What Do We Mean When We Say “Addiction”?
Texts on addiction often begin with the caveat that there is little agreement within the field of addiction: what it is, what causes it, or what, if anything, should be done about it. This kind of ambivalence is reflected in the fact that addiction remains highly stigmatized even as it has become increasingly ubiquitous. Addicts of various kinds remain victimized and vilified as literal and symbolic representations of the failing “War on Drugs,” the massive pharmaceutical and for-profit healthcare industries, economic and political systems marked by ongoing instability, and a conservative ethos in which addiction is the embodiment of moral failure. On the other hand, life for many of us also feels deeply addictive: compulsive, unmanageable and even destructive. Meaningful action or change often feels hopeless or naive in the face of deep-seated structural injustice. Perpetual, alienated consumption–of media, drugs, food, games, pleasure itself–can become a way to find some semblance of control or momentary security. It can feel as though one of the only things we can control is what we consume, and perhaps even what we’re addicted to.
Addiction is many things to many people: a disease, a disorder, a coping mechanism, a myth, and who exactly qualifies as an “addict” is hotly contested. Billions of dollars are spent researching how and why certain people are becoming increasingly addicted to certain things, especially drugs. While some of this research has helped problematize the notion that addiction is merely a moral failing or conscious choice, it can reinforce a somewhat arbitrary distinction between “Real Addiction” (i.e., drug addiction) and “addiction” (everything else). Some definitions highlight neuroscience, others highlight behavior, but each one is attempting to figure out why so many of us seem compelled to persist in certain behaviors despite negative consequences, and even despite the desire to stop.
One helpful definition for considering addiction and recovery in terms of moral agency under constraint comes from Gabor Maté, a medical doctor who has done extensive work with long-term addicts in Vancouver. He writes, “Addiction is any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life or the lives of others.”1 For Maté, the processes leading up to addiction are as, if not more, important than the particular object or activity of one’s addiction. Maté’s hypothesis is that addiction primarily stems from trauma experienced in the womb, in childhood, and/or early in life. These various traumatic experiences can affect a person’s ongoing capacity to regulate dopamine, serotonin, and endorphins, among other biological mechanisms, all of which play a key role in their ability to make decisions and evaluations, form attachments, imagine the future, and feel emotions like pleasure, love, and desire. All of these processes are further exacerbated by social and political oppression.
For Maté, addiction does not necessarily originate exclusively within the body, nor does it occur arbitrarily apart from a person’s lived history or context. It stems from our attempts to cope with the difficulties of life. Some of us have crushing addictions that take over the entirety of our being, while others of us have more manageable addictions that, while problematic, can be maintained throughout the so-called normal course of life. While there are very serious political, cultural, and biological differences in terms of how different addictions are treated, the phenomenon itself seems to cover a wide territory.
Moral Agency Under Constraint
Addiction and recovery present a compelling case study when discussing moral agency in part because they challenge some of its most fundamental assumptions. Most traditional conceptions of moral agency in Western ethics feel unsatisfactory in light of addiction because they tend to assume that we each equally possess the ability to perform moral actions that result from rational deliberation on principles, ends, and means through the exertion of our will. It is on this basis of conscious, volitional decision-making and acting that we become accountable and are held responsible. This way of thinking about agency does not account for the phenomenon of addiction or the experience of addicts, whose desires and actions become compulsive and ultimately destructive even as they recognize that they remain a moral agent. Their sense of self has become compromised and overtaken by the effects of addiction, with every day becoming more of the same. This often leads to feelings of isolation and an inability to think and act meaningfully about themselves and their future. The fact that each of us may relate to certain aspects of addiction to varying degrees may mean we need to reconceptualize how we understand moral agency in the first place.
Despite the severe difficulties of addiction, many addicts do achieve ongoing recovery, often described as an ability to be oneself again. Less a result of conscious deliberation and decision making, moral agency for many recovering addicts emerges through ongoing daily practices of recovery in communities. It is an experience of finding oneself able to live life as one imagines it should be lived, to think imaginatively about one’s future in light of one’s past, and to form meaningful relationships in which one relies on others as they are also relied upon.
The concept of “moral agency under constraint” thus attempts to acknowledge the ways in which we must all navigate the various forces that shape our lives and constrain meaningful and efficacious moral action. It also highlights the imaginative ways that individuals and communities have enacted and experienced agency in unique ways, specific to their own social and histories and contexts. The individuals in the documentary Dopesick help us see the extreme end of the addiction spectrum and, in doing so, allow us to reconsider our sense of agency along that spectrum.
Addiction as Constraint
“A little pill was controlling me. Like it literally took over my mind and my thoughts.” – Colby, in Dopesick2
Most drug addicts describe the experience of addiction as having their thoughts and actions overtaken by the desire to do drugs. In the film Dopesick, Colby describes losing every meaningful possession and relationship throughout the process of addiction. On the one hand, he understands what was at stake and what was he was losing. He knew it was destructive and unmanageable. On the other hand, he could not fully acknowledge that he was the one performing these actions. It is as though the drug is literally dictating the movements of his body as well as his own deliberation process.
