Neurobiologist, Philosopher, and Addict

Addiction is a thorny problem, both biologically and philosophically. Most of the people who work on that problem don’t have a lot of firsthand experience with it. But my guest today, Owen Flanagan, comes at the problem as a neurobiologist, as a philosopher, and as an addict. He spent two decades actively addicted to alcohol and pills.

FLANAGAN: I was in some ways in shock that I was actually a prime example of someone who was living a dysfunctional life. I’ve even written a book on the meaning of life, but I can’t get my act together.

Welcome to People I (Mostly) Admire, with Steve Levitt.

Owen’s latest book is called What is It Like to Be an Addict? But he has also done important research on the philosophy of emotion and the problem of consciousness. That last subject is how he caught the attention of the Dalai Lama. And that’s where our conversation starts.

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FLANAGAN: My own journey has been that, as an undergraduate, I was very interested in psychology, and also what became neuroscience, as well as philosophy. And some of my teachers encouraged me to go on to graduate school in psychology. But in those days, the 1970s, psychology meant you studied rats. And I didn’t go for rats. But I always thought of myself as a philosopher of mind, a philosopher of psychology. In the early ‘90s, there started to be a lot of interest in the nature of consciousness inside philosophy and also inside psychology and neuroscience. And you might think, “Well gee, conscious mental life must always have been the topic of psychological inquiry.” But actually, for reasons that have to do with psychology trying to be purist about method, and during a period of the rise of behaviorism, the thought was now let’s just study behavior and the external world, come up with correlations about, what kind of things produce what kinds of behavior, and those will be the laws of psychology.

LEVITT: So economics had that same feeling, that economics wanted to be like physics, and so a lot of topics were just off limits because we have to be a hard science, so we have to study things that can be studied like the sciences study them.

FLANAGAN: Yeah, so physics envy, people would talk about. But in the early ‘90s, there were several philosophers, I was one of them, who had a background in neuroscience and psychology, and we started to say, “No we need to really face up to the fact that everything about our conscious mental lives is where the thrill of victory and the agony of defeat occur.” They’re not in our behavior, and they’re not in the external world. They’re inside us. So then the question arose, could we explain consciousness empirically? Naturalistically?

LEVITT: And just to make sure I understand, what do you mean by consciousness?

FLANAGAN: So I mean something like the private thoughts that you have that you never say. The ruminations that you have that you never talk about in public. The emotions that we experience internally but don’t always come out in behavior. William James would talk about the stream of consciousness. So I think of that. While we’re awake, there’s a flow to our experience that involves quite idiosyncratic, distinctive thoughts that are ours. I’ll sometimes say to students, “What if there was a way to record your mental life and put it into a transcript and then the next day in class you pass it on to the student next to you?” And they’re all horrified at that thought, right? Because our consciousness is uniquely ours, but it’s also the zone in which the meaning of life, purpose, and so on. So I had written a book called Consciousness Reconsidered in the early ‘90s, and the current Dalai Lama is quite interested in science, so he was interested in having me as a philosopher come to a meeting that he did on destructive emotions and how to overcome them.

LEVITT: I’m surprised to hear you say that he’s interested in science. I’m just used to religious leaders feeling like science is an attack on their spiritual thinking. Why do you think the Dalai Lama — is it something about him in particular, or is it something about Buddhism?

FLANAGAN: Yeah, both. So the interesting thing about this particular Dalai Lama is that almost everyone who’s ever met him says he would have been an engineer had he not been chosen as a young boy to be the Dalai Lama. I think that’s probably right. He had a scientific sort of orientation towards the world. Now, what you’re exactly right about though, Steve, is that Buddhism as a tradition, just like most other ancient religions, is what you would, for the most part, call ‘pre-scientific’ or ‘anti-scientific.’ So it has to do with him. But the other thing in particular is that so much of Buddhism is devoted to practices of, in some sense, disciplining your mind. We often hear about mindfulness or meditation, and what is very good about the current Dalai Lama is that he’s interested in any scientific techniques, whether they be testing meditators on magnetic resonance imaging, and so on and so forth, to see whether or not they have effects neurally. He isn’t what we would call ‘fully on board’ scientifically, but he’s very interested in some of the things that Buddhists have said about cosmology, some of the things Buddhists have said about psychological states. He’s keen to add a certain amount of scientific education to the training of Buddhist monks and nuns, mostly in India where they have come since 1959.

LEVITT: Did you like him?

FLANAGAN: I liked him, but I wasn’t blown away like a lot of other people are.

LEVITT: Really? Ah.

FLANAGAN: I mean, I thought he’s like a normal, nice guy.

LEVITT: Interesting.

FLANAGAN: But that’s my general view of the best religious leaders, that they’re just normal, and in some ways they’re bureaucrats. He has to be a bureaucrat running this complicated——

LEVITT: So who does blow you away? Have you met people who have blown you away if the Dalai Lama didn’t?

