Whilst at a detailed level there are many different theories of "addiction", most of the differences are superficial rather than fundamental. A central feature is the desire to distinguish between addicted behaviour and nonaddicted behaviour, coupled to a preference for explaining the former in terms of physical and pharmacological processes (laws of nature), and the latter in terms of volition and intentionality. Thus, to be addicted is to be "compelled"; whereas compulsion is not seen as a feature of "nonaddicted" behaviour. This distinction remains at the heart of virtually all theories of addiction, and thus identifies them as theoretical "isotopes" rather than new theories. In the following chapter it is argued that this dominant theory, and hence all its variants or isotopes, is based on a flawed philosophy of science, and that consequently there is ample room for genuine theoretical innovation.
Debates about the notion of addiction, whether "it" is a disease or not, whether people's regular repetitive actions with respect to psychoactive substances are volitional or compelled, and whether scientists will sooner or later find the mechanism that underlies such behaviour (and thereby the "magic bullet" that will "cure" it) are merely microcosms of ethical and philosophical debates that have troubled thinkers for centuries. However, researchers who specialise in a particular field sometimes become preoccupied, a not unnatural occurrence when people find fascination in a particular research topic. This means however that a kind of "tunnel vision" can develop, whereby awareness of relevant issues in other fields is sacrificed. This may have happened with research into addiction where there is sometimes a lack of awareness that issues central to addiction are not specific to that area. To some extent the tricky questions, perhaps imponderables, that trouble addiction workers have troubled others in various guises since the dawn of recorded history. Consequently the arguments that ensue often have a familiar feel to them; they tend to keep popping up like old friends and bad pennies. In effect, "the flat tyre keeps being reinvented time after time" (a quote for which I am indebted to Professor Keith Tones, of Leeds Metropolitan University) with respect to central issues about the nature of addiction.
The classification of an aspect of human existence as a "disease" arises not so much from any compelling unity in the principles underlying the class of phenomena so labelled as from a unity in how we intend to conceptualise and deal with the phenomenon at a societal level. If something is a "disease", then the remedy lies in some form of "treatment" since the phenomenon is defined by the "disease" label as pathological or "abnormal". It is clear to see, however, that a consensus definition of disease is probably easier to apply, and fits less awkwardly, in cases such as pneumonia or influenza where an invading causal agent can be isolated, than in cases such as dyslexia, attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) where the aetiology is more debatable, and where viewing the associated behaviours as abnormal or pathological raises value-laden and ethical, as well as purely scientific and medical, questions. See Davies (1993) for a discussion of the dyslexia issue; also The Psychologist (1995) for discussions of ADD/ADHD.
"Disease" definitions also raise problems with respect to the presence or absence of "free will", and thus can provoke collision between volitional accounts of human action and alternative accounts based on materialist, reductionist and hence determinist philosophies that underlie much of what we refer to as "scientific knowledge". Calling something a "disease" carries an important social message, not just a medical one. It implies that the phenomenon itself is not brought about directly by the individuals who display it; though they may of course put themselves more or less at risk by their "voluntary" actions. Thus AIDS (the disease) is not brought about because people deliberately produce a deficiency in their immune systems; even though their actions with respect to sexual practices, or injecting drug use, may be seen to have a bearing on whether they acquire the disease. In a similar way mountaineers do not deliberately choose to suffer from cerebral oedema, even though they choose to climb to heights where this condition is more likely to come about. Nonetheless, a disease is not usually conceptualised in itself as having a voluntary basis, and consequently the label removes personal responsibility from the individual who therefore merits "treatment". It is this implied removal of personal responsibility which makes "disease" notions so popular and attractive in social cognitive terms. If something is a disease, the individual "sufferer" cannot be blamed for it. The value of the label is thus substantial, and so we witness a relentless widening in the use of the concept, bringing in more and more problems under its protective canopy even though the fit between some of these and a commonsense notion of disease becomes increasingly loose. Are we really expected to take the alleged condition "shopaholism" seriously? And if so, who is next in the queue (no pun intended) to have responsibility for their own ill-considered actions removed by the wonders of science?
