“Do the cocaine” is the obvious answer, but the book has a lot more to say than that.
Introduction
Commentary
It took me a while to appreciate the critical perspective philosophers of science provide about our research institutions. We take our instruments and traditions of knowledge for granted out of a very common human impulse to respect the legacy of the humans who came before us, so that those who inherit the legacy also inherit the legitimacy. Pickard summarizes the situation succinctly:
“In 1997, Alan L. Leshner, then directory of the US National Institute on Drug Abuse (NIDA), published his seminal article ‘Addiction is a Brain Disease, and It Matters,’ cementing a broken brain model of addiction as scientific orthodoxy. Since then, the brain disease model has grabbed the spotlight, claiming by far the lion’s share of funding and credibility, and putting neuroscience and animal models at the center of addiction research. Dissent is heresy. Junior scientists would be foolish to question the paradigm, while senior scientists have built their labs and legacies within it.”
This is a hurdle that, once recognized in research, pops the illusion of objectivity that holds academia beyond the reproach of institutional criticism, especially when the dominant paradigms for those modes of analysis are developed in those same academic institutions.
It’s especially easy to see this with AI research in 2026. Corporate labs completely outpace academic labs in funding and infrastructure, so academic talent is often forced to accept partnerships to do certain cutting-edge research projects at all. That’s assuming they don’t outright quit academic to work full-time for corporate labs or use their lab as a pipeline to startups they have a hand in. This means a lot of breakthroughs happen behind closed doors without independent auditing or peer-review. Even researchers have to consider the attention economy when hype and marketing are directly related to the interests of corporations, and therefore the probability of receiving research funding and opportunities for career advancement. Ethics researchers who study algorithmic bias or safety vulnerabilities are ignored if not harassed or blacklisted.
Addiction and recovery research struggles under a different set of pressures, but they impact the field nonetheless. The stigma and expense of any treatment or program make it difficult to get funding from sources outside of federal agencies, which are slow to pivot in response to new research and subject to sociopolitical headwinds. Policies like harm reduction that have strong empirical support are characterized by non-experts as proposals from morality or empathy rather than scientific rigor. Groups like Alcoholics Anonymous (AA) have been enormously successful in spreading their approach to recovery, but they developed prior to modern science and relied heavily on PR campaigns that treated mental health issues and addiction as “diseases like any other.” So to protest against the brain disease model isn’t just brushing up against established scientists with careers, but also against the conventional wisdom that the public has been made aware of through the education efforts of philanthropic and mutual aid societies. I couldn’t agree more with Pickard’s framing, but I think she sells her own point short by marking the 1997 Leshner paper as a singular event that cemented the brain disease model as orthodoxy in science. Or, as Pickard says, the “broken brain” model. There was a long history of AA collaborating with doctors and researchers behind it too.
I’ve said a lot without actually describing the broken brain model as Pickard frames it:
“The core idea of the model is as gripping as it is familiar. After prolonged drug use, ‘a metaphorical switch in the brain’ is flicked and the brain is ‘hijacked’ by drugs… the brain disease model treats addiction as occurring when the kind of freedom of will that we normally take for granted is lost: The ordinary, voluntary behavior of a rat or a person - pressing a lever, downing a drink, swallowing a pill, injecting, inhaling, or snorting a substance - becomes compulsive, transformed into a passive, involuntary symptom of a brain disease.”
“Hijacking” is one of the most common ways that the relationship between drugs and the brain’s dopmaine system are explained within recovery spaces, and I’m including psychoeducation classes in this. As a quick test, I spat “do drugs hijack the dopamine system” into Google, and received the following answer:
“Yes, addictive drugs completely hijack the brain’s natural dopamine reward system. They flood pathways with massive chemical surges—up to 10 times higher than natural rewards like food or social connection—rewiring how the brain processes motivation, pleasure, and control. You can review detailed scientific breakdowns of this process via the National Institute on Drug Abuse.”
Upon following the link to the NIDA page here https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain (published July 2020) and we see:
“Simple activities in everyday life can produce small bursts of neurotransmitters in the brain bringing pleasurable feelings. Drugs can hijack that process.”
“It was once thought that surges of the neurotransmitter dopamine produced by drugs directly caused the euphoria, but scientists now think dopamine has more to do with getting us to repeat pleasurable activities (reinforcement) than with producing pleasure directly.”
Clark Fisher, author of The Urge, has mentioned that it’s not necessarily a coincidence that “hijack” was produced as a term following the crime hysteria of the late 1990s, following carjacking being coined and popularized by national media like Nightline. The notion of a hostile invader suddenly seizing control of the path someone takes was already embedded in the public imagination. The notion of hijacking was intuitive and utilized as an attempt to combat stigma, though it had a lot of unintended consequences as well, such as increasing the risk of some patients developing a sense of learned helplessness from feeling they have no agency. It has remained controversial, though the ease of delivering the explanation has remained a factor in its popularity.
