Addiction and the Psychology of Deliberate Self-Harm and Suicide

"Addiction science is at an impasse. Rates of addiction remain high. Translational results from decades of research conducted within the dominant brain disease paradigm are shockingly meager. Meanwhile, theories of addiction multiply and compete, fomenting disagreement about something as apparently simple as how addiction should be defined. Ultimately the cost of this impasse is borne by people with addiction themselves."

"We need a new paradigm that puts psychology first. Psychology is our most basic, powerful tool for understanding ourselves and each other. Humans are self-conscious and self-reflective beings. We understand ourselves to act for reasons, both good and bad. We take our actions to be explained by our thoughts and feelings, beliefs and desires, pleasures and pains, hopes and fears, plans and intentions. To understand human beings and explain their behavior, the first place to look is to their minds-that is, their psychological states."

"My book What Would You Do Alone in a Cage with Nothing but Cocaine?: A Philosophy of Addiction argues for this paradigm shift. Addiction should not be defined as a brain disease but as a kind of behavior, namely a destructive pattern of drug use. A person is addicted if they continue to use drugs despite evident and severe costs, thereby acting profoundly against their own good."

Addiction science faces stagnant outcomes and competing theories, with high addiction rates despite decades of brain-focused research. Psychological states offer the primary explanatory level for human behavior because people act for reasons grounded in thoughts, feelings, beliefs, desires, hopes, fears, plans, and intentions. Defining addiction as a destructive pattern of drug use—continuing despite severe costs—centers behavior rather than brain pathology. Self-harming and suicidal mindsets commonly underpin such self-destructive drug use and deserve greater emphasis. First-person testimonials reveal these mindsets and provide essential data. Attentive listening to personal accounts can improve theoretical models, research priorities, and treatment approaches.

Read at Psychology Today