An analogous debate has raged for some decades over homosexual behaviour, where once again disease/genetic arguments collide with conceptions based on choice, despite the fact that where multi-determined and molar behaviours are concerned there is nothing contradictory about acknowledging that both arguments can have value in particular contexts. One is clearly free to choose whether to carry out many behaviours which have been shown to have a genetic or hereditary component. For example in The Naked Civil Servant (Crisp, 1985), an autobiographical work describing the life of Quentin Crisp, the author describes the problems created by a homosexual lifestyle at a time when such behaviour was against the law in the U.K. The central character is at one point asked to tell the court how long he has suffered from homosexuality. He replies that he has been homosexual for many years, but he ironically questions the appropriateness of the term "suffering from". In a similar vein, those of us who can remember the days when homosexual activity was illegal may also remember media coverage of certain scandals. within which reference to homosexual behaviour as a "condition" that people "suffered from" was the norm. The author even recalls a popular science programme about "cures" for this condition based on aversion therapy (electric shock), which featured a number of people who had been arrested for homosexual acts, and who had consequently "volunteered" for the new "treatment".
Nowadays, such a view would be seen by most of us as homophobic and unwarranted. Subsequent changes in the law meant that it was no longer necessary to plead illness when such behaviour came to light, and consequently there was no longer any drive to have it "treated". Homosexuals of both genders now can "come out" and present their sexual behaviour in an open and positive light; stressing choice and personal preference (Assiter & Carol, 1993; Carol, 1994) as the main motives; and few if any feel a need to sign up for electric-shock aversion therapy in order to be "cured". The status of homosexual behaviour as the manifestation of disease, and the conclusion that treatment was an appropriate disposal, can thus be seen with hindsight to have depended crucially on the position of that behaviour with regard to the law, notwithstanding the wealth of scientific journal articles attesting to the physical and genetic bases of the "condition". It is argued here that, in a similar way, the legislation surrounding drug use places a premium on deterministic explanations to which people would need less recourse in a different judicial climate. In both these cases, the legal status of the activity appears to determine the preferred mode of explanation.
The debate about whether drug users use drugs volitionally because they want to, or whether the behaviour is compelled by forces beyond the individual's control, also has a philosophical origin. However, the issue cannot be resolved by "science", unless science itself is viewed as a way of finding absolute truth, rather than a convenient way of conceptualising the world which helps in the solving of particular types of problems. The reasons for conceptualising something as a disease, particularly in grey areas like addiction, or dyslexia, are primarily social and functional; yet these labels can apparently be "proved to exist" by scientific data which in one way or another show what the underlying physiological mechanism is. However, from a reductionist point of view all behaviour has an underlying mechanism. Thus, if it became necessary to re-conceptualise road crossing as a "disease" (suppose for example that it was made illegal, but numbers of high-status people persisted in doing it) we could confidently expect our scientists to "prove" its disease status by identifying, or at least suggesting, an underlying mechanism; for there surely is one, or else we would be unable to cross the road.
Furthermore, once the underlying mechanism had been revealed, we might anticipate the supremely illogical announcement that the scientific data showed the behaviour to be non-volitional or "compulsive" on the precise grounds that a mechanism had been identified. It remains a mystery why the fact of finding, unsurprisingly, that a behaviour has an underlying mechanism should be taken as conclusive evidence that the behaviour is not volitional. In fact, the philosophy behind science as mechanism is simply that, basically, everything is underlain by a tangible mechanism or process. This is not unreasonable. In principle, however, such a philosophical stance has nothing to say on the issue of volition. It can neither confirm nor disconfirm volitional theories; and it certainly cannot discriminate between volitional and nonvolitional acts.* The emergence of this problem with respect to drug use is however simply the re-emergence in a specific area of a centuries old debate about the sources of human action; it is nothing new.
The third issue arising from the opening paragraph of this section concerns the ways in which scientists construe the work that they do. The preferred and widely held notion of science sees it as the pursuit of some ultimate truth by individuals whose actions are free from motive, ideology or favour. Skinner for example writes, "Science is a search for order, for uniformities, for lawful relation among the events of nature"; and also "If we are to use the methods of science in the field of human affairs, we must assume that behaviour is lawful and determined..." (Skinner, 1953; Machan, 1974). It is worthwhile noting specifically that Skinner carefully avoids claiming that the theory of operant behaviour "proves" the lawfulness or determinist nature of human behaviour. That is, he acknowledges, an assumption ("we must assume that behaviour is lawful and determined.") that has to be made before his theory of human action can be applied.
