Hanna Pickard, "What Would You Do Alone in a Cage with Nothing But Cocaine?: A Philosophy of Addiction" (Princeton UP, 2026)

Feb 24, 2026

Hanna Pickard, Johns Hopkins philosopher and clinician, offers a humanistic, heterogeneous take on addiction. She questions the brain-disease vs moral-failing split. The conversation covers rat choice experiments, why the disease model persists, diverse causes like self-medication and self-harm, and responsibility without blame.

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ANECDOTE

The Rat Alone With Cocaine Image And Its History

The book title references a 1985 rat study where isolated rats pressed a lever for cocaine until 90% died within a month.
Later researchers added choice (saccharin or social reward) and most rats chose alternatives, overturning the simple hijacked-brain story.

INSIGHT

Alternative Rewards Reverse Drug Preference In Rats

Choice experiments showed rats prefer saccharin or social reward over drugs, even when previously 'addicted.'
Marco Venero's social-reward studies found 100% preference for social alternatives over the drug.

INSIGHT

Funding And Institutional Incentives Sustain The Brain Model

Neuroscience clings to the brain-disease model partly because it attracts funding and institutional investment.
Pickard notes disciplinary capture: labs and careers are built on that paradigm, making change costly.

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Dr. Hanna Pickard has written a revolutionary new paradigm for understanding addiction.

Why do people with addiction use drugs self-destructively? Why don’t they quit out of self-concern? Why does the rat in the experiment, alone in a cage, press the lever again and again for cocaine—to the point of death? In this pathbreaking book What Would You Do Alone in a Cage with Nothing But Cocaine?: A Philosophy of Addiction (Princeton UP, 2026), Johns Hopkins University professor Pickard proposes a new paradigm for understanding the puzzle of addiction. For too long, our thinking has been hostage to a false dichotomy: either addiction is a brain disease, or it is a moral failing. Pickard argues that it is neither, and that both models stifle addiction research and fail people who need help.

Drawing on her expertise as an academic philosopher and her clinical work in a therapeutic community, Pickard explores the meaning of drugs for people with addiction and the diverse factors that keep them using despite the costs. People use drugs to cope with suffering—but also to self-harm, or even to die. Some identify as “addicts," while others are in denial or struggle with cravings and self-control. Social, cultural, and economic circumstances are crucial to explaining addiction—but brain pathology may also matter. By integrating addiction science with philosophy, clinical practice, and the psychology and voices of people with addiction themselves, Pickard shows why there is no one-size-fits-all theory or ethics of addiction. The result is a heterogeneous and humanistic paradigm for understanding and treating addiction, and a fresh way of thinking about responsibility, blame, and relationships with people who use drugs.

Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her new book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, will be released in April 2026.

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