FLANAGAN: Well, I guess you could ask the question, like, are there any people intellectually who blew me away? And there are some people I’ve met who I think just have 10 more — I don’t know what it is, wattage or something like that? Some geniuses. Alasdair MacIntyre is a philosopher friend of mine. He’s a mind of a different order. The Dalai Lama, I suspect, is a nice human being. He’s charismatic, but there are plenty of other people who are charismatic. I once was asked to tell an audience of religious people about why I was not religious. And I did say to them that when I first read the gospels, I just thought, “Well, Jesus is a nice guy, but there’s no jokes, and if there were a God, he would be much, much better than that.”

LEVITT: So going back to Buddhism, I remember there being big claims in the past about how neuroscience had linked Buddhist practice to changes in the brain, did you find that work convincing?

FLANAGAN: No. It’s not held up at all. We’re in a time of excessive, sort of, ‘neuroenthusiasm’ I call it, where sort of everything needs to be tied into the brain. So you’re absolutely right. There was an effort on the part of a group out of Wisconsin, a very good group of neuroscientists, but they were trying to argue that, for example, there were cortical activity in very adept meditators that showed that they were more likely to have shifted brain regions associated with happiness in the right direction. The trouble is, there are no brain regions associated with happiness. This is another problem with this excessive enthusiasm. The brain, we’re just at the beginning of really understanding how the brain works. So there clearly are and can be some good effects of various kinds of meditation: calming the mind, serenity, gaining more self control. They’ve been practiced for 2,500 years. There’s prayer and meditation in many traditions. They have various degrees of effectiveness, but there’s no really interesting evidence about what they’re doing to the brain itself.

LEVITT: You ended up examining Buddhism from a philosophical and neuroscientific perspective in a book that’s called The Bodhisattva’s Brain. Could you explain how the Buddhist worldview differs from the typical Western perspective?

FLANAGAN: There’s different ways to think about it. So in terms of what you might call metaphysics, or theology, where we ask the question, why is there something rather than nothing? Why is there anything at all? Abrahamic traditions: Judaism, Islam, and Christianity, tend to think clearly the reason there’s something rather than nothing is that a God, a good God, created the world out of nothing, and as it were, that’s why we’re here. And so the story we tell about the cosmos is one of a creator God who’s good, and we’re made in his image, and then our job is to follow out a morality created that way. If you think of it in terms of what astrophysics says, it’ll say, “Well, 14 billion years ago, a singularity banged. 10 billion years after that, some life originated on earth, and that’s why we’re here.” In Buddhism, even the Dalai Lama will say, “No. Big Bang’s all the way back. No beginning.” And so many people will say that makes Buddhism officially atheistic, which is not entirely wrong. So in terms of that idea, it’s quite heretical and different from Abrahamic traditions. But the core ethical idea of Buddhism is that one should take a vow to eliminate all suffering and bring something like happiness in its place, which many people say is very similar to the golden rule, which one sees across lots of other religions. Then there’s the minor matter of what does afterlife look like in all these different traditions if you’re sticking with religions? And of course, in the Abrahamic traditions, when you die there is an afterwards, namely heaven, hopefully. And what goes to heaven? Well, it’s not your body. It’s your conscious self. So again, we’re back to consciousness. In the Buddhist case it’s — you recycle into new bodies, possibly for — well, not all eternity because eventually you dissolve back into the bosom of the universe. But it’s a very different theory about what happens in the afterwards. Now in both these cases, what I try to do as a philosopher is what I call ‘naturalize’ them. And what all that means is, if you are a philosopher and you’re interested in the wisdom of Buddhism but you don’t think that there’s any ghosts and spirits and bodhisattvas flying on lotus leaves, and there is no reincarnation, or if you’re interested in the ethical message of Christianity or Islam or Judaism, but you don’t believe in God, how do you take this wisdom? And that’s been one of the big projects of my life, to find wisdom in other traditions.

LEVITT: Look at religions through a scientific lens and parse out the parts that are inconsistent with modern scientific views. Whatever’s left, see what that looks like.

FLANAGAN: Precisely. Yep, that’s exactly right.

LEVITT: I mean, the last few hundred years have obviously been marked by the scientific approach explaining an increasingly large set of phenomena that religion used to be relied on to explain. Does it surprise you, as someone who’s studied these religions, how resilient world religions have been despite the rise of science?

FLANAGAN: Yes, it’s quite interesting to me that they are so resilient. There do seem to me, Steve, to be a bunch of different reasons for that. So one reason just is that an awful lot of people across the world have associated being ethical with having religious beliefs. I think that will gradually dissolve, that particular belief that you won’t have moral children, for example, or a well ordered society, unless people have religion. As more and more experience comes in from places like Northern Europe where religious belief is really well under 50 percent. Probably 30 percent at most. Stephen Jay Gould, before he passed away, he thought that there were ways to just give religion authority over faith and ethics, and then let science explain the rest of the world. He called it the principle of non-overlapping magisteria. You could keep them separate. And this is, of course, what places like the Vatican try to do, what the Dalai Lama tries to do, I think what most modern religions try to do, at least in places where science is so advanced.

