How Freedom Lovers Can Reckon with Addicts and Addiction
A new book looks at addiction through the lens of choice and responsibility.
What Is It Like To Be an Addict? Understanding Substance Abuse, by Owen Flanagan, Oxford University Press, 320 pages, $24.99
Addiction is a problem that defenders of liberty need to face, for if citizens cannot control their appetites, the state may be inclined to take over the job for them. Freedom depends on self-command supported by a fragile web of norms and relationships that lets us keep our own lives in order and get along with one another. Addiction is the acute case of the appetites run amok, as they often do when unfettered by such constraints as wealth, religion, and community.
Owen Flanagan's new book, What Is It Like To Be an Addict?, should be welcomed by anyone concerned with these issues. Despite its modest size, this is a work of large ambition and broad range informed not just by the author's long career as a prominent philosopher but by his many years as a desperately addicted abuser of alcohol and sedatives.
"This is a deeply personal book," he writes. "I was addicted to booze and benzos for twenty years on and off from the late 1970s until the early 2000s. The last years were especially ugly, requiring several hospitalizations, and involving constant self-loathing and suicidal despair."
Unsurprisingly given his experience, Flanagan stresses that we should pay close attention to what the addicted have to tell us. And among the most important things addicts say is that they are by no means blameless just because they supposedly have a disease. On the contrary, many feel shame (for being an addict) and guilt (for behaviors that are slowly destroying them and harming their loved ones).
To Flanagan, these feelings are right and good. That stance may inspire horror from some people, who will see it as victim-blaming. But it's consistent with Flanagan's view that addicts can't be reduced to flesh-and-blood automatons jerked about by their cravings. As he notes, even people who claim to believe this will then earnestly implore an addict to get help—a plea that could only be directed at someone presumed to have the ability to make choices. "Every treatment that works to unseat addiction," he writes, "assumes that addicts are responsible and must participate in undoing their own addiction."
Flanagan doesn't even think addiction is a disease, exactly—more of a multifactorial disorder of enormous social, physical, psychological, and pharmacological complexity. Indeed, one of his book's main points is that addiction cannot be seen as any one simple thing. But he doggedly insists that addicts retain some agency during their plight.
"Practices of compassion, forgiveness, and excusing are distinct from whether or not we hold the addict responsible," he writes. "We hold addicts responsible in many respects and rightly so. Thus, the determination that addiction is a disease or mental disorder is much less consequential as far as holding addicts responsible goes than many suggest."
Flanagan takes care to distinguish between unwilling addicts, willing addicts, and resigned addicts, helping us through these categories to think about what we mean by addiction and how best to mitigate it. Particularly notable are the minority who are willing addicts—he mentions as an example Keith Richards, who has said he was a longtime heroin user. At least some of these individuals are in control of the consequences of their habit and satisfied with their lives. Is their addiction any more meaningful than a coffee habit?
Unwilling addicts want to quit, and many will eventually succeed. And resigned addicts are those who wanted to quit, couldn't, and just gave up, surrendering to hopelessness. They are in a sense beyond unwilling; by not trying to quit, they effectively acquiesce. Here, the author says, a kind of accommodation may help. One nonprofit in Europe helps resigned addicts to lead orderly lives through more disciplined consumption—in one methadone-like program, six pints of beer spread throughout the day—as well as suitable paid employment.
As for himself, the author credits Alcoholics Anonymous with saving his life by enabling his sobriety, but he also thinks it has a certain cultishness; like any good rationalist, he insists on "the distinction between the belief in a Higher Power having an effect and the Higher Power having an effect."
Flanagan is also a capable researcher and reporter. Who knew that many addicts call the rest of us "earth people"? Or, more significantly, that there is so much overlap between addiction and other psychiatric disorders? "Twenty-five percent of individuals with severe mental illness, defined as a disorder that severely compromises normal functioning—schizophrenia with delusions or immobilizing depression—have a substance use disorder," the author says. "In the other direction, 15 percent of individuals with a substance use disorder also have a severe mental illness."
This book's focus is substance abuse rather than, say, Facebook addiction, if such a thing exists. Flanagan is properly skeptical of the movement to medicalize all of life's setbacks and sadnesses. He notes that men in most cultures are more likely than women to abuse alcohol and drugs, but that women are gaining. "There is no country where female alcoholism…rates are near 10 percent. But there are many countries in which the male alcoholism rate is above 10 percent and a few that top 13 percent: Russia (16.29 percent), Hungary (15.29 percent), Lithuania (13.35 percent), and South Korea (13.10 percent)."
He reminds us that while the war on drugs appears to be a costly failure, we can't say for sure that many addictions wouldn't be worse in its absence. And he notes some of the problems that have accompanied legalization initiatives. In Portugal, after a decade of good results, "substance use is on the rise, and fewer and fewer people in need are getting treatment. Recent data indicate that both overall drug use and drug overdose rates are up." In Oregon, decriminalization Measure 110 "is being unwound" after evictions and fentanyl supplies surged. But he cautions: "The data do not mean, as some are quick to insist, that decriminalization, harm reduction, and treatment are not for the best."
What Is It Like To Be an Addict? has its shortcomings, which largely stem from the author's academic tribe. The book is not particularly well-organized or well-written; again and again, Flanagan tells us what he's going to tell us, and then tells us the thing a couple more times to be on the safe side. And the book can be heavy on jargon. At one point, despite his professed sobriety, he writes: "When I report on the experiences of fellow addicts based on their autophenomenological reports, I am doing heterophenomenology."
Particularly nettlesome is the author's claim that, although addicts are responsible for their addiction, the rest of us are responsible too because of the woeful conditions we've allowed to persist. He wheels out the usual suspects including "social displacement," poverty, inequality, racism, depression, "lack of good life options," and other all-purpose woes that "are not caused by addicts."
Blinkered by his ready-made list of villains, the author takes little account of other potential factors. Affluence in particular seems at least as likely a culprit as poverty. Today's poor are often richer than middle-class Americans were in the middle of the last century, and today's American middle class is extraordinarily affluent by historical and global standards. That means more of us can afford substance abuse of all kinds, not to mention addictions to shopping and other costly behaviors.
How about changes to family life or to levels of church attendance? Isn't it possible that the religious and familial dimensions of A.A. are essential to its remarkable success? It's noteworthy that the author's own salvation came not from any arm of government but from a private, apolitical institution operating on a shoestring and making no attempt to end inequality or racism. Drunks come to A.A. and somehow get sober anyway.
But in truth, the author's gestures toward collective responsibility feel more obligatory than emphatic. What he really wants is a humane, evidence-based approach to the problem of addiction consistent with individual agency, and that's an approach fully in accord with a faith in human liberty. At the same time, we might as well recognize that voters will quickly lose their enthusiasm for legalizing drugs if they blame it for public chaos. Freedom always and everywhere relies on self-regulation.
These are tough times for individual agency. Many philosophers and psychologists scoff at the notion of free will, which others seem to regard as the sole province of the "privileged." A therapeutic culture and the nanny state give us all incentives to see ourselves as victims, helpless in the face of implacable forces of oppression. It is refreshing to read a book that refuses to dehumanize addicts by depriving them of responsibility or delegitimizing the shame they feel for their actions.
