Addiction Becomes Normal: On the Late-Modern American Subject by Jaeyoon Park. University of Chicago Press, 2024. 230 pages.

On Addiction: Insights from History, Ethnography, and Critical Theory by Darin Weinberg. Duke University Press, 2024. 200 pages.

IF YOU WERE DIAGNOSED with, say, Parkinson's disease, or obsessive-compulsive disorder, no one would argue that it was your fault. You didn't "choose" your fate, they would say. But what if you were diagnosed with substance use disorder? The rhetorical landscape now changes drastically: you drank too much, you made poor choices, you failed to deal with your pain responsibly. You lack self-control.

Addiction is unique among medical conditions in its troubled association with free will. If a condition is classified as a disorder, then it's no longer a choice. A disorder implies involuntariness, and involuntariness implies guiltlessness, giving the patient a free pass. How addiction is classified is enormously consequential, determining whether an insurance provider will cover treatment costs, or to what extent family members are likely to extend empathy or blame. This is just the tip of the iceberg. Legally, the question of responsibility determines whether someone experiencing addiction deserves jail time for drug possession. It decides whether that person is entitled to medical care: doctors are reluctant to approve alcoholics for liver transplants unless they meet strict criteria like being able to sustain a period of abstinence. Conversely, the question of responsibility could force someone into involuntary treatment under the presumption that they are not capable of making decisions for themselves. The question of choice haunts policy debates too: should overburdened governments be spending limited taxpayer dollars on a self-selecting population that has repeatedly made bad decisions (and is likely to continue making them)?

Knowing the stakes are high, doctors and public health officials are increasingly falling in the it's-not-a-choice camp by calling addiction a "brain disease." In this now-dominant neuroscientific account, the addicted user's brain is "hijacked" by a drug, creating physiological changes that leave them more vulnerable to compulsion and loss of self-control. As Nora Volkow, who has championed this explanatory model throughout her tenure as director of the National Institute on Drug Abuse, puts it: "[B]ecause of drug use, a person's brain is no longer able to produce something needed for our functioning and that healthy people take for granted, free will." Addiction, then, is not a choice but a pathology, and because the addict can't be held responsible for their actions, they are deserving of treatment and empathy rather than criminalization and punishment. Yet it's difficult to tell when someone crosses the line between substance "abuse" and substance "dependence" (which, until the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, were viewed as distinct conditions). Addicts themselves report a messier sense of agency than this understanding implies, watching themselves repeatedly make choices they know are wrong.

The blurry line between free choice and total compulsion is baked into the word's etymology, stemming from the Latin ad-dicere ("to speak"), which in Roman law became addīcere, a legal term signifying the "giving over" of a person or property. The obvious connotations of slavery and bondage in this usage are complicated by the willed act of speaking, which introduces an element of conscious choice -- the paradoxical decision to become unfree. This bind was at the core of the now-obsolete English verb "to addict," according to the OED, meaning "to bind or attach oneself to a person, party, or cause; to devote oneself to as a servant, adherent, or disciple." One could addict oneself to a vice, like sin or drink, though one could also be "addict" to practices worthy of admiration, like prayer or devotion. Whether a person chose a toxic or noble object, they were engaging in an active process of giving up their agency.

This medical and semantic gray area leaves us mired in a fog of troubling questions: Is addiction a free choice, or an unwanted compulsion? Is it a unique condition marked by diseased pathology, or just an extreme manifestation of a normal psychological urge -- a repeated craving -- that is inherent in all of us to some degree? The language of addiction is ubiquitous in contemporary culture -- we are "addicted" to everything from sugar to Netflix to our phones, even exercise. It holds persuasive explanatory power even in the context of mundane activities. Is there any difference between craving a drug and being unable to put your phone down? Is it merely a question of degree? Neuroimaging studies have shown that the same regions of the brain stimulated by opioids, cocaine, or amphetamines light up in response to sugar, sex, or seeing a loved one's face.