To take another example, an editorial in the influential journal Addiction commences with the assertion, "Science is at its best the selfless and disinterested pursuit of truth" (Edwards et al. 1995). The assumptions underlying these two quotes, namely that a) human action is underlaid by laws that parallel, and are in fact nothing more than instances of, the kinds of laws underlying the events of nature (i.e. physical laws); and b) that scientists are the selfless and disinterested pursuers of the ultimate truths underlying these laws, probably coincide rather well with the self perceptions of many practising scientists. But if so then the matter is one for regret rather than congratulation. The sentiments are laudable, but they reveal a disregard for (or dismissal of?) alternative contemporary philosophies of knowledge in general and science in particular; and perhaps also a potentially dangerous misunderstanding of the place of the scientist within society insofar as the idea is perpetrated that science proceeds untouched by human motivation. "Therefore", it comprises a body of value-free knowledge, and this warrants its privileged and superordinate ("more true") epistemological status vis a vis other forms of knowledge—this raises a number of issues which are, at the very least, worthy of acknowledgment.
In order to explore these stormy waters further, let us commence with a brief examination of the idea that laws can be found underlying human action that parallel "the laws of nature". The sport of boxing, let it be acknowledged, is not to everyone's taste. It is possible to argue the case in favour of boxing, in terms of people's rights to do what they wish just as long as they do so in full awareness of the possible consequences of their actions, and provided no-one else's liberty to do likewise is interfered with. This is basically the philosophy put forward by Mill in 1859 (cited in Friedman & Szasz, 1992) and it remains a viable principle for the organisation of a society to the present day. The basis for Mill's argument is captured in the much-cited essay On Liberty, in which he states, "The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others."
On the other hand, Mill also conceded that a breach of duty to others could constitute "harm" as envisioned in the above quotation, giving rise thereby to arguments above definitions of "duty". It is possible to argue that boxers fail in their duty to their families and dependants by risking injury in the boxing ring, but the same argument then applies to any risky occupation, including deep-sea oil exploration, grand-prix racing and, until recently, coal mining. All these activities, whilst involving risk, also actually constitute the very means by which people provide for their families and dependants. However, the real health consequences of boxing are a cause of serious concern, and it can be argued that the sport should be banned precisely for those reasons, regardless of whether people wish to take part or not. The good (freedom) of individuals in a society is thus, arguably, not the same as the common good of the society as a whole, and so interventions that violate individual freedoms are justified at the societal level in terms of a greater common good (Beauchamp, 1987). In a sense, these arguments, involving pitting freedom of individual choice against the need to serve the interests of the broader society at large parallel quite closely some of the arguments about drug prohibition versus legalisation, the pro- and anti- boxing argument, the annual death toll of climbers in the Grampians of Scotland, and a number of other areas of activity where the exercise of individual freedoms, whilst not seriously infringing the rights of other specified individuals to do as they wish, nonetheless imposes a cost on the society as a whole.
However one feels about boxing, perhaps we may agree that Muhammed Ali was arguably the greatest, most skilled and most charismatic exponent of the boxing arts ever to grace (or if you prefer, disgrace) the surface of the planet; and it is a matter of fact and regret that he has paid the final terrible price for his choice of vocation. Ali, it may be recalled, took part in a number of legendary confrontations with chat show hosts as well as in the boxing ring. In one such unattributed incident, it is alleged that Ali was asked to explain why he became a boxer.
Questions beginning with "why" are of special interest to psychologists, particularly "attribution theorists" whose interest lies in trying to understand why people choose the types of explanations they do, when asked to explain their behaviours. This approach assumes, on the basis of substantial evidence, that people's explanations for their behaviour are not simple causal accounts, but cognitive constructions that take into account the circumstances in which the explaining is to take place. From an attributional perspective, Ali's answer was not disappointing. After a moment's thought, he intoned the following three line epithet in his own inimitable sing-song style:-**
"The bird flies through the air.
The waves pound on the seashore.
I beat people up."
This brilliant piece of improvisation was greeted with gales of laughter and applause, and rightly so. The collision of two matrices of meaning (Koestler, 1964) is self evident.
