If I claimed that Owen Flanagan’s What Is It Like to Be an Addict? was the best book ever written about addiction, I’d be obliged to enter various caveats.
I have not read all books about addiction (though I hesitate to admit that to TLS readers). Some of the unread are probably very bad, but some of them might, for all I know, be quite good. Also, “good” can mean various things in this regard. The best book about addiction might be an alcohol-orientated novel by one of our many great alcoholic writers. Perhaps “best” here would pick out the most vivid or moving memoir: a book that might, for example, help non-addicts understand the experience of addiction from the inside. (There are many plausible candidates here.) Maybe the best book would be the one that has helped the most people into and through recovery, perhaps the “Big Book” of Alcoholics Anonymous. Or the one that most responsibly and compellingly assembles research on the nature of and treatments for addiction at the time of publication.
Flanagan’s book assays all these projects in a compact space. He describes his addiction to alcohol and “benzos” (primarily Klonopin), and recovery, quickly, but in harrowing and inspiring detail. He has known and knows many addicts and recovering addicts, and has lost many friends and family members to addiction. The first-person aspect lends Flanagan’s discussion a special sort of authority, but he deploys others as well. He engages usefully with addiction narratives in literature and film. He has a comprehensive grasp on and makes reasonable assessments of the scientific literature. What Is It Like to Be an Addict? cannot be considered a self-help book, but I must say that it deepened my commitment to my recovery and understanding of my own condition. For I, like Flanagan, both pursued and recovered from addictions during my career as an academic philosopher.
Flanagan’s status as an eminent ethicist and philosopher of mind (emeritus now at Duke University), and the author of significant works such as The Geography of Morals (2017) is extremely useful here. For, even before the empirical research can be productively pursued, basic conceptual work must be accomplished. What, exactly, is addiction? And are the actions of a person in addiction unfree or compelled? To what extent or on what occasions is an addict responsible for her addiction or for the actions she takes in addiction? I hope you’ll pardon my disciplinary chauvinism when I remark that these are demonstrably not projects we should leave to psychologists or sociologists or neurologists. Elucidating the basic conceptual terrain is an urgent philosophical, but also practical, task.
It is a task that philosophers have conspicuously neglected, even though addiction shows up all the time as a puzzle within discussions of free will, for example. The only full-length philosophical monograph I have read on the matter is Herbert Fingarette’s Heavy Drinking: The myth of alcohol as a disease (1988). Flanagan pays his respects to Fingarette, a fascinating and underappreciated intellectual figure (the author, for example, of the classic Confucius: The secular as sacred, 1972), but his own account is quite a bit more thoughtful. He’s not out to shatter myths (much less the “disease” model at the heart of Alcoholics Anonymous, which he says repeatedly “saved my life”), but to reconsider carefully the meaning of “disease” and the implications of any particular understanding for recovery.
In setting out his own positions in the first chapter, Flanagan makes useful and pointed remarks such as:
There have been heated arguments about whether addiction is a disease, disorder, or dysfunction … No one, however, can say at this time with any precision what disease, disorder, or dysfunction addiction across substance addictions is, or even what disease, disorder, or dysfunction any single addiction (e.g. heroin addiction or alcoholism) is.
Flanagan’s position, which he gives compelling reasons to accept, is that “totalizing explanations are false” and that addiction is not adequately characterized exclusively as a neurological condition or a matter of “social dislocation”, for example. Addiction, Flanagan says, in part reflecting the “integrated” research programme pursued by the philosopher and clinician Hanna Pickard and others, is “a set of psychosocial behavioral disorders”. To account for it, he argues, many approaches are needed simultaneously, from first-person phenomenology to systematic psychology, from brain imaging to structural sociology to philosophical ethics and spiritual understandings of the human.
He allows the task of explaining addiction to lead him to a number of useful philosophical techniques and conclusions, including “subjective realism” (the position that “mental states” are real objects of some sort, though “entirely subjective”), and a concomitant “expanded natural method” for co-ordinating the subjective and objective. These have been developed elsewhere in Flanagan’s writings and are put to work here to develop an approach that is at once sharp and reasonable.
It would be satisfying to have an explanation of addiction in terms of a single dimension, possibly curable by pill or a simple behavioural or social change. But one can be addicted to many activities and substances, and at many degrees of intensity, with many results. The simple explanations are satisfying. They are also false, and hence no basis for comprehensive approaches to treatment or recovery. The claims that all addicts are “self- medicating”, or that addiction is simply a disorder of the dopamine system, for example, are not sustained by the current research, and were never terribly plausible.
Despite wide engagement with scientific results, Flanagan turns decisively to the first-person accounts of addicts when it comes to the question of whether the actions of addicts are compelled and whether addicts are morally responsible, perhaps the most traditional philosophical questions raised by addiction. If the simple brain-disease or “allergy” model (shattered by Fingarette) were accurate, it would seem wrong to hold addicts responsible for their actions in addiction. But, as Flanagan points out, addicts in recovery often demand to take responsibility for their actions, even deep in addiction. And recovery, in twelve-step programmes or outside them, often demands making amends to people who have been harmed by one’s addiction – or, rather, by oneself in one’s addiction.
In one of his more directly polemical moments, Flanagan writes:
Integrated, ecumenical, interdisciplinary reflection on addiction replaces narrow, proprietary, disciplinary chest-puffing claims about what kind of disorder addiction is – a social disorder, a psychological disorder, a brain disorder. And it rejects superficial ethical theory that judges that addicts are not responsible. Addicts don’t think that [my emphasis], and no treatment regimen on offer acts as if it is so.
“We need to think”, he continues, “about how, given what we know about addiction, we should adjust our attitudes of shame, guilt, resentment, retribution, forgiveness, patience and so on. Eliminating them is not prudent, it is not warranted ethically, and it is not respectful to how most addicts self-describe.”
Flanagan navigates carefully through the fraught questions of whether addicts are free and whether they are responsible. He is a traditional enough thinker to affirm that if addicts were entirely driven or determined by factors beyond our control, we would not be responsible. But many factors of many addicts’ lives are under their control to various extents, including whether they do things that might allow them to stop. An addict might voluntarily enter rehab, for example, which might reduce his or her involuntary addictive behaviour. So Flanagan takes addicts’ reduced freedom seriously, but also describes how moral responsibility can persist in and through addiction. This, as he says, is something many addicts will insist on.
I suppose I would like to consider more radical approaches to these matters, or more radical philosophical conclusions deriving from addiction. I think we might begin by trying to tease apart the notions of freedom and responsibility. No one should deny that addicts undergo, to various degrees from slight to total, a loss of freedom. I think this is something that recovering addicts will testify to no less surely than they will demand responsibility for their actions. In addiction, we might say, freedom and responsibility are radically discorrelated. And we might experiment with the conclusion that moral responsibility simply does not require free will. Many other phenomena suggest that this is plausible: for example, when we hold entities such as “social media” or “capitalism” responsible for various ills.
At any rate, Owen Flanagan is an adventurous intellectual, the sort of thinker who would draw conclusions like that if he thought they could be sustained by data or experience. But he’s too reasonable to fire off gigantic speculative revisions of all of ethics before the basic conceptual work of clarification can reasonably be accomplished. He’s gone very far here to make that happen.
Crispin Sartwell is a Senior Fellow at the American Institute for Philosophical and Cultural Thought. His most recent book is Beauty: A quick immersion, 2022
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