A similar sentiment is conveyed by Rae-Ann, a twenty-three year old in active addiction for five years. She states, “It’s crazy to see how our lives have changed. Five years ago I never would have imagined that I’d be homeless or wearing the same clothes for three or four days at a time. But when you start doing pills you start to not really give a fuck what people think. Because you know that you need that drug…When you’re sick you’ll do anything to get un-sick.” Her boyfriend adds, “It makes you do things that you’d never do. It’s not you. It’s the drug, right?”3
Elevated to a neurochemical need, the short-term feeling of control and normalcy produced by the drug powerfully overrides a sense of self and the feelings associated with agency. This continual process of drug use divides, if not erodes, the self as increasingly drastic actions are taken, compelled by the effects of addiction, to recreate the sense of control initially produced by the drug. The addict does not experience this process as a subject so much as an object of the drug.
“That’s the main thing with heroin, it gives you a feeling of security…you just shut the whole world out. You know, nothin’ else matters, it doesn’t matter about the next day, nothin’ matters except gettin’ your next fix. That’s your main object, your only object at that point in time, the rest doesn’t matter.”4
In her work with recovering addicts, Gerda Reith discovered that many of her participants described the experience of addiction as a loss or stagnation in time. For addicts in active addiction, both the past and future begin to erode as they become trapped in repetitive moments devoted almost exclusively to finding and doing drugs. Indeed, many of the addicts Reith talks to use drugs as a means to stop the impending future altogether. Life’s prospects become so grim that there is a desire to focus solely on the feelings of security produced by the drugs within the present. Life loses any direction.
For addicts who have become stuck in this repeating present, it becomes difficult for any semblance of selfhood and meaning to emerge. What little agency addicts do experience feels futile because there is seemingly nowhere to put it and nothing to compare it to. Reith writes, “When no compelling image of the future exists to draw the individual forwards, death holds little of the existential terror that it has for individuals whose self-image is made up of a vision of themselves as agents engaging in future events.”5 Agency, to the extent that it can be enacted, belongs to a time that no longer exists, if it ever existed in the first place.
I’m definitely not happy with where I’m at in life and I don’t enjoy this whatsoever. Like I might seem happy and whatever; I try to make the best of what it is but it’s killing me and it’s killing my family, I miss my friends, and I miss my normal life. I miss working every day.
– Ryan, in Dopesick6
Toward the end of Dopesick, Ryan has resorted to living in a tent, becoming “really homeless” for the first time. He has been unable to get into a rehab facility due to a long waiting list at one facility, and the requirement of five days of sobriety at another. He has also recently been informed that his best friend has died from an overdose. This is the first death that seems to shake him.
What begins to emerge here is a state of being, involving both body and environment, in which selfhood and agency seem to have worn away. One becomes determined to act in ways they cannot reconcile within themselves, that they do not recognize. Isolated from any real sense of community, and stuck in a repeating, directionless present, any meaningful sense of identity becomes unintelligible as agency becomes abstracted into an unimaginable future.
Recovery as Moral Agency
“The only way to fix [the desire to relapse] is to let it out like you’re doing right now, to talk about it. If you sit there and you keep thinking about it and pondering on it, eventually it’s gonna happen. You gotta share that with other people…” Josh, responding to another addict in recovery in Dopesick7
Recovery from addiction is not merely a decision or an isolated act. Instead, it is an ongoing process that involves reorienting one’s life, or having it reoriented, in a new way. For many addicts, this happens throughout the process of following the Twelve Steps, though for some it occurs through other forms of individual and/or communal therapy.
In Politics of Piety, Saba Mahmood looks at the distinct ways agency emerges and is understood by women in Islamic pietist groups in Egypt. While this may sound wholly unrelated to the topic of addiction, her work allows for ways of conceiving of agency that do not rely on a “substantive” account of the self that enacts agency through an exertion of the will alone. She also cautions against merely conflating agency with liberal conceptions of resistance. This is important when thinking about addiction because the will is described as having been eroded or rendered incapable of overcoming addiction on its own. Merely insisting that one resist the tendency to do drugs, for example, often leads to ego fatigue and relapse.
Mahmood’s focus on the ways the subject and agency emerge in embodied practices is therefore illuminating. She writes, “Any discussion of the issue of transformation must begin with an analysis of the specific practices of subjectivation that make the subjects of a particular social imaginary possible.”8 She goes on to state, “It is the sequence of practices and actions one is engaged in that determines one’s desires and emotions. In other words, action does not issue forth from natural feelings but creates them.”9 The practices and actions in the case of addiction are the repeated use of drugs or other addictive behaviors and their effect on biological mechanisms. This in turn radically shapes the addict’s desires and emotions, which ultimately reinforces addiction. Recovery introduces new “sequences of practices and actions” that re-orient the addict toward recovery.
