Addiction, identity & 'denial' with Professor Hanna Pickard

Meeting Professor Hanna Pickard and Her New Book Hello and welcome to the Alcohol Problem podcast. I'm Doctor James Morris and the aim of this podcast is to explore a range of alcohol related issues by talking to people, including alcohol researchers and people with lived experience. In this episode, I talked to Professor Hannah Picard about addiction, identity and denial following the release of her new book. What would You Do? Alone in a cage with nothing but cocaine, a philosophy of addiction. So, Hannah, thank you so much for joining me. Yeah, I'm really pleased to have you on because we've kind of had similar interests for quite some time. So yeah, could you just tell our audience A brief bit about yourself, who you are and what you do, please? Speaker 2 Sure. So thanks so much for having me. First of all, James, it's really nice to be here and see you again and have a chance to have a conversation together. So I'm Hannah Picard. My training is as a philosopher, but I also spent a decade working part time for the NHS in an outpatient therapeutic community for people with personality disorders and complex needs, many of whom also struggled with drug and behavioural addictions. And I guess I've been working on addiction in a philosophical but interdisciplinary and also clinically anchored, or at least I hope way for a couple of decades. And the occasion for us having this conversation is that in January 2026, I finally published a book that brings all of my work together and extends it. So it was a bit of a milestone for me. And, you know, it's lovely to be here and have a chance to talk with you about some of the themes in that book. The book's called What Would You Do Alone in a Cage With Nothing But Cocaine? A philosophy of addiction. Speaker 1 Yeah, and I've been reading some of it and can highly recommend it. But yeah, I mean, I guess the key thing that I'd really like to cover is around, you know, the idea of kind of how people come to recognise themselves as having addiction or a problem with alcohol and particularly in terms of the sort of implications that has in terms of self labelling. So, you know, I'm very interested in the idea of how people self label as having alcohol problems and the the risk of being stigmatised as a result. Particularly we know that the sort of alcoholism model carries a lot of stigma, but people can also benefit in some ways or from from self labelling in that way. So yeah, that obviously relates also to this idea of denial that I'd really like to talk to you about. And you know, you published some years ago a really fantastic academic paper, but you've also covered it in the book. So yeah, what do you think is a good starting point for how we kind of understand some of the maybe key issues in terms of how people come to recognise a problem? Beyond Blame: Responsibility Without the Disease Model Yeah, well, in, in a sense, I think the best starting point is some of your work, which I give a shout out to in the introduction because it's been really influential on my own thinking. So, you know, I, I sort of think that the brain disease model, which is of course the dominant model of addiction, has sort of made a claim for itself that it effectively combats stigma. And of course, by contrast to what's called the moral model, which, you know, honestly is a sort of model that's infected our cultural thinking throughout history, coming in large part, I think through religious ideas as opposed to a scientific model, right? It's not the model which any serious researcher has ever studied or cleaved to as telling the truth about addiction. But, you know, as opposed to the moral model, the brain disease model of addiction probably does have some improvements, but yet it too has these tacit moralising assumptions and it too brings stigma. So, you know, I, I think that the phrase used by the sociologist Nick Haslam is excellent. It's been a mixed blessing, right? On the one hand, it means that people are more inclined to see addiction as something that science and medicine ought to do research on and we ought to commit public funding to treat. But on the other hand, as with any disease label, there's also a fair bit of stigma attached. There can be perceptions of danger, perceptions of difference, and also a kind of other ring. And of course, having a disease is something that none of us want, especially a brain disease, right? Because in some sense, if, if, if your problem is that you have a brain disease, then the solution to it really isn't going to rest with you, right? There's something fundamentally wrong with your brain that surely would be fixing by a neurologist. So, you know, I really loved the way your work has explored how those kind of ideas associated with the disease label have really impeded people from being able to recognise that they might have a problem or that they might be struggling with addiction. Because even though doing so might provide access to treatment, it comes with this terrible cost to self, right? So, you know, I think that's one of the things that moving away from a disease label can really help us with, opening up space for a sort of demoralised and more humane understanding of addiction that allows people to recognise the problems they're having without sort of having to also deal with the possibility or the reality that they have a brain disease. Speaker 1 Yeah. And I think it is really important to recognise, I suppose, that the disease model or brain disease model more specifically, is a step forward to comparing