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Addiction: Entries and Exits

Jon Elster EDITOR
Copyright Date: 1999
Published by: Russell Sage Foundation
Pages: 332
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  • Book Info
    Book Description:

    Addictionfocuses on the emergence, nature, and persistence of addictive behavior, as well as the efforts of addicts to overcome their condition. Do addicts act of their own free will, or are they driven by forces beyond their control? Do structured treatment programs offer more hope for recovery? What causes relapses to occur? Recent scholarship has focused attention on the voluntary aspects of addiction, particularly the role played by choice. Addiction draws upon this new research and the investigations of economists, psychiatrists, philosophers, neuropharmacologists, historians, and sociologists to offer an important new approach to our understanding of addictive behavior.

    The notion that addicts favor present rewards over future gains or penalties echoes throughout the chapters inAddiction. The effect of cultural values and beliefs on addicts, and on those who treat them, is also explored, particularly in chapters by Elster on alcoholism and by Acker on American heroin addicts in the 1920s and 1930s. Essays by Gardner and by Waal and Mørland discuss the neurobiological roots of addiction Among their findings are evidence that addictive drugs also have an important effect on areas of the central nervous system unrelated to euphoria or dysphoria, and that tolerance and withdrawal phenomena vary greatly from drug to drug.

    The plight of addicts struggling to regain control of their lives receives important consideration inAddiction. Elster, Skog, and O'Donoghue and Rabin look at self-administered therapies ranging from behavioral modifications to cognitive techniques, and discuss conditions under which various treatment strategies work. Drug-based forms of treatment are discussed by Gardner, drawing on work that suggests that parts of the population have low levels of dopamine, inducing a tendency toward sensation-seeking.

    There are many different explanations for the impulsive, self-destructive behavior that is addiction. By bringing the triple perspective of neurobiology, choice, and culture to bear on the phenomenon,Addictionoffers a unique and valuable source of information and debate on a problem of world-wide proportions.

    eISBN: 978-1-61044-182-7
    Subjects: Psychology, Political Science, Sociology

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Contributors
    (pp. vii-vii)
  4. Acknowledgments
    (pp. viii-viii)
  5. Introduction
    (pp. ix-xx)
    Jon Elster

    A common image of addiction is captured in the following thumbnail sketch of rats who have been trained to stimulate the pleasure circuits in their brains by pressing a lever:

    The rat rapidly acquires the lever-pressing “habit”—giving itself approximately 5,000–10,000 pleasure/reward “hits” during each one-hour daily test session. During these test sessions, the rat is totally focused on obtaining the desired electrical stimulation—lever-pressing at maximum speed and completely ignoring other attractions within the test chamber (food, water, playthings, sexually receptive rats of the opposite sex). After several weeks, the rat suddenly faces a new and unexpected behavioral...


    • Chapter 1 Disordered Appetites: Addiction, Compulsion, and Dependence
      (pp. 3-28)
      Gary Watson

      In both popular and technical discussion, addictive behavior is said to be in some senseout of control.However, this description does not distinguish addiction from various forms of moral weakness. The excessive indulgence of appetites, for example, gluttony and promiscuity, are excesses for which we still hold one another responsible. The loss of control in addiction seems different: Addiction appears to be a source of compulsive desire, desire too strong for the agent to resist.¹

      The World Health Organization expresses this view in its 1969 definition of “dependence” (a term that replaced the use of “addiction” in its earlier...

    • Chapter 2 Freedom of the Will and Addiction
      (pp. 29-54)
      Olav Gjelsvik

      “Like my cat, I often simply do what I want to do. I am then not using an ability that only persons have” (Parfit 1984, ix). I concur. The quoted writer, and possibly his cat, enjoy what I call freedom of action: Acts are free when agents simply do what they want to do.

      Whether writers and cats enjoy freedom of the will is a different and complex question. The capacity for free will is here approached this way: Let us think of our desire,D,which effectively produces behavior,B,at a time,t,as the content of our...


