In Addiction and Virtue, Kent Dunnington engages in a bold interdisciplinary task, dialoguing with psychology and medicine while drawing from philosophy and theology in hopes to shed new light on the modern scourge of addiction. Typical descriptions of addiction categorize it either as a disease, leaving the addicted person an unwilling victim to powers he or she hopelessly endures barring medical treatment, or an indicator of an especially morally decrepit or deformed person who takes twisted satisfaction in particular acts of debauchery. In other words, the addicted person’s will is completely uninvolved as he or she suffers the illness of an addiction—much as victims of cancer or Alzheimer’s—thus relieving the person of culpability in the formation of an addiction and in ongoing lapses into addictive behavior, or the addicted person is supremely culpable each and every time he or she acts in accordance with the addiction since each lapse is the result of intentional, willful behavior directed in decidedly morally disoriented ways. Dunnington finds both descriptions lacking, not least because they do not take the accounts of addicts seriously, nor do they consider the broad range of issues related to addiction, including relapses well after the pains of urges have dissipated. Instead, Dunnington, the holder of a Ph.D. in philosophy and a M.T.S. in theology, indicates that the independence of the modern sciences from the traditional resources of philosophy and theology have crippled the sciences’ options for describing behavior in terms other than the two extremes of disease and choice—or, in philosophical terms, determinism and voluntarism. Among the neglected resources are the components of traditional formulations of virtue, especially the concept of habit. For Dunnington, habit mediates between the two extremes precisely because it is a concept that is able to negotiate both the complexities of willful action and the ability of humans to develop expertise in specific skills such that they are able to engage in actions without the hindrance of thinking about fundamental steps along the way (e.g., the way a master musician need not think about how to move her fingers to create each note on an instrument or the way that a world class basketball player need not agonize over proper shooting form before or during a field goal attempt). The category of virtue also opens to Dunnington the concepts of character development and teleological orientation, both of which help him analyze modern addiction.
On the first page of the preface, Dunnington reveals his goal: to describe addiction in “theologically substantive ways” rather than the typical “scientifically reductive” ones (9). The manner in which Dunnington makes and then further supports his case is akin to city planning and development: he surveys the city (disease) that currently serves as the home (or dominant model) for understanding addiction, finds it wanting, identifies an alternative city (habit), builds a bridge across the bay to this new city, and finally engages in city development (or filling in the complexities of this new way of describing addiction). This is evident in the progression of the chapters.
The opening chapter is an exercise in “making room” (16). Specifically, he begins with an analysis of the scientific model of addiction (“disease”) and immediately establishes that such attempts “not only have failed but in fact are bound to fail” (16). Dunnington shows that the common medical model established by the National Institute on Drug Abuse for describing addiction depends upon two “phenomena”: “tolerance” and “withdrawl.” The former refers to the “progressively decreasing effect” of the addictive substance upon the addicted person such that increasing “doses of the drug [are required] to achieve similar results.” The latter pertains to the sense of dependency the addicted person experiences upon the addictive substance with “dysphoria resulting from cessation or curbing of the use of the drug” (18). Dunnington argues that the form of this definition posits tolerance and withdrawl as necessary and sufficient conditions for addiction (18). That is, in order to describe a person as addicted, the phenomena of tolerance and withdrawl must surface in relation to the substance in question, and the presence of these phenomena in relation to a particular substance is adequate for diagnosing the presence of addiction. The problem, says Dunnington, is that both conditions fail. There are many who experience tolerance and withdrawl symptoms who should not be considered addicts. Included in this list are those who experience these symptoms with respect to anesthesia and medication administered during and after surgery. In this case, tolerance and withdrawl symptoms prove not to be sufficient for attributing addiction to the patients. Similarly, Dunnington notices a number cases wherein drug addicts returning from the Vietnam War did not experience one or both of these symptoms upon cessation of the drug. In these cases, it would seems that the double phenomena was not a necessary cause of addiction (19).