it with the historical moral model. But you know, there was the claim, you know, Nora Volkow claimed, I think it was in 2015. I've cited it quite a bit, you know, something like if we call it a disease, we remove the blame. And it is true that blame seems to be reduced when people attribute addiction to a disease or a brain disease. But we know that that stigma is more than just blame, isn't it? That, as you say, no wants to to have a disease. And so it might provoke an emotional reaction or you still don't. Even if you don't blame someone, you still might not want to be close with them or give them a job or whatever. So, yeah, I think, you know, I'm picking that blame is not just the only part of addiction. Stigma is really important. And that sort of ties in, I suppose, I think, with the really important work that you've done as well around responsibility and blame. Can you say a bit more about that perhaps? Speaker 2 Yeah, sure. So I guess I agree, especially as someone with some clinical experience, of the absolute importance of avoiding punitive blaming attitudes. But there are ways of doing that without embracing a disease model. And part of the work I've done in relation to addiction has been to articulate what I think of as a clinical stance of how we engage with people who are acting in ways that are harmful either to themselves or others, and which would naturally invite blame as holding them responsible and to account, but without blame. And so maybe it's actually nice to get this idea sort of in the conversation between us early, just because I do think of it as such an important plank of the new paradigm prediction that I put forward in this book. So the, the idea here is really that it's all too easy for us. And I, I, I guess I think you can see this and Volkos work that you've alluded to. It's all too easy for us to get trapped between these very sort of extreme black and white kind of stances or sets of ideas. And one is the blaming stance, where we see someone as an agent who has some choice and control over what they do. And so if they do something harmful, they're responsible and to blame. And so we feel entitled to be punishing and judgmental and hostile towards them. And on the other hand, especially if one wants to avoid that stance, which of course is a, as a clinician you need to do because it's very unproductive as a way of engaging with anyone, but especially a patient. You might sort of recoil to what I've called the rescue stance, where what you do is you basically deny that the person has agency. You deny that they have any choice or control over what they're doing whatsoever, thereby avoiding this slide to responsibility and from the slide to responsibility, therefore also avoiding the slide to blame, right? And so you sort of see them as someone who can't help it, as a victim of a disease and in need and worthy of care and treatment and concern. So you can notice in in these two stances that actually, although the second no doubt feels preferable if we want to be in a position of caring and helping and treating people. There's also a reason to think it's going to be really ineffective, which is that if the problems in someone's life really stand from how they're behaving, that's a really fundamental part of what's causing the harm to them or to others, then that behaviour needs to be addressed for them to get better and, and improve. And it's very hard to do that if you deny that they have any choice or control. Because in some sense then the solution, again, we're back to some medical fix as opposed to thinking that it's an extremely challenging and difficult thing to do. But people sometimes need to learn to behave in other ways. And in particular with addiction, people need to learn to change their relationship to drugs that either stop using or moderate use significantly. So we get caught in this, in this sort of oscillation between either rescuing people to avoid blame, but in virtue of rescuing them also undermining part of the attitude we need to take towards them and help them take towards themselves, which really helps them get better, which is to think of themselves as an agent where there's hope and potential and possibility for them in the future that they can do things differently. So what I've tried to do in the book is sort of carve this in between plays, which I really think is enacted and effective clinical practise and I hope will feel very resonant with any of your listeners who are clinicians, which is to sort of show how we can acknowledge agency and with it responsibility. Indeed, we can use responsibility as a clinical tool to help people change in ways that are meaningful to them, but avoid blame, right? We don't have to slide from responsibility to blame. And in ways, the way I, I sometimes put this a little bit sloganistically is to say that, you know, just as if we're holding someone else responsible, it's because we think they have choice, some degree of choice, so do we in respect to the method and means by which we hold them responsible. We have choice about whether to blame or not, whether to be judgmental, punitive, hostile or not. So there are choices on both sides, right? And the responsibility without blame stance, which are articulated in the book, is really an attempt to flesh that out both philosophically and practically and see how important it is to apply it to addiction on as a way both of, I think changing how we think and relate to people with addiction, but also also as part of understanding what addiction is. Getting it right. Because it's not black and