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Hanna Pickard, "What Would You Do Alone in a Cage with Nothing But Cocaine?: A Philosophy of Addiction" (Princeton UP, 2026)
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- [00:01]
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welcome to the New Books Network. Hi and welcome to New Books Network. I'm your host, Emily Dufton, and today I'm talking to Dr. Hannah Pickard, author of the new book what would you do alone in a cage with nothing but A Philosophy of Addiction? Which was just released last month by Princeton University Press. Hannah is the Bloomberg Distinguished professor of Philosophy and Bioethics and Krieger Eisenhower professor at Johns Hopkins University, where she's jointly appointed in the William H. Miller III Department of Philosophy and the Berman Institute of Bioethics and secondarily appointed in the Department of Psychological and Brain Sciences. She completed her undergraduate work at Queen's University in Ontario, Canada, and graduate work in philosophy at the University of Oxford, and she also worked for a decade in the British medical system as an assistant team therapist at the Oxford Complex Needs Service, a National Health Service specialist service for people with personality disorders and complex needs. All of these experiences inform what would you do alone in a cage with nothing but cocaine? Which is clearly a provocative title and frankly a lot of fun to say. And the ideas in Hannah's book are no less intriguing. Her analysis calls for a new paradigm for addiction, one which draws not only from the concepts of morality, criminality and neuroscience that have long defined the field, but also from things like philosophy, psychology, science, ethics, clinical materials, memoirs, and more. The result is a deeply researched and highly nuanced approach to the ancient question of why people use drugs in destructive ways. Her conclusions are radical, as she admits herself, but but also humane, with an emphasis on imagining a new kind of treatment system that results in the increase of a person's own good, and I'm so excited to talk to her today. Welcome to the show, Hannah.
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C
Thanks so much for having me, Emily.
- [02:36]
B
So I found that people who write about drugs generally have a really interesting backstory for why they've given their careers to this particular topic. What would you do is your first book, and I'd like to know where it came from. What inspired you to take on explicating a new philosophical, philosophical and scientific paradigm for addiction as your first book? That's no small that's no small task.
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C
So for me, although like many people, of course, there have been people in my life who've struggled with addiction in ways. I think this really important sort of inspirational and motivational moment came from my early days of clinical work where I. I was very naive and not yet at all sure footed about how to relate to people or help them. But I, of course, brought into the clinic a whole bunch of cultural assumptions that we all share. And in relation to addiction in particular, that was that it was a brain disease, right? That was the fundamental explanation of what was wrong with people with addiction. And in those early clinical days, I saw that some of the ways we helped and treated patients with addiction simply made no sense if addiction was a brain disease, that people changed by undertaking to do things differently to the group, sometimes writing a behavioral contract, which they signed and we signed and they took with them and sort of kept in their pocket because of the way it symbolized the group and the group support and that kind of sort of undertaking, plus support from the group as a mechanism for recovery, just makes no sense if addiction is a brain disease. So I was really struck, I guess, by the dissonance between what I was just observing as a naive and novice clinician and all of these background cultural assumptions I had going into the clinic. And for me, that was really sort of an inspiring moment where I kind of wanted to understand what was going on, right? Because I am as well as someone with a little bit of clinical experience, a philosopher. And I guess I have this really deep faith that we're better equipped to manage the world when we understand it correctly. So I was really driven to sort of understand what was happening when people were addicted to drugs correctly and dispel those assumptions, right?
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B
So you take this decade of experience on the ground working with people with, as we said before, very complicated series of issues, and you combine it with some really deep research, not only in the fields of neuroscience, which have long dominated the studies of addiction, but from like an absolute ton of sources. So two questions. One, why was a philosopher in a clinic to begin with? And second, what then prompted you to transform both your personal experience with this really wide ranging realm of research from like memoirs to, you know, behavioral studies, to everything else that you bring into to feed the book.