Whether in a twelve step group or not, recovery is never a simple decision; it involves habituation over time. As Josh goes on to say in the documentary, it means “meetings, new people, new places.”10 Because addiction involves ongoing habits that are reinforced over time at the neurochemical level, recovery also involves forming new habits. What begins to occur throughout this process is a re-emergence of one’s sense of who they are that was lost in addiction.
[When using] I didn’t really have any wild dreams; hope for the future, but the more straight you get the more your imagination returns to what you wanted when you were a child.11
The shock of how bad life had gotten becomes a surprise at how much progress can be made while in recovery. This language of feeling like oneself again, like “when you were a child,” is common within recovery as individuals begin to make a way out of the repetitive present. As neurochemicals stabilize over time, one begins to find pleasure again in new areas of life as the future once again becomes a tangible object of the imagination.
Reith compares this change in perception to “a moment of epiphany in which the addict re-evaluates his or her life and the place of drugs in it, and to the inception of an orientation which, ultimately, does not involve drugs.”12 This moment of epiphany has significance in religious conversion experiences, those lived and written, and functions as an important literary device. It is important to note, however, that these revelatory moments most successfully lead to sustained recovery when combined and supported by other concrete recovery practices over time, such as the Twelve Steps or other therapeutic communities.
I finally felt that I mattered and that was one of the big driving forces to working at the Dream Center…I help take care of the guys and when they’re struggling they come to me and I relate and we talk about it and we go through our problems together…I show up at every grad for every person that I connect with just let them know…that you do matter and it is possible to have people care about you.”13
As ethicist Alasdair MacIntyre argues in Dependent Rational Animals, all mammalian life–from dolphins to humans–begins and ends in radical dependency on others. Recovery, particularly in the Twelve Step model, becomes a means of working toward MacIntyre’s “virtues of acknowledged dependence.” These virtues describe an intentional dependence on others where one is incapable of meeting their own needs and a willingness to help others when you are capable of doing so. Once cultivated, these allow for the emergence of “independent rational agency.” This is not an independence free from others, or a rationality of calculation, but a kind of agency that occurs within communities of giving and receiving.14
In the same way that every addict relies on something or someone outside of their own sense of self–whether it is a community or a Higher Power, or both–there is a strong sense within recovery communities that agency will only be maintained to the extent that one continues to rely on others for their own recovery. There are times in which the most powerful impetus to remain in recovery is to help others do so as well. This communal bond resists the constraints of societal isolation as well as internalized feelings of shame.
What Does Addiction Recovery Teach Us About Moral Agency Under Constraint?
The model of agency under constraint demonstrated in the processes of addiction recovery reveals that becoming persons capable of intentional moral efficacy requires addicts to engage in regular, embodied practices over time in communities of mutual dependence. Recovery is not so much guided by an abstract end goal (freedom, agency, etc.) but engages with what Mahmood calls “the architecture of the self that undergirds [the] particular mode of living and attachment,”15 in its formulation of proper practices and organizational structure. Moral agency emerges in the process of recovery as persons begin to form new patterns of life marked by regaining selfhood through embodied practice, having a reawakened sense of time that includes an ability to think meaningfully about the past and the future, and developing communities of mutual dependence.
More broadly, the site of addiction-recovery sheds light on the ways moral agency and constraint are experienced as felt phenomena that arise from particular biological and environmental realities. This is true for both hardcore drug addicts and any of us who feel unable to break out of cycles of consumption, dependence, or production. More work needs to be done exploring the relationship between these affective, bodily experiences and the economic and political practices from which they emerge. This is not limited to addiction, but could apply to other biological-political phenomena in mental and emotional health, for example. Examining these connections will allow us to explore how biological and political bodies shape and are shaped by one another in ways that go beyond strictly conscious deliberation and action.
- Gabor Maté, In the Realm of Hungry Ghosts (Berkeley: North Atlantic Books, 2010), 136
- Dopesick: Fentanyl’s Deadly Grip, directed by Shawney Cohen, (Toronto: Vice Studies Canada, 2016), https://www.youtube.com/watch?v=28rJqj-7pEY.
- Gerda Reith, “In Search of Lost Time: Recall Projection and the Phenomenon of Addiction,” Time & Society 8, no. 1 (1999): 104
- Ibid., 106
- Saba Mahmood, Politics of Piety (Princeton: Princeton University Press, 2005), 15
- Ibid., 157.
- Reith, 109.
- Ibid., 109
- Alasdair MacIntyre, Dependent Rational Animals: Why Human Beings Need the Virtues (Chicago: Open Court, 1999), 97-99.
- Mahmood, 166