white, right? It's not like either it's something which someone has full agency for and is responsible for and should be judged for, or they're helpless and simply a victim of a brain disease. The truth, which we all know, is that it's complicated and messy and there's a lot of heterogeneity between different people. And I think both to understand addiction and to do justice to the people who struggle with it, we have to get better at recognising that grey zone as opposed to always oscillating between these black and white extreme options. Why We Deny: The Psychology of Addiction Yeah, absolutely. But I, I suppose, you know, in some sense we have this sort of luxury or privilege of exploring it and thinking about it in all its kind of nuance. But, you know, I think I've mentioned it with other guests before. You know, someone that I played golf with said to me, you know, he wasn't especially interested in what I did, but he just said, So what is it? Is it a disease or is it a weakness? And when I replied it's complicated or neither or whatever, you basically told me where to go with a swear word, beginning with F, you know? And it's sort of very sort of British humorist kind of way. But yeah, there's that strong need or desire for humans to kind of reduce often complex things down into simplistic explanations. And yeah, that's that's valuable in much of our life. We need that to function and to get by in the everyday. But yeah, when it comes to something like addiction, then it tends to be very problematic and why we have these strong cultural and historical discourses and ideas and beliefs that that kind of sometimes go down the route of, of reducing it to something far more simple than it could ever be. But yeah, I think that's really important, that idea of that it's it's not just choice, but it's also not just kind of total loss of control, because that is often how what people reduce it down to. Is it just loss of control and failure to exercise proper, proper discipline or moral fortitude or whatever? Or are they just, you know, a victim to hijacked brain bathways or whatever? Speaker 2 Yeah. So let me just make a few points in response to that. So one of the one of the reasons I think we really need to get beyond this forced dichotomy is that if we stick with it, we just absolutely failed to look at all the variety and depth of human psychology which can explain drug use. And that's something that is really important to me in the book is that I really try to document all the different things which contribute to different people, but not all people in terms of explaining why they use drugs self destructively with that black and white thinking completely messes. So, you know, that includes some things that people are quite familiar with, like self medication. But I also think that for some people thinking of the opposite it desire to self harm or die is important. It includes self identity. It also includes problems of control. It includes craving and also denial, which is one of the things that we're going to talk about today. So, you know, the cost to our understanding, but also our ability to tailor treatment to individual needs is really substantive if we allow ourselves to stick with that black and white thinking. And the story you tell is, of course, familiar to all of us who do academic work. People sometimes want like the one take home message or OK, like, you know, in a nutshell, is it this or is it that? And I guess I'm also always curious about why people feel such a need for that. I mean, I think it's much more pervasive in our culture than just around addiction, right? Or drug use. It's kind of, you know, we all people want the sound bite. They, you know, want to have a sense that there's a clear, easy, reliable answer that they could just, you know, have in their pockets and use to govern all possible situations and behaviour. And you know, I, I guess for me in ways like that itself is an inclination in us that really naturally leads to asking about the propensity in all of us for denial, right? Because you know, my hypothesis about the person you say that you encountered in the Golf Club. And of course, this is really not about him per SE. He's just a sort of stand in for people who have this kind of response. Is that actually the greyness and the nuance and the uncertainty that comes with it is deeply uncomfortable to sit with, right? And so we are motivated to reject it, right? Indeed, to kind of get a bit angry about somebody who asks you to sit with that and to demand this sort of much more easier to handle simple, clear reductions. So, you know, it in some sense it's a it's a lovely story to get us launched on to talking about denial because denial just is a psychological process where we deny some element of reality in order to avoid the psychological pain that acknowledging it would bring. So, you know, in some sense, you know, what I'm suggesting is that with apologies to your friend on on the golf course, it does feel to me like a place where, you know, something like denial is work, right? Why is it so hard to tolerate the reality of complexity around drug use and addiction, right? That's the truth, I think about it. So that's the the the unwillingness to face that truth is something in US or in that person, not in the world itself. And just so you know, we have this really important feature of some people's experience with addiction, especially alcohol. I think we can talk about why, especially alcohol, which is that we can explain what's going on partially by their own resistance to recognising the problem with