- [05:55]
C
So I guess I found myself in a clinic because although I am a philosopher by training, and in some sense philosophy is my first love and my anchor, I had always felt slightly uneasy just in that kind of abstract ivory tower. And I always was more interested in the Kinds of philosophy that to do seriously, you needed to kind of connect to the real world in deep and kind of honest ways. So practical ethics, philosophy of mind, philosophy of psychiatry. And so I kind of, at one point, just decided that, well, to make that connection deep and real, I had to be in that world. I had to get some clinical experience. And, you know, lest your listeners feel concerned that a philosopher was allowed to have contact with patients without very much training, Let me say immediately that one of the things about the service that I was working within Is that it was all group work. And group work is a really wonderful way to learn about clinical contexts and clinical treatment. Because as a naive or novice person in a group, there's always somebody who's more senior, who's in charge of the group and who's guiding it and holds responsibility. So it's a really wonderful place to learn as a novice clinician. But it's also a mechanism for treatment that I think is incredibly powerful and wonderful. And needs to be harnessed and used much more than it typically is. So that's how, sort of, as a philosopher, I ended up in this unusual situation of spending half my week doing research and half my week working clinically for a while. Yeah. And I guess, you know, that sense of wanting to reach from philosophy to the world Is also part of the explanation of both why addiction really captured my own intellectual interests, but also was the right kind of topic, maybe, for me to take on. Because I think it really is a topic which we simply cannot understand from one perspective or disciplinary lens. The breadth of sources and modalities for studying and thinking about addiction that I draw in the book really feels to me essential to have any real and deep understanding of it. So it was kind of a. Not only a problem that my patients, the members of our groups, sometimes struggled with, but also a problem that really felt sort of deeply puzzling, but also necessary to approach in this interdisciplinary way that I just liked. I like thinking outside of the box in that sort of way.
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B
Right, right. That's such an important idea, and it's one that you return to over and over throughout this book, that it is very problematic and ultimately destructive to continue addiction through one disciplinary lens and describe it as one thing. When you say it's so heterogeneous, we'll. We'll come to that actual, real word, that specific word. You use it. But before we do, when you take this sort of heterodox view of addiction, not only are you drawing on a wide variety of other sources, but you also have A lot of really interesting design elements that I thought was just really fun. Throughout the book, there are these pictures of rats. Quite often through it, there were graphs that there was a map, a literal map of how to navigate the concepts in your book. This almost like JRR Tolkien esque map with, I think it was science, psychology, philosophy, ethics and clinical material where they overlap, but also with mountains and roads. And I almost like, if you looked closely, there was someone on a tiny bicycle. It was just adorable. Or maybe I saw that just myself. But I'd love to hear about where these design concepts came from and why you chose to add these elements.
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C
I mean, I'm so glad you liked the map and those quirky elements of the book, which are certainly unusual in an academic or philosophical text. I mean, I guess the map in particular really came from thinking as best I could about how to make the book more accessible to readers. I mean, I really believe that we can't understand addiction unless we approach it from this really broad range of disciplines. And I myself have had to learn a great deal about disciplines that are not where my original training lies. And in writing the book and trying to make them accessible and integrate them together, I was just so aware that I've had years of study and people will have a few hours or a few days in which to read the book. So I wanted to do everything I could to kind of orient the reader and help them see the connections, but also make it possible for them to decide, say, that they didn't want to visit one of the locations on the map and could navigate their way around it and yet sort of get a sense of the book as a whole. So, you know, the map is one of the mechanisms to help the reader orient themselves and think about which bits they might like to read more and which bits they might like to read less. And there are sort of touch points throughout the book where I try to summarize what the last section contained and what's coming next. So if you didn't get on well with the last section, you could at least read that summary and then move on to something you like more. So there are a number of sort of stopping points in the book to help people do that. And I guess the illustrations in the book were done by a neuroscientist who's both a friend and someone who I collaborate with, Marco Venero. And he's a wonderful artist. So huge shout out to Marco for being willing to illustrate the book in this way. But I guess I asked him to do that partially because the book itself draws on poetry and literature. I mean, I wish it drew on art, apart from Marco's as well, as well as all of these different academic disciplines and interpersonal ethics and clinical contexts to try to understand addiction. And somehow the idea that there were visual representations which kind of, in some sense, like, showed that breadth of sources felt really like a lovely way of. Again, like representing the kind of interdisciplinary methodology of the book in a way that was intuitive and fun and just made it a bit more approachable. So I'm really delighted you like it. For me, it was. One of the nicest things about the book was to get those illustrations in.
