The Age of Addiction

Not everyone is happy with all the talk of expanding addiction. It bothers clinicians who fear stigmatization, libertarians who smell an excuse for indiscipline, social scientists who fear neuroscientific reductionism and imperialism, and philosophers who detect concept creep and equivocation, the misleading practice of using the same word to describe different things.

I shared many of these concerns and wanted to give the critics a hearing. Using the brain-disease model of food addiction as a case study, I wrote a dialogue that boiled down the arguments on both sides. Here’s a taste of the pros (P) and cons (C):C: You can’t compare drugs and food. We don’t have to take drugs. We do have to eat.P: Eat food, yes. Eat engineered food, no. People don’t overconsume corn. They overconsume corn processed into Cheetos, Doritos, and other mass-marketed, synthetically flavored products designed to maximized brain reward.C: So take junk food off the grocery list.P: Not so easy if you’re hooked.C: Get unhooked. This is a bad habit, not a real brain disease like schizophrenia or multiple sclerosis. People quit bad habits all the time.P: People don’t quit cravings or forget cues. They don’t restore lost receptors with a snap of the fingers.C: But they can overcome bad habits by adopting other, healthier habits. They can change their routines. Start going to Weight Watchers, stop going to McDonald’s. What you call addiction has an element of choice and a developmental trajectory. People wise up as they get older. They outgrow addictions, often quitting on their own. Ex-tobacco smokers outnumber current smokers in several developed nations.P: Yet people have to eat, as you say. And shop for groceries. Talk about cues. But, yes, there are workarounds like learning to prepare meals with fresh, carefully measured, low-fat ingredients. And avoiding fructose, which is nothing but a brain-pleasing additive.C: The vast majority of people eat and drink fructose at least occasionally. Ditto other feel-good additives. Yet they don’t all become addicts.P: You could say the same thing of drugs. Fewer than 20 percent of the people who ever try crack or heroin wind up as addicts. More people than that have trouble controlling their food intake, ruining their health in the process …You can guess what follows. Is food addiction about dumb policies that make brain-altering and potentially addictive processed foods available at low cost to susceptible populations with few healthy alternatives? Or is it about dumb people who lack the discipline and future orientation to establish healthy regimes to maintain proper weight and nutrition?

Tell me what you think about food addiction—any addiction—and I’ll tell you what your politics are.

Drafts of The Age of Addiction provoked two different sorts of criticisms. Either I had been too quick to accept the idea of novel addictions, or I had underrated the hydra-headed menace of limbic capitalism and failed to show how to counter it. The book, historian Bill McAllister told me, was really about who controls our brains. Naming the system was not enough.

The second charge troubled me more than the first. Behavioral addictions are obviously subject to hype, and not every form of consumer excess is an addiction. In fact, one way to describe proliferating addictions is simply as the most harmful endpoints on different spectrums of excessive consumption.

Yet the harms are real, often lethal, and bear the stamp of corporate design and business rationalization. What could be done about the McDonaldization of old and new vices?

A lot, it turns out. We have options like education, taxation, age restrictions, prescription-only sales, advertising bans, spatial segregation (smokers freezing outdoors), digitally decluttered environments (favored by wary elites), lawsuits, international treaties to control supply and marketing, manufacturing quotas, and state monopolies designed to limit supply and intoxication. Blanket prohibitions have not worked well, as organized crime typically steps in when licit commerce is outlawed. But combinations of the other policies have produced some public health victories, such as the recent leveling off and decline of global per capita cigarette consumption. Limbic capitalists don’t win them all.

Limbic capitalists are likewise vulnerable to ridicule. BUGA UP, Billboard Utilising Graffitists Against Unhealthy Promotions, was founded by Australian anti-smoking activists in 1978. The acronym punned on Aussie slang for screwing something up. What the activists screwed up was billboards, which they altered with spray paint. Overnight “Have a Winfield”—a popular Australian cigarette brand—became “Have a Wank.”

Cheeky populism worked. In 1992 the Australian government outlawed all tobacco ads save for those at point of sale. It was a victory for activists like Arthur Chesterfield-Evans, a spray-can-wielding surgeon who gave a defiant speech to a crowd gathered around a Sydney billboard. “After six years of surgery,” he said, “I could accept that people suffer and die. But I had real trouble coming to terms with the fact that cigarette diseases were the result of a cold-blooded and systematic campaign of deception waged by monied interests against less informed consumers.”

Then the doctor climbed a ladder, rattled his can, and spray-painted “Legal drug pushers the real criminals.” The cheering, placard-waving crowd joined in, covering the ad from top to bottom with mocking graffiti. The police, who were looking on, did nothing to stop them.

All of this happened back in 1983. More than a generation later we still live in a world in which monied interests wage cold-blooded and systematic campaigns of deception against less informed consumers, above all those with low levels of education and social status.

The question I leave for readers is this: Do we, like Dr. Chesterfield-Evans, have the moral courage and political wit to do something about it?