The Ontology of Addiction
In this essay, I provide a brief philosophical analysis of the ontology of addiction. I propose that an adequate ontology of addiction needs to acknowledge the perspectives of “ontological breadth” and “ontological depth.”
Philosophers have for long pointed out that all concepts have ontological roots or make assumptions about the nature of reality (Bishop, 2007; Polkinghorn, 2004; Slife, 2005). Addiction theories and definitions (like all scientific conceptions), and addiction treatments likewise begin with certain philosophical assumptions that determine the nature of the concept and how it may be applied (Slife, 2005; Richardson, 2002; Bohman, 1993). In addictionology, these ontological assumptions often go unnoticed and consequently unchallenged by researchers and clinicians when they begin to explore and treat the disorder (Shaffer, 1986; Hill, 2010).
Integral Ontological Pluralism (Ontological Breadth)
Most addiction models, including the compound models, are not based on a pluralistic ontological foundation. This may be one of the pivotal reasons that conceptual integration has not yet been achieved in the addiction sciences. Ontological pluralism underscores that addiction is not a single “pre-given” entity, but rather a multiplicity of third-person realities. Moreover, the miscellany of the ontological realities of addiction has a special ‘enactive’ relationship with etiological theories and their respective methodologies.
The idea of enactment is vital in understanding why different theories of addiction do not have to be in contradiction to each other, as they are often interpreted, but can rather be understood as “true but partial”. Enactment is the bringing forth of certain aspects of reality (ontology) when using a certain lens (methodology) to view it (Wilber, 2003a, 2003b, 2006; Esbjörn-Hargens & Zimmerman, 2009; Esbjörn-Hargens, 2010).
In short, reality is not to be discovered as a “pre-given” truth, but rather, we co-create or “co-enact” reality as we use various paradigms to explore it (using paradigm in the Kuhnian sense–which includes the social injunctions associated with a certain worldview). For example, when attempting to understand addiction using objective empirical research methods, we enact a different ontological reality than when using a phenomenological approach. By avoiding what Wilber refers to as the “myth of the given”, we understand addiction as a multiple object with no existing “pre-given” reality to be discovered (Wilber, 2003a, 2003b, 2006). Yet it must be noted, we are not referring here to the conception of immaterialism. Integral Pluralism and its conception of enactment can be seen as an option “between” subjective idealism or immaterialism and positivism or materialism. Wilber (in Esbjörn-Hargens, 2010) says:
“This is why I use the word sub-sist. There is a reality or a What that subsists and has intrinsic features but it doesn’t ex-ist without a Who and a How. So that is where Integral Pluralism in general comes into being: it is bringing forth a reality but it is not creating the reality à la subjective idealism” (p. 169).”
Different research methods in addictionology enact addiction in unique ways, and consequently, bring forth different etiological models. Virtually all etiological models (typically based on a positivist foundation, including intrapsychic models founded on psychoanalytic metapsychology) treat addiction as a single object “out there” to be discovered or uncovered, and therefore, eventually run into trouble attempting to explain a feature of addiction outside of its enacted reality.
For example, physiological models and their accompanying research (naturalistic scientific) methodologies, enact the biological reality of addiction, and are inherently incapable of showing any truth of addiction outside the realm of biology, i.e. societal, existential, and so forth. In acknowledging the multiplicity of addiction’s ontological existence, the “incompatibility” of the various etiological models disappears, because we can see that each enacts a different reality of addiction–each bringing forth valuable insights in its specific ontological domain. What one considers real depends in part on the means and apparatus one uses, so objects are therefore “enacted” (Murray, 2010).
In discussing the status of the ontology of climate change, Esbjörn-Hargens (2010) raises some stimulating points that are relevant to addiction studies. In explaining the “inevitability of ontological pluralism” of climate change, he points out a relationship between the various methods that are used to “see” or enact this complex phenomenon, i.e. the relationship of (1) the common professions that encounter the phenomenon (the Who), (2) the associated methodology of each discipline (the How), and (3) the consequent view of climate change (the What). Exactly the same assertion can be made for the “enactment” of addiction models.
Applying the above-mentioned triadic relationship to the phenomenon of addiction highlights some fascinating, but seldom acknowledged, issues. When the various professions explore etiological models and apply their respective clinical methodologies, they may not refer to the same ontic phenomenon. We often acknowledge that various researchers and clinicians explore or treat different aspects of addiction, but often, this is based on the assumption of a common ontic reality of addiction, and, when “puzzled”, together we assume it forms a comprehensive picture of addiction. (This is the underlying ontological and epistemological assumption of the biopsychosocial model and other compound models).
Is the above-mentioned statement a correct ontological assumption (What) to build theories (Why) on? Is the neurobiologist seeing the same addiction as the existential therapist? Is the psychoanalyst talking about the same addiction as the 12 Step counselor? Is the biochemist measuring the same addiction as the social scientist? Yes and no. Yes, in the sense that they all attempt to view the socially defined and agreed-upon phenomena called addiction; and no, in the sense that they are “bringing-forth-into-the-world” and enacting different realities of the phenomenon of addiction, ranging in ontological complexity (first, second and third orders of ontology)– which can “overlap” ontologically, but are not the same ontic phenomenon.
In short: there are essential structures of addiction that share the “various enactments” of it, but how it “exists-in-the-world” (in a Heideggerian sense) varies, depending on the unique permutation of its integral enactment triad of “Who–How–What”. Esbjörn-Hargens (2010) says: “In fact, there is not a clear, single, independently existing object, nor are there multiple different objects. There is something in-between: a multiple object … This multiple object [addiction] is actually a complex set of phenomena that cannot easily be reduced to a single independent object” (p. 148).