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B
Oh, that's fantastic. That's great. Thanks so much for sharing that. So the design illustrates the complexity of addiction. Your whole book argues about the complexity of addiction. And you ultimately argue that the way we have been thinking about the complexity of addiction is not complex at all. You argue in one of the most forceful statements in your book that, quote, the currently dominant scientific paradigm is broken. It is time for heresy. And I think those are two really important concepts. The currently dominant scientific paradigm and also the heresy. So first, can you tell me what the currently dominant scientific paradigm is about the thinking of addiction today?
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C
Of course. And this was the paradigm, Right, that I myself had in my head in those early clinical days that we were talking about earlier. Right. It's, I think, the paradigm many of us in contemporary society kind of take for granted, Even if we haven't thought about it deeply very much. So I take the currently dominant paradigm to be the idea that addiction is a chronic, relapsing, neurobiological disease characterized by compulsive drug use. And if we just unpack that a little bit, There are a couple of really important ideas in it. One is that addiction is a neurobiological disease. So we have here a. An identification of addiction with, in effect, brain pathology. So we have addiction if and only if we have brain pathology. That pathology is the cause of drug use in addiction. Right. So it's what causes and explains drug use in addiction. And the nature of drug use in addiction is compulsive. So there are sort of three independent bits. So there are three independent bits of the currently dominant model. The idea of brain pathology, the idea of it being the cause of drug use, and the idea of drug use being compulsive, all of which, I think are deeply questionable, if not outright falsified by evidence we have. So that's the model that the book really interrogates and tries to supplant Right.
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B
And you do a really nice job of showing where this paradigm came from. You talk a lot about animal research, specifically rat testing. I was wondering if you could talk a little bit about that, because I do believe that might be the source of your book title, if I'm not incorrect.
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C
Yeah, it's the source of the book title. So the book title is a shout out to a seminal study in the history of animal models conducted by Michael Bozarth and Roy Wise in 1985, where Roy rats really were kept alone in a cage with nothing but a lever which they could press for cocaine and food and water. And I think nobody will be surprised that in that context, what happened was that the rats pressed the lever for a lot of cocaine. And because cocaine's anorectic, they stopped eating and drinking. And within a month, 90% of them had died. And I guess I think of that image of a rat in a cage pressing a lever for cocaine to the point of death as a really elegant illustration of the brain disease model that we were just talking about. Because if you ask, well, what would make an animal take cocaine to the point of death, forgoing natural rewards essential for survival, it's really intuitive that the hypothesis that it's the power of drugs to hijack the brain and compel use is what explains that rat's behavior. So early studies of animals really looked like they supported a brain disease model of addiction. But the irony is that animal models have moved on, and yet we are still stuck with the brain disease models. So in the book I Tell the History, which involves subsequent studies, first by Serge Ahmed, who was working in George Koob's lab at the time, and later by Marco Veniro, the illustrator of my book, who, in the early days of the studies he was running, was working in Yavin Shahom's lab. And really what these scientists did was something so simple and so intuitive that it's kind of amazing once you see it, that we interpreted the first study the way they did it all. They introduced a second lever into the experimental chamber to offer the rats a choice between cocaine or whatever drug they were working with and an alternative reward. And in the early studies, the alternative was saccharin water. And then in the later studies, Marco started using social reward. So the extraordinary finding across these studies is that when you offer rats, even those who show every indication of addiction, an alternative to drugs, they take it. Right. So 90% of the rats took saccharin water, and an extraordinary 100% take the social reward over the drug. So the title Is really a shout out to that early study. But also, I kind of chose it because it sort of alludes to the history in the following sense, if you think seriously about what you would do alone in a cage with nothing but cocaine. For many of us, if we're honest, the answer is we would take a lot of cocaine. But that's not because we're thinking that drugs have hijacked our brain. It's because we imagine the psychological impact of living in isolation and emptiness and the suffering that that would induce in us, and the way in which cocaine is the only thing that brings relief. And in some sense, I think, that alternative hypothesis that we can generate from our own imagination here, right. The idea that what might make the difference in addiction Is not a brain that's hijacked by drugs, but the environmental poverty in which sometimes animals or people live and the psychological impact of that environment, plus the fact that drugs offer relief, Is one of the really important, Certain alternative hypotheses to explain addiction that I consider in the book. So in some sense, the title tries to wrap all of this together, right? The need to be more imaginative, more humanistic, More thoughtful about psychology, more thoughtful about environmental context when thinking about addiction.