Also, Pickard makes an excellent shout-out to contingency management as “the most effective treatment for cocaine and some polydrug addictions… not pharmacological but behavioral… It is based on operant conditioning principles… elaborated by B.F. Skinner in the 1930s and 1940s” - well before the brain disease model and hijacking metaphor were commonly accepted. I truly love to highlight contingency management whenever it comes up. It’s the easiest counterargument to the idea that addiction can be understood and managed solely through the lens of an individual being internally disordered. In fact, from the studies we’ve done on animals since 1985, Pickard notes that 90% of rats would forego cocaine for sweetened water, and nearly 100% of rats would choose one minute of playtime with another rat over cocaine:
“So much for the idea that rats are compelled by their cocaine-broken brains to keep pressing the lever for more, when all it takes to lure them away is a drink of saccharin water, a minute of playtime, or the whiff of a buddy… Why then did they take so much cocaine in Bozarth and Wise’s 1985 experiment, when they were alone in a cage with nothing but cocaine? Presumably, because they were alone in a cage with nothing but cocaine. The currenly dominant scientific paradigm is broken. It is time for heresy.”
I reveal my own bias when I say this, but I can’t hide my love of writing that delivers the catharsis of cutting through a Gordion Knot that’s been sitting in my stomach. One of the best things about standing on the shoulders of giants is that there’s so much to see from the heights they’ve reached and depths they’ve traversed. But to step down and find a new vantage point, perhaps slaying the giant in the process, becomes more difficult too. The bigger they are, the harder they fall, and the harder it is to fell them. Pickard’s sword comes in the form of a paradigm which,
“can be distilled into two core and connected characteristics: humanism and heterogeneity.”
Humanism
Admittedly, the very first time I heard of the term humanism, I chalked it up as a feel-good garnish on top of a “real” substantive theory that was driven empiricism and rationality. I have since repented for my STEM bro ways.
Humanism historically has referred to a distinct approach within the umbrellas of psychology and philosophy that rejected Freudian psychoanalysis that treated unconscious drives as deterministic while also rejecting Watson’s behaviorsm that reduced human complexity to conditioning. Instead, humanism posits that each person exists within the center of their own subjective interpretation of reality shaped by their unique capacity for processing experiences. To the extent that fundamental biological drives for humans can exist in this framework, it is to reproduce the experience of itself with growth, differentiation, and fulfillment. A lack of congruence, or alignment, between an ideal self and a real self is seen as the source of pathological suffering. Cognitive distortions or denial supported by rationalizations are defense mechanisms against the tension of incongruence. Rather than external institutions or social expectations determining the success of an individual’s function, humanists tend to trust an individual in their own interpretation of reality to evaluate the feedback provided by their own subconscious processes. In fact, external imposition of the conditions of worth is considered one of the main reasons individuals are deterred from actualizing themselves according to their own feedback.
Pickard explains incongruence without using the term, sparing readers from jargon in a way I refuse to do myself:
“people with addiction tend to speak of when and why they first started using; where they use; who they use with; what makes them want to use; what drugs do for them; what drugs mean to them; how they crave them, love them, need them, hate them; how they feel when they use; how they feel when they don’t use; how they feel about the fact that they use; and even, for some people, how their use is part of their identity - their sense of who they are. Often, although not always, they also express uncertaintly about the brain disease model, which sits uneasily with their own experience of addiction.”
To some extent, duh. People rarely experience their life as random spiritual possession that actually hijacks the direction of their life. Isn’t that how we get the most boring horror movies too? Alien (1979) is the top rated horror movie on IMDB, and it’s not because the details concerning the biological process of the Xenomorph reproduction cycle was of intense interest to anyone except maybe hard sci-fi fans. There are countless nature documentaries about parasitic insects that scratch that itch far better. Alien shows us an apex biological predator indifferent to human suffering paralleled closely with a manmade corporation’s indifference, explicitly inspired by the cosmic apathy found in Lovecraftian horror. The android programmed to fulfill the corporation’s mission admires the alien as a “perfect organism” compared to the “expendable” working-class crew who are simply trying to earn paychecks for survival.
It’s similarly of little interest to us to consider addiction just a mechanistic process in which a substance has altered our biology. The term “hijack” is loaded with narrative implications that shape a subjective construction of one’s experience with a substance. It suggests an independent force or agent at work that overrides one’s autonomy and identity, not unlike a malevolent spirit or parasitic alien that hijacks one’s body. Before the instruments of modern medicine that allowed us to explain the world through material mechanisms and physical laws, lots of cultures built their systems of knowledge on the premise of spiritual laws. For instance, many in Ancient Greece thought that drinking invited the consciousness of the god Dionysus to inhabit one’s body, but this is arguably a deeply humanist perspective rather than a mechanical explanation. Dionysus as a concept served as a way to discuss an altered state of consciousness in which repressed desires and thoughts can emerge to drive action. The dissolution of ego, felt internally and perceived externally, in the process of Dionysus taking over introduces a liminality through which social and personal transgressions are negotiated. The word “enthusiasm” has its roots in exactly this type of possession referred to as enthousiasmos.
Not to wax nostalgic about an era I was never born in, but it feels often that in replacing supernatural explanations with mechanistic materialist ones vetted by rationality and empiricism, we pathologized common expressions of our experiences so that they could be mapped onto standardizable measures. Dionysus no longer possesses us when we drink; the GABA receptors responsible for inhibitory neurotransmitters are obstructed while our prefrontal cortex downregulates. Both Jung and Nietzsche used the myth of Dionysus to critique the hyper-rational and hyper-material paradigms that defined the trajectory of “Western” civilization. From a humanist perspective, Jung calls out the repression of the self that results from the conditioning of worth imposed by external social mechanisms. Nietzsche argued that the passions of life had been stifled and sterilized through the worship of reason and logic, thereby leading to a nihilism that reason cannot address.