Addiction and the self

Abstract

Addiction is standardly characterized as a neurobiological disease of compulsion. Against this characterization, I argue that many cases of addiction cannot be explained without recognizing the value of drugs to those who are addicted; and I explore in detail an insufficiently recognized source of value, namely, a sense of self and social identity as an addict. For people who lack a genuine alternative sense of self and social identity, recovery represents an existential threat. Given that an addict identification carries expectations of continued consumption despite negative consequences, there is therefore a parsimonious explanation of why people who identify as addicts continue to use drugs despite these consequences: they self‐identify as addicts and that is what addicts are supposed to do. I conclude by considering how it is nonetheless possible to overcome addiction despite this identity, in part by imagining and enacting a new one. Importantly, this possibility requires the availability of social support and material resources that are all too frequently absent in the lives of those who struggle with addiction.

Out of our heads: Addiction and psychiatric externalism

“…Recovering addicts invariably display "self-binding" practices [95], on the model of Odysseus binding himself to the ship's mast in order to resist the sirens' song: finding new social circles, and routes to and from work unassociated with their prior drug use; sending paycheques to spouses' accounts to prevent themselves from gambling; wearing long-sleeved shirts to avoid constantly seeing inviting and available veins; removing cigarette-lighters from their cars ( [96], p. 21). 8 Moreover, as Hanna Pickard [97] observes, addiction often conveys a sense of self and self-worth. In other words, it need not exclusively be experienced as a diminishment or loss of self (i.e., destruction of an individual's life due to addictive cravings or impulses) but rather as an identity gain [98]: a pathway to meaningful practices, relationships (e.g., with fellow addicts), social roles, and other forms of group identification that enduringly scaffold an individual's identity and sense of purpose.…”

“…Accordingly, recovery may, among other things, involve cultivating environments and networks of relationships that scaffold the development and maintenance of post-addiction sources of social reward and relationships, self-esteem, and social identity. As one addict in recovery says, a non-addict sense of self does not suddenly emerge once the addiction is overcome; it must be actively imagined and created: "[Y] ou've got to work at becoming someone and something else" (quoted in [97], p.15). Supportive material and social niches furnish scaffolding essential for this post-addiction identity-work.…”

“Chasing the first high”: memory sampling in drug choice

“…Complementing various therapies (see above), qualitative sociological research has long suggested that overcoming SUD is facilitated by the capacity to vividly and realistically imagine an alternative drug-free life of personal value [46,[117][118][119].…”

Chasing the First High: Memory Sampling in Drug Choice

“…Together, these findings support two routes by which acute stress may influence memory retrieval and yield relapse: (a) diminishing retrieval of drug-inconsistent context memories, leaving initial drug-related memories to guide behavior; and (b) promoting retrieval of drug-consistent context memories and hence drug memories themselves. Complementing various therapies (see above), qualitative sociological research has long suggested that overcoming SUD is facilitated by the capacity to vividly and realistically imagine an alternative drug-free life of personal value [46,[117][118][119]. 2) is established, conditioning to develop an association between the image and two kinds of stimuli: (i) drug-associated cues, so as to increase the probability of spontaneous retrieval when opportunities to consume are present; (ii) personal reminders such as smells [151] and app-based individualized photos and pictures [108] (for a real-world example see www.sobergrid.com), which can be voluntarily self-cued to facilitate retrieval.…”