Discourse with Owen Flanagan: Part 1
T. Virgil Murthy and Owen Flanagan talk about addiction and philosophy.
Earlier this month I held the following conversation—the first of a series of these I hope to do on this blog1—with Owen Flanagan.
Owen Flanagan is the James B. Duke University Professor Emeritus of Philosophy, and also an emeritus professor of neurobiology, at Duke. He’s written celebrated work in consciousness, philosophy of (moral) psychology, neuroscience, ethical theory, and more. (In particular, he penned my very favorite response of all time to the Mary’s room thought experiment.) Among his works are fan favorites Consciousness Reconsidered and The Problem of the Soul, as well as the recent books The Geography of Morals and How to Do Things with Emotions: Anger and Shame across Cultures. Currently, he’s working on the forthcoming book What Is It Like to Be an Addict? Integrating the Subjective and Objective Perspectives on Substance Abuse. It will be published by Oxford University Press in 2024.
As a young addict philosopher, looking for illustrious shoulders on which to stand, I thought Owen would be an excellent inaugural addict to converse with for this series. The interview will be divided into two parts. Part 1 is below; Part 2 is here.
Content warning: discussion of alcohol and drug use.
In this first part, we talk about being addicts in the academy; the pluralism of addiction; the addict identity; distinctions between addicts and heavy users; and more!
Addicts in the academy
TVM: Hi, Owen, and thanks for participating in this interview series today! Let’s start with the following question: “What is it like to be an addict philosopher?” What are our experiences, as addict academic researchers?
OF: Good question. So when I first realized I was an addict I was an assistant professor, already starting my career. That’s kind of when it hit me. One thing I learned was this: if you have a good job that doesn’t require a lot of contact hours, then there are workarounds for being an active addict. If I only had to teach two courses a semester, and do my own research when I was ready, willing, and able, then my life was very private in a way that was conducive to using. Professors have a kind of impunity in certain ways because of the nature of our jobs. We’re not around colleagues 9-to-5 necessarily, or on the late shift doing physical labor. So that was one thing it was like.
Another thing is that I was ashamed in a lot of ways about my addiction—I just didn’t want people to know. I was good at finding people who liked to use like I did, and there were always some of them. I was living in Boston in those years, Virgil, and there were famous philosophers in that area, whom of course I won’t name, who were well-known for being falling-down drunks. I would hear stories about them, and I’d think: Well, I’m not quite like them. It probably helped a certain amount with rationalization and denial. It cultivated the hope that I could be a “functional alcoholic.” I hid it from people I knew, at APA meetings and things like that. There was so much drinking, and you could always find people to drink like you did, afterward, even if they weren’t alcoholics. That was my experience; what’s yours?
TVM: So, you raise two points here that I find quite interesting and consonant with my experience. I was in undergrad during active use, for the most part—although the pandemic, of course, was not super conducive to maintaining remission. I definitely was both benefited and harmed in different respects by the ways in which academic work is a strange kind of labor, as you describe. There are times and places at which you don’t have to be anywhere or doing anything; there’s work-hour flexibility. Actually, I think the very regimented schedule of elementary and high school kept me from finding out that I was an alcoholic. College was entirely different and had these long abscesses of free time. I could disappear off during those times.
In terms of being able to find people drinking or using like us—my experience converges very closely with that. I have this uncanny and empirically well-established ability, or behavior maybe, of the following kind. First I would make friends with a group of people to drink with. Then it would quickly become obvious to them that I shouldn’t be drinking, and they would begin to enforce norms against my drinking. At which point I would go make more friends who didn’t know yet.
OF: Until there’s only a small group of people—for me, they weren’t even people affiliated with the university, but people I could hang out with in bars in the wee hours of the morning.
TVM: Oh, absolutely. I did a great job of inadvertently publicizing through a bullhorn that I shouldn’t be drinking, to broader and broader swaths of the population that I had carved out for the purpose of drinking with. And I think in certain ways, academic culture is very conducive to that. One of the things that always puts me on guard is when I’m traveling—for a conference or a talk or visit—and I don’t know anybody in that city. My various unsuccessful attempts to stop drinking relied on other people’s enforcement of norms about it. But then when I took a plane to a different city and nobody there knew, they’d invite me to a bar…there was a golden opportunity there. So nowadays a big part of my maintenance system is that I have announced to the whole world that I am an alcoholic.
On the topic of the different sensibilities (within addict communities) around addicts’ relationship to active use, “recovery,” “sobriety,” what have you: I feel very strongly that I am one of these people for whom—well—there’s no such thing as “drinking in moderation” for me. I know that isn’t the relationship that everybody has. For me it’s what the empirical evidence indicates. I know some people suggest it’s the irresponsibility of youth, et cetera, that people grow up and “use responsibly.” And I’m sure that’s true for many! But I ran all sorts of absurd controlled experiments, and, like, no, it’s not in the cards for me.