alcohol that they're having, right? The damage it is doing to themselves and their lives. And of course that refusal to recognise that problem is part of what allows people to keep on drinking or to keep on using drugs, right? Because one of the core sets of reasons you would have for thinking there's reason to quit or to moderate use is something you're in denial of, right? If you don't think that your drug use is causing you any problems, then why would you stop? So denial plays this incredibly important role in understanding addiction, which I think has been really under theorised partially because it's grey and it's psychological, right? There's no need or room for it if either what we're doing is moralising drug use or thinking that the problem is simply with a broken brain, right? Denial is just not in the landscape if we're caught between those two poles. Speaker 1 Yes, that's, there's so much in there. And yeah, I do think that the idea that we all conduct motivated reasoning, you know, we all use cognitive biases that make us feel better in the moment or less bad in the moment or whatever, you know, everyone engages probably in wishful thinking or, or whatever. So yeah, I think, yeah, the problem with denial is that it's kind of caricature, doesn't it? It's stereotyped as this thing where it's so obvious to everybody else, but the person cannot be doing anything other than willfully choosing not to believe it. And yeah, that that might reflect some cases in some ways as a protective mechanism. Because to yeah, admit that you have using the term admit and try to come as an alcohol problem has a lot of implications for how one sees oneself and how other people will in turn treat you. And in turn that you would need to therefore do something about your drinking when you probably place a lot of value on it. And again, maybe some of those beliefs might be distorted by cognitive biases. But yeah, the term itself is problematic. I think because it is, again, another reductionist term. It just sort of boils it down to boils addiction down to the only problem is the person failing to see what's evident to everybody else. Speaker 2 Yeah. So I mean, part of the project I undertake in this bit of the book is to track the complexity of both motivated irrationality and cognitive biases, which may have nothing to do with motivation. They're just unfortunately part of what it is to be human and to reason less than ideally rationally, as we all do. So, you know, I think, you know, I really think there are sort of two ways of kind of diffusing that instinct to see denial as black and white and also to see it as stigmatising. And one is to simply look at, you know, the wealth of findings from cognitive science and behavioural economics, which just show that all of us are so much less than perfectly rational in so many contexts. And to recognise that, you know, many of those tendencies, like, you know, putting off something you need to do because it's always better to wait one day than to start it today. But unfortunately, that will be true tomorrow. But you don't think of that tomorrow. You just think about it today, you know, and in that sense, to procrastinate or, you know, privileging immediate reward over future reward, I mean, all of these tendencies are just absolutely rampant in all of our, you know, cognitive lives. So there's nothing specific to people with addiction, which means that, you know, they do this and we don't. It's just that when these kinds of biases sort of latch on to someone's drug use, it can have a particularly pernicious effect. Right. So deciding that you're going to always wait for the next day to quit is a much more significant decision than say, you know, my decision that I'm always going to wait for the next day to learn how to play golf. I'm sure my life would be if I knew how to play golf. But, you know, it's, it's not a fundamentally destructive force in my life that I don't know how to play golf, right? Even if it was better if I didn't always put it off. OK. So, so one thing to say is that this is just the nature of the human beast, right? We know that we're less than rational. And that is really helpful to think about when we're thinking about people who are making decisions around drugs that feel denial like that feel less than rational, right? It's something we're all doing. But the second thing is also, I think to recognise that, you know, in all of our lives, this motivated irrationality is also present, right? So here are the ideas that you know, and, and, and I think if we stop and think and are honest, we can always kind of see this in ourselves as individuals. So, you know, just think about the different way you're likely to approach a new piece of evidence that is consistent with something that you want to be true and already believe or is, on the other hand, challenging of something that you want to be true and already believe, right? You're going to be much more sceptical and inclined to dismiss the evidence if it's challenging and much more inclined to sort of gratefully receive it if it's consistent with, you know, your beliefs that you hold dear, right? So I think something as small as that is, you know, something that we can all of us recognise in ourselves. But then really if we, if we start down that path, I mean, I in my own life and certainly, you know, the people in, in my, in my wider circle, friends and family, there are many cases I can point to where somebody's initial reaction to really painful news is denial, right? We find that in people denying medical diagnosis and people, you