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, Bloomberg Distinguished Professor of Philosophy and Bioethics with clinical experience in addiction treatment. She challenges the brain-disease vs moral-failing split and explores why people keep using despite harms. The conversation covers rat studies, environmental explanations, a humanistic, heterogeneous paradigm, and rethinking responsibility without blame in treatment.

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ANECDOTE

Philosopher Learns Addiction From Group Clinic

Hanna Pickard began clinical work naive about addiction and assumed the brain disease model.
She observed group behavioral contracts and social mechanisms help patients change, which contradicted a pure brain-disease explanation.

INSIGHT

Three Pillars Of The Dominant Addiction Paradigm

The dominant paradigm defines addiction as a chronic relapsing neurobiological disease characterized by compulsive drug use.
It bundles three claims: brain pathology equals addiction, that pathology causes use, and that use is compulsive—each is questionable.

ANECDOTE

Rat Cage Study Inspired The Title

The book title references Bozarth and Wise's rat study where isolated rats pressed for cocaine until 90% died.
Later experiments added choice (saccharin or social reward) and most rats preferred alternatives over drugs.

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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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