuhan portrays our relationship with technology as capable of becoming a form of addiction or habit, Marcuse portrays it as a form of bribery, and Jacques Ellul portrays it as a form of religious cultism. (shrink)

The definitive book on ethics for chemical dependency treatment professionals.

Alcohol use disorder is a burden to society creating social and health problems. Detection of AUD and its effects on the brain are difficult to assess. This problem is enhanced by the comorbid use of other substances such as nicotine that has been present in previous studies. Recent machine learning algorithms have raised the attention of researchers as a useful tool in studying and detecting AUD. This work uses AUD and controls samples free of any other substance use to (...) assess the performance of a set of commonly used machine learning classifiers detecting AUD from resting state functional network connectivity derived from independent component analysis. The cohort used included 51 alcohol dependent subjects and 51 control subjects. Despite alcohol, none of the 102 subjects reported use of nicotine, cannabis or any other dependence or habit formation substance. Classification features consisted of whole brain rsFNC estimates undergoing a feature selection process using a random forest approach. Features were then fed to 10 different machine learning classifiers to be evaluated based on their classification performance. A neural network classifier showed the highest performance with an area under the curve of 0.79. Other good performers with similar AUC scores were logistic regression, nearest neighbor, and support vector machine classifiers. The worst results were obtained with Gaussian process and quadratic discriminant analysis. The feature selection outcome pointed to functional connections between visual, sensorimotor, executive control, reward, and salience networks as the most relevant for classification. We conclude that AUD can be identified using machine learning classifiers in the absence of nicotine comorbidity. (shrink)

From a gender-historical perspective, this article deals with the history of and discussions around an observed increase in female alcoholism. Since the 1950s, psychiatric, pedagogical and psychological discourses have lamented the increasing consumption of alcohol by women, and identified women’s emancipation as its cause. The article examines the male-dominated debates on female alcoholism up to 1968 and the emerging feminist counter-movement that followed. It analyzes the shifts in the social role of women as expressed in the discussions about ‘the (...) drinking woman’ as well as simultaneous scientific-patriarchal counter-movements. On the one hand, the article shows how a classic concept of addiction is eroding due to the failure of medical treatment attempts and is being replaced by new psychosocial explanatory knowledge. On the other hand, it illustrates how women’s self-help is appropriating and reinterpreting this knowledge. (shrink)

The validity of an argument depends on the soundness of its premises. In the recent paper by Steele et al., conclusions are based on the initial construction of definitions relating to ‘desire’ and...

ArgumentWe examine the criteria used to validate the use of nonhuman organisms in North-American alcohol addiction research from the 1950s to the present day. We argue that this field, where the similarities between behaviors in humans and non-humans are particularly difficult to assess, has addressed questions of model validity by transforming the situatedness of non-human organisms into an experimental tool. We demonstrate that model validity does not hinge on the standardization of one type of organism in isolation, as (...) often the case with genetic model organisms. Rather, organisms are viewed as necessarily situated: they cannot be understood as a model for human behavior in isolation from their environmental conditions. Hence the environment itself is standardized as part of the modeling process; and model validity is assessed with reference to the environmental conditions under which organisms are studied. (shrink)

Scholars usually distinguish between testimonial and hermeneutical epistemic injustice in healthcare. The former arises from negative stereotyping and stigmatization, while the latter occurs when the hermeneutical resources of the dominant community are inadequate for articulating the experience of one’s illness. However, the heuristics provided by these two types of epistemic predicaments tend to overlook salient forms of epistemic injustice. In this paper, we prove this argument on the example of the temporality of patients with drug dependence. We identify three (...) temporal dimensions of epistemic injustice affecting drug-dependent patients: the temporal features of their cognitive processes, their individual temporal experience, and the mismatch of social temporality. Notably, the last aspect, which highlights the disparity between the availability of care and its accessibility, does not fit neatly into the categories of testimonial or hermeneutical injustice. (We should note that the International Network of People Who Use Drugs (INPUD) and The Asian Network of People who use Drugs (ANPUD) consider the term “drug addiction” to be associated with disempowerment and negative stereotyping. Instead, they suggest the expression “drug dependence” (INPUD 2020). However, the concept of “drug addiction” is still being used in the current public health, philosophy, and sociology debates that concern the specific field of addiction studies. Replacing the notion of drug addiction with “drug dependence” would not eliminate existing epistemic injustices or allow us to avoid creating new ones, such as those related to ignoring pain claims (O’Brien 2011). Still, for the sake of clarity we will use the notion “drug dependence” when speaking of people while retaining the term “drug addiction” for labelling healthcare practices and the topic for philosophy of healthcare.). (shrink)

A conceptual analysis of basic notions of addictiology, i.e., Euphoria, Ecstasy, Inebriation, Abuse, Dependence, and Addiction was presented. Three different forms of dependence were distinguished: purely psychic, psycho-physiological, and purely somatic dependence. Two kinds of addiction were differentiated, i.e. appetitive and deprivative addiction. The conceptual requirements of addiction were discussed. Keeping these in mind some ethical problems of drug therapy and psychotherapy were explained. Criteria for the assessment of therapeutic approaches are suggested: effectiveness, (...) side effects, economic, ethic, and esthetic valuation. (shrink)

As earlier research on Korsakoff syndrome (KS), a frequent neurological complication of alcohol-dependence (AD), mainly focused on cognition, affective impairments have been little investigated despite their crucial impact in AD. This article proposes new research avenues on this topic by combining two theoretical frameworks: (a) dual-process models, positing that addictions are due to an imbalance between underactivated reflective system and overactivated affective-automatic one; (b) continuity theory, postulating a gradual worsening of cognitive impairments from AD to KS. We suggest (...) that this joint perspective may renew the current knowledge by clarifying the affective-automatic deficits in KS and their interactions with reflective impairments, but also by offering a direct exploration of the continuity between AD and KS regarding reflective and affective-automatic abilities. (shrink)

Attentional bias has been suggested to contribute to the persistence of substance use behavior. However, the empirical evidence for its proposed role in addiction is inconsistent. This might be due to the inability of commonly used measures to differentiate between attentional engagement and attentional disengagement. Attesting to the importance of differentiating between both components of AB, a recent study using the odd-one-out task showed that substance use was differentially related to engagement and disengagement bias. However, the AB measures derived (...) from the OOOT showed insufficient reliability to be used as a solid measure of individual differences. Therefore, the current study aimed to improve the reliability of the AB measures derived from the OOOT by using more distinct contrast stimuli, adding practice trials, increasing the number of trials, and by having participants perform the task in an alcohol-relevant context. We contrasted the original OOOT with the adapted OOOT and assessed AB in low- and high-drinking individuals. Participants were 245 undergraduate students who typically tend to drink either low or high amounts of alcohol. In one condition, AB was measured with the original OOOT in a typical laboratory context, whereas in the other condition, AB was measured with the OOOT-adapt in a bar context. The OOOT-adapt showed superior internal consistency, especially for the high-drinking group. Further, specifically the OOOT-adapt differentiated between low- and high-drinking participants showing that high drinkers engaged faster with alcohol cues than did low drinkers. Thus, the OOOT-adapt was found to be a promising candidate to reliably index AB in the context of alcohol use. The OOOT-adapt further showed superior criterion validity as it could differentiate between low- and high-drinking individuals, thereby adding to the evidence that AB might be involved in substance use behavior. (shrink)