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What would you do alone in a cage with nothing but cocaine?

The ‘gray area’ of addiction.

Imagine you’re alone in a room. No phone. No windows. No way out.

There’s only one thing in there with you: a giant pile of cocaine.

Maybe you’ve never touched drugs in your life. Maybe you think people who use drugs are bad or morally suspect. But you’re trapped in that room, for an unknown amount of time, and you’ve got nothing else to do.

This is the question the philosopher Hanna Pickard asks in her exquisitely titled book What Would You Do Alone in a Cage With Nothing but Cocaine? Pickard thinks our usual stories about addiction are too neat. Either addicts are moral failures, or they’re helpless victims of a hijacked brain. Her book makes a convincing case that both stories miss what’s actually happening — not just in the brain, but in the world people live in and the inner lives they’re trying to manage.

I invited Pickard onto The Gray Area to talk about what addiction is, what it isn’t, and what it means to hold people responsible without reaching for blame. As always, there’s much more in the full podcast, which drops every Monday and Friday, so listen to and follow us on Apple Podcasts, Spotify, Pandora, or wherever you find podcasts.

This interview has been edited for length and clarity.

Is the title meant to be a rhetorical question? Because if I was alone in a cage with nothing but cocaine, I’d probably, for sure, do a lot of cocaine.

Right. And what you just did is the point of the title.

I want it to stop people and make them think for themselves about what an environment does to drug taking. Being alone in a cage with nothing but cocaine is a metaphor for the social, economic, and material circumstances that many people with addiction live in.

But it’s also a shoutout to the history of animal models in addiction science. One of the early experiments literally put rats alone in a cage with nothing but cocaine to see what they’d do.

Historically, that was read as evidence for a brain disease model where cocaine hijacks the brain and compels use.

But, notice what happens when you imagine your own case: You don’t imagine doing cocaine, because you think it hijacks your brain. You imagine doing it because you’re isolated, and bored, and suffering, and cocaine is the only relief available.

What compelled you to write the book? Is there something about how people talk about addiction that feels wrong or incomplete?

I think there are deep misconceptions about addiction in public discourse and in addiction science, and they span the political divide. They’re everywhere.

Because I’ve worked with people with addiction, my worry is that the way the rest of us misconceive addiction affects treatment and attitudes. It has real consequences. I’d been writing papers for a long time, and then, I felt ready to bring it together into something systematic that could correct these misconceptions.

A big misconception is that there are only two approaches. One is an antiquated moral model that treats drug use and addiction as morally wrong. No serious scientist or policymaker holds that model in a simple form, but it contaminates the cultural air. We all have bits of it that come out.

Then, the supposed antidote is the brain disease model, which rose in the 1990s and positions itself as stigma reduction. But, it’s got its own problems, and, in my view, it’s not giving us what people with addictions actually need.

So, the book tries to offer something less simplistic, more humane, and in the middle.

Do you think of addiction as a disease in any........

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