LEVITT: Can I ask you a broader question about philosophy? It’s something I’ve wondered about for a long time. The ancient Greeks had lots of ideas about how the world works. And we know now that they were deeply confused. They thought the Earth was the center of the universe. They were totally wrong about medicine and the human body. They thought there were four basic elements: fire, water, earth, and air. But the two areas I can think of where ancient Greek thinking has held up is first in math; they were really good at things like geometry and trigonometry — and in philosophy. Why do you think the ancient Greek philosophers have stood the test of time so well when so many other dimensions of Greek knowledge have been superseded?

FLANAGAN: Yeah, that’s a really good question. You would think that I had thought a lot about it, but I haven’t, having spent a career teaching philosophy. A philosopher at Harvard, Alfred North Whitehead, once said, “The safest generalization to make about Western philosophy is that it’s but a series of footnotes to Plato.” And that’s interesting because we do live in a lineage that attaches great importance to what the early Greek philosophers said. You see the same kind of thing over on the side of people like Confucius. I mean, Buddha, Confucius, Plato, and Socrates lived around the same time. That’s called the Axial Age, some people call it, where the sort of grand world traditions start. In any case, what I would say is that they were concerned with basic, perennial, fundamental problems about the human condition. Like what is a good human life? What’s the role of friendship in a good human life? How do you raise children? How do you be a decent person? What is a good political organization? Plato has been really, really popular lately in political theory because Plato said, “Democracy will cause you trouble sometimes. You’ll elect people who are not competent.” So, I think it partly, Steve, has to do with the fact that there’s the interest in these perennial problems that we still have today.

LEVITT: Do you think neuroscience eventually will diminish the importance of the classical philosophers, that we’ll find other ways of explaining or predicting behavior?

FLANAGAN: Well, we’ll certainly find other ways of predicting behavior, because any set of causes that are fairly reliably correlated with outcomes, you know this from economics, you’ll be able to then predict some behavior. I don’t think that neuroscience is remotely equipped to solve questions other than what the mechanisms are. Will all the answers to what makes us tick come from neuroscience? I think the answer is obviously not. First of all, a lot of the causes of behavior in the world, they’re not——

LEVITT: They’re external. 

FLANAGAN: Yeah. Some proximate causes might be in the brain. But if you really want to understand how life seems to the subject who lives it, that is from a first person’s subjective point of view, which again might perfectly correlate with certain neural mechanisms underneath, but I think that the subjective point of view is pretty ineliminable. For example, let’s suppose an addiction, you can give me a place where the craving occurs. Let’s suppose, although no one could do this, you could point to a certain set of neural activity and say, “That’s the craving.” Well, that’s just the mechanism that, as it were, realizes the craving. The craving is felt by the subject of experience, the person, himself or herself. And so we’re going to need that vocabulary forever, I think. The vocabulary of mental life, social life, and so on. 

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LEVITT: Another topic that you’ve studied extensively is addiction. And it’s a subject that is of particular relevance to you because you’ve suffered from alcohol and drug addiction for many years, for decades. And let me start by saying how much I respect your courage, writing in such detail about the darkest times of your life. Can you talk about why you decided to share your addiction story?

FLANAGAN: Yeah. Thank you for asking. It wasn’t entirely easy. So I’ve now been sober — I haven’t used alcohol or taken any of the drugs I loved, which were benzodiazepines, in 18 years. And of course all my family, all my loved ones, knew about my recovery and my addictions. Like a lot of addicts, I was good at hiding it, so it wasn’t as if the entire world around me knew, but of course, as I was getting better, I was very often going to meetings with other addicts and sharing my story, and I realized the healing power of stories in groups like Alcoholics Anonymous, Narcotics Anonymous, and so on and so forth. Cause that’s pretty much what addicts do when they get together, we share our experience, our strength, and our hope with other addicts. And so given that I also worked on the nature of mind and consciousness, and I also worked in ethics, a lot of friends would say, “Owen, you’re perfectly positioned to write about this.” And of course what I was doing was I was following all the psychology, all the neuroscience, all the writings that people were making about how we should treat addicts ethically; should we not blame them? Do they have any responsibility?

LEVITT: So you were doing this while you were an addict, you were doing this to help understand being an addict or why?

