Hi Nicole. I may not have been as clear as I could have been about what I was and wasn’t trying to address in the essay. I don’t doubt for a moment that AA, NA, SMART, and similar programs help many people, often in life-saving ways. And I agree they involve concrete actions, practices, and coping skills.
I don’t know why these programs work when they do, nor why they don’t work when they don’t.
My essay wasn’t meant to critique existing approaches. It was meant to suggest something narrower: that “addiction” may not be a single, uniform phenomenon. If there are different underlying patterns for different people, then it wouldn’t be surprising if some people need something different, or something in addition to, what standard programs are designed to provide.
That’s not an argument against these programs. It’s an argument for a bigger map.
Thanks for this Jasmine. I agree that all words are labels—but not all labels do the same work. To me, the issue is whether the language clarifies or distorts what’s happening. I’m less invested in defending the word addiction than in naming a real, recurring pattern where biology, psychology, and context interact in ways that narrow regulatory flexibility and constrain choice over time. That pattern is more than a single behavior, but also not a fixed disease entity. The question isn’t so much which label is correct, but which language helps us see the phenomenon clearly enough to reduce harm and support change.
Thanks for taking the time to think this through and to lay it out so carefully. I agree with much of what you’re saying, especially that words matter, that the word “addiction” has been stretched beyond usefulness, and that the disease/choice framing has done real harm. I also agree that drug use is behavior, and that behavior change—not labels—is what ultimately matters.
Where I may differ slightly is around what I’m actually trying to explain. I’m not using the word addiction to point at a discrete behavioral phenomenon or disease entity. I’m using the word as shorthand for a pattern that unfolds over time—specifically, a loss of regulatory flexibility under sustained internal and environmental strain over time. In that sense, my use of “developmental” doesn’t mean to point at something that exists before drug use, but rather that earlier conditions shape how systems respond once drug use begins.
I take your point that labels often obscure more than they clarify, and I too am deeply concerned about medicalization and institutional incentives. At the same time, I’m interested in whether some higher-order patterns—like persistence despite harm—are still worth naming, not as explanations in themselves, but as pointers to where regulation breaks down and where it can be restored.
Mainly, I appreciate your thoughtful engagement and your candor about your lived experience. We’re clearly aligned in wanting models that reduce harm, avoid mystification, and support real change.
I appreciate this point. Labels can flatten what’s actually happening. What I’m trying to describe in the essay isn’t the label ‘addiction’ but a specific pattern – substance use that emerges from regulatory difficulties and serves a particular function. Whether we call that ‘addiction,’ ‘problematic use,’ ‘abuse’, or something else matters less than recognizing the developmental substrate that makes certain substances so compelling for certain people. Does that distinction make sense?
Hi Nicole. I may not have been as clear as I could have been about what I was and wasn’t trying to address in the essay. I don’t doubt for a moment that AA, NA, SMART, and similar programs help many people, often in life-saving ways. And I agree they involve concrete actions, practices, and coping skills.
I don’t know why these programs work when they do, nor why they don’t work when they don’t.
My essay wasn’t meant to critique existing approaches. It was meant to suggest something narrower: that “addiction” may not be a single, uniform phenomenon. If there are different underlying patterns for different people, then it wouldn’t be surprising if some people need something different, or something in addition to, what standard programs are designed to provide.
That’s not an argument against these programs. It’s an argument for a bigger map.
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Thanks for your kind words, Andrew. I agree with the Louise Gluck quote!
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Thanks Stuart. I’m glad the essay resonates for you.
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Thanks for this Jasmine. I agree that all words are labels—but not all labels do the same work. To me, the issue is whether the language clarifies or distorts what’s happening. I’m less invested in defending the word addiction than in naming a real, recurring pattern where biology, psychology, and context interact in ways that narrow regulatory flexibility and constrain choice over time. That pattern is more than a single behavior, but also not a fixed disease entity. The question isn’t so much which label is correct, but which language helps us see the phenomenon clearly enough to reduce harm and support change.
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Amen to that.
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Thanks for taking the time to express your appreciation, Jay.
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Thanks for taking the time to think this through and to lay it out so carefully. I agree with much of what you’re saying, especially that words matter, that the word “addiction” has been stretched beyond usefulness, and that the disease/choice framing has done real harm. I also agree that drug use is behavior, and that behavior change—not labels—is what ultimately matters.
Where I may differ slightly is around what I’m actually trying to explain. I’m not using the word addiction to point at a discrete behavioral phenomenon or disease entity. I’m using the word as shorthand for a pattern that unfolds over time—specifically, a loss of regulatory flexibility under sustained internal and environmental strain over time. In that sense, my use of “developmental” doesn’t mean to point at something that exists before drug use, but rather that earlier conditions shape how systems respond once drug use begins.
I take your point that labels often obscure more than they clarify, and I too am deeply concerned about medicalization and institutional incentives. At the same time, I’m interested in whether some higher-order patterns—like persistence despite harm—are still worth naming, not as explanations in themselves, but as pointers to where regulation breaks down and where it can be restored.
Mainly, I appreciate your thoughtful engagement and your candor about your lived experience. We’re clearly aligned in wanting models that reduce harm, avoid mystification, and support real change.
Report comment
I appreciate this point. Labels can flatten what’s actually happening. What I’m trying to describe in the essay isn’t the label ‘addiction’ but a specific pattern – substance use that emerges from regulatory difficulties and serves a particular function. Whether we call that ‘addiction,’ ‘problematic use,’ ‘abuse’, or something else matters less than recognizing the developmental substrate that makes certain substances so compelling for certain people. Does that distinction make sense?
Report comment