Excerpted from WHAT WOULD YOU DO ALONE IN A CAGE WITH NOTHING BUT COCAINE: A Philosophy of Dependancy © 2026 by Hanna Pickard. Reprinted by permission of Princeton College Press.
Keith Richards, lead guitarist for the Rolling Stones and intercourse, medication, and rock ’n’ roll icon, famously mentioned that he by no means had an issue with medication, he solely had an issue with the police. Richards did have an issue with the police. His notoriety as a Rolling Stone and as a drug person meant he was focused and harassed each at dwelling and on the highway, resulting in a number of drug-related prices throughout the Nineteen Sixties and Nineteen Seventies and one jail sentence. However Richards was additionally dedicated to medication. He was a day by day polydrug person and bodily depending on heroin at varied phases of his life. In his memoir, Life, he’s clear that, though medication generally took a toll on his work and his relationships, additionally they vastly enhanced each. For Richards, medication are linked to his creativity and his depth, to dwelling in a manner that squeezes probably the most out of life. He’s additionally sincere about the truth that his wealth protected him from prices that different drug customers face. Richards was ready to make use of solely the purest and highest high quality medication and to get glorious medical care each time he wanted. By saying that he by no means had an issue with medication, I take Richards to imply that regardless of the prices of his drug behavior—which at occasions in his life had been certainly extreme—they had been in his view value it. His drug use, regardless of its prices, accorded together with his personal set of values—his conception of the great life, for him. His drawback was that his values didn’t accord with these embodied by the regulation—witness his drawback with the police.
What counts as a value and what counts as a profit and the way a lot weight to connect to both presupposes a set of values by which they’re measured, that’s, a conception of the great. One individual likes to really feel wild and chaotic and uncontrolled—to flee from the inflexible confines of their unusual life and self. That is a part of the great life, for them. One other individual hates it. Their good life is one in all calm routine. Their drug of alternative is a pleasant cup of tea. What for the primary is a advantage of alcohol or amphetamines or psychedelics is a value for the second. However how a lot does the primary individual love that feeling of untamed abandon—sufficient to threat their job, their relationship, their well being? It relies upon. How a lot do they worth their job and their relationship and their well being? The working explication of dependancy as a sample of drug use that counts profoundly in opposition to an individual’s personal good presses these questions. Which values? Whose conception of the great? And the way can we all know? Suppose we ask these questions on Richards. We’d marvel: Was he proper that he by no means had an issue with medication or was he in denial?
To reply this query, we should start by noting a regular however underappreciated distinction between dependancy and bodily dependence. Opioids, alcohol, and nicotine are courses of medicine that, if taken frequently and at adequate doses, produce bodily dependence: a physiological situation outlined by the prevalence of a bodily withdrawal syndrome upon sudden abstinence or dose discount. Richards was definitely, at occasions, bodily depending on heroin. Withdrawal from heroin sometimes lasts as much as one week, and, equally to withdrawal from any opioid, can embrace fever, nausea, diarrhea, aches, cramps, runny nostril, watery eyes, insomnia, formication, and extra. Opioid withdrawal just isn’t life-threatening. However as this record attests, it’s terrible to expertise. It may be alleviated by way of treatment, together with methadone and buprenorphine (themselves opioids), clonidine (a psychiatric treatment used to deal with ache and hypertension) and over-the-counter medicines for symptom aid.
Bodily dependence is very related to weighing prices and advantages of drug use. Though the character and severity of withdrawal signs varies with drug class, experiencing withdrawal is a big value of not utilizing, and avoiding it a big advantage of utilizing. Certainly, with respect to extreme alcohol dependancy, withdrawal could be life-threatening. However bodily dependence is neither essential nor adequate for dependancy. Though there are inevitably psychological results of sudden abstinence or dose discount if an individual is addicted, varied medication to which individuals turn out to be addicted should not have a bodily withdrawal syndrome, for instance, hashish and cocaine. This is the reason bodily dependence just isn’t essential for dependancy. However equally, it isn’t adequate, as a result of folks could be bodily depending on medication once we would by no means think about them to be addicted.
Many psychiatric medicines, similar to antidepressants, have a bodily withdrawal syndrome. Antidepressants are psychoactive. They have an effect on cognition, emotion, temper. Sudden abstinence or dose discount will trigger folks to enter withdrawal, which usually lasts between one and three weeks and has signs which can be just like opioid withdrawal. But we don’t think about folks to be hooked on antidepressants. Equally, individuals who undergo from debilitating ache could also be on standing opioid prescriptions. It is a routine a part of palliative care however will also be acceptable for some persistent, long-term ache sufferers. These sufferers will likely be bodily dependent. Within the wake of the US opioid epidemic and widespread recognition that—largely because of relentless propaganda, manipulation, and incentivization by pharmaceutical corporations—docs had been overprescribing opioids, many ache sufferers had their prescriptions immediately discontinued. Overprescription was a horrible drawback, however this was an equally horrible response. Sudden discontinuation precipitates withdrawal—in addition to the return of debilitating ache—pushing folks towards sourcing opioids on the streets to alleviate each. It additionally fails to acknowledge {that a} affected person who’s bodily depending on opioids just isn’t thereby addicted. Within the context of debilitating ache, a secure opioid prescription could make it doable to operate—to work, to sleep, to have the capability to be current and engaged in relationships with others, to reside a satisfying life. So can also taking the exact same opioid at the exact same dose whether it is sourced not from a pharmacy however from the streets. With respect to psychiatric medicines, we don’t think about folks addicted just because they’re bodily dependent. Equally, with respect to opioids, we should always not think about folks addicted just because they’re bodily dependent—regardless of the place the medication are sourced. It’s because, in each instances, medication could make life considerably higher, not worse.
Hanna Pickard is Bloomberg Distinguished Professor of Philosophy and Bioethics and Krieger-Eisenhower Professor at Johns Hopkins College.
2025 PopSci Outside Reward Information
Leave a Reply