know, denying when like far more risk has happened to loved ones and really like holding the hope beyond reason that it hasn't happened. So again, that kind of tendency to, you know, really do everything you can cognitively to turn away from painful reality because of how painful it is. It's something that I again, I think we can recognise as just, you know, hard what it is to be human right for all of us. And so now again, if we take that and, and turn back to addiction and we think of how valuable drug use is for so many people with addiction. And I understand that that can sound a little bit funny because we think of drug use and addiction as self-destructive. And of course it is. But part of what keeps people going is that it also has value. And we need to be much more real about recognising that value alongside the harms if we're to understand what keeps people stuck using drugs in ways that are so self-destructive. So if we think of drugs as something that have tremendous value for people, maybe that's because drugs are the only thing that's providing them with relief from pain and suffering and emotional distress. Maybe it's because drugs are to become deeply part of their identity, right? Their sense of who they are and their daily routines. Maybe that's because actually it's extremely painful to recognise that they have a problem with drugs and that some of the other problems in their lives might be due to drugs and in some sense, you know, due to themselves and consequence, right? There's a tremendous shame sometimes in acknowledging that it's your drug use which has had this really devastating effect in your life, especially when that involves an effect on other people who you love, right? It's incredibly painful to to acknowledge. So we see the value of drugs and the value of resisting the idea that you have a problem with drugs in someone's life. And then we can understand why they would be really motivated to sort of reject any evidence that comes their way to find, to use the sort of, you know, foibles of human psychology to push that evidence to one side. So they don't actually have to recognise that they have a problem, right? They can deny that they have a problem. And so that kind of picture where on the one hand, we need to think in more serious ways about the ways that drugs have value, complex value, deep value and meaning for people in addiction alongside the harms that drug use does to them. And the way in which motivated reasoning and cognitive biases. Therefore consider, you know, jump in and protect us from the pain of having to kind of lose those valuable things can be really, really important in terms of understanding why someone keeps using and also in thinking about how to help them, right? Because the help here really has to do with kind of getting them to face reality, but in ways which they feel supportive and have, you know, other people and, you know, a context with which they can deal with the pain that that reality is going to cause them. So again, that is, you know, a kind of intervention, which is psychological and it's social. It's not about fixing their brain, right? It's about helping them see things differently and helping them have some support in facing whatever the pain would be of of life without drugs. Speaker 1 And in turn that, you know, brain change would happen as they go through those processes. But as you know, Mark Lewis would say, brain change happens when we we do anything. And quite amusingly, when, when you're saying about how, you know, we, we know how we treat information we agree with so much more favourably than information we disagree with. I remember reading a kind of neuroscientific explanation of how, you know, the brains, people's brains light up when they sort of see information they agree with. So it's the sort of seductive allure of neuroscience can be sort of quite convincing and explaining sometimes real things. But yeah, in the case of addiction, I think, you know, it's problematic because and yeah, it's, it's, they're just a mediator of our experiences rather than necessarily the the causes or effects or multitude of complex things going on in our, as you've explained, relational world, our social world, our identity and so on. Widening Our Gaze: Beyond Brains to Culture That's so important part of the the puzzle of addiction, as you explain. Speaker 2 Yeah, so maybe I can like take this moment to just say something about neuroscience because honestly, some of my best friends are neuroscientists. I work in an animal lab and I think people often think that I'm sort of deeply anti neuroscience because of my stance on the brain disease model, but I'm not. So let me just make a couple of points. So the first is that I think it's really important to recognise that neuroscience can contribute to our understanding of addiction, which I think we need to see as drug use. That is a form of behaviour that's gone wrong totally, apart from whether the brain disease model of addiction is correct. And that's because neuroscience can contribute to our understanding of all human behaviour, right? It's not restricted to disease, right? So we don't lose the potential gains that neuroscience can offer to our understanding by denying that addiction is a brain disease, right? Because neuroscience can help us understand all sorts of things about human minds and behaviour that have nothing to do with disease. So that's, that's the first, the first really important point, I think. But the second is that I really do think neuroscience can sometimes shed light on why or how people have certain