What actually constitutes addiction in your view?

So I like to start by thinking not about addiction, but about drug use because I think one of the things that's gone wrong in our understanding of addiction is a failure to recognize how prevalent and ordinary and intelligible drug use is today and indeed across human history, so a substance we ingest that has a psychoactive effect and that can be used for medical, religious, personal, or cultural reasons: nicotine, caffeine, alcohol.

So it's an expansive notion of drug.

And they do things for us that it's perfectly natural to want: experiences of pleasure, euphoria, transcendence, but also heightened cognitive awareness.

In some contexts, heightened spirituality, relief from all sorts of negative feelings like anxiety, boredom, loneliness, anger, rage, despair.

And so drugs just serve this panoply of functions that we use them for all the time in our lives without very much ill happening to us in the majority of cases.

And I want us to start there because I think it brings to the fore something really important and indeed distinctive about addiction, which is that addiction is a form of drug use where that kind of basic intelligibility, that psychological sense we can make of why we and others use drugs has been lost.

Moving on to recovery rooms, the concept of addiction as a disease is certainly built in.

[laughs]

Yeah, it's the source of the book title.

So the book title, um, is a shout-out to a seminal study in the history of animal models conducted by Michael Bozarth and Roy Wise in nineteen eighty-five, where 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 an anorectic, they stopped eating and drinking, and within a month, ninety percent of them had died.

And I guess I, I think of that image of a rat in a cage pressing a lever for cocaine to the point of death as a, a, 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.

Um, what do you mean by these ideas, and how would they apply to new behavioral understandings of addiction?