A recent Jacobin interview conducted by Chandler Dandridge explored psychological and social frameworks for understanding addiction through a discussion with Hanna Pickard, Bloomberg Distinguished Professor of Philosophy and Bioethics and Krieger-Eisenhower Professor at Johns Hopkins University. “One of the dominant ways of thinking about addiction is as a disease. While there is evidence for this approach, it often leads to a dismissal of addiction’s social causes, rooted in alienation and purposelessness,” wrote Dandridge.
In her book, What Would You Do Alone in a Cage with Nothing but Cocaine?, Pickard challenges the brain disease and moral models of addiction by defining it as a pattern of drug use that persists despite severe personal costs and by emphasizing the social and psychological factors underlying the condition. Moreover, Pickard argues that addiction cannot be adequately explained as a brain disease of compulsion, and is better understood as a response to specific psychological and social environments, where the absence of meaningful alternatives leads to drug use despite severe personal costs.
She also suggests that using a “psychology-first” approach to addiction treatment avoids both moral judgment and biological reductionism by understanding addiction through individuals’ psychological states and life circumstances, recognizing it as a “heterogeneous” condition with multiple underlying motivations rather than a single brain-based compulsion or moral failing.
In addition, Pickard proposes using “responsibility without blame” as a clinical and relational approach that recognizes individuals with addiction as capable agents who can be supported to change harmful behavior without judgment, moral condemnation, or the denial of their agency. “Needless to say, the idea of responsibility without blame is also part of how I hope to productively address moralism about drugs and drug users,” she said.
The author also explained that her work in therapeutic communities showed that recovery often emerged from agency, mutual support, and belonging within egalitarian group settings, rather than from medication, causing her to question brain disease models of addiction. She concluded that the community can foster recovery by providing care, respect, and reciprocal relationships that help individuals rebuild self-worth, identity, and hope through shared social engagement. “Placing addiction treatment within a community has tremendous therapeutic potential because of how it can help people find new identities and also newfound hope and optimism about relationships with other people and the world at large, because it’s a shared project,” added Pickard.