OF: I’m the same way. I tried a million different times. I used to think I had a “dosing problem.” The problem was navigating between five of this, that, or the other thing and fifteen of them. Five was too few, fifteen was too many. But I thought there must be some perfect recipe. I had to smash that astounding illusion.
The pluralism and multiple realizability of addiction
OF: On this point we should move over to talking about the pluralism of addiction more generally.
TVM: Right. So, for the benefit of the audience, I should point out that in your work you’ve emphasized the pluralism and disunity of addict experience, especially as a caveat against neuroscientific accounts of addiction based in unified theories of single generating mechanisms. You’ve also discussed the role of addict memoirs and self-reports, and concepts devised by addict communities, in relation to our understanding of addiction.
OF: For the past twenty years or so since I’ve started to really pay attention to the empirical work on addiction, I’ve learned that some people tend to develop a whole theory based on partial evidence. So, as you know, there’s the one theory that addiction is a choice. Evidence toward this theory includes that even the most extreme alcoholics or heroin addicts don’t just grab the drug in front of the police, for example. They wait until they get home to start drinking and using. Well, that’s true, but it doesn’t follow that there’s control.
TVM: Oh, I agree. You’ve read my papers on this—I think there are a lot of questionable suppressed premises that are necessary when using that as evidence toward the choice theory.
OF: Here are some of the ways in which I think addiction is not a unified phenomenon (which is usually the way I like to say it).
So first off, I have some views about process addictions, but I’m not a process addict, so I separate out substance addictions. One can make a kind out of them because they involve substances rather than processes like gambling or sex. I start with the idea that what unifies substance addictions, first pass, is that they involve, literally, substances. Something you can ingest, snort, drink, et cetera. So, what unifies them? Well, as you know, for about twenty years everyone was on board with this “mid-brain mutiny” hypothesis involving the dopamine system. On that view, what happens to people with certain bodies is that the dopamine neurotransmitters go berserk; pretty soon, they take over and physical dependence occurs. But from what I’ve done, looking at the neuroscience side of it, that’s just not true. Different substances interact differently with the brain. First of all, they get metabolized through different sites in the body. Even, say, snorting cocaine doesn’t go directly to your brain. It gets into tissue, gets absorbed, it has to go through the blood-brain barrier. Then, obviously, alcohol gets absorbed through the digestive system. Second, it’s not true that all these substances confer direct hits to the dopamine system. They just don’t. So now, on the current science, there look to be about 18 different sites in the brain involved in addiction, and over a hundred different neurotransmitters. There’s multiple brain realizability of addiction! Opioids hit one set of receptors; cocaine hits a different set; alcohol, another—so, they’re not unified in the brain.
TVM: So even the hijacking hypothesis should perhaps be regarded as a disunified set of hypotheses corresponding to different drugs, different people, different reward systems and transmitters.
OF: And that doesn’t even begin to cover all the different ways of being an addict socially or culturally, the way it fits into one’s life, one’s attitudes toward it. One of the things I’ve interested in, which you’ve written about too, is philosophers’ distinctions between “willing,” “unwilling,” and “resigned” addicts. I like that to some extent—it’s another way of recognizing the heterogeneity of addiction. Some people do make all-things-considered judgments that they are on board with their addiction to a substance. Other people are unwilling, in the sense that they wish they weren’t addicted. They haven’t yet figured out a way out but are trying. And then there are resigned addicts who have thrown in the towel, so to speak. They wish they weren’t using but are no longer trying to stop. So there are plenty of different locations (biological, social, cultural, attitudinal, and so on) to think about the pluralism of addict experience.
TVM: But you don’t think this problematizes the concept of addict altogether, and neither do I. There’s a tension here, maybe, between suspicion of unified generating-mechanism theories and appreciating the consistency and meaningfulness of having an addict identity or community. Addict is, I wouldn’t say, a “natural kind,” but a social kind. A demarcation between addicts and nonaddicts.
As you know, I share your suspicions about unified hypotheses about why people are or become addicts. There are always exceptions. And then those exceptions get redescribed with various ad hoc hypotheses. People end up with hybrid theories where the mechanism is self-medication but also hijacking—like, addicts start using to cope with trauma, but then the mid-brain mutinies, if you will. Or someone will present a very bespoke akrasia theory, where the theorist means something much more specific and idiosyncratic by “akrasia” than we do usually, more permissive and restrictive in post hoc ways. The examples and counterexamples play into each other.