FLANAGAN: I was doing it a little bit while being an addict, but pretty ineffectively. But I was doing it really in a dedicated way towards the end and once I stopped. So I started to write a few articles. They were hidden away in academic journals, and I just waited till I retired. That wasn’t just because I didn’t want my story out while I was still working and teaching, although it was a little bit of that, it was more that I just needed to take a big breath and have there be some time. But I ultimately decided it could be of value to both professionals who work in narrow silos, like the people who work on the neurology of addiction, or people who work only in clinical settings with addicts, or people who have family members who are addicts. So that was the reason behind it. I’m now quite happy I wrote it, although I’m still a little bit reticent. I’m not the kind of guy who likes to share in public that much, but I’ve done this and I’m willing to.

LEVITT: Yeah. So I’m a complete outsider to the study of addiction, but my general impression is that at least for the last few decades, experts have been telling the public that addiction is a disease, it’s not a character flaw or a lack of willpower, or the result of bad choices. Is that a semi-accurate, if possibly outdated and oversimplified characterization of what mainstream addiction science believes, or at least used to believe?

FLANAGAN: I think that’s exactly the way to express it. The idea that addiction is a disease has actually been around for a long time. For example, in the, what they call, The Big Book of Alcoholics Anonymous, there’s a preface by Dr. Silkworth in which he says that his view is that addiction is an allergy. Now I find that amusing because my addiction was the opposite of an allergy. I wanted it all. When I have an allergy to something — plums, I only can have one and then I can’t eat the second one, even if I want it. But, he thought as did Carl Gustav Jung at that time, 1930s, that the only cure they’ve ever seen is a wholesale psychic change in the addict. Usually they describe that as a sort of spiritual change. But the addiction as a disease model was picked up elsewhere in addiction neuroscience. And now, most people will say addiction is a disease, it’s just like any other physical illness, some people are more susceptible than others genetically, some people are brought up in environments where they use and eventually they get caught up, then the disease is usually said to be some kind of neural disorder. The main candidate has been to say it’s a midbrain mutiny in the dopaminergic system. Everybody says dopamine, dopamine, dopamine.

LEVITT: Did your lived experiences as an addict fit well with that mainstream scientific view of addiction?

FLANAGAN: Not at all. Not at all. That’s a great way of asking the question. My addiction was, and I know a lot of people who are like this, was a consuming lifestyle. There was all the mental energy spent on trying to get enough of the substances I need. There was all the attempts to moderate that didn’t work. There was craving. There was sometimes obsessive thinking. One economic aspect of my addiction and everybody else’s, there’s no addiction unless there’s a supply, and there’s no addiction unless the supply is priced right. So sometimes what I find useful is to separate out what you might call the causes of addiction that might be in a person’s history. The actual nature of addiction, which is all the feelings, the conscious life of the addict, which involves things like letting other people down, feeling guilt and shame and so on. And then problems of control, of executing. Usually when you say you’re going to go to the movies, then you go. Often for addicts, you say, “I’m not going to take the next drink,” and you drink it right then and there. It’s not a big deal to me if someone wants to call it a disease, because that’s the language that insurance takes and helps people get treatment, but the Diagnostic and Statistical Manual of the American Psychiatric Association refers nowadays to substance-use disorders. And I think the language of disorder is the better language because it’s what’s used in psychiatry. And I think of the subjective experiential side of whatever the brain and the body are doing as key from the addict’s point of view about what they’re suffering from.

LEVITT: Could you talk more about your own experience because you sound so cogent and put together as we talk today, but my understanding is that alcohol and drugs took just about everything from you along the way before your recovery.

FLANAGAN: Yep. Yeah, my history was quite simple. I grew up in the suburbs of Manhattan, in Westchester County. My dad was a very successful accountant in New York.

LEVITT: Can I tell you say in your book one of the all time ironies is that there was a lot of discussion about Alcoholics Anonymous in your home, not because people were in it, but because your dad was their accountant, right?

FLANAGAN: It’s the weirdest thing. In 1939 when Alcoholics Anonymous published the big books of Alcoholics Anonymous, they realized, oh my god, our book is a best seller, and we’re a non profit. So they said, “We need an accountant.” And, so my father’s original partner, a guy named Wilbur Smith, had been an early member of A.A., and they said, “Oh good Wilbur, you’ll be the C.P.A.” And Wilbur got the account and then passed it on to my father. Yeah, so I grew up in a household where we identified very much with being Irish. I knew we were drinkers. I loved watching my parents during cocktail hour. I didn’t see any dysfunction there. I loved the looks of drinks. I loved the sound of drinks. I loved the way in which my family behaved during cocktail hour. And like all college students then, I drank, but not more than anyone else. But alcohol, by my twenties in retrospect, I was starting to be in the grip. I was a regular every day drinker. I always found that there were a lot of other people who liked to drink with me. Maybe not as much as I did, but by the end, I had lost my marriage. I didn’t think I could stop. I had tried a lot of times. I’ve been hospitalized a few times. I spent two times in 28-day programs. The second time, luckily, it took. But at the end I was in a kind of a suicidal despair. But I had some friends who had met me in Alcoholics Anonymous who were also like me, not religious, and they stuck it out with me and I think of it as a great piece of cosmic luck because if I look back, Steve, it easily could have gone the other way. And I know many people who didn’t make it. Many people have died of alcoholism. But for 18 years, it’s been better. I’m healed and the good news is that my loved ones love me. My kids, who are now in their early 40s, love and respect me. They didn’t always see the worst side of me. 

