ADDICTION AND ACTION: ARISTOTLE AND AQUINAS IN DIALOGUE WITH ADDICTION STUDIES A Dissertation by KENT J. DUNNINGTON Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY August 2007 Major Subject: Philosophy ADDICTION AND ACTION: ARISTOTLE AND AQUINAS IN DIALOGUE WITH ADDICTION STUDIES A Dissertation by KENT J. DUNNINGTON Submitted to the Office of Graduate Studies of Texas A&M University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Approved by: Chair of Committee, John J. McDermott Committee Members, Scott Austin Theodore George David Erlandson Stanley Hauerwas Reinhard Huetter Head of Department, Daniel Conway August 2007 Major Subject: Philosophy iii ABSTRACT Addiction and Action: Aristotle and Aquinas in Dialogue with Addiction Studies. (August 2007) Kent J. Dunnington, B.S., Southern Nazarene University; M.A., Texas A&M University; M.T.S., Duke University Chair of Advisory Committee: Dr. John J. McDermott The phenomenon of addiction has been a subject of investigation for a number of academic disciplines, but little has been written about addiction from a philosophical perspective. This dissertation inserts philosophy into the conversations taking place within the multi-disciplinary field of “Addiction Studies.” It contends that the philosophical accounts of human action given by Aristotle and St. Thomas Aquinas provide means for an analysis of many of the conceptual confusions in the field of Addiction Studies, including those surrounding the concepts of choice, compulsion, and habit. It argues that the category of habit in these two thinkers is richer and more complex than contemporary conceptions of habit and that the category of habit in its Aristotelian and Thomistic guises is indispensable for charting an intelligible path between the muddled polarities that construe addiction as either a disease or a type of willful misconduct. Furthermore, it suggests that recognizing the distance between Aristotle’s social context and the modern social context affords powerful insight into the character of modern addiction, and that an exploration of the parallels between the habit of addiction and Aquinas’s development of the habit of charity offers suggestive inroads for thinking about addiction as a moral strategy for integrated and purposive action. iv TABLE OF CONTENTS Page ABSTRACT ………………………………………………………………………... iii TABLE OF CONTENTS ………………………………………………………….. iv CHAPTER I INTRODUCTION: THE “SCIENCE” OF ADDICTION ………………. 1 Science and the Defining of Addiction ……………………….......... 3 The “Science” of Assessing Risk …...…………………………….. 8 Medicalized Treatment …………………………………………… 14 II INCONTINENCE AND HABIT ……………………………………… 20 The Addiction Paradox …………………………………………… 20 Addiction and Incontinence ………………………………………. 29 Aristotle on Incontinence …………………………………………… 39 Aquinas on Incontinence ………………………………………........ 58 III HABIT AND ADDICTION …………………………………………… 61 Passion and Craving ………………………………………………... 63 Aquinas on the Necessity of Habit ……………………………......... 72 Aquinas on Habit …………………………………………………….. 79 Habit, Loss of Control, and Relapse ………………………………..... 107 IV MODERN ADDICTION ………………………………………………... 114 Habit Groups …………………………………………………….. 114 Addiction and Intemperance ……………………………………… 120 Aristotle on Habit and Happiness …………………………………. 136 Modern Addiction ……………………………………………….. 143 v CHAPTER Page V ADDICTION AND CHARITY ………………………………………. 166 Aquinas on Charity ………………………………………………... 168 Addiction and Charity ………………………………………………... 172 The Habit of Addiction …………………………………………... 189 Is Charity an Addiction? …………………………………………... 198 VI CONCLUSION: TOWARD AN AESTHETIC OF RECOVERY …….. 213 Character and Recovery …………………………………………... 220 Friendship and Recovery …………………………………………... 223 Vision and Recovery ………………………………………………... 233 REFERENCES …………………………………………………………………… 239 VITA …………………………………………………………………………….. 249 1 CHAPTER I INTRODUCTION: THE “SCIENCE” OF ADDICTION This is a dissertation about addiction, written by a student of philosophy. The central question with which the dissertation deals is that of how to describe and understand addiction as human action. This might provoke an immediate question: Aren’t addictions diseases and therefore not the sort of thing that humans do but rather the sort of thing that humans suffer? The question might be put more trenchantly: What business has a student of philosophy writing a dissertation about addiction? Shouldn’t that be left to the experts—the scientists?1 It may have been a worry such as this that led a member of a hiring committee with which I recently interviewed to ask me how my dissertation counted as philosophy instead of psychology. I found this to be an odd question mainly because, having