Using the Addiction Card
If someone is an addict, does that mean he or she is immune from moral responsibility? From substance addiction to addictive behaviors, many addicts blame others, attributing their addiction problem to a source outside their control. A recent example is the case of Robert Aaron Long, the gunman responsible for the series of shootings at Atlanta-area spas on March 16, 2021, which claimed the lives of eight people. Long, who grew up attending a conservative Southern Baptist church, reportedly blamed his “sex addiction” for his behavior, telling investigators that “he targeted the spas because he wanted to remove a ‘temptation.’” Religion scholars, however, have pointed to survey data indicating a much higher percentage of sex addiction and porn addiction among Christian evangelical men than among non-evangelical men. When the sexual misdeeds and other immoral conduct of some well-known evangelical leaders came to light, they were quick to play the addiction card to avoid blame and moral responsibility. But how persuasive is their addiction card argument?
The Neuroscience of Addiction
The American Society of Addiction Medicine states that “people with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.” In short, addicts have difficulty with self-control. Over the past three decades, scientists have studied the brains of people with drug addictions by using new neuroimaging technologies to understand the neurological basis of addiction. What they have found is clear evidence of changes to “circuits involved in rewards, stress, and self-control.” These changes are neurobiological abnormalities in the neural circuits that shape behavior, and some of them “occur within the neurons that produce dopamine, impairing their function and their ability to send dopamine signals to other regions of the brain” (205). Just like other animals, humans have a reward system in their brains. The system has neurons that release dopamine, a neurotransmitter known for multiple functions, including mediating reward pleasure.
We now know that “our reward and self-control circuits evolved precisely to enable us to discover new, important, healthy rewards, remember them, and pursue them single-mindedly.” Still, substances such as narcotics and activities such as sex can sometimes “hijack” those circuits. A drug of abuse, for example, can do so by interfering with the natural removal process of dopamine from the synapses that have received it, as the excess of dopamine continues to stay in the network. Over time, the dopamine receptors cease to operate as effectively as before, and the brain’s reward system develops drug intolerance — “the reduced reward that individuals obtain from drugs as they take them repeatedly — in addition to the diminished responsiveness to rewards that people experience during withdrawal” (205). Because the brain still associates the pleasurable feeling with the effects of the drug while not getting the same level of the feeling it remembers, an addict must consume a greater amount of the drug to get the same level of pleasurable sensation. The result is that the addicts often are unable to resist taking the drug.
Wanting vs. Liking
In an oft-cited paper by Terry Berridge and Kent Robinson, these researchers argue that the anhedonia hypothesis, also known as the dopamine-pleasure hypothesis, is false. Based on their experiment, they assert that drug addiction has to do with “excessive amplification specifically of psychological “wanting,” especially triggered by cues, without necessarily an amplification of ‘liking.’” The anhedonia hypothesis expresses the widely accepted earlier view that dopamine is the pleasure chemical. It became a standard account of how the brain processes a reward, starting with a significant discovery by James Olds and Peter Milner in another experiment involving a rat’s brain. Berridge and Robinson initially set out to prove the truth of the anhedonia hypothesis, supposing “that depletion of brain dopamine in rats via a neurochemical lesion would reduce “liking” reactions for pleasant tastes, based on the notion that dopamine mediates “liking.” But to their surprise, the rats continued to “like” sugar taste even after depletion of almost all dopamine in their brain, which was confirmed by hedonic orofacial expressions elicited by sweetness.
In subsequent experiments by other researchers, it was found that manipulating the dopamine level did not affect the subjects’ ability to experience and rate pleasure. Further neuroimaging studies seemed to indicate that people’s subjective “wanting” ratings, rather than their “liking” ratings, correlated to changes to dopamine neurotransmission in their brains. So what do they mean by “liking” and “wanting”? “Wanting” refers to “a particular kind of desire – namely, mesolimbic incentive salience,” which “is often triggered in pulses by reward-related cues or by vivid imagery about the reward.” As such, wanting is less related to cognitive goals than to reward cues. By contrast, “liking,” which is “the actual pleasurable impact of reward consumption,” need not correspond to sensitization.
According to Berridge and Robinson, many researchers on the brain’s reward system reach the conclusion that “dopamine mediates desire rather than pleasure.” That is to say, “wanting,” rather than “liking,” is dependent upon dopamine. The implications of this conclusion for drug addiction were profound. Drug addicts do not necessarily “like” the drugs of their abuse when they repeatedly seek the drugs; they simply have a stronger cue-triggered and intense “want” to take drugs. If drugs of abuse (e.g., cocaine, amphetamine, heroin, alcohol, nicotine, etc.) are taken repeatedly at high doses, brain dopamine systems can be sensitized, “altering the shape and number of tiny spines on dendrites of neurons in nucleus accumbens.” The sensitization of the dopamine systems promotes excessive “wanting” disassociated from pleasurable “liking.”