LEVITT: I’m curious how your intellectual training interacted with your addiction. Here you are, someone who thinks professionally about what it means to lead a good life, someone who also deeply understands brain function and neuroscience. I imagine your experience as an addict was altered because you knew so much.

FLANAGAN: Yeah. I was in some ways in shock that I was actually a prime example of someone who was living a dysfunctional life. Like I could think, how could a guy like me who knows so much about what makes people tick, how you ought to live to have a good, meaningful life. I’ve even written a book on the meaning of life, but I can’t get my act together. It was a miserably, bewildering time, or times, I should say. But that’s why I set myself once I got better, to really trying to learn from all the different areas that we’re really doing contemporary research on addiction about what helps addicts, what doesn’t help addicts, how to think about the disease versus disorder model, in an attempt to help science and treatment of addiction and also help addicts themselves understand themselves better, and their loved ones understand them better.

LEVITT: You write a lot about the emotions you felt as an addict, and it seems like shame was a central one. Can you say what you mean by shame?

FLANAGAN: Guilt is feeling bad for having done an act which is wrong. Let’s say you tell a lie. Shame is the feeling for the disposition to lie. For being a person who is a liar. So, sure, addicts every day feel guilty if they’re trying to quit but can’t. They also feel ashamed because they have a characterological tendency to keep doing this again and again. If you say to addicts, “Oh, you have a disease, you shouldn’t feel ashamed or guilty.” It’s a little bit like gaslighting people because they’re definitely going to feel shame and guilt, but if addiction is a disease, it’s like type two diabetes, at least that’s what we say in meetings. Type one diabetes is because you have insufficient insulin produced by the pancreatic cells that are supposed to produce insulin. Type 2 diabetes is in part caused by the agent participating in the development of their own disease. Diet, exercise, and so on. And so, pretty much all addicts have to participate in a form of life, which is either drinking or smoking weed or using a methamphetamine. And one reason I think it’s so important to think that shame and guilt are not inappropriate here is because every known cure for addiction involves addicts taking responsibility for their action. So I think that we need to find space between the pure disease model, where, “This colon cancer you got is not caused by you in any way.” And the moral model, which says, “Oh, this is all on you.” To some kind of model that says, “There’s lots of complicated disorders, addictions are among them.” Where the person participates in the development of their own addiction and they participate to a certain extent in sustaining it, even as they want to give it up. But there’s not one treatment for addiction — not one pharmaceutical treatment that treats what anybody has ever said is the addiction in the brain. So you would think, if addiction is a brain disorder, then tell me which one it is? So this is why I’m so interested in this space of the emotions that we attach to it.

LEVITT: Has your writing on addiction angered other scholars in the area? It seems completely obvious to me that you have extra insight into this issue because of your history as an addict, but I could also see among petty academics, people conjuring up reasons why a former addict’s scholarly work on addiction shouldn’t be given credence. Maybe your scientific conclusions are too swayed by your subjective experiences or you have incentive to portray addiction in some particular way that’s self-serving. Have you experienced that kind of skepticism at all?

FLANAGAN: Knowing the way we scholars are, there probably are people who either do or will now speak that way because my book is out just so recently. The testimony of addicts hasn’t been utilized enough in addiction research and I think one of the reasons is because addicts are thought to have something wrong with them. Even addicts who are in recovery. And as you probably know, there’s, to this date, controversy about whether or not, “Once an addict, always an addict,” you will hear in rooms of Narcotics Anonymous and Alcoholics Anonymous. Addicts will say things like, “I am an alcoholic.” Even if they haven’t had a drink in 40 years. I don’t say that. I don’t know what to think about that issue. If it is a disease, you put it into remission if you stop using for a long time. But I think that you’re right, there will be people who wonder whether an addict who in certain ways is acknowledging his or her brokenness, is a reliable reporter. And all I can say there is that in the book, most of what I write about is not my own testimony, except when I think it’s useful. And sometimes I think it is a good way to catch the attention of an audience to say, “Here’s what it seemed like for me.” And also sometimes, “Here’s what it seems like from the thousands of other addicts who I’ve had the good fortune to talk to.” Addicts in recovery, for the most part. I had the luxury of being able to read everything there is in psychology and everything there is in neuroscience and be on top of it. I pretty much have to go in there with my credibility as an honest broker about what scientists are saying and then hopefully the moves are transparent enough that the scientists can judge for themselves.

