What Would You Do Alone in a Cage with Nothing but Cocaine?: A Philosophy of Addiction

Johns Hopkins philosophy professor Pickard’s scrupulous debut study challenges the dominant “diseased brain” paradigm of drug addiction. According to this model, prolonged drug use flicks a “metaphorical switch” that rewires the brain’s reward circuits and turns drug use into a passive, involuntary action. Such a framework, she writes, flattens addiction’s diverse motivations, manifestations, and consequences, while relieving addicts of agency. In its place, she proposes a more capacious paradigm that sees addiction as individualized, complex (there is no “one-size-fits-all explanation or theory of addiction”), and attempting to answer core psychological needs. For these reasons, addiction interventions should be therapeutic and behavioral rather than solely pharmacological; Pickard’s suggestions include encouraging addicts to take responsibility for their actions without assigning blame, and placing them in supportive group settings. The book’s analytical depth and multidisciplinary approach (it draws on drug users’ memoirs, medical research, and philosophy) are its strengths, and Pickard convincingly shows that while the diseased brain model aimed to destigmatize addiction, it has largely failed to do so while amplifying some addicts’ pessimism about recovery. Addiction researchers and clinicians will be enlightened. (Jan.)