The Theory of Rational Addiction in Addiction Recovery
Several interesting contributions to the understanding of addiction and the treatment of addiction have come, not from medicine, but from the field of economics. The late Daniel Kahneman, a Nobel laureate in economics, came up with “system one” (automatic) and “system two” (deliberative) behaviors in his bestselling book, Thinking, Fast and Slow. The balance between impulsive behavior and thoughtful behavior is critical to addiction recovery, and it’s something that can be learned and strengthened.
Economics also brought us contingency management, which is still the most effective way of getting people to stay in recovery long enough to get better. Economists figured out that if you want people to do something, pay them. Even a small sum, reliably dispensed, can lead to people in recovery supplying clean blood and urine tests day after day for months on end.
Now compare the costs of contingency management, an economist would suggest, with the cost of doing nothing: ruined potential, depression, suicide, theft to support addiction, crime to support addiction, people staying addicted for years or decades longer than need be, lost productivity, increased unreimbursed medical expenses, businesses run into the ground, families broken up, children raised in high-risk environments. From a non-judgmental, coldly rational, economic cost-benefit analysis, it makes sense to pay people in recovery to stay in recovery until they complete recovery.
The field of economics has brought another interesting theory to bear on addiction, and that is the theory of rational addiction. First articulated by behavioral economists Gary Becker and Kevin Murphy in 1988, rational addiction declares that addiction is a rational choice people make voluntarily and willingly and it is wrong to brand them as lacking character or judgment.
However, this view of addiction as voluntary behavior contradicts a great deal of what we know about addiction, such as that 50% of substance use disorders have a genetic origin. Another factor is trauma or stress, particularly during development — in the womb, as an infant, as a child, as a teenager, and as a young adult. That is a long stretch of time in which exposure to even economic hardship alone can increase the odds for depression and addiction.
Recently, rational addiction theory has been applied to the addiction to ultra-processed foods, or what we at AddictionNews refer to as eating addiction. Penn State University food economist, Joshua Reed, recently gave a talk on the subject for which there is no video or transcript available as of yet. His personal website amplifies the ways in which rational addiction can lead to public policy choices:
- Did FDA labeling rules for fast food restaurants lead to healthier choices being made by consumers?
- Have so-called “soda taxes” decreased the consumption of sugar-added beverages?
The field of rational addiction has much to offer the field of addiction recovery, when it comes to ways to improve the lives of people who are substance-dependent. The field of rational addiction confirms the theory of substitution whereby growing healthy habits can substitute for unhealthy habits, using the same techniques of repetition, cues, and triggers to launch healthy, life-affirming choices.
Written by Steve O’Keefe. First published October 10, 2024.
Sources:
“In What Sense Are Addicts Irrational?” Drug and Alcohol Dependency, September 2007.
“The theory of Rational Addiction,” Addiction, September 2019.
“Reed to discuss rational addiction to ultra-processed food on Oct. 16,” Penn State News, October 9, 2024.
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