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A few years back, I had a Columbia psychologist named Carl Hart as a guest on this podcast. He’s an advocate for essentially full legalization of all drugs. I have to say, I found his arguments surprisingly persuasive. Owen Flanagan knows Carl and is familiar with his arguments. And I’m curious what Owen thinks about drug legalization.

FLANAGAN: Well, notice the major drug of abuse in the world still remains alcohol. And that’s, of course, legal. There’s no future, nor would it be smart, because we know from the experience of prohibition, to try to make alcohol illegal. So we have one good example of something that’s legal. Another drug, of course, that’s legal is cigarettes. Now Carl, it’s important to say this because he’s an African American scholar, a psychologist, a neuroscientist, he saw what happened during the crack cocaine crisis, and the racialization, and so on and so forth. And furthermore, Carl has done this fantastic work showing that every drug that is abused also has performance enhancing characteristics at low doses. I think that part of Carl’s research is spectacular. Now Carl himself, and I’m sure he talked about this, but he wrote about it, he is a — and now the question is fill in the blank. He is a recreational heroin smoker. And his book in which he defends legalizing all drugs is very libertarian. And he’s clear about that. His view is that consenting adults should just have the rights to live whatever way they want, no matter what. And I have tendencies to think that’s not an implausible starting point. But now we do have at least some evidence from some places that have tried partial legalizations, and there’s some good news and there’s some bad news. So in 2001, Portugal decriminalized possession. It asked the police officers to register users, so the police were suddenly put into the role of like a social worker. When they found users, they were supposed to register them, and they were sent to them what they called dissuasion commissions, which is an Orwellian name. And the dissuasion commissions were then supposed to send the person on for treatment. And this worked well for a while, but now drug use is up and overdose deaths are up in Portugal. Now, this doesn’t mean that partial legalization won’t work well, it just means that in that case, what happened is it looks like the police got tired of having to be social workers. And unfortunately in Portugal now, there’s big backup for treatment and things aren’t looking so good.

LEVITT: Portland is the other example.

FLANAGAN: Yeah, exactly. Oregon in 2020 passed Measure 110, and that similarly did decriminalization for low amounts of drug. But in 2022, there was a 20 percent increase in overdose deaths in Portland — maybe in Oregon in general, I’m not sure where the statistics are — and an increase in illicit drug use. And they were finding that illicit drug disorders were at 9 percent, that’s 3 percent higher than the U.S. average, and alcoholism was at 12.3 percent, that’s 2 points higher than the U.S. average. That of course led recently to Measure 110 coming off the books. But, in all these cases, there were very big problems. So Oregon was actually the 50th in state expenditure of all the states to treatment for addiction at the time they passed the ordinance.

LEVITT: Really? That’s surprising to me. 

FLANAGAN: Yeah. So that meant that they didn’t have enough people in place to do treatment. So that was the big problem there. But I expect over time, at least these efforts to do harm reduction by decriminalizing, by allowing better treatment, and so on and so forth, that will become more and more common and we’ll hopefully work out the kinks. But right now it’s tricky.

LEVITT: Yeah, it seems like to really make Carl Hart’s idea work, you need to go further. I don’t think anybody’s drug of choice in a world in which there was a grocery store variety of drugs would be fentanyl. People use fentanyl because it’s cheap and it’s available. But in a world in which people could shop around and figure out what drugs satisfy them, and yet make them functional, is a world where things might be better. We’re a million miles away from that world, but in my own view, I think that’s the way in which possibly this sort of legalization could pay dividends if we could pull it off wholesale.

FLANAGAN: If we could, you’re right. The whole fentanyl thing is a tricky case, and in fact, as an economist, you might be interested in this: about three quarters of the costs, financial costs, are for non-addicted drug and alcohol use. And then a lot of the social costs, you know, the terrible, terrible last few years with the mostly fentanyl overdoses, many of those people are recreational users who get something mixed with fentanyl, and so on and so forth. Now, whether or not fentanyl would not be the drug of choice is an interesting question because even U.S. government work that describes the effects of various drugs, acts as if fentanyl is the bomb. It says something like, “Fentanyl is known for its hedonic effects in low doses.” But, it’s a tricky one. This is where I just, maybe like you are, I don’t know what to do about these legalizations idea. I don’t know how you do it. It would probably be for the good if, just like we allow methadone and buprenorphine as substitute opiates, if there were some harm reduction techniques where at least addicts could be shown what dosages of different things that they happen to like, they might be able to take in dosages which would also allow them to live a decent human life. Because many of the problems caused by — well, some drug addictions, of course, are caused by social dislocation and things like that, and are sustained by it. So there might be a lot of different ways to keep people from wanting to cross lines with drugs by enough testimony of people who have done it who say, “This isn’t going very well for me.”

LEVITT: We’ve talked a lot about the addict, what about the friends and families of addicts? Do you have advice as a former addict, or a philosopher, for people who are interacting with addicts?