However, whilst fully accepting that the psychological analysis of jokes is one of the world's more boring and unimaginative enterprises, it now becomes necessary to try to answer the question, "Why is it funny?", in order to illustrate the point that is being made. So what is it that collides with what in Ali's hilarious and ridiculous riposte?
The structure of a bird, its wings, its bones, its musculature, have developed as a consequence of the operation of biological laws outlined in the theory of evolution and captured in adaptive genes. Flying requires certain kinds of structure. It is not simply the case that birds decide to fly according to some whim, whilst other animals do not. Birds fly because they have evolved the genetic make-up that makes flying the best way to get about for birds. Birds fly because that is what they do; what they are designed for. "The bird flies through the air" is a statement of biological fact deriving from the operation of laws of nature.
Waves pound on the seashore for reasons concerning gravity, the pull that larger bodies exert on smaller ones; and the action of the winds deriving from perturbations of the atmosphere as the planet wobbles on its axis. The gravitational force exerted primarily by the moon tugs the oceans about in a fashion that is predictable from a knowledge of gravity and of the moon, and the winds whip up the surface from time to time in a less predictable but nonetheless determined manner. These things happen as a consequence of the operation of physical laws of nature.
Mohammed Ali's epithet is funny because he ironically implies that his boxing is a law of nature also. We are invited to believe that he boxed because he was expressly designed to do so, as in the case of the bird that flies; and because he had no choice in the matter, as when the waves pound on the beach. He asks us to consider that he boxed due to the operation of laws that transcend human decision making. This is funny, because we know that such an explanation is inappropriate and unhelpful; that a more informative explanation would give greater prominence to social circumstances and early life history, opportunities, business deals, motives, aspirations, situations, personal perceptions, luck, and decision making. In terms of Koestler's analysis therefore, our "laws of nature" matrix collides with our "human beings as sentient decision makers" matrix, and the result is humour. According to Koestler, if we felt the idea, that Ali's behaviour was caused by universal laws, was reasonable and appropriate, WE WOULD NOT FIND IT FUNNY.
It is worthwhile pursuing Ali's ironic explanation with a more homely, hypothetical example. Suppose that whilst walking down the street we observe a woman frantically waving her arms about. Let it be further supposed that as students of human behaviour, we are sufficiently intrigued by her behaviour to ask why she is acting in such a way. Now imagine our surprise if, in response to the question she replies in terms of transmission of neurochemicals to receptor sites, innervation of motor neurones, conversion of sugars into lactic acid within muscles, levels of dopamine in the mesoacumbens, or other physiological factors that might well be involved in arm waving. How would we react to such an answer?
It is clear that within a social context, such an explanation would be quite uninformative as an explanation for the behaviour which is clearly a motivated social act. It conveys no sense of purpose, has no social relevance, and might in all probability be seen as deliberate refusal to provide an explanation in any circumstance other than a physiology laboratory. On the other hand, "My Mother is on the other side of the street", a simple statement of fact, has total explanatory power within that context, explaining as it does the purpose of the act; that is, the reason why "the organism" (she) behaved as it (she) did.
Explaining some motivated act in terms of a "law of nature" is thus not only funny in certain situations (as has hopefully been illustrated above). It can also be totally unhelpful within anything resembling a social context, and can in principle provide no evidence for differentiating one person's behaviour from another's; we are all subject to laws of nature. However, choosing to explain the actions of a subset of the human population (for example, "addicts"') in terms of laws of nature is not merely unhelpful in individual terms; it is also illogical. It can only claim any discriminatory value by comparison with a group of people to whom those universal laws do not apply. Thus, to suggest that "addicts' " behaviour is determined by laws of the universe at a physiological, neurological, biochemical, or pharmacological level only has value if we can assume that a similar type of determinist explanation cannot be applied to the rest of us.
In fact, of course, we can choose to describe everyone's behaviour in these socially irrelevant terms if we so wish. From a reductionist/determinist viewpoint, all behaviour is "caused" (determined) by factors at this micro-level. Consequently, the supposed "compulsive" nature of addiction is not an empirically derived scientific finding; it is an a priori assumption underlying much of the research to which reductionist/ mechanistic philosophies give rise. And as we have seen, such an assumption is quite unwarranted.. If you prefer mechanistic explanations for behaviour, you are certainly entitled to them, and you can surely find mechanisms that underlie any behaviour that people perform if you so wish. But what you can never do is provide evidence to support a theory that requires a distinction between "compulsive" and "non-compulsive" mechanisms. Unless you live in hopes of one day demonstrating the mechanism that underlies free will!