experiences or behaving the way they do, But that in some sense we need to be wary of precisely that black and white reductionist tendency. As if once we've seen something light up in some region of the brain, we have a full and complete understanding and explanation. We don't, right? Neuroscience sits alongside cognitive science, it sits alongside human psychology and attention to people's own lived experience, and sits alongside the sort of social and material and cultural contexts in which people live, all of which need to be woven together to give a full explanation and understanding of human minds and behaviours. So I really am in no way anti neuroscience. I'm anti the idea that the only thing we should be caring about is neuroscience. And I, I really think that our understanding of addiction has been impoverished by a kind of relentless focus on understanding the brain bases of the reward system and behaviour that is driven by reward speaking as opposed to thinking that whatever we learn about the brain is really illuminating when it is connected to cognitive science, psychology, behaviour and social context. So in some sense, the book really argues for a widening of our lens of gaze, as opposed to a rejection of the one thing that we're currently very, very focused. Right? I don't think it should be rejected. I just think we need to widen our gaze. Speaker 1 Yeah, and and probably say the same about genetics, or maybe I'd be more sceptical. I mean, there's been so much money and time spent on seeking out genetic explanations for complex behaviours like addiction. And I think it has come at the cost of recognising how valuable our kind of social and lived environment is. You know, we know that the most effective ways to reduce alcohol problems are going to be the kind of tightening of the supply, availability and and price that contributes to it being so, so normalised in society. And this kind of dichotomy where you have kind of many forms of heavy drinking totally socially acceptable. And then it's just deemed a problem when someone is no longer performing their kind of responsibilities in a sort of kind of capitalistic way, you know, going to work and paying taxes and so on. So, yeah, I think, yeah, all levels can can play a role in our understanding of something so complex that, you know, I don't know what you feel about this because of use of the buyer psychosocial module, but yeah, it's sort of rebalancing it. But I think that we need, we need going forward. Speaker 2 Yeah. So like I think there are two kinds of points that I want to make in response to that, which I really agree with. One is just, you know, to recognise. I think it's really important to recognise not only that sometimes we know that an intervention will help, it's a psychological or social or economic intervention, and yet we're failing to do it. Meanwhile, we keep pumping funding into animal models and neuroscience. Again, animal models are actually something that I've spent a lot of time studying. They run through the book. I do think we learn a lot from, but I also think it's important to recognise that the translational results from early decades of, of funding of research for animal models and neuroscience are actually really disappointing, right? So, you know, in terms of the discovery of new and effective medications from different forms of addiction, basically there's been almost nothing. And the medications that we still use to treat alcohol addiction and opioid addiction were discovered basically in the 50s and 60s and early 70s. So before the ascent of the brain disease model and the new techniques that are used with neuroscience and animal models, right? So you know, it it hasn't delivered on the translational promise. And that's part of why from a simply practical perspective, I think the time is right just to rethink some of the assumptions and orientations that we have a little bit. But the second point that sort of your remarks made me want to bring out is really connected to alcohol in particular, right? Because, you know, one of the things about alcohol, as opposed to other classes of drugs that are criminalised in many societies and often highly stigmatised, is that alcohol, at least in our shared societies, the UK and the US and many comparable countries around the world, is culturally sanctioned. So it's pervasive, it's normal, the way in which it's woven into daily life without people becoming addicted. Most people drink in some form or other. Many people drink a little bit every day. And so that sort of way in which alcohol is woven into the fabric of our Society, of course, means that on the one hand, there's maybe a little bit more pressure expectations that one drinks and participates, right. So you can always think of how if you're at the pub with your friends, you know, I lived in the UK as well as the US, so I know what this is like. And everyone's getting a pint and you say, no thanks, I'll just have a ginger ale. People are, you know, they can be like, what? Not drink. You know, you have to answer for that, right? So there's a way in which we all live in a society in which alcohol is very much a part of it. But of course now if we think back to denial, that means that it's way easier for people to be in denial around their alcohol use then it would be, say, to be in denial if they were addicted to a drug which was more highly stigmatised and more criminalised. Because there is always a way that they can kind of normalise it using their cultural tools, right? I mean, maybe there's someone at the pub who has more of a problem than