Much of the conversation around addiction swings between two worldviews. On one side is the belief that addiction is a brain disease, that the addicted person’s brain compels them to continuously use drugs despite dire consequences. Much of this belief is derived from scientists studying rats in isolated conditions, offering the animals only cocaine as respite from the distress. The impact of this experiment coincided with the so-called Decade of the Brain in the 1990s and has driven our (mis)understanding of addiction in the twenty-first century.

The other side of the conversation is rooted in an older view that suggests addiction is a moral failing. The addicted person simply chooses to use drugs due to their defective character, and drugs are, de facto, bad. While nearly all scientists and clinicians reject this worldview, it still holds sway among the public. Indeed, much of public policy related to drugs is derived from moral, not medical, associations.

In her new book, What Would You Do Alone in a Cage with Nothing but Cocaine?, the philosopher Hanna Pickard proposes a new paradigm of addiction. Pickard explores the shortcomings of the brain disease model and moves us away from the moral model by centering addiction as “a pattern of drug use that persists despite evident and severe costs such that it counts profoundly against a person’s own good.” Pickard uncovers the social and psychological elements that better define the condition, allowing a more humane attitude to emerge.