Book Reviews
Theory of Addiction. By Robert West. Blackwell Publishing, Oxford, UK. 2006, 211pp., £24.99. ISBN: 1-4051-1359-6
The distinguished psychologist Robert West invites the reader to join him in a journey through the thickets of addiction to see if it is possible to produce a unified theory of an extremely complex phenomenon. In places, he characterizes his monograph as ‘an essay’ or ‘a paper’; it is no such thing. The details and arguments he provides require close reading and are not for the faint hearted; whether one accepts his thesis or not, the result is a ‘must have’ summary of everything you need to know about addiction. For instance, West dissects around 30 different theories about its origin, ranging from rational choice and conscious decision-making, through cognitive, behavioural, and economic features, to operant learning and classical conditioning, and the role of neurotransmitters such as dopamine. At the same time he pits these against what he calls the ‘big questions’, of which he gives nine examples: differences in behaviour of individuals, in the actions of drugs, and even cultural and ethnic variations. If any one of these ‘in the real world’ contradicts the theory, then the latter fails to be all embracing.It is not surprising, therefore, that only a few claims have been made for a comprehensive (synthetic) theory. The best known perhaps is that of excessive appetites described in a book of that name by Jim Orford, hailed at that time as one of the most exciting reads on the addictions, but surprisingly missing from West's bibliography (he does mention about a later article). This collects all types of addiction under one head by postulating an interaction between ecological, socioeconomic, and cultural factors with the makeup and behaviour of a minority of susceptible individuals, but with the important let out that ‘no definition will serve all people in all places at all times’. West puts his money on motivational dysfunction. Motivation, he defines as moment to moment control through reflexes, impulses, inhibitions, desires, drives, and emotions, inherently unstable and subject to constant balancing. Susceptible individuals have difficulty in achieving balance and succumb not only to various unhealthy forces which may include, e.g. inherent mental and physical weaknesses, different drugs, and adverse social and environmental conditions, but are also dominated by emotions such as boredom, anomie, reward seeking, and avoidance of unpleasant situations. No wonder relapse is almost universal and abstinence difficult to sustain; focusing treatment on only one aspect is unlikely to be successful. Changing identity, remodelling the social and physical environment, and long-term medication are all needed. But as West remarks, ‘We have the ingredients but we do not have the recipe’.
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