In conclusion, the notion of addiction as a “multiple ontological object” may be one of the “missing links” in addiction science’s failure to provide functional conceptual integration in the field.
Addiction as a Third-order Complexity (Ontological Depth)
Esbjörn-Hargens describes three orders of ontological complexity as follows: “the first order is characterized by phenomena that we can more or less ‘see’ with our own senses. The second order is the result of using various extensions of our senses (instruments, computer programs, charts) to see the phenomena … The third order cannot be seen with our senses nor indirectly by our instruments, but only by indications” (p. 159).
The construct of addiction can thus be understood as existing on a “probability continuum” of ontological complexity, co-arising and enacted through different methodologies and worldviews. For example, a first order ontology could be the experience of being high on the drug. It is available to our senses. A second order ontology could be the pharmacological effect of a drug on neurotransmitter levels or unconscious psychological drives as risk factors to substance abuse. This we can understand only through measurement and calculations, and through a metapsychological perspective. Both these approaches can grasp only partial aspects of human existence.
At the highest level of abstraction lies the notion of an individual’s addiction-in-the-world, which is a staggeringly complex phenomenon beyond our senses or instruments. So addiction “is two steps removed from our direct experience (the first order) and our perception of it relies on many abstract indicators (the second order), which are epistemologically distant and ontologically complex” (Esbjörn-Hargens, 2010, p. 159).
When understanding addiction as a third order ontology, we begin to understand why certain models of addictions, especially the single-factor models, give rise to such partial and reductionist explanations. They are good at explaining certain simpler features of addiction in the realm of its enacted first or second order ontology, but methodologically and epistemologically, they are incapable of enacting addiction on a third order ontology. Technically, a third order ontology is actually the level of ontological complexity where the notion of addiction exists. (A first or second order ontology cannot articulate a complex phenomenon like addiction). Heather (in West, 2005) points out certain features of the ontological complexity of addiction, and the problem faced when etiological models do not include a perspective of ontological complexity:
“[A]ddiction . . . is best defined by repeated failures to refrain from drug use despite prior resolutions to do so. This definition is consistent with views of addiction that see decision-making, ambivalence and conflict as central features of the addict’s behaviour and experience. On this basis, a three-level framework of required explanation is (needed) consisting of (1) the level of neuroadaptation, [1st order ontology] (2) the level of desire for drugs [2nd order ontology] and (3) the level of ‘akrasia’ or failures of resolve [3rd order ontology] . . . explanatory concepts used at the ‘lower’ levels in this framework can never be held to be sufficient as explanations at higher levels, i.e. the postulation of additional determinants is always required at Levels 2 and 3. In particular, it is a failure to address problems at the highest level in the framework that marks the inadequacy of most existing theories of addiction (p. 2).”
Most of the models discussed have as their foundation a natural scientific worldview and positivistic methodology that are typically adequate for exploring phenomena existing on the first and second order of ontological complexity. However, such models are hopelessly inadequate in explaining complex phenomena such as addiction (or any human behaviour) which “exist” on the third order of ontological complexity. For example, reward deficiency syndrome (Blum, 1995) can only be understood as one of many possible physiological risks that interact with other aspects of being human, without having to reduce human behaviour and motivation to neurotransmitter levels. Simply put, even though an addict has low neurotransmitter levels, at the molecular realm of brain physiology concepts such as addiction are meaningless. To talk at molecular level about addiction is like saying that an amoeba, which only exists in a primitive level of ontological complexity, has abandonment issues originating from poor object relations.
Boss (1983) points out that the natural scientific method has its limitations in explaining the human realm, as it originated from and is only sovereign in the non-human realm (natural sciences).
In our current context we could say that by using Heidegger’s method in exploring psychology and psychiatry, Boss echoes the dangers of explaining higher-order complex phenomenon (which includes any aspect of human-being-in-the-world) by using methodology (i.e., empirical observation) and epistemology (i.e., positivistic) dominant in lower orders of complexity. He believes that in Freud’s metapsychology (and most other theory of human existence) there is, inevitably, an abstraction and tapering from our lived engagement in-the-world (human-being-in-the-world reduced to first and second order ontology).
In Conclusion
In summary: the phenomenon of addiction is a third order ontology, which can only be co-enacted (“brought-forth-in-the-world”) when juxtaposed with associated “methodological variety” and “epistemological depth” (Esbjörn-Hargens, 2010). I refer to this perspective as “ontological depth.”
Methodological variety refers to the fact that “the more epistemological distance and ontological complexity increase, the more methodological variety will increase. Thus, the more multiple an object becomes (the What), the more methods and disciplines you will need to study and make sense of it (the How), and the more perspectives there will be on what is or is not the nature of that object (the Who)” (Esbjörn-Hargens, 2010, p. 162). I refer to this perspective as “ontological breadth.”
In short, trying to reduce our human being-in-the-world to a first or second order ontology, as natural scientific methods do (without acknowledging ontological depth), and trying to understand addiction through only one lens (without acknowledging ontological breadth) is fundamentally flawed. Addiction is caused by, affects and manifests in all areas of our being-in-the-world, and only paradigms (or rather meta-paradigms) that function on this level of ontological depth and ontological breadth may suffice, if we are ever to understand, and successfully treat this colossal nemesis.
All references in this essay can be found in my book An Integral Foundation for Addiction Treatment: Beyond the Biopsychosocial Model. Integral Publishers.