FLANAGAN: Yeah, well, they shouldn’t feel too guilty if they have to distance themselves and walk away from the relationship because addicts in active addiction can be toxic in a million different ways. First of all, usually if addicts are in relationships, and they’re not with another addict in a relationship, they have to dissemble, lie, exaggerate their sobriety — sneak, because they’re spending a lot of money, typically. You’re not sustaining a relationship on the terms that both parties went into it. So I think that holding the addicts responsible is something that I really want to push and return to a positive place. That families of addicts can expect their loved ones who are addicts to get their act together and should feel free to demand that people do the things that are necessary, whether that’s getting psychiatric help, psychological help, help from a social worker, A.A. or N.A.

LEVITT: If you could go back in time armed with your current knowledge, I’m curious, what would you say to the 18-year-old version of yourself? And do you think the 18-year-old version of yourself would listen to you and do things differently?

FLANAGAN: Yeah, that’s a good question. I think the 18-year-old version of me might have listened because, like a lot of professors, I’m a nerd so I believe in knowledge. Despite knowing that we were drinkers as a family, and despite knowing that alcoholism was a possibility, I didn’t really understand what it was, and I didn’t understand some of the warning signs. I just think I wasn’t well educated on it. I probably, though, wouldn’t have ever not been a drinker, but whether I’d become an alcoholic drinker, I don’t know. 

LEVITT: You’ve thought a lot about what it means to lead a good life. So I’m curious, in your opinion, what should my listeners be doing more of and what should they be doing less of?

FLANAGAN: So, what experiences in my life have I thought are like the best things? I would say the different kinds of love: romantic love, familial love. Just in terms of like, they fill up your entire being with a kind of joy and appreciation for the well being of another. I’m not thinking about sort of instrumental friendships, although those are fine too. I mean, we all have the people that we play tennis with, not because we love them as an individual, just because they match our tennis ability. But I do think that the — this is back to the beginning when you asked about the Greek philosophers, Plato, and Aristotle, and Socrates, still speak to us. They wrote about things like this, about friendship and about it being among the best things in life. So I think love, friendship, to me, both experientially, not just because I read about them in books as being among the best things in life, but they are the best things in life.

LEVITT:  And what should we be doing less of? 

FLANAGAN: Gosh, we should sure doing less of being on our phones. Looking at the news every five minutes. By the way, these are clearly addictive behaviors. It’s well known, it goes back to behaviorism. We knew that when people get on what are called intermittent schedules of reinforcement, like a slot machine at a gambling casino, say, those are very addictive. And it’s clear that we have a world in which we’re moving away from friendships and social relations to a certain extent and living by ourselves, and we’re pressing buttons like every five seconds or five minutes to see how the world has changed or get some news. 

Owen Flanagan’s book on addiction is entitled What is it Like to Be an Addict? It’s a fascinating combination of highly personal memoir and cutting edge scientific thinking and addiction. It was interesting for me to hear Owen Flanagan call out phone addictions at the end of our conversation. In my own mind, I make a sharp distinction between addictions that actively destroy one’s life, like drugs or alcohol or gambling, and seemingly less harmful activities that have some of the hallmarks of addiction, like constantly checking one’s phone or in my case, my golf hobby. Since I talked with Owen, I found myself thinking a lot about whether addictions per se are bad or only ones that destroy your health or drain your bank account. I don’t have a clear answer, and I’m curious to hear what you think. Is it really a problem to check one’s phone all the time to become more and more obsessed with a hobby? In my case, golf, even as my actual enjoyment of the activity gets less and less. And what about people who are addicted to positive things like exercise? I know a lot of people like that. Send us an email with your thoughts on addiction. The email address is PIMA@Freakonomics.com. And we’ll talk about some of the most interesting comments we get in a future listener question segment. Speaking of the listener question segment, let me invite my producer, Morgan on now.

LEVEY: Hi, Steve.

LEVITT: Morgan, usually you’re in charge of the listener question segment, but today I’m hijacking it, and I’m going to give you a little quiz, and you have no preparation.

LEVEY: Oh, great.

LEVITT: Okay, well, you know that I love data and I think you also know how frustrated I am by the terrible data we get around the podcast. But in spite of that, this week I was just looking at our data provider and trying to learn a few things about the podcast. And I honed in on the geography of who’s downloading PIMA and I want to ask you a couple of questions, and see whether you know who’s actually listening to our show. Are you ready for that?

LEVEY: Sure.

LEVITT: Okay. So let me start with the easiest question: What country gives us the most downloads?

LEVEY: The United States.

LEVITT: That is correct. By almost tenfold — we get almost ten times as many downloads in the U.S. as we do from the other country. Let me ask you a slightly harder question. What country that doesn’t have English as an official language gives us our most downloads?

LEVEY: Doesn’t have English as an official language…oh, somewhere in Europe?