The once-hidden architecture of addiction, which neuroscience has now revealed exists in each of us, has implications for what it means to be human -- which may explain, at least in part, the fear and stigma directed at people living with addiction, who become the ultimate Other. William Burroughs, a lifelong heroin user, knew intimately that "the face of 'evil' is always the face of total need":

In the words of total need: "Wouldn't you?" Yes you would. You would lie, cheat, inform on your friends, steal, do anything to satisfy total need. Because you would be in a state of total sickness, total possession, and not in a position to act in any other way. Dope fiends are sick people who cannot act other than they do.

The most frightening thing about addicts is that we could be just like them. Wouldn't you? Yes, you would.

Into the fray of this tortured discursive terrain enter two scholars: Jaeyoon Park, a political scientist with a critical theory bent, and Darin Weinberg, a sociologist who has spent his career thinking about how concepts of addiction play out in public policy and treatment contexts. Both feel that the dominant medicalized scientific framework around addiction has come to an impasse. Park's Addiction Becomes Normal: On the Late-Modern American Subject (2024) and Weinberg's career-spanning collection of essays, On Addiction: Insights from History, Ethnography, and Critical Theory (2024) turn away from neuroscience and invoke critical theory instead.

Questions about free will and the dissolution of rational choice are embedded in critical theory's DNA. Anxieties about agency were common in 19th-century psychoanalysis, dominated by debates about instinctual drives and the unconscious, and in Marxist economic theories that positioned the individual as subject to crushing forces of labor and capital. Weinberg points out that even the ostensibly value-neutral assumption that all people possess the faculty of self-government is a feature of modern liberal discourse, which sees health and rational choice as universal goods synonymous with freedom. This discourse makes it impossible to understand why someone would act against their own self-interest. The Frankfurt School obsessively undermined the idea of choice by showing how ideologies and systems shape individuals. A few decades later, addiction became an irresistible conceptual metaphor for post-structural thinkers like Jacques Derrida with his evocation of our "narcotic modernity," or Eve Kosofsky Sedgwick with her "epidemics of the will."

Weinberg embraces the critical tradition's core insight that scientific knowledge is never objective or disinterested. He thus rejects neuroscience's blanket reduction of addictive behavior to biology and its relegation of social contexts to "secondary reinforcers." A holistic understanding of addiction would require an interdisciplinary perspective, he argues, that engages with the history and sociology of science. Though he wouldn't use the term, his work has a strong deconstructive edge, breaking down binaries that have overdetermined our thinking about addiction: mind/body, nature/culture, rationality/emotion, universal/particular, micro/macro, subjective/objective, and theory/practice.

It's not surprising, then, that Weinberg's intervention in the contemporary addiction debate pursues the "is it a choice?" line of questioning, and his answer is that it's complicated. He convincingly shows that neither the natural nor social sciences have been able to explain the role of choice in addiction. The neuroscientific model cannot meaningfully distinguish between addiction and many "normal" human behaviors that entail a loss of rational self-control (a night out drinking with friends, bungee jumping, falling in love), making it impossible to argue that addiction is a unique condition deserving of special treatment. As for the sociological model, it positions addictive behavior as a rational response to less-than-ideal systems and conditions (racism, classism, capitalism). It has the dangerous pitfall of verging close to a logic of free choice -- indeed, such sociologists are called "choice theorists."

To really understand how addiction happens, Weinberg insists we must break down the boundary between theory and practice and look at how particular individuals experience drug use on the ground. In the most compelling chapter of the book, which details Weinberg's fieldwork in Los Angeles treatment programs, he theorizes an "ecology of addiction." It's a breath of fresh air -- in part because it leaves behind the neuroscientific search for the abstract essence of addiction. Here, large block quotes dedicated to the voices of people struggling to negotiate between the safe and structured space inside recovery programs and the temptations and frustrations of the world "out there" animate long stretches of otherwise fairly stiff prose. They show that as much as we would like to find a clear answer to the question of choice, the devil is in the details -- the realities of addiction "are to be found in the embodied configurations of local practice within which the specific details of particular people's sense of estrangement from their drug use takes shape." Weinberg concludes that only a posthumanist framework tracing a multiplicity of overlapping factors is supple enough to explain how flesh-and-blood individuals move in and out of self-control, and, crucially, how they can be supported throughout that process.

