Updated: Aug 29
Editor’s Note: It’s David Courtwright week on Points! Today we feature a review by contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University, of Courtwright’s most recent book, The Age of Addiction (Harvard University Press, 2019). We’ll follow Hudson’s review with an interview with Courtwright on Thursday. Enjoy!
Let me invite the skeptical reader to ask the obvious question: hasn’t this always been the case? Courtwright would agree, but with a caveat. To conclude “more of the same” ignores three critical distinctions. First, the rate “hedonic change” has accelerated, Courtwright likening it to the rapid pace of technological change, following its own “Moore’s Law of brain reward” (164). (Moore’s law, first delineated in 1965, predicted that the speed and capability of computers would double every two years due to advancements in the number of components per integrated circuit; in the past half-century, this has proven to be untrue: computer speed now doubles much more rapidly.)
Second, pleasure and vice are more diverse and ubiquitous, appealing to specific subsets of the population. Third, and most significantly, pleasure and vices are meticulously engineered by companies with billion-dollar marketing and advertising budgets. In effect, this means that Big Pharma, Silicon Valley and the food industry have grown much more efficient at weaponizing our weaknesses against us, and reaping the profitable rewards. This asymmetry means companies are able cater and concoct an ever-widening array of products and pleasures, while conveniently sidestepping externalities and effects on global health. Whereas earlier eras met vice with reluctance, if not with outright resistance, today the tendency is on an opposite trajectory: vice is both normalized and accepted.
The Age of Addiction hones in on the brain reward system’s “big bang” moment, tracing it back to the agricultural revolution. What characterized pleasure, vice and addiction then was limited. People dabbled with local food-drugs but had little else at their disposal. Pleasure was in its infancy. Gambling, for instance, consisted of improvised devices: “sticks, shells, fruit pits,” and the occasional animal bone. Questions of accessibility or affordability were not yet part of the vocabulary. From the agricultural revolution on, the story follows a familiar trajectory: the invention of new technology, innovative forms of transportation, and specialized knowledge that built up networks for global trade, transforming rickety ship with a few luxury goods into colossal container ships packed with the inexpensive goodies we all enjoy today.
The second half of the book deals with changes over the last hundred years or so. In the late nineteenth and early twentieth centuries pleasure, vice and addiction seeped into urban areas, leaving few places or people untouched by their influence. In response, anti-vice reformers rallied and challenged vice’s legitimacy and sought to ban or suppress commodities like narcotics and alcohol and activities like prostitution and gambling. Reformers, as Courtwright sees it, have been unfairly maligned and should be given a second hearing, or at least some credit for enacting regulatory measures that curbed use and resulted in improvements to public health. He argues that we should not separate some reform measures and label them “progressive” (among them, sewage and water infrastructure and vaccination efforts) from their other attempts to eliminate vice. In practice the desires that propelled one propelled the other activities as well, all with the aim of improving public health and safety. Yet the gains made by anti-vice reformers were partial. They failed, as Courtwright documents, for multiple reasons: from internal divisions, corporate resistance and government ambivalence on the one hand, and from their desire to raise revenue on the other.
Neoliberalism was in its ascendancy by the late twentieth century. It brought with it a new figure, the “vice entrepreneur” who pushed and profited from packaged delights. Courtwright coins the term “limbic capitalism,” described as “a technologically advanced but socially regressive business system in which global industries, often with the help of complicit governments and criminal organizations, encourage excessive consumption and addiction.” Limbic capitalism refined the art of exploiting brain reward and weaponizing it against consumers, perhaps best captured by the Pringles slogan: “Once you pop, the fun don’t stop.” This corporate slogan distills the limbic capitalisms formula: hook customers, encourage them to indulge, rinse and repeat—or, in short, reap the rewards and ignore responsibility for subsequent externalities. Limbic capitalism continues as a force to be reckoned with. It has aided overeating, led to distracted driving, compulsive porn consumption, and other ills. And all of it was intentionally constructed to be this way, causing some of the biggest public health problems globally, according to Courtwright.
“Limbic capitalism” differs from capitalism through its route of administration: brain reward and its repetition. But is limbic capitalism more predatory or detrimental to public health than the routine behavior of say, Big Pharma or the climate catastrophe wrought by the fossil fuel industry? And does that matter? These are some questions that lingered. One feature that works in limbic capitalism’s favor it is that it is easy to understand, meaning there is less asymmetry of information—risk, for instance—when buying cigarettes or alcohol than in other transactions, like purchasing health insurance, signing financial contracts, or whatever it is we are agreeing to when we hit the “agree” button after every iPhone update. The book’s last line recommends that “we should be against excess,” which, in general, is sensible. But as a concrete matter, policy implications and what limiting excesses means in practice—preference for punitive or health-oriented approaches—also matters but gets less attention. Courtwright offers solutions: government regulation, restrictions on advertising, targeted taxation, and education campaigns. All of these could be good, depending on a lot of other things.
Like any book, Age of Addiction has shortcomings, many of which might be exposed by the authors and thinkers he cites. Critics of the brain disease model will be disappointed there is not a full airing of arguments made against it, such as Marc Lewis’s The Biology of Desire. Stanton Peele, mentioned twice, will likely continue to have his reservations about this book over exposure and accessibility. This same could be said for Bruce Alexander, whose book The Globalization of Addiction disagrees with Courtwright when Courtwright argues that exposure is a driving force for addiction — Alexander’s other writings suggest that exposure is a secondary or tertiary concern.
Courtwright also perhaps missed an opportunity in his exploration of vice, a very elastic category, limiting it only to individuals and excluding corporate persons. Vice is defined as “bad for the individual, bad for other people, bad for the social order, or some combination of the three” (emphasis mine). Vice looked at through the lens of greed would have been an edifying avenue for him to pursue: patients rationing insulin, some dying; the “public health” consequence of things like the EpiPen, a drug that sells for several hundred of dollars while its active ingredients cost pennies. This could have played to Courtwright’s advantage, given that he uses the idea of “nudges.” Everyone can get behind Courtwright’s goal, which ultimately is about improving public health, but if public health continues to be mostly privatized, preventing people from accessing essential services—mental health services, medication, and the rest—many of the issues discussed will unfortunately remain unresolved.