ABSTRACT
The orthodox conception of drug addiction 1 within science and medicine is a neurobiological disease characterized by compulsive drug use despite negative consequences (cf. NIDA 2009; WHO 2004). This conception depends on three core ideas: disease, compulsion, and negative consequences. Yet the meaning of the ideas of disease and compulsion, and the significance of negative consequences, is rarely made explicit. I argue that it is only when the significance of negative consequences is appreciated that the puzzle of addiction comes clearly into view; and I suggest that there are both conceptual and empirical grounds for skepticism about the claim that addiction is a form of compulsion, and agnosticism about the claim that addiction is a neurobiological disease. Addiction is better characterized as involving choices which, while on the surface puzzling, can be explained by recognizing the multiple functions that drugs serve, and by contextualizing them in relation to a host of interacting factors, including psychiatric co-morbidity, limited socio-economic opportunities, temporally myopic decision-making, denial, and self-identity. 2