However, whether or not our research assumptions are well or ill-founded, they still have important implications. An important feature of contrasting explanations in terms of laws of nature as opposed the explanations in terms that have social relevance, is that they can both be true within a scientific conception of "truth". If the woman who was waving her arms about chooses to explain her actions in terms of the neurology, biochemistry and physiology of her anatomy, she is not telling lies. But what she is doing is offering an explanation of a type which is mismatched to the purpose of the question (e.g. "Why are you waving your arms about?"). Within the context described, such an answer could only make sense as a deliberate refusal to answer the question; a desire not to reveal the motive for the behaviour. Consequently, the answer is completely unhelpful with respect to understanding the social relevance of the behaviour. Furthermore, it would lead us to suppose, in an imaginary world in which arm waving was viewed as a problem behaviour or "disease", that the appropriate "treatment" also lay at a physiological, neurological or biochemical level, rather than in terms of the lady's mother and the presence of a busy street. We could provide the lady with medication or perhaps even surgery to stop her arms moving; or we could build a zebra crossing.
It should by now be plain that scientists choose their preferred type of explanation to suit the type of knowledge they possess, and advocate the policies and interventions most consistent with that knowledge. This of course is a very long way from the "selfless and disinterested pursuit of truth" described earlier. Furthermore, the processes by which scientists find themselves searching for the physiological mechanisms underlying drug-taking rather than, say, the physiological mechanisms of standing for parliament are very much social and political, and scientists ignore cultural, political and historical factors at their peril. It has been argued elsewhere that defining oneself as a selfless and disinterested searcher after truth is to lay oneself open to manipulation by those who harbour no such conceits (Machan op. cit.).
Muhammed Ali's joke is more than peripherally related to the prevailing concept of addiction. Addiction, we are invited to believe, is a "law of nature". People are addicted because their drug taking takes on the same status as birds flying (i.e. irresistible pharmacological/ physiological forces that compel). People do not make decisions about their drug use. Instead of decision making, the word "addiction" invites us to view regular excessive drug use in terms of forces over which the person has no control. From such a position, they cannot behave otherwise. We might therefore offer the following as an answer to the question, "Why do you take drugs?"
The bird flies through the air.
The waves pound on the seashore.
I take heroin.
Suddenly, however, the irony is lost and no-one is laughing, though the absurdity of the explanation is identical in both cases. And meanwhile, in both the scientific and the popular literature, the terms "addiction" and "compulsive use" trip from pen and tongue as though there were no epistemological problems raised by the use of these terms. The idea that drug taking is a career and that, like boxing, it depends on circumstances, decisions, chance meetings, motives, business deals, opportunities, and so forth is relegated to a back seat. In its place a "law of the universe" is proposed by way of explanation; an explanation that Muhammed Ali used, in different circumstances, for the amusement of a chat-show audience.
Notes
*The conclusion that demonstration of a mechanism is sufficient to render an act nonvolitional only makes sense in conjunction with a parallel but unarticulated assumption; namely that volitional acts are NOT so underlaid. This, of course, runs contrary to the basic mechanistic assumption that everything is underlaid by mechanism. (I am indebted to Prof. Michael Bozarth for the amazing, possibly ironic, quote, "One day we will understand the pharmacology of free will." Florence, 1989, verbal communication whilst standing with the author at the bar). If on the other hand it is the contention that there is no such thing as volition, or that volition is delusional or epiphenomenological (the mere experience of "the machine working") then the mechanist may not use words such as "compulsive" to distinguish one set of behaviours from another, since he invokes a dimension in which he does not believe. (return to text)
**authors note:- I can remember distinctly reading an account of this incident somewhere, but it is one of the unwritten rules of authorship that, at the end of the day, you will be unable to find the reference for the most crucial and interesting thing that you come across. However, in this instance I am not going to be deterred by such a mere detail. (return to text)
