Anyone raising children in an American city these days has had to confront the following disconcerting scene: a person unconscious or semiconscious, in filthy clothes, stoned at midday, a nuisance if not a menace. As you lead your child gingerly around an adult prone on the sidewalk, the questions come: Why is that person lying there? Are they okay? Why do they take drugs if they know it could kill them? We tie ourselves in syntactic knots trying to formulate credible answers. We want to emphasize personal responsibility: that person made choices, but you can make different ones. We also don’t want our children to think us hard-hearted: that person is still a human being; somebody loves them. This conversation is even more difficult for the millions of Americans who have addicts in their own families.
Our first reaction to addiction is revulsion, because the addict’s apparently willed incapacity seems to reflect a denial of our basic human drive to live and to create. All our moral instincts tell us that people who work are entitled to more respect than those who idle; that people who take care of their children deserve our support more than those who neglect them; that people who obey the law get more consideration than those who break it. Even in an atomized society, no man is an island, and no one succeeds or fails entirely alone. Our resentment of idlers and thieves is both axiomatic and natural. Those who won’t do their part leave more work for the rest of us.
Neuroscientific learning about brain processes associated with addiction tends, however, to challenge our settled beliefs in this regard. Once the chemical hooks are in, the MRIs show, volition is a chimera: the addict leaves the world of goals and duties and future-orientation and merges completely with his desire for the drug of choice. The data suggest a large, perhaps dominant role for both genetics and trauma in the formation of addicted brains. (The moral narrative is further complicated by the reckless overprescribing of pain medications that contributed greatly to the current crisis.) Castigating addicts for their drug use, we are told, is like kicking the cat for going outside a full litter box. In place of agency we get a broad vocabulary of victimization and disadvantage.
Of course, we all want to hear that it’s not our fault. Addicts are even more eager than the rest of us to give their agency away—ceding it to their substance of choice and to the dealers supplying it. They become quite purposive when they need a fix, which is why you might find your car window smashed and the console and glove box rifled. We might even feel envious of them in their enslavement: they have given up the struggle.
The pop-neuroscience narrative tells us that agency is a mirage, but this is an especially pernicious form of scientism. Indeed, addicts themselves must know that this consoling story is not entirely true. The addict must regain a sense of his own agency if he is to return to the social world he left. He must pretend to be ordinarily responsible until, as the brain slowly heals from addiction, he actually becomes responsible. Tough love probably doesn’t work, in the sense of shame and recrimination. And yet without accountability there can be no reconciliation, no forgiveness.
The old narrative of personal responsibility still holds some explanatory power for most of us. It comports with our sense of dignity. It is ratified by our moral intuitions and by our personal experience of desire. Addicts use their preferred substance because they can expect a predictable outcome, either the intense pleasure of a high in the early stages of addiction, or later, relief from the dysphoria and physical symptoms of withdrawal. As Ann Marlowe wrote in her addiction memoir, How To Stop Time:
There are not a lot of surprises, which is often the point; your rhythms are defined by the familiar and predictable arc of the drug’s breakdown in your body, rather than the hazards of time. It is absence of pain that you are looking for, but absence of living that you get.
Addiction is the presiding metaphor for American life. Drug addiction was a recognized evil in the ancient world—some sources describe Marcus Aurelius as an opium addict—but addiction as a category has lately become distended beyond recognition. More and more people now claim to be “addicted” to food, to sex, to video games. These things all activate the same dopamine receptors, after all—all depend upon the same mechanism of desire and reward. (Experts in the field now refer to alcoholism primly as “alcohol use disorder,” which adds nothing to our understanding.) But treating all addiction as essentially the same elides key behavioral distinctions. Some addicts continue to work. Some addicts will suffer withdrawal rather than steal from their own families. And regardless of what areas of the brain are lighting up an MRI, end-stage alcoholism is a very different phenomenon from excessive gaming or social media use; their costs are not commensurate.
Decriminalization and various “harm reduction” strategies have proliferated in the West, in a spirit partly of libertinism and partly of despair. If prohibition has not eliminated demand, the argument seems to be, then let’s try doing the opposite. Despite some claimed successes, the preponderance of the evidence shows that such programs do not work as intended. The outstanding example is Portugal, which decriminalized all drugs in 2001 and has, after a short-lived period of success, cultivated an enormous crop of addicts. Vancouver’s free needle-exchange sites have helped reduce the spread of HIV, but the public disorder in the city’s downtown east side is an ongoing embarrassment in an otherwise charming city. Oregon’s 2020 move to decriminalize drug possession was followed by a significant spike in overdose deaths. The state still has one of the nation’s highest rates of drug addiction.
Our instinctive skepticism about such strategies is, however, deeper than dry statistical arguments and, in a sense, obviates them. We understand that a functioning society does not permit the impermissible. One can argue about alcohol and marijuana, but the legalization of hard drugs is despair masquerading as realism. We can expect that the places that pursue legalization and those with permissive regimes of physician-assisted suicide will eventually converge, because the moral logic of both policies is evidently the same.
Every addict is potentially an ex-addict. People do get clean, build families, and become leaders in their communities: it happens every day. Even those who choose to stay high, who continue to inflict damage, are entitled to some consideration just by virtue of being human beings—that is, not because they’ve earned our respect but because we are obliged to give it to them nonetheless. We mostly honor this idea in the breach. When confronted with the addicts in my community, I often find myself pretending to more empathy than I actually feel in the moment. Mostly what I experience is a mix of impatience and contempt, which is then converted fairly quickly to shame, which I then turn outward again, in the form of rage at the one who has foisted this experience upon me. This cycle seems as endlessly renewable as the problem of addiction itself.
I myself was briefly a heavy user of illicit drugs in my early twenties, before deciding that the life story I was writing under the influence couldn’t end well. I maintain to this day, though, that I got more out drugs than they got out of me. I know from experience why people use drugs: because they want to. And I know why they are reluctant to stop: because they don’t want to. Addiction usually ends in misery and exploitation, but that’s never how it starts. I’m reluctant to name my former drug of choice, but I can tell you that, for a while, it made me feel more myself in every way.
While one wouldn’t want to make pleasure an end in itself, the Epicurean spirit—the love of good food, of good sex, of good music and fine art—has much to recommend it. Dullness is not virtue, and people who find no delight in the world are untrustworthy, and bad company besides. If only our addiction culture were truly Epicurean, it would at least be a worthy foe.
What defines addicts today is anhedonia. Where in the grips of their addiction they once chased ecstasy, the best they can hope for now is a torpid equilibrium. Their ultimate sickness unto death is boredom. It is in this sense that addiction is a potent American metaphor. We are living in a culture both decadent and dreary, drained even of the salutary purposes of pleasure.
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