    • Chapter 3 The Neurobiology and Genetics of Addiction: Implications of the “Reward Deficiency Syndrome” for Therapeutic Strategies in Chemical Dependency
      (pp. 57-119)
      Eliot L. Gardner

      In spite of decades of research into the underlying determinants of drug addiction and chemical dependence, no clearly efficacious therapeutic modality has emerged (Kleber 1992, 1994; O’Brien 1997). Group therapy and support on the Alcoholics Anonymous twelve-step program model, “therapeutic communities,” cognitive and behavioral therapies, various pharmacotherapies (methadone maintenance, nicotine patch, Antabuse, naltrexone), and other therapeutic modalities all claim varying degrees of success (Lowinson et al. 1977; O’Brien 1997), yet careful epidemiological studies (including the National Household Survey on Drug Abuse) reveal that more than five million Americans continue to suffer from severe drug addiction (Woodward et al. 1997; Epstein...

    • Chapter 4 Addiction as Impeded Rationality
      (pp. 120-148)
      Helge Waal and Jørg Mørland

      From a clinical point of view, drug taking is a complex behavior that involves consciousness and deliberate actions. The drug taker has to procure the drug or accept an offer. Consumption further involves a varied set of actions and procedures. This behavior dearly involves series of choices. The puzzling question is, therefore, why any individual continues to make what he or she—and certainly we—judge to be poor choices, choices of regret and poor net result.

      The traditional explanation either leans on lack of norms and morals or rests the case on a disease concept. The former has ancient...


    • Chapter 5 Hyperbolic Discounting, Willpower, and Addiction
      (pp. 151-168)
      Ole-Jørgen Skog

      Theories of addiction have traditionally not analyzed very carefully the basic problems of choice that addicted people are faced with. Addicts are conceived as consumption robots, helpless victims of their environment or their vices. Under these circumstances, “addiction” is not much more than a label, a ghost in the machine, called upon to explain norm-violating, self-destructive consumption behavior. Unfortunately, the proof of addiction is the very same behavior, and the explanation therefore becomes circular. A proper understanding of addiction requires a theory of how people conceive their world, how they evaluate different options, and how they make their choices. Among...

    • Chapter 6 Addiction and Self-Control
      (pp. 169-206)
      Ted O’Donoghue and Matthew Rabin

      Many observers suspect that self-control problems and related time inconsistencies play an important role in the consumption of addictive products, leading people to develop and maintain addictions against their long-run interests. People often consume addictive products despite an expressed desire to quit. For many people, it would appear that the long-run harm caused by an addiction outweighs its short-run benefits. In extreme cases, people destroy their lives with harmful addictions. Our goal in this chapter is to carefully explore the role that self-control problems—and people’s awareness of those problems—play in harmful addictions. To do so, we develop a...


    • Chapter 7 The Intuitive Explanation of Passionate Mistakes and Why It’s Not Adequate
      (pp. 209-238)
      George Ainslie

      People have always been puzzled by their own propensity to do things that they will regret—often deliberately and in full knowledge that they will regret them. Intoxication has been an exemplar of this kind of choice, confronting us not only with a self—destructive behavior but with an urge to repeat it that grows more robust with every “bad” experience.

      This pattern seems irrational. We have always had an idea that the things we choose have a consistent value and that normal choice making consists of detecting that value and comparing it with the value of the available alternatives....

    • Chapter 8 Emotion and Addiction: Neurobiology, Culture, and Choice
      (pp. 239-276)
      Jon Elster

      In this chapter I compare the phenomenon of addiction with that of emotion in the hope that the comparison may enhance our understanding of both. The discussion is methodological rather than substantive and, hence, has to cover a lot of ground very briefly. For fuller discussions I refer the reader to Elster (1999a, 1999b). Although included in a volume on addiction, the chapter treats the two phenomena symmetrically rather than merely using emotion as a foil for addiction. The value of the comparison is, I believe, enhanced by an evenhanded treatment.

      I distinguish three main approaches to emotion and addiction:...


    • Chapter 9 Addicts as Objects of Study: Clinical Encounters in the 1920s
      (pp. 279-300)
      Caroline Jean Acker

      Unlike many students of addiction, I do not seek to understand what addictionis. Rather, as a socially trained historian of medical and scientific disciplines, I am chiefly interested in how addiction is thought about in different disciplinary contexts—and why and how addiction becomes an interesting problem to a particular discipline in a particular time and place. For example, economists did not ponder the basis of addicts’ behavior in the 1920s; they did in the 1990s.

      Following Charles Rosenberg (1979), I use the concept of “ecology of knowledge” to characterize knowledge production in its disciplinary contexts and to situate...

  11. Index
    (pp. 301-310)