The Puzzle of Addition: The orthodox conception of drug addiction is a neurobiological disease characterised by compulsive drug use despite negative consequences. But this conception depends on three core ideas that are rarely clarified: disease, compulsion, and negative consequences. Pickard argues that it is only when the significance of negative consequences is appreciated that the puzzle of addiction comes clearly into view; and she discusses some conceptual and empirical grounds supporting scepticism about the claim that addiction can be accurately characterised as a form of compulsion, and agnosticism about the claim that addiction is a neurobiological disease. Addiction is better characterized as involving drug choices that, while on the surface puzzling, can be explained by recognizing the multiple functions that drugs serve, and by contextualizing drug choices in relation to a host of interacting and individualized factors. Alongside craving or strength of motivation to use, these factors include (1) psychiatric co-morbidity, (2) limited socio-economic opportunities, (3) temporally myopic decision-making, (4) denial and motivated irrationality, and, lastly, (5) a sense of self and social identity. She shall briefly explain the relevance of all five factors, but conclude by focussing on (5) in more detail, exploring the distinctive way that the human drive not only for social reward and belonging but also to know who one is can serve to cement addiction and impede recovery.
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