been immersed in the thought of Aristotle and Aquinas, it seemed to me that neither of them could have the slightest idea how to answer a question like that. For Aristotle and Aquinas, the division of knowledges in contemporary academia would have seemed artificial and arbitrary at best. Aristotle was not only among the profoundest This dissertation follows the style and format of The Chicago Manual of Style, 14th ed. 1 That philosophers are worried by these questions may best explain why so philosophers have written little on addiction. To my knowledge, only two monographs have been written by philosophers qua philosophers on addiction: Francis Seeburger’s excellent Addiction and Responsibility: An Inquiry Into the Addictive Mind (New York: Crossroad, 1993) and Bruce Wilshire’s Wild Hunger: The Primal Roots of Modern Addiction (New York: Rowman and Littlefield Publishers, 1998). The late philosopher, Herbert Fingarette, has written a well known though highly contested book about alcoholism, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988), but Fingarette writes mainly as a participant in the field of alcohol studies. A recent conference entitled “What Is Addiction?” (May 4-6, 2007), hosted by the Center for Ethics and Values at the University of Alabama, Birmingham, is a hopeful sign that philosophy is beginning to enter the conversation about addiction. 2 “psychologists” of his day; indeed he was its leading “natural scientist.” He believed that we could only come to understand human action as we grasped its similarities with and differences from animal movement. So the notion that something called “philosophy” would have to ask permission before investigating the subject matters of “psychology,” “sociology,” “politics,” and even the “natural sciences” could not have occurred to Aristotle. Nevertheless, such a prejudice is built into the academic curriculum of our day, and I should therefore like to defend my disregard of it. I eschew the artificial division between the disciplines, not the various findings of the disciplines, and I trust that this dissertation attests a willingness to interact with different disciplines, especially the so-called social sciences of psychology and sociology.2 I also interact throughout with the discussions taking place within the biological sciences, but, insofar as the researchers in these fields—especially neurology, genetics, and pharmacology—are assumed to be the “experts” on addiction, I would like in this introduction to briefly articulate both the achievements and the limitations of biological and medical approaches to addiction. I do so by examining, first, how the biological sciences attempt to define addiction; second, how they attempt to assess risk for addiction; and third, the attempts to treat addiction through medical intervention. 2 The literature on addiction in each of these fields is vast. The most comprehensive psychological approach can be found in Jim Orford, Excessive Appetites: A Psychological View of Addictions, 2d ed. (New York: John Wiley & Sons, 2001). To my knowledge, there is not a “standard” text in the sociology of addiction, but one of the seminal works on alcoholism is D.J. Pittman and C.R. Snyder, Society, Culture and Drinking Patterns (New York: Wiley, 1962). 3 Science and the Defining of Addiction The Institute of Medicine defines addiction as a “brain disease” characterized by “compulsive use of a drug,” which is “manifested by a complex set of behaviors that are the result of genetic, biological, psychosocial, and environmental interactions.”3 The American Medical Association and the American Psychological Association offer similar definitions. The term “substance dependence” is used as an equivalent to “addiction” by each of these classification systems, and it is in fact the related phenomena of “tolerance” and “withdrawal” that have been central to the medical and scientific establishment’s attempts to define addiction. Tolerance is defined as “a physiological process in which repeated doses of a drug over time elicit a progressively decreasing effect and the person requires higher or more frequent doses of the drug to achieve the same results.”4 Withdrawal is the dysphoria resultant on cessation or curbing of the person’s use of the drug, involving the body’s agitation at the disruption of the modified equilibriums it has established through the process of use. One inroad to understanding the neurological processes behind the tolerance and withdrawal associated with substance abuse is to learn that the human brain produces its own drugs and, in turn, “takes” the drugs it produces: the brain produces neurotransmitters which are absorbed by the