Biopsychology Colloquium: Loss of Control in Addiction: The Search for an Adequate Theory and the Case for Intellectual Humility

Some theorists say that addiction involves loss of control over using drugs while others say control is preserved. In this chapter, I disagree with both sides, not so much in substance, but rather in epistemic tenor. Both sides, I argue, run well ahead of what the evidence allows. I frame the discussion in terms of a key division in human motivational architecture: We not only have desires, we also have powerful capacities to exercise top-down regulation over these desires. I review a number of influential theories of addiction, both ones that favor loss of control and ones that deny it, and I find that they all have a massive gap: They lack an adequate explanation for when and how top-down regulation over inappropriate desires succeeds and fails. Without this critical piece, we simply cannot have much confidence in these views.