Philosophy, Psychiatry, & Psychology

Zoey Lavallee (pronouns: they, their) attempts to offer a unified account of addictive craving that explain what craving is across all substance and process addictions. They think that their theory of craving, if true, “bolsters social and psychological views of addiction” and undermines neurobiological theories. My own view is that addictive carvings are a disunified hodgepodge and thus that it is not possible to corral cravings for one addiction type into a unified kind, let alone to do so across addiction types. I also do not think that neurobiological and social and psychological theories of addiction need to be seen as competitors when it comes to the phenomenology of addiction. I’ll explain using Lavallee’s fine article as my foil.

Like Lavallee, I think that a good theory of craving ought to respect the first-person phenomenology of addicts (Flanagan, 2011, 2013a, 2013b, 2018). I’ll use my own experience with alcohol addiction and craving to argue against her “existentially loaded” theory. First, let me lay out Lavallee’s argument, which proceeds in five steps.

1. 1. Addictive craving: An adequate theory of addiction needs to provide an adequate theory of addictive craving; an adequate theory of craving is one that “captures” the phenomenology of craving.

2. 2. The received view: “The received view of craving is a neurobiological account which defines cravings as intense urges that result from the pathological effects of drugs on the dopamine system.”

3. 3. The received view fails to capture the phenomenology of craving: “This account has more or less been taken without debate to capture the phenomenology of addictive craving; in other words, to capture what is going on in the moment when an individual in active addiction or in recovery from addiction feels unable to resist the intense desire to engage in their addiction.”

4. 4. The alternative view of craving captures the phenomenology of craving: Lavallee writes: “I contend that dominant neurobiological views do not pick out the desire that is typically driving behavior in the moment when a person fails to resist a craving.” “The default conception of craving is inadequate; it mis-identifies the content of addictive craving.” The right conception of craving takes seriously the following phenomenological facts:

   When people with addictions describe the intense addictive desire that often overwhelms intentions, resolutions, and attempts to abstain, they commonly describe it as a desire to numb out or dissociate; to feel alive; to feel accepted or connected to others; to be alleviated of mental or physical distress or pain; to feel safe or secure; to not feel anxious or awkward, and so on. They describe psychologically complex experiences as the object of their desire. In other words, when someone experiences a craving, the desired effects of engaging in one’s addiction are not simple immediate effects of being high, but something more existentially loaded.

5. 5. The existentially loaded theory of the content of cravings is the right view. It [End Page 243] accounts for the phenomenology of cravings across substance and process addictions. It succeeds where “the received view” fails. Lavallee says: “what makes addictive cravings uniquely strong is not a matter of how drugs interact with the brain’s reward system, but rather it is the outcome of the particular psychological and emotional content of the cravings experienced by people with addictions” (my bold).

The argument, as I have reconstructed it, is (more-or-less) logically valid. If the premises are true, the conclusion must be true. The key question comes down to whether the premises are true, and thus whether the argument is sound.

Premises #1 is a plausible demand on an adequate theory of addiction, namely, that it ought to have something plausible to say about cravings, which are after all cited in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, as a component of...