Princeton UP Ideas Podcast · New Books Network

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

·49 min·4 clips

Pickard traces her title to a rat study where 90% died after pressing for cocaine.

1. New Books Network's interview with Hannah Pickard centers on her Princeton University Press book, What Would You Do Alone in a Cage with Nothing But Cocaine?: A Philosophy of Addiction. 2. Emily Dufton hosts the interview, and Pickard speaks as a Bloomberg Distinguished Professor of Philosophy and Bioethics at Johns Hopkins University with clinical experience in the Oxford Complex Needs Service. 3. The episode asks what addiction looks like if it is treated as drug use gone wrong rather than as a single brain disease. 4. Pickard says her early clinical work showed that behavioral contracts signed by patients and group members made practical sense even though they did not fit the brain disease model. 5. She explains that the service was all group work, with a senior clinician holding responsibility while she learned as a novice clinician. 6. Pickard also describes the book's map, which organizes science, psychology, philosophy, ethics, and clinical material so readers can navigate the arguments. 7. She defines the dominant model as 'a chronic, relapsing neurobiological disease characterized by compulsive drug use' and rejects its claim that brain pathology is the whole story. 8. The title comes from Michael Bozarth and Roy Wise's 1985 rat study, where isolated rats pressed a cocaine lever until 90% had died within a month. 9. Pickard contrasts that with later work by Serge Ahmed, George Koop, Marco Venero, and Yavin Shaham, where rats chose saccharine water or social reward over cocaine. 10. She argues that the brain disease model survives in addiction neuroscience because it justifies spending money on neuroscience research and protects laboratories already built around it. 11. Pickard calls her own view 'heresy' because it refuses the false choice between brain disease and moral blame. 12. Her model starts with drug use as ordinary behavior and argues that addiction is drug use that has gone wrong. 13. She lists alcohol, nicotine, caffeine, amphetamines, opioids, kratom, and marijuana to show that drug use itself is not automatically pathological. 14. She treats self-medication, attachment to drugs, self-harm, identity, denial, and craving as different psychological pathways that can overlap or conflict. 15. Her notion of humanism means beginning with a person's beliefs, desires, emotions, moods, intentions, and needs before reaching for neuroscience. 16. Her notion of heterogeneity means that two people can show similar drug use for very different reasons, so treatment has to be tailored. 17. Dufton keeps the interview concrete by pressing Pickard for definitions, examples, and clinical implications rather than letting the discussion stay abstract. 18. Pickard's tone is measured and methodical, and she keeps returning to the distinction between responsibility without blame and punitive moralism. 19. Philosophy of psychiatry readers, addiction clinicians, and policy-minded listeners will get the most from it. 20. Listeners seeking gossip, celebrity, or a quick summary can skip it.

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