The issue, according to Dunnington, is not that these symptoms never accompany addiction. Indeed, they often due. Rather, he notes that these symptoms are insufficient for identifying a causal relationship between addicts and addictive substances. Indeed, merely pointing to physical phenomena dependent upon altered brain physiology (and, thus, unwilling “disease”) misses that addiction precisely does involve willful action. For instance, those who are great in any venture, for example world class musicians, experience changes in brain physiology over the course of “years of practice,” yet no one would say “that playing the cello may cease to be something a cellist does and becomes something a cellist suffers, a kind of disease” (20). In short, Dunnington rejects a “deterministic causal relationship between brain structure and behavior” (28).
Chapter 2 turns to Aristotle’s taxonomy of ethical actions (37ff.) in order to show a legitimate range of action between choice (or “voluntarism”) and disease (or “determinism”). Specifically, Dunnington focuses upon incontinent actions, which are those actions that agents recognize as ethically wrong yet find themselves unable persistently to avoid committing. Establishing addiction within the realm of incontinent action serves as the bridge to Dunnington’s affirmation of the category of habit at the end of this chapter and into the following chapter. he addict that Dunnington suggests is generally in view when referring to addiction is the incontinent agent; it is the behavior of this group that he seeks to illuminate. After detailing in great analytical depth the tension between right belief and wrong action (or right belief and suspended right belief) in the incontinent agent, Dunnington explores “cravings” or urges. He notes the mystery of relapse for those committed to the disease model, for despite the variation in period of time that psychological and physical cravings persist in addicts, these cravings do eventually disappear for those who on the road to recovery. Nevertheless, relapse is not uncommon in this group even once devoid of cravings (50–51). The problem, argues Dunnington, is the presence of habit(s) in service to a particular addiction. This old habit has not been replaced by a new habit.
The end of chapter two cried out, “Land ho!” by naming what lie on the other side of the bridge, namely addiction as habit. In chapter three, Dunnington unpacks this claim, using Aquinas to make the link. Dunnington rightly notes the fragility of human “deliberative” processes and sets habit amid this gap of finitude. One might legitimately read between Dunnington’s lines and affirm that the capacity for habit formation is a divine blessing upon his creatures, easing our tasks and allowing our work before the Lord to become akin to “second nature.” Dunnington affirms the capacity for habit formation, writing, “Deliberative action is inherently fragile and unstable because it requires an agent with finite powers to engage in an activity that tends to deplete those powers” (58). He continues, “The goal of moral training is the formation of moral habits because habit names the possibility of acting well without the exertion that is required of deliberative practical reasoning” (58). Citing Aquinas, Dunnington even dares to venture that habits are indispensable to a robust description of human action (59).
In order to make the link between habits and the deeply embedded reality of addiction, Dunnington outlines Aquinas’ exposition on habit formation and identifies this with addiction formation. He gleans from Aquinas two basic dimensions of habit: reason and desire (see 72–79). Dunnington argues that the cognitive level—a sin qua non for culpable versions of addiction—consists of three elements: the imagination, the cognitive estimation, and memory. All three intertwine at the level of reason to create habits. First, imagination allows the sensible to persist in the mind, and a well-habituated imagination allows artists to “’see’ a world that differs from the one the non-artist sees” (73). That is to say, following Ricoeur, more possibilities for seeing the world are revealed through the rich imagination. Second, the cognitive estimation attaches evaluative ideas of reason to the sensible, for sensible things themselves do not present judgments to the observer. Dunnington calls the “cognitive estimation power . . . the paradigmatic locus of habit as embodied knowledge” (74) and the “single most powerful component of addiction and the addictive experience” (75). It is here that ideas are joined to sensory perceptions in the mind. Finally, the memory is that power of the mind that persistently joins the cognitive estimation and the imagination (76). The formation of the habit itself is sealed by the joining of desire to the cognitive process. Apart from desire, the union of imagination, cognitive estimation, and memory are insufficient to form a habit. This is evident in the cases of relapse among those seemingly well on the way to recovery, for they labor to reform actions but, argues Dunnington, are unable to create new habits of desire to replace the old ones and, thus, fall back into old habits.