So the one family of reasons I’m worried about generating mechanism theories is this weird equivocation or self-betrayal they often end up with. This is close to, as you’ve seen in my work, my criticism of theories on the grounds of being metaphysically totalizing. If addiction is a response to trauma, then literally anything an addict does, ever, is confirmation of their being an addict, and that isn’t a way we should treat people’s behavior in relation to theory confirmation. My other worry is that these endeavors are irretrievably theory-laden. When addicts provide testimony in these kinds of clinical settings, there’s epistemic injustice. The researcher provides hermeneutical tools devised to confirm the hypothesized theory through the received testimony. I don’t know how you feel about Ian Hacking, although I’m sure you’re not surprised by my invocation of him—
OF: I am a big fan of the discussion of looping effects in the human sciences! They’re very helpful and explanatory. The self-interpretations of addicts and the descriptions the culture offers for the nature of things are out there and available for us. People use AA- or NA-isms, they appeal to the brain-disease model, and those change how one relates to or feels about what ails one.
OF: Let me ask you, though: I think it would be helpful for all theorists to critically think about how we view addiction in terms of generating mechanisms, or what I’d call causal theories. Someone might say, “Well, trauma will do it.” And then you could divide up trauma into kinds. But also, being a risk-taking, fun-seeking adolescent, maybe, could do it; that’s a causal trajectory.
TVM: Being Mad, of course, will do it on these theories—another one of these unexplained overlaps.
OF: Right. So there’s all these different theories about causal contributors. But there are also the components or constituents of the things that we call the addiction. And we could go narrow or wide on that. We could say, “Well, I’m looking for the narrowest supervenience base of addictive cravings.” And I think that’s a perfectly worthy inquiry, to see what it turns up. Those might turn out to be sites of intervention. And then there’s the effects of addiction. I think it would be useful for people who theorize addiction the way you and I do to distinguish between, on the one hand, what are we claiming are the causal mechanisms or histories that make people more or less prone, cultural permissions, drug availability, gendered permissions, and then on the other hand the downstream effects.
TVM: Right. This is what the Wrath of Grapes theorists take issue with in the self-medication hypothesis.
Does pluralism problematize the addict identity?
OF: Back to what you said a minute ago—that even though we’re both pluralists about addiction, that doesn’t problematize the concept of addiction.
TVM: Or of “addict,” to be more specific. I think maybe it does problematize the concept of addiction!
OF: Yeah. It’s an interesting question. I guess in some ways it sort of does problematize the category. If we say there’s no there there, but there are a bunch of social kinds that maybe fall under a superordinance social kind…With respect to substances, you can corral them into a group fairly easily, in a way addicts and nonaddicts alike will agree with: “Ah, you’re talking about this group of people who use one of these substances,” and then list the substances. Then there are behaviors, they’re interacting with the world. And very often they’re starting to feel that harming them. They’re in distress. So that’s the high-level description of the phenomenon.
The question, then, seems to be: should addicts trade out the folk, common-sense ways of picking out the phenomenon for what scientists say? For example, should we self-describe with “substance use disorder,” and then specify the substance and look at the DSM-V criteria and pick out which profile fits you? There are eleven criteria. So if we look at the combinatorics, since you need to have at least three to qualify with an SUD—I worked it out once and think it’s about eight thousand combinations. There are eight thousand different clinical presentations you can have for a substance use disorder. Just as there is sometimes linguistic reform for moral reasons, there might be some in this area eventually, again on the grounds of looping effects. But for now, I am totally on board with, “No, we get to claim our own nomenclature. We have been in communities of lots of other people like us.”
TVM: Right. Hacking describes, and seems to be on board with, hermeneutic reclamation endeavors by the autistic pride community.
OF: He is in favor of those reclamations.
Here’s one case that I’ve sort of wondered about. I started going to AA in the late nineties, in my forties. There are, sometimes, college students who come to meetings and report that they were hospitalized for drinking and have decided to stop. I have no problem with their self-description as alcoholics, but I wonder whether, at some future point, those kinds of users won’t self-describe that way.
The “delicacy caveat”
TVM: On this point, we should talk about the demarcation between addicts and nonaddict heavy users, insofar as one exists.
OF: I remember when I first read George Vaillant’s The Natural History of Alcoholism, I worried it led to this view that maybe we are all “able to moderate.” I think this is a dangerous view—you and I think it false about ourselves. But anyway, Vaillant was the first to produce evidence of this “aging out” or “maturing out” hypothesis. The trouble with that is it leads people like you and me, the addicts of a different sort, to suspect we didn’t “try enough” or didn’t figure out the perfect balance. The problem there, I think, Virgil, is that the data doesn’t discriminate between addicts and people who drink a lot every weekend. Or, say, college students.
TVM: I was able to escape detection for a long time because of that category conflation!
