The author overcame his dependence on pills and alcohol. Now he wants to beat back misconceptions about the science of addiction.
Excerpt – Introduced in 1997 by the National Institute on Drug Abuse, the notion that addicts’ brains are “hijacked” by drugs implies that they are condemned to uncontrolled and chronic use. Mr. [former vodka and Klonopin addict, emeritus professor of philosophy and neurobiology at Duke University, author of “What Is It Like to Be an Addict?” Owen] Flanagan makes clear that brain changes are very real, but he also makes clear that they do not render addicts unresponsive to reasons why they should stop. So the aim, he suggests, should be to create conditions that increase the odds that addicts will decide to stop.
The author goes on to challenge a host of additional dogmas, including the monolithic and hugely popular theory that dopamine overwhelmingly determines addictive behavior—from heroin addiction to video gaming to gambling. Citing ample research, Mr. Flanagan shows that “addictions are implemented in many brain regions and involve multiple neurotransmitter systems depending on what substance one is addicted to.” [..]
How we understand addiction matters because questions of responsibility are inescapably tied to explanations of behavior. This brings us to another provocation: Can addicts be held responsible “if they lie, cheat, and steal because of their disease or disorder? Yes. Are they responsible for lapses and relapses? Yes.” [..]
Shame can be a motivating force, he writes, and “addicts and clinicians can work profitably with this shame.” The trick, he explains, is to hold addicts accountable in ways that don’t undermine their recovery.
Mr. Flanagan ponders whether there are ethical trade-offs in “stigmatizing addiction more than it deserves in order to protect the well-being of future generations.” The “ethics of addiction,” he concludes, should favor the “well-being and standing of us all.” Had officials in places such as San Francisco and Seattle taken this understanding into account, both their cities and the homeless addicts who claimed the streets might have suffered a lot less.
In his 50s, Mr. Flanagan extricated himself from alcohol and pills. He credits the “compassionate souls,” among them a longtime psychiatrist, who reminded him that he was “a bona fide person before I was an addicted person, and that person was most likely still there.”
Full book review, S Satel, Wall Street Journal, 2025.4.29