Thus far, the focus has been in relocating the conversation on addiction from a land split by the false alternatives of disease or choice to a new land that respects the intricacy of addiction as something between disease and choice. In chapter three, Dunnington named and described this new land according to the classical virtue category of habit. Chapter four begins a new course, shifting from revolution and relocation to infrastructure and development. In other words, Dunnington begins to unpack the implications of addiction as habit and the distinction between the habits of incontinent addiction and those of vice. As the vice traditionally identified with overindulgence, Dunnington begins his work of development by contrasting addiction and intemperance, showing why the former is not merely a synonym for the latter. Intemperance, he reminds, historically is “not concerned with pleasure in general, rather with pleasures of the body” (89). That is, intemperance is directed toward maximizing physical “goods,” such as sexual pleasure, not “pleasures of the soul” (89).
Conversely, Dunnington contends that addiction is not ultimately oriented toward physical goods; indeed, many addicts express “strong sensory aversions to the object” of addiction (91). He finds this particularly true among “advanced addicts” (92). Instead, especially notes in the accounts of addicts the pursuit of “moral and intellectual goods,” such as the “ability to communicate, being at ease with oneself, being unafraid and being part of community” (94–95). Dunnington writes, “Put simply, intemperance may be understood as a form of hedonism, whereas addiction cannot. Indeed, the life of the addicted person would seem appalling to one who was set on maximizing immediate sensory gratification” (94).
Chapter five may be the most scandalizing in his development of addiction in the realm of habit, for he describes addiction as distinctly modern, owing to the “seismic shifts in social arrangements and worldview that accompanied the emergence of the modern way of life” (101). Dunnington argues “that the prevalence of addiction is correlative to specific challenges that emerge wherever modern modes of conceiving the moral life are at odds with traditional forms of moral endeavor” (106). He identifies three such challenges: arbitrariness, boredom, and loneliness (see 106–22). Modern arbitrariness results from the lack of a shared telos that communally guides people. That is, it is a symptom of the absence of a shared metaphysical framework. In just such an environment, addiction provides personal teleological meaning for life amid absence of meaning communally, thereby facilitating the ordering of one’s life around a singular goal (see 109). Modern boredom is related, for the metaphysical and teleological absence has lead to the modern obsession with “leisure” activity without criteria to determine which or what kind of action. One may even be busy yet still bored—”[t]he modern worker is busy, but she lacks purpose” (117)—resulting in a society where addiction claims the idle and the occupied (118). Modern loneliness is related to both arbitrariness and boredom in that the result of communal fracture and teleological ambiguity is a society of people socialized to modernity’s ideals who, nevertheless, belong nowhere. Dunnington details a number of addict testimonies that emphasize the community that both arises around addictive substances and the personal fulfillment found in those communities. Addiction answers all three of these challenges on the individual level, providing meaning, purpose, and community.
In chapter six Dunnington moves to add explicit theological character to his thus far primarily philosophical discourse. The theological “depth dimension” will persist and grow through the rest of the volume. Its introduction in this chapter begins with probably the most obvious theological category when considering addiction: sin. In showing the different facets of sin and sinfulness in traditional Christian thought, Dunnington is able to dismiss the notion that sin is purely an act of intentional, autonomous malicious willing. Rather, like addiction, sin binds the will amid its own kind of incontinence. Dunnington finds biblical evidence of just this in Rom. 7:15–19 (see 131–34). Despite the obvious pathological similarities, Dunnington is still careful not to conflate the categories of addiction and sin, for he reserves the qualification that morbid addicts (see ch. 2) who suffer from mental illness are not sinning in their addictions since the volitional component is entirely removed from the equation. Nevertheless, incontinent addiction, is the result of and the ongoing practice of sinfulness (136).