them. So they can say, well, you know, I'm not like them, right? Or, you know, maybe they can say, well, look like, you know, all my friends go out drinking and sometimes end up making a fool of themselves. So the kind of cultural context in which one's in means both that denial may be something that is more natural and possible to occur in relation to 1's own alcohol use, right? But it also means that we potentially have a place for interventions that could be really meaningful, right? Cultural interventions are important and cultures that have attitudes towards drinking, say where it is on the one hand accepted as part of ordinary culture, but on the other, there are very strict norms about what counts as you know enough and when you have to stop and against sorts of comportment, which mean that you have to drink a certain amount, which can then sort of lead you down, you know, lead you down the garden path towards having a problem have been shown to be really important and effective in at A at a population level, keeping people's drinking within healthy limits. So, you know, it got the role of culture in both sort of explaining how people could fail to recognise they have a problem, but also giving us a tool to try to shift something to help people drink more healthily is something that is really important to think more about. And again, it's just, I think, been insufficiently part of the orthodox scientific and to some extent public health discourse around addiction. Speaker 1 That's so interesting. Who Are You Without Alcohol? Identity in Recovery And yeah, I was thinking about the kind of current, you know, debates about this no safe level of alcohol consumption message that the World Health Organisations led on which, you know, kind of technically true that any amount of alcohol is carcinogenic or not good for us. But, you know, this, this kind of idea that therefore you just shouldn't drink at all goes back to the sort of moral kind of idea that overlooks the fact that, you know, we do lots of things in life that carry risk. That doesn't instantly mean that we just shouldn't do them at all. So, yeah, understanding that the cultural reasons for alcohol use and the the benefits or sometimes perceived benefits that people get from them, real or otherwise, are still important to factor in and therefore why such messages might actually miss the mark with many drinkers. So perhaps that's a nice kind of way to sort of lead into point that we've touched on. But it's really important to try and cover is, you know, this idea of identity and you know, to drink and to enjoy alcohol, you know, that becomes part of who we are and what we do and in many ways is embedded within positive beliefs about or expectancies about alcohol, which sometimes are artefacts rather than necessarily true. But I think that identity aspect is so important in both terms of drug or alcohol use identities, but also recovery identities, which again also I think ties into what we're saying. Because some people do say, you know, when they're asked about the recovery, that the starting point was when they started to be honest with themselves. And I think that kind of does nicely capture the way in which people, being honest with yourself is a sometimes a difficult thing to do, but still, you know, is important and to recognise how it does sometimes conflict with our identity or the meanings or things that we value in life, if that makes sense. Speaker 2 Yeah, I mean, I, I guess I'm kind to think that the the idea that you start to recover when you're honest with yourself is true for some, but not all people. Like again, I really want to keep the heterogeneity in place. I think there's a really important community of people who are some of the most sort of vulnerable people who are addicted to drugs, where the problem is not a lack of self honesty or denial. The problem is that there is no community or meaningful work or life for them apart from their drug using community. And so you know, I just like I just I always want to be so cautious about making generalisations and make sure that we keep all of the differences between people in those situations clearly in view. But you know, if for the person who whose identity in some sense, if I can put it this way, you will know the language better than I their, their identity is as a drinker but not as an alcoholic, right? So their drinker identity gives them a sense. It probably connects them to other people. It gives them a set of activities that structure their daily life or certainly their weekends. It kind of may even be something that they find themselves taking some pride in. I mean, in our society, we often brag about how much we drank or how drunk we were, right? So there can be a kind of machismo around that. So there's the person where that identity is very important to who they are, but yet they don't identify as a person with a problem, right? Because that would be very threatening to their sense of self. And Part B could mean they have to give up this drinker identity, which is part of who they are, right? But which they're sort of seeing in a positive light. I'm sure there's some recognition that, you know, they feel less good on Saturday and Sunday morning or whatever it is, or perhaps, you know, or relationship or two struggled a bit because of it. But yet their overall sense is one of positive identity and balance. And then the idea that this is a really big problem really threatens that. And so you have to be honest and real and face up to the pain that actually this identity you had as a drinker isn't such