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B
Oh, and I think it succeeds. I think it's a great title. But as you say, animal research moved on. We understand more about animal research, and yet the brain disease paradigm stayed on. It stayed strong. Why is there such social and academic adherence to this model? What. What did it offer? Why do people love it so much?
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C
That's a great question. I think that probably the explanations Are slightly different in different contexts. So one of the things that I do think it's important to recognize when thinking about addiction research Is that there is a difference between addiction neuroscience and the social sciences in humanities. So I don't think of this model as so dominant in the social sciences and humanities. It's much more dominant in addiction neuroscience. And I think it's really important always to think about scientific endeavors Within a sociological and economic context. So, you know, one of the things about the brain disease model Is that if it's true, it really justifies spending money on neuroscience research in particular. And I think that kind of capture of funding Is an important reason why neuroscientists might cleave to the model, and another may just be that they've sort of built their labs and legacies within it, and so there's a real cost to giving it up. Right. And so it has a kind of neuroscientific capture because of the value it's had for that particular discipline. I think the reasons, when we think about sort of social and interpersonal and maybe policy contexts are quite different. So one of the things about the brain disease model is that it has really positioned itself as the only alternative and the antidote to a moral model of addiction. And I think fear that without it, we're just stuck with the moral model of addiction can be a really strong motivating factor for all of us who care about trying to treat people with addiction. Right. And certainly much better than the moral model would lead people to. So I think that has meant that people have been sort of inclined to really like, cling on out of fear to the brain disease model. But of course, I think that dichotomy is false. And in some sense the whole point of the book is to point out that there's an alternative. We're not stuck between either the brain disease model or the moral model. We can be more complex and also, I think, more true to the phenomenon in our thinking.
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B
So the second part of your forceful statement is that it's time for heresy away from this currently dominant scientific paradigm. And you just explained all the reasons why you think it's broken. So what do you mean by heresy and what does that mean in terms of addiction?
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C
Well, I guess I have experienced my own questions and interrogations and ultimately rejection of elements of the brain disease model as being treated as if I'm a bit of a heretic. Right. Like people feel deeply uncomfortable. So in some sense, that experience of trying to get people to think a bit outside of the box and the difficulty I've had doing that is no doubt the source of my choice of the word. But in some sense, I feel like the model I put forward in the book, it is complicated, it does kind of embrace a lot of gray. But there's something very, very intuitive about it. So let me just tell you what this so called heretical model consists in. It's really to refocus our attention, at least in the first instance, away from the brain and onto the fact that addiction involves drug use, namely a kind of behavior. And drug use is a kind of behavior which occurs outside of addiction.
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Right.
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C
It's really important that we recognize that alcohol is a drug, nicotine is a drug, caffeine is a drug just as much as amphetamines or opioids or Kratom or marijuana are. These are all drugs. And many of us use them without ever getting anywhere close to addiction. So drug use is a really ordinary part of human behavior. And the way I think of addiction in the book is that it's drug use that has gone wrong. So it's a kind of behavior where rather than being psychologically intelligible, because like many things we do, it brings us benefits. All of a sudden, it seems like the costs of drug use have really tipped the balance. And yet somebody persists. So it's drug use, which lacks a kind of basic psychological intelligibility and has gone wrong in the sense that. That it's persisting even though it looks like it's no longer good for a person. So in some sense, I would like to think that this notion that addiction is drug use gone wrong, a kind of behavior we're familiar with in some sense, but all of a sudden has become puzzling, is very intuitive. And if we refocus the idea of addiction onto the idea of drug use as a behavior and away from the idea of brain pathology, part of what's really important is that all sorts of different kinds of explanat explanations can emerge. And I don't reject the idea that brain pathology might be one kind of explanation in some instances. I reject the idea that it's only. I reject the idea that it's ever only the one explanation that. Right. That somehow, like really all we need to do is attend to the brain in the way it may or may not be dysfunctioning. Because I think that when we start to look at other areas of research and listen to what people with addiction themselves say about their relationship with drugs, this sort of panoply of variety and heterogeneity opens up. And it's so important, because it's only if we recognize those differences between people that we're in a position to help everyone as best we can.