Chapter seven focuses on one particular aspect of sin that brings about the modern character of addiction: specifically, chapter seven deals with addiction as a “counterfeit form of worship” (141). A facet of sin is its disorientation from rest and fellowship with and dependence upon God; addiction is a grasping for orientation amid the loss of God as object of worship. Dunnington draws extensively from Aquinas’ version of caritas as the chief theological virtue and its nature of forming the other virtues to raise them from the immanent to the transcendent, that is, into worship of God. True worship of God is formed and driven by caritas, and it is the sole “appetite” that neither knows nor should know moderation (156). In place of this limitless caritas, addicts pursue some other good without concern or desire for moderation. This other good becomes a mental “obsession” which, “like caritas, transfigures all other objects or activities in its own image and appropriates them for its own ends” (154). Consequently, addicts become “possessed” by addiction and succumb to “idolatry” amid the “simulacrum” that addiction produces (158, 175). In a sense, the final chapter turns to an admonishment to the church and a reminder of the importance of both thinking rightly and, from this, acting faithfully and lovingly. It is a reminder of the receptive posture of the church: we are to be “dependent on the triune God of Israel who became incarnate in Jesus of Nazareth” (181). Because of this right and good receptive posture, Dunnington may affirm that “Christian identity is always relative,” that is, relative to who God is and what he has given us to be and do (181). The applicable action that derives from this ontological relation is the church’s responsibility to the addict. Dunnington arranges this relation in terms of “friendship.” He calls the church to learn from the often successful methodology of groups such as AA and recapitulate its message theologically: more than recognition that one is an addict is recognition in the church that we are all “repentant sinners” (185–86). This should translate into helping addicts realize their true identity and directing them to true worship. More than propositional declaration, this entails befriending addicts and presenting them with a new community, a community of redeemed sinners (186–91).
Dunnington’s interdisciplinary effort is bold and bound to rub some people the wrong way. Those in the medical or psychological community may be less than satisfied with Dunnington’s rejection of the disease model, some theologians may be uncomfortable with the amount of weight borne by the philosophical concept of habit, and philosophers may wish to strike talk of sin from the record. Nevertheless, this reader is pleased and even largely compelled by Dunnington’s argument. The author successfully strikes a delicate balance, not dismissing the reality of the often present phenomenological symptoms among addicts, richly using a well-nuanced philosophical/ethical concept in habit and category in virtue, and emphasizing the “depth dimension” of addiction through his appeal to sin. For this Dunnington ought to be commended and his work ought to be accepted as an important development both in the application of virtue theory and, more importantly, in the diagnosis of addiction. The conceptual illumination offered to the latter will hopefully affect progress in helping addicts of various stripes. May public servants, clinical practitioners, and the church all take notice!
As with all proposals, room remains for refining. On the conceptual level, one may wonder on at least two points. Dunnington is intentional to situation addiction in the realm of modernity, indicating that it is a uniquely modern problem. This may well be primarily; however, it seems a bit naïve to limit addiction to modernity as if the problem of human sin and the human need for community and direction were less severe issues in premodern times. Certainly many of the typically modern problems (e.g., metaphysical minimization or even loss, individualism, social isolationism) are typically modern for a reason: they are heightened or even rampant in some sectors. Nevertheless, as Dunnington notes, an aspect of the doctrine of sin is teleological disorientation; this was no less true in premodern times. Even if premoderns tended to share a common telos with their social sphere, I’m inclined to think that many slipped through those social cracks as well and ventured toward an individuated telos. Could this not have resulted in various addictions? After all, such individual sinfulness did result in the existence of vices; why not addictions? Thus “unique” may go too far.
An additional concern may come from those of us who admire and draw from Aquinas’ explication of the virtues yet are not satisfied with his theological description of them, most notably with regard to the infusion of caritas. Dunnington relies heavily on this form of virtue, and to his credit, Aquinas’ description of virtue is the most complete Christian explication. Regrettably there isn’t a robust, distinctly Protestant rendering on the level of Aquinas’ work. Still, the inevitable question is whether virtue language becomes unusable for those who find theological problems with infusion. Again in fairness to Dunnington, I am not inclined to think the land of habits and virtues becomes uninhabitable amid this theological scruple, yet for some, it may well.
These two concerns notwithstanding, I commend this book to all of the fields addressed in the book: medical and clinical professionals, philosophers, theologians, and pastors. If right thinking truly precedes right acting, and I believe it does, then this book should be consulted for the betterment of those who work with addicts and of addicts themselves. Knowing is not the same as doing or changing; neither does knowing cause action or change, but in and with the right spirit (rather, Spirit), it informs the steps one takes in doing and changing.
I am grateful to IVP Academic for providing a review copy of this book.