LEVITT: Yes.

LEVEY: Germany?

LEVITT: Correct. Okay. So that was too easy, too, because Germany is much bigger than the other countries. But that was good. I didn’t know for sure you’d get that.

LEVEY: You have low expectations of me, I see.

LEVITT: I’m not sure I would get these right. Now let me give you a tougher one, and that question is: Per capita, what country gives us the most downloads? Cause I would have said the U.S. for certain, but it turns out that’s not right. And I was actually shocked by this.

LEVEY: Okay, this could easily be wrong, but we have a lot of listeners who write in from Australia, so I’m going to guess Australia.

LEVITT: And that’s exactly what I would have said too, because it is true. We get such an overabundance of emails from Australia. It turns out though, interestingly, it is Canada. So our downloads per capita in Canada, they’re not that much higher than the U.S., they’re only a couple percent, 1 or 2 percent higher, but they are indeed higher. So now, this is another tough question, let’s see how you do. Among the many countries that have English as their official language, it turns out we have almost the same download rate except for one, which is only a third as high. Can you guess what English speaking country has only one third the download rate of all of the other English speaking countries?

LEVEY: What English… 

LEVITT: This is another question I would get wrong for sure, so I’m not going to hold it against you if you get it wrong.

LEVEY: The U.K.?

LEVITT: It is the U.K. Compared to Australia and New Zealand, per capita, we get about one third of the downloads in the U.K. And I was trying to think of hypotheses and this one is probably completely wrong, but I wonder whether in the U.K., there’s just a lot of content being produced and so if you live there, you tend to consume U.K. content. Whereas maybe in Australia, and New Zealand, and South Africa, there’s not as much podcast content being produced, and so they look to America. I don’t know, that’s my hypothesis.

LEVEY: You know, outside of American guests, we probably have the most English guests, I’d say. 

LEVITT: We do. It’s true. 

LEVEY: And we have very few, if any, Australian guests? Peter Singer, I believe, is Australian, and maybe that’s our only Australian guest. So anyway, I don’t know. But are we keeping score here? You’ve asked me, I believe, four questions, and I’ve gotten three of the four correct? Is that right? 

LEVITT: That’s true. Okay, I’ll give you one more. And again, it’s a hard one. Germany provides us the most downloads in sheer numbers of any country where English is not the official language. But there is another country where English is not an official language that has a per capita download rate that is three times greater than Germany. Can you guess what country that is?

LEVEY: Whew, I’m going to just go out on a limb and say Brazil.

LEVITT: Oh, okay, interesting. That is not correct. It’s the Netherlands. And again, it’s one of these things where I’m not exactly sure why the Netherlands would be so much bigger than Germany. It is true that almost everyone in the Netherlands does speak English. But, of course, almost everyone in Germany speaks English as well. I’d be interested if listeners have an explanation.

LEVEY: So what are our takeaways?

LEVITT: The only other thing I noticed is that we sometimes in the past, we’ve altered our content for India because I think India has very strict rules about the use of expletives in podcasts. And it turns out that India provides the eighth most downloads of any country. But on a per capita basis, perhaps unsurprisingly, India is really a disaster. So if you index the United States to be 100, that’s your baseline, then the download rate per capita in India is 0.3. So about one three hundredth the rate of per capita downloads in India as in the U.S.

LEVEY: To be fair, I wouldn’t say we alter our content, we just bleep expletives.

LEVITT: We bleeped them for everyone.

LEVEY: Yes, we bleep them for everyone. Then our show doesn’t get labeled as explicit.

LEVITT: Maybe we’d like to be. I suspect that maybe if we had a little more explicit content, we might have a few more downloads.

LEVEY: That decision gets made at a higher pay grade than mine.

LEVITT: Mine too. All right, but we’ll work on that.

LEVEY: Listeners, if you have a question for Steve or a question about the show or a question for this week’s guest, Owen Flanagan, please write to us. The email is PIMA@Freakonomics.com. That’s P-I-M-A@Freakonomics.com. If you have a question for Owen, we can get that question to him and maybe answer it in a future listener question segment. Steve and I do try to read every email that’s sent, and we usually succeed, so we look forward to reading your email. Thanks.

In two weeks we’re back with a brand new episode featuring Jack Szostak. He’s a Nobel Prize winning chemist, who spent the last 20 years searching for the origin of life. As always, thanks for listening and we’ll see you back soon.

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People I (Mostly) Admire is part of the Freakonomics Radio Network, which also includes Freakonomics Radio, No Stupid Questions, and The Economics of Everyday Things. All our shows are produced by Stitcher and Renbud Radio. This episode was produced by Morgan Levey, and mixed by Greg Rippin. We had research assistance from Daniel Moritz-Rabson. Our theme music was composed by Luis Guerra. We can be reached at PIMA@Freakonomics.com, that’s P-I-M-A@Freakonomics.com.