ABSTRACT
From the earliest reflections on their use, the power of intoxicants to alter cognition, affect, and comportment has been both celebrated and a cause of anxiety. Less ambivalence has been expressed in the nearly equally long-standing concern that some individuals seem incapable of giving up the use of intoxicants even while acknowledging the harms arising from their consumption. This paper explores the various ways that the chronic use of, or addiction to, intoxicants has been understood from ancient times to the recent ascendence of neuroscience. The aim here is not to provide a comprehensive survey of the development of understandings of intoxicant addiction across human history, but rather to explore how distinct medical and moral regimes have variously conceived of chronic intoxicant use. The chapter identifies a variety of factors that have been determinative of changing ideas about addiction. While the chapter is broadly structured in terms of the chronological development of thinking about the nature of the chronic intoxicant use in the West, some comparative reference is made to the Islamic world and Asia. The principal focus is on alcohol consumption, given the rich documentation of its ubiquity and very long history of continuous use.
In the course of this account of successive conceptions of addiction, the paper focuses on several important themes. Central amongst these is the question of the extent and nature of the self-control of chronic users of intoxicants. This matter touches on the moral agency, criminal liability, and capacity of chronic users to discontinue their use of intoxicants. It will be seen that throughout history, this question of self-control has been connected to particular philosophical or theological and scientific understandings of the relationship between mind and body. This, in turn, links to the construction of the self. It will be seen that, at different points in history, the framings of chronic intoxication as a problem variously cast in social, moral, physiological, and psychological terms reflect, but also contest, prevailing conceptions of the self.