- [26:13]
B
Right, right. That word. There's that word again. Heterogeneity. And it comes up over and over in your book. You say that your work is guided by two driving concep, humanism and heterogeneity. What do you mean by these ideas? And how would they apply to new behavioral understandings of addiction?
- [26:32]
C
Yeah, so by humanism, I really mean that we want to start by understanding another person and their behavior, including a person with addiction, by appeal to their psychology. Right. Their. Their mental states, their beliefs, their desires, their emotions, their moods, their intentions, their needs. Right. That's how we, all of us, understand, fundamentally, ourselves and each other in the first instance. And I think that the focus on neuroscience has really sidelined psychology as a fundamental way of explaining drug use in addiction and understanding what's going on with another person. So that deeply humanistic idea that we are people together and we relate to each other fundamentally through psychological understanding is something I'm really trying to recenter in our understanding and relationship with people with addiction in the book. So that's what humanism is. It's connected to heterogeneity in the following way. People are different, right? We're different. And behavior that on the surface looks similar, we know, can be explained in very different ways in very different people when we attend to their psychology. So the refocus away from neuroscience onto psychology also opens up the way in which the differences in psychologies between different people with addiction all of a sudden come into view. And so just to kind of list the things that I consider in the book so that it's kind of between us and available to your listeners. I think about self medication and the use of drugs to cope with suffering, Especially in context of adversity, where there are other mental health conditions potentially and very limited socioeconomic opportunities connected to that. I think about how people with addiction can develop almost an attachment relationship to drugs. There are also some people who I think use drugs out of a desire to self harm or to die. And I think this is something we're extremely bad at looking in the face and speaking plainly and honestly about because it's so difficult for us to think about the human drive towards self harm and towards suicide and to feel comfortable naming that and knowing what to do with it. I think self identity can be part of what people. I think self identity can be part of what keeps people stuck in addiction. Sometimes their relationship to drugs and to other users in their community is really wrapped up in their identity. And there's a sense of not knowing who they would be or how they would live or who their social network would be without drugs. And that commitment to keep using denial is incredibly important as well. This is something we talk about all the time in ordinary folks psychological lore, but it's been really under theorized by addiction science. So people are often in denial that their drug use carries costs. And that means that they sort of fail to see the reason to stop using. There's a tremendous amount of human irrationality in ways in which all of us have biases in our thinking which incline us to do things like fail to act in our long term interests or fail to think that we really ought to reckon with whatever's going wrong in our lives today and put that off until tomorrow. So I think there's sort of a range of ordinary human cognitive biases can really explain why some people keep using drugs and addiction. And finally there's the complexity and variety of craving and how that can make it so painful and difficult for people to give up using. So I sort of, you know, I talk about all of this complexity in the book, which I think we've really not paid proper justice to in our thinking about addiction, but just to sort of point a few things out that are, I think, quite helpful to see. Some of these explanations can work in tandem, but some can't. So if you're self identifying as an addict, you're not in denial. So those two explanations kind of push in opposite directions. But if you're a person who is using drugs to self medicate, you might also be self identifying as an addict. Right. Those two explanations can work in tandem. So there's a lot of complexity, and we just need to get better at recognizing it, thinking about it, and using it to help us tailor treatment to the individual. Right.
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B
This is why you need a map.
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C
That's right, yes.
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B
So if you're suggesting that addiction is a pattern of behavior rather than just a brain disease, it's not a broken brain, as so many people have said, it's more a matter of behavior. But that also suggests that a person can then take a more active role in their recovery because they're not suffering from a chronic brain disease, or perhaps even that brain disease could be changed. But you explore the concept of responsibility at length, and I'd love it if you could talk more about that.