Wanting, Liking, and Valuing
Like other scientific data, neuroscientific findings can lead to different interpretations. Commenting on the paper by Berridge and Robinson, Gideon Yaffe suggests that “addicts act in accord with, rather than in opposition to, their values at the time of action; they do not act akractically” (204). The term “valuing” here does not refer to either “wanting” or “liking.” For instance, a mafia boss might not “want” to or “like” to order killing people, even if he “values” it as the surest way to solidify his position in the criminal underworld. By “valuing,” Yaffe means taking oneself to have reason to do those things that promote something. “Akratically” here signifies “weakly-willed,” that is, “out of weakness of will.” The question is whether what addicts are strongly inclined to do is what they “want” to do, what they “like” to do, and/or what they “value” doing.
On Yaffe’s interpretation, the dopamine level between the time of receiving a cue and the time of receiving a reward “represents the difference between the amount that the subject expects something to be supported by reasons and the amount that it is actually supported by reasons” (201). As noted above, Berridge and Robinson infer from their data that addicts are motivated by an intense feeling of “wanting” rather than a feeling of pleasure (i.e. the experience of liking). But Yaffe thinks that the intense feeling of “wanting,” at the time of action, is an accurate representation of the subject’s “valuing” in that the dopamine signal represents a fact about the past influencing future decisions by setting expectations for the future.
But if Yaffe is correct, the implication is that addicts do not “value” the drug or activity of abuse, at least during the period when they do not expect themselves to have more reason to use it. Should a person’s valuing of something be measured by the difference in the levels of the dopamine signal in one’s brain? For example, imagine a person who is addicted to porn. Although he may be watching porn frequently, he also engages in other daily activities such as performing his job. Does this mean that he values porn only when he is motivated to watch it, or that he values porn less when he is not motivated to watch it? I don’t find Yaffe’s reasoning persuasive. In my view, what an addict really values can be better determined not by measuring changes in the dopamine level but by how the subject responds to the salience of a substance or activity of abuse. That is to say, the determination of a person’s valuing should be made not by observing the changes in their emotional or dispositional gravitation toward, and satisfaction by, certain objects, but by what this person wills to do or not to do in response to this gravitational pull.
Imagine a playboy who habitually sleeps with women other than his wife. Later in his life, however, he finally realizes the hurt he has been inflicting on his wife, who is now in stage four cancer. As a result, he decides to change himself. He is still quite tempted to flirt with other women when there are triggering cues but is deliberately focused on what he ought to do — taking care of his wife. If this kind of scenario is realistically possible, the dopamine signal in one’s brain, which may well represent the difference between what he has expected and the satisfaction he has received, has nothing to do with his “valuing” but simply with his “wanting,” as Berridge and Robinson suspected. By “valuing” something, we “endorse” a particular desire of ours. Thus, when an addict willfully refuses to take proper steps to end his destructive behavior or keeps delaying taking such steps to bring an end to what he feels strongly inclined to do, the addict effectively endorses that to which he is addicted.
However, all of this is not to gainsay that there is a difficult road ahead for an addict’s recovery. As there are various factors of addiction such as personal environment, lack of self-esteem, depression, and medical history that may have played an important role in the formation of the addict’s habits, it would be hard to challenge the power of addiction unless the addict has the courage to confront these factors. The power of addiction is real. We now have neuroimaging evidence of abnormalities in the reward system of addicts’ brains. There is no denial that addiction changes the brain’s communication pathways. But this is only a part, though important, of the story about addiction. The human brain is plastic in that it can adapt and rewire itself. Addicts also possess the power to rebuild and strengthen other neural pathways with practice. More often than not, addicts remain the same because they continue to value the “wrong” object or value an object in an “inordinate” manner without serious and disciplined efforts to change the course. Such addicts would be to blame for the harm they cause to others and themselves not so much because they fell into the temptation of a pleasure-promising substance or activity but because they would continually value what they should know is a problem. If this is right, one cannot play a victim if he is also the accomplice. ♦
Kevin Jung is Professor of Theological Ethics and Moral Philosophy and the Associate Dean of Academic Affairs at the Wake Forest University School of Divinity. He also serves on the faculty of the Master of Arts in Bioethics Program where he teaches neuroethics.
Jung, Kevin. “Using the Addiction Card.” Canopy Forum, July 19, 2021. https://canopyforum.org/2021/07/19/using-the-addiction-card/