a great thing for you after all. And that, of course, raises the question then, if it has been an important part of yourself, well, who are you then, right. Who are you going to be with your friends in your community when you're by yourself alone at night if you're not a drinker, right? And so, you know that place for identity, both the way it can be sort of part of what sustains people's use, but also the way in order to quit. If your identity has been one either of a drinker or of an outright addict, like I suggested, some of the people who live in really much more deprived situations and have no life or sense of identity apart from their community with other addicts might feel. So you know, when that identity is important to your sense of who you are, then to give it out really leave something like an existential void, right? Who are you if not an addict or who are you if not a drinker? In the the other case we're considering, that is a question you're going to need to answer if you're to succeed in recovering because we all need a sense of self, right? We all need a sense of identity. It's incredibly destabilising, terrifying even to feel that that's ripped from you and there's nothing left. So that's something that needs to be built for people often through recovery. And of course it's something which everyone needs social support in doing, right? That's an incredibly important plank of establishing a new identity, is that there are people there who recognise you as this new person and who validate it and who you know. When you see yourself through their eyes, you see someone who is living a life of meaning and has succeeded in overcoming whatever problem with alcohol or any drug you felt you had and needed to get beyond. Right. So again, this points to have, you know, the psychology and social context in which a person lives is just so important to understanding what might keep them stuck using drugs in ways that are self-destructive and what needs to happen for them to move away from that relationship to drugs. You know, and which we just simply will not see if all we're doing is training our gaze on a broken brain or alternatively, engaging in punitive, moralising, shaming behaviour, right? So it's really our own ability to see and be real about and engage with that grey middle zone of psychology and social context which allows what's going on and how we might help to come into view. Speaker 1 Yeah, I think that's so important. And yeah, you kind of got me thinking of all the other really important things that could contribute to behaviour change and the problems of even the term recovery, you know, is very laden and certain ideas and a sort of dichotomy of people with or without addiction. And we know that for instance, many people drink heavily and then possibly one of the key reasons why they may not problem recognise it, so to speak, is that they feel that it would be very difficult to change the self efficacy isn't a sufficiently high as a really key predictor of behaviour change in so-called addiction. So, yeah, I think that that kind of point to really emphasise the heterogeneity, the diversity and difference in alcohol, drug and alcohol use and when it becomes problematic and then, you know, captured under the idea of addiction and recovery is quite a good point to kind of ground up on because yeah, there's always so many different factors at play and yeah, identity is really important, but so is self efficacy and so many of the other things we've touched on. So yeah. Embracing Complexity: A Humanist Approach to Addiction Are there any kind of closing thoughts that you would like to finish on or? Yeah. Speaker 2 Yeah. So maybe there's just sort of two kind of connected points that I really think are important to emphasise. 1 is in relation to the heterogeneity, really honing our willingness and ability to listen hard and seriously to the different things that different people say about their relationships with drugs and really take that as central to research and treatment alike. But the second, I guess, related theme, which we haven't named, but which I, you know, has been really part of our conversation. The second theme of the book is a, is a kind of humanism about addiction, which really involves not just thinking psychologically about other people and their relationships with drugs, but also we're reflecting on ourselves and our own moralism and the assumptions that we may unwittingly bring to our engagement and understanding of other people and frankly, our research. So, you know, I, I guess those, those sort of two things are just themes that I really want to always draw out of every conversation and just kind of bang on a bit about the need for heterogeneity. And that involves listening to what people say and also the need for humanism and how that involves actually reflecting on some elements of our own minds and attitudes that, you know, we might not always feel very easy about when they come to life, but that's it. So, you know, let me at least end by thanking you for a really fun conversation. So it's a pleasure to talk with you. I really appreciate the chance to talk about the book today. Speaker 1 That's fantastic. Thank you so much, Hannah. And yeah, I'm really looking forward to listening to this one back. So yeah, we'll put your book in the show notes. And again, thank you so much for your time. Thanks for listening to this episode of The Alcohol Problem Podcast. Please leave a rating if you've enjoyed the show. If you're interested in help with your drinking, you can visit me at Doctor James morris.com.