- [32:11]
C
Yeah. So, I mean, I guess in ways this connects to what we were talking about earlier in relation to the moral model and how people have cleaved to the brain disease model out of fear of the moral model. Because the thought is that if addiction isn't a brain disease, it's just ordinary behavior, then people are doing something wrong and they're to blame, they're responsible and to blame. And so we, we end up in this quite sort of punitive, stigmatizing place. So I actually think the first thing to say that's really important before talking about responsibility is that I think that we need to be honest that there's nothing intrinsically, morally wrong about using drugs. Right. So if we go back to that idea I started with, that drug use is an ordinary element of human behavior, many of us use drugs. There's nothing intrinsically, morally wrong when we do so. Now, of course, there are contexts where it's morally wrong. It's morally wrong to drink and drive, it's morally wrong to use drugs. In ways that compromise your capacity, say, to look after your children. So there's obviously nuance here, but that kind of knee jerk moralism is the first thing that we need to start interrogating before we start talking about agency and responsibility. Okay, so that piece on the table, let's now think a little bit about agency and responsibilities. So I guess one of the things that felt to me so important when I was working clinically was the way in which when people's problems stem from their behavior, right? When people have problems with drugs, it's because they're using drugs that they have those problems, right? That's what you need to address us to help them. We have whatever is going on in the brain in at least some cases of addiction, we have no way of fixing it. The way we help people is to get them to do things differently, to change their relationship with drugs, to stop using or to use less. And the power of, say, those contracts, those behavioral contracts made with the group support to affect that change was really incredible for me when I first started working clinically. So we really need to be able to address people's agency and support them to do things differently when their actions are the source of the problem for them in their life. So that's where I start from.
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B
Right?
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C
And what was so interesting in the clinic, I suppose, is the way that responsibility was a really effective tool for doing that because and only when it was divorced from blame. So within the clinic, there's this way of engaging people about their agency that I have labeled responsibility without blame.
- [35:19]
B
I love this phrase. I think it's really great.
- [35:21]
C
Well, in our society, we so naturally and almost like unthinkingly run these two ideas together, right? As if the whole point of responsibility is to give us an entitlement to blame and be punitive and hostile towards someone. But. But in the clinical context where I was working, practices of holding responsible, of asking people to explain their behavior, of asking people to be accountable to the group for changing their behavior, all of this was done not with sort of the idea that we were going to be blaming or be punishing and sort of hostile, but out of care and concern and fundamentally with respect, right? All of this was done because we cared about the person, we wanted things to go better for them, and we wanted to have a real relationship with them. So for me, it really showed me that this sort of idea I'd had about responsibility is inexorably linked to blame that I think is very pervasive in our culture was just a mistake that if it was unhooked from blame. Responsibility could be this really powerful tool for change, right, to make a person's life better, not worse. And so the book really articulates that idea of responsibility and how it can be kept separate from blame in order to try to help us think about how outside of the clinic, but in our ordinary lives and our relationships with people who might struggle with drugs, there's this possibility, which is not to think it's a brain disease over which they have absolutely no power or control, or to think that they're responsible for doing something that's morally wrong and hence ought to be blamed and punished for doing so, but to kind of find this middle ground where we acknowledge there's some agency, but want to use that acknowledgement to help them make changes rather than to license us to be hostile and blaming. So I spent a lot of time really trying to explicate that idea and I guess, to some extent, model it. Right.
- [37:36]
B
That idea, that concept of agency of behavior, also seems to open up new potential avenues for treatment. You suggest that we should allow drug users to decide their own understanding and evaluation of their drug use. And. And you argue that for more effective treatment programs, we should place their voice at the heart of their diagnosis. Do you feel like that's common right now in treating addiction? And why do you think that would make. Why do you think that would make an impact or a beneficial effect?
