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One of the most obvious social changes over the second half of the 20th century was the increase in the proportion of young people using alcohol and different kinds of drugs. Recreational use of illegal substances has increased and is now a conspicuous part of the social landscape. We know that using substances is associated with a range of poor outcomes. The UK has a high level of adolescent alcohol consumption and problem use. What are the implications? The literature is rarely focused on the more specifically developmental aspects of use in adolescence, and preliminary evidence suggests that indeed there may be links between the rising trends in both substance use and mental health outcomes.

This chapter compares typical experiences and practices of identification and anonymity in the state-run Addiction Hospital and the House of Recovery. “Identification” can refer both to the determination or recognition of “what a thing or a person is” and to “the becoming or making oneself one with another, in feeling, interest, or action.” This chapter focuses on both meanings and their relationship with one another. It begins with the Addiction Hospital, describing the institution and then shifts to the House of Recovery. In each case, it examines how the possibilities for self-identification were opened up or foreclosed by ascriptions of identity made by interlocutors, and how such opening up or foreclosure in turn shaped the mutual potential for identification with one another. Finally, it concludes with a brief consideration of identification and anonymity within ethnographic practices.

We discuss how the complexities of conducting neuroscience research on addiction limit its application to the criminal law. Individual addicts vary enormously, and the general findings of neuroscientists do not always describe particular cases. Moreover, the neuroscience of addiction may not be relevant to the criminal law because addiction itself may not be relevant. We examine several ways in which it might be thought that addiction is relevant to the penal law before identifying the single respect in which its significance is likely to be greatest. Some jurisdictions have created specialty drug courts that make addiction a necessary condition for eligibility, so evidence from neuroscience is potentially helpful to ensure that defendants would benefit from these diversionary programs. With respect to criminal liability itself, however, we believe that neuroscience turns out to be of limited value at the present time as well as in the foreseeable future.

Dopamine is a neurotransmitter critical for reward processing and is elevated by most addicting drugs. The effect of THC and other CB₁ agonists moderately elevate dopamine in reward related regions of the rodent brain; however, there is less consistent evidence in humans for marijuana-induced changes in dopamine release or for morphological changes in brain reward areas. In humans, cannabis use disorder has been identified, which shows similar features of other substance use disorders, but not in the same extremes as opiates, psychostimulants or alcohol. This chapter discusses the interaction between cannabis and other drugs in relapse to drugs use, with a special case for the interaction between cannabinoids and opiates. Finally, the relationship between cannabinoid effects on men and women in sexual behaviour is discussed.

While dopaminergic neurotransmission has largely been implicated in reinforcement learning and model-based versus model-free decision making, serotonergic neurotransmission has been implicated in encoding aversive outcomes. Accordingly, serotonin dysfunction has been observed in disorders characterized by negative affect including depression, anxiety and addiction. Serotonin dysfunction in these mental disorders is described and its association with negative affect is discussed.

The context of forced displacement in chapter 7 is what we know as chronic homelessness in the United States. Here we explore the risk to interhuman relationship that is its result. Published narratives of persons without home and those in a transitional housing facility put a practical face on homelessness and help shed light on some of its most complicating factors.These elements, not surprisingly, include the state of affordable housing, addiction, mental illness, incarceration, and other “nontraditional” circumstances. Forced displacement in the form of homelessness most often results in the objectification—whether as objects of need or objects of distain—that leads to overwhelming social exclusion. This threatens relationship in the form of a just community and rejects the moral obligation to care for the displaced other.

This book’s conclusion epitomizes this book’s claims with an analysis of Lisa Cholodenko’s High Art (1998), a film falling under New Queer Cinema’s non-redemptive, underground narratives of queerness. Ugliness as the negative operates as both literal and conceptual. It refers to an inherent erotic tangibility in older media processes of photographic documentation—the use of negatives—and it describes the ways that lesbian desire becomes defined through heroin addiction. This chapter shows how queer erotics communicates as a photographic negative, that is, a desire paradigm without the ability to be properly “developed.” The deeply counterintuitive possibilities of ugliness here reinforce the book’s larger argument about the importance of nondominant expressions of difference that queer female sexuality requires.

Incentive salience (‘wanting’) normally provides an ‘oomph’ that spurs attention to and motivation for objects of desire. But when amplified excessively by brain mesolimbic sensitization, a set of neurobiological changes that increase the reactivity of dopamine-related brain systems, ‘wanting’ can have pathological intensity, leading to the kind of compulsive ‘wanting’ associated with impulse control disorders, such as addiction. A stimulus attributed with excessive incentive salience may trigger an overwhelming urge to consume its related reward. Sensitization of its underlying neural systems can make rewards and their cues powerful triggers of craving and instigate seeking behavior, and similar changes in the brain may possibly occur spontaneously in certain binge-eating disorders and in some other compulsive pursuits of incentives. Selective surges in ‘wanting’ spurred on by environmental triggers can explain why, under these conditions, rewards can be ‘wanted’ much more than they are ‘liked’. The incentive sensitization theory provides an explanation for the compulsive pursuit and over-consumption of addictive incentives