Park, on the other hand, is more invested in asking whether addiction is "normal," and if it is, then what kind of subject it affects. Distinguishing between a person (a singular human being) and a subject (a general category of being in a society), he makes clear that he is interested primarily in the latter. His real project is rewriting Michel Foucault's influential story of modern subjecthood, in which deviant actions became reconfigured as pathological identities: the individual no longer commits the act of sodomy but is designated a homosexual; the individual no longer consumes drugs but is an addict. Starting in the 1970s, this narrative gradually became reversed -- addiction is no longer a feature of essential deviancy limited to substance use but a general tendency that could affect anyone in relation to any object. This evolution happened not only because ideas necessarily evolve over time, but also because of events like the opioid epidemic, which make it easy to imagine the average white, middle-class prescription drug user as a blameless victim who has fallen on hard times.

Park understands addiction as a set of habitual behaviors that are not so different from, say, those promoted by the wellness industry. When I'm clipped into the pedals and pounding away on my Peloton, I feel good. Really good. My brain releases neurochemical signals telling me how good this behavior is making me feel, forging new synapses that will prime me to seek (and enjoy) this behavior in the future. Through repetition, I am forging a habit that will be hard to shake. The only difference between my compulsive pedaling and addiction is that one is beneficial, whereas the other is damaging. The core mechanism is the same.

This example illustrates what Park calls the "normalization of addiction," the relatively novel idea that "addiction itself is normal, in the sense that addictive craving and compulsion are simply strong versions of normal (healthy, quotidian) desire and conduct, not aberrant ways of being." We all have cravings and pursue activities that produce pleasure, sometimes to our detriment -- addiction is just the extreme end of the spectrum. This is the premise of popular neuroscientific accounts of addiction like Anna Lembke's Dopamine Nation: Finding Balance in the Age of Indulgence (2021), which argues that because dopamine is "a kind of universal currency for measuring the addictive potential of any experience," stories of addiction "are just extreme versions of what we are all capable of."

What this reveals, Park argues, is that we collectively no longer understand ourselves as subjects possessing an immutable inner essence that defines our behavior. Instead, the late-modern American subject is a product of accretion -- a collection of accumulated habits, memories, and experiences devoid of an essential core. You quite literally are what you do, the product of your actions and environment, not unlike Weinberg's posthuman subject shaped by myriad local contextual factors. Park chronicles this new subject's appearance in addiction science, policy, and criminal law. I have seen it myself in the harm reduction community's changing "person-first language" around addiction, which "shows that a person 'has' a problem, rather than 'is' the problem" -- the individual is not an essentialized addict but just a "person with substance use disorder." Park pays less attention to popular culture, where these new ideas about subjecthood haven't materially changed addiction's stigmatized association with criminality, deviance, and free choice.

These books are well-intentioned in their desire to do justice to a complex and contentious issue, but they are also incredibly conceptual and at times ungrounded. Even worse, they are dry. This is partly a problem of audience -- both authors write primarily for their academic colleagues -- but it's also a problem rooted in metaphors. In the critical medical humanities and social sciences, scholars have the habit of turning embodied realities into abstractions symbolizing philosophical quandaries. This means that addiction is not just about dependence on a substance or behavior but also about "agency" as a meta-concept. The addict, a specific human being with a unique history, becomes "the Addict," an allegory of broken will in a world whose enormous forces eviscerate the individual's power to take meaningful action.

Perhaps abstractions are unavoidable when our humanity is confronted with something as overwhelming as addiction. Within the Gordian knot where compulsion and free will become hopelessly tangled, it is reassuring to know that -- at least discursively -- we are moving toward more nuanced and less ethically suspect understandings of addiction as a shared feature of what it means to be human. Framing addiction as a product of environments and forces rather than of individual failing is certainly a welcome step forward. Yet after swimming around in the conceptual soup of late-modern addiction discourse, I find the question of whether these problems are normal or pathological, consciously chosen or unfreely experienced, beside the point. They happen. Rather than asking, like Park does, what the normalization of addiction can tell us about the late-modern American subject, or how we can most persuasively frame the addict's loss of self-control, as Weinberg does, I would ask: What kind of community demands proof of responsibility from those suffering from any kind of condition? Why is the absence of free choice a prerequisite for deserving treatment? What does this tell us about our limited understandings of our duty of care toward each other -- and do we want to live in that kind of society?