OF: Right. There are many college students who do dumb things, get drunk a lot, drive drunk, have risky sex, but aren’t in any sense addicts or alcoholics. I think what’s happening in that sort of research is this. They’re turning up a whole class, among the plural class of people who use substances, of people who actually don’t have whatever it is that constitutes, or whatever many different things there are that constitute, addiction.
TVM: This gets us pretty close to what you call the “delicacy caveat” in empirical research on addiction: some people who satisfy some of the DSM-V diagnostic criteria are really not the people we mean to describe by “addict.” I certainly think there is a distinction between addicts and nonaddict heavy users.
I’m working on this long monograph about addicts’ perceptions of our substances of choice—it keeps undergoing revisions as I try to make it clearer that I don’t mean it as a generating mechanism theory—where I describe a sort of neurodivergence in addiction. Basically what I argue therein is that a lot of addicts, definitely me, describe having atypical perceptions about their substance of choice. For me, if alcohol is in a room, I’m looking at it. Some of these almost rise to the level of morality-related beliefs, like the conviction that it is wrong to dispose of small leftover amounts of the substance. For example: I feel like it is wrong, morally wrong, to pour out alcohol.
OF: Yeah, totally with you on that.
TVM: And I know—like, it doesn’t pass rational reflection.
OF: Of course! I’m with you. Beliefs about the person across from you who’s leaving liquor in their glass: you think, there’s something wrong there!
TVM: Absolutely! In my Normal Person Plus post on this site, I talk about this from the first-person. It’s similar to the subjective-objective divide you grapple with a lot in your work. I say: on the one hand, with rational reflection, I totally know that I shouldn’t be drinking people’s abandoned drinks. On the other hand, I totally should! There are these two superimposed perspectives. So I argue, in a lot of cases, there are these strange convictions, perceptions, attentional biases. And I mean “strange” in a Foucauldian way: as “typical” is socially defined now, it’s not that. I think the effectiveness of talking outright about these perceptions is that they do demarcate between addicts and a certain kind of nonaddict heavy user. I don’t know how familiar you are with the Big Book of Alcoholics Anonymous—
OF: Very familiar; I almost know it by heart.
TVM: So you know how the stories are separated out into three sets. The canonical ones like Doctor Bob, then the young people who figured out something was going on and quit, and then the catastrophic stories. In one of the second set of stories, there’s a woman who was very much like me—every time she put alcohol in her system she’d black out. But then she took a bunch of tests online to figure out whether she was an alcoholic, and it would always say no. Meanwhile, she was hiding her bottles, rationing her trash so the empties wouldn’t clink. She had one really salient vignette about how she bought a half-gallon of whiskey, drank half of it, and then the next day was grappling with this feeling that she had to drink the rest. That rang really true to me, and motivated me to write that some of the interiority of being an addict shows up in these convictions about behaviors you are morally required to do, or taboos that you aren’t allowed to break. Feeling obligated to finish abandoned drinks. Feeling forbidden to pour out bottles.
I think a good way of demarcating between addicts and heavy users, even if the latter are using in a way that seems compulsive from the outside, are the thought patterns and behaviors predicted by this neurodivergence thing. Almost every addict I’ve ever spoken to has described behaviors that are really normatively strange—not just in terms of volume of consumption, but timing, situation-indexed ways—and downstream of these kinds of beliefs. For me, it would be like, I’d get drunk while I was sick. Seriously ill with the flu. I’d think, “Oh, I can have a hot toddy and not be judged for it,” and then just get drunk. Which, if you try to rationally reflect on that, it just sounds unhinged.
OF: I was that way too. This is all very interesting. I’ve wondered about it, and have some comments.
I remember, almost the first time I ever went to an AA meeting when I was trying to get sober. There was a guy with thirty-five years who said, “I just went to a Christmas party, packed with people, I opened the door, looked twenty-five feet away, saw a bottle of Chivas Regal, first thing I saw.” That broke my heart. I couldn’t imagine being burdened with this same perceptual capacity—having it without having the obsession. This guy had broken the link somehow. I really did think for a long time that people who had gotten sober had all the same desires but weren’t acting on them, and that was crushing.
TVM: Absolutely. I feel my desires are different now, but the perceptions are still there.
TVM: Thank you so very much for conversing with me today, Owen. I really appreciate this, and am looking forward to talking more with you and people like you. I am so glad that you’re helping out so much with this project.
We are launching this section of the blog, currently titled just “Discourse,” with the objective of creating and platforming conversations with addicts, people who have or had substance use disorders, and allies working in academic research, policy, and activism. This discourse project is inspired by interview series like Shelley Tremain’s Dialogues on Disability and Cliff Sosis’s What Is It Like to Be a Philosopher?