Consumption is the endpoint of any resource-allocation decision in which individuals acquire something for their own use. This can occur in conserved and ancient forms (e.g., ingesting food, drinks, or drugs of abuse) but also in modern and symbolic forms (e.g., shopping and purchasing products, scanning and appreciating images, and paying for and burning fuel). Humans make hundreds of consumption decisions each day, with important personal consequences for their health and finances as well as collective consequences for others’ welfare and the sanctity of the environment. Growing evidence suggests that decisions to consume across multiple domains rely on overlapping circuits in the mesolimbocortical system, which evolved to motivate animals towards adaptive and pleasing ends including food, mates, and secure shelter. Correlated psychological processes may also contribute to decisions to consume, often encouraging individuals to approach highly salient and immediate rewards, even at a long-term cost to themselves or others. In addition, decisions to consume food and other material goods appear responsive to contextual feelings of security or uncertainty as well as perceived social status. Although from disparate fields, all of the authors in the current volume conduct research on some aspect of consumption, ranging from food hoarding in animals to the neural and psychological bases of pleasure, addiction, shopping, saving, and hoarding in humans. This work emanates from multiple scientific approaches, including evolutionary theory, animal behavior, neuroscience, experimental psychology, and clinical psychopathology. Through this integrative collection, we hope to illuminate a critical and timely convergence

Chapter five charts how and why the medical profession developed and popularized the view that heavy habitual drinking constitutes an incurable physiological disease. In public lectures, journals, and speeches, physicians detailed the catalogue of destruction wreaked by alcohol, publicizing a new pathology of intemperance. Through vivid description and illustration, physicians asserted that the drunkard’s compulsion to drink derived from a diseased stomach. While heightening public fear, however, physicians had little inclination to attempt to develop a cure for the condition. Promising therapies emerged in the 1820s which physicians actively discouraged people from using. By mid century, finally spurred on by patient demand, physicians experimented with treating inebriates in hospitals and asylums, but their efforts remained scattered and experimental. This chapter argues that by heightening public fear, but failing to develop therapies, physicians encouraged the popularity of the Washingtonians, who promised to cure drunkards. As Washingtonians exerted an ever-greater influence on popular culture, sensational accounts of delirium tremens proliferated. The medical impulse to pathologize habitual drinking thus led to a popular lurid fascination with the drunkard’s struggle with the cravings for drink.

Montague proposes a computational model to understand addiction. His key idea is a special kind of reward prediction error signal in addicts. In his comments, Yaffe discusses what Montague's work on the neuroscience of addiction does and does not show about moral responsibility. Sripada then outlines how additional deficits in reflective judgments of addicts might also be relevant to their moral responsibility. Montague replies by agreeing that we need a new generation of models to capture the kinds of considerations raised by his commentators.

American bioethics affords extraordinary respect to the values of personal autonomy and patient self-determination. Many would argue that the most significant achievement deriving from bioethics in the past 40 years has been to replace a paternalistic model of health provider–patient relationships with one that sees patient self-determination as the normative foundation for practice. This shift away from paternalism towards respect for self-determination has been on going in behavioral and mental health as well, especially as it is reflected in the ‘recovery movement’. As a result of the emphasis placed on patient autonomy, arguments in favor of mandatory treatment are rare and often half-hearted. Can a case be made which acknowledges the centrality and importance of autonomy but which would still deem ethical mandatory treatment for addicts? I think it can.

The ubiquity of the disease concept of addiction obscures the fact that it did not emerge from the accretion of scientific discoveries. Addiction-as-disease has been continuously redefined, mostly in the direction of conceptual elasticity, such that it now yields an embarrassment of riches: a growing range of allegedly addictive phenomena, which do not involve drugs. This article begins with questions that have been raised about whether “addiction” is a discrete disease entity with a distinct etiology. It then summarizes the historical and cultural conditions under which addiction-as-disease was constructed, the specific actors and institutions who promulgated it, and the discursive procedures through which it is reproduced and internalized by those said to be afflicted. Understanding how the dominance of addiction discourse was accomplished in these ways does not imply that the lived experience of what is called addiction is therefore any less acute or compelling. But it does invite attention to the contradictory uses of disease discourse: a humane warrant for necessary health services and legitimation of repressive drug policies.

The author believes and attempts to demonstrate that “drug abuse” and “drug addiction” are moral rather than medical problems. The basic issue underlying these problems is: In a conflict between the individual and the state, where should the individual’s autonomy end and the state’s right to intervene begin? The author suggests that genuine commitment to the ethic of personal freedom and responsibility requires that, much as we may disapprove of a person’s choice of drug, we must regard freedom of self-medication as a fundamental right.