- [38:10]
C
I don't think it's common. I do think it's present in good clinical care. So I don't want to pretend that something about that idea isn't recognized by clinicians and groups that are working really actively with people with addiction. But I think there are, nonetheless, places in our understanding, in clinical context and scientific research, where it's absolutely missing and much to the detriment of our understanding of addiction and our ability to help people. So, first and foremost, let me say that if you want to understand why somebody is doing something, you need to start by talking to them and asking them about it. And if you want to understand whether drug use is or isn't good for someone, you need to start by talking to them and asking them about how they think about it and what they feel drugs are or aren't doing in their lives. So that sort of recognition of a person's own ability to explain their behavior and reflect on how they feel and think about some aspect of their lives is really fundamental to a humanistic orientation to drug users, just the way it's fundamental to a humanistic orientation to each other. Right? It's what it is to treat each other as people who have their own inner lives and are worthy of our respect and whose testimony matters. So I believe that's true across the board. There are complications in addiction, and that can have to do with the way in which people can be, on the one hand in denial or on the other hand, scared to speak openly and honestly. Honestly out of fear that they will be judged and stigmatized. So although we have to start with what people say, I don't think what people say is the end of the matter because there's complexity and what people say doesn't always reflect the inner truth for them. That doesn't mean we don't start there. It just means we need to be mindful of that and we may not end there. And the reason it matters is that whether somebody, drug use really is a problem in some sense ultimately depends on what they want for their lives. Right. And we need to take into account their own understanding of what is and isn't good for them if we're going to understand whether or not drug use is good for them. Right. So the book is very, very philosophical about, on the one hand, maintaining the idea that what's good or not for someone has a kind of objectivity, but on the other, recognizing that for creatures, us self conscious, self reflective creatures with our own idea of what the good life consists in, we need nonetheless to think of our own understanding as partly determinative of the objective good for an individual person. So it really tries to kind of walk that line between objectivity and subjectivity. So that's part of it. But it's also because if we listen to people and we start to understand why they're using drugs from their perspective, we're often much better able to tailor treatment to them. Right. So individually tailored care is just generally understood as good practice in medicine. And I think there's something about addiction where that basic premise of good care has not yet caught up. So we need to be listening to people and attending to what they say and what's true for them in order to give the best kind of care. So there's sort of just a plethora of reasons why a person's own voice is something that's so important to be listening to when we're interested in understanding addiction and thinking about how to help.
- [42:03]
B
Right, right. So who are your intended readers with this book and what would sort of the ideal outcome of its wide distribution be?
- [42:16]
C
Well, I suppose I wrote the book with the hope that it would appeal not only to Philosophers and anyone who does research in addiction, no matter their disciplinary orientation, but also be at least in part readable by interested members of the general public. The book has some hard bits, so you do have to put in some work, but I nonetheless tried to make it as readable and accessible as possible, while not skimping on the need to be serious about assessment of argument and evidence, and of course, to some extent, policymakers too. But lastly, and in ways for me, most importantly, people with addiction themselves. So I think many people with addiction don't tend to feel particularly seen by the brain disease model. And one of the things in my life that's been most meaningful is when people who struggle with problems come up to me and say how much they appreciated some dimension of my work or the book because it spoke to something that's been true for them, that's not really been given public recognition or voice so very much for me, people with addiction themselves are part of the intended audience for the book.
- [43:36]
B
That's great. Well, I really want to thank you for writing it. I really enjoyed what would you do alone in a cage with nothing but cocaine. And as you say in your book, you know, the time has come for heresy. And I think this book will do a lot for advancing that heretical conversation. This is incredibly well researched and deep dive on the complexities of addiction and I think you've added so much to the conversation with it. So I'd like to end our conversation with the same question we ask everyone, which is what are you working on now and what can we expect to talk about with you next?
- [44:12]
C
Oh, well, thank you so much for having me, Emily, and I certainly. I hope you're right. It changes the conversation a little bit. That is why I wrote the book, because I feel like there are so many misconceptions about addiction and it's so important to correct them, to try to shift the conversation and ultimately help people. But in future, the conversations that I hope you can have with me will come out of two other books I'm working on. So one is about Responsibility Without Blame, which we talked about a little bit, but in conjunction with the criminal justice system. And that book is co authored with my friend and longstanding collaborator, Professor Nicola Lacey, who's a philosopher of law and criminal justice theorist at the lse. And the other book is on how to live as an atheist. So an extremely different topic, but nonetheless something I'm very excited to write about.
- [45:08]
B
Wonderful. Well, I'm sad you're stepping briefly away from drugs, but hopefully we'll welcome you back soon. And I can't wait to talk about these other exciting topics with you when you come back to New Books Network. Thank you so much again for coming here.
- [45:21]
C
Thanks again for having me.