Professional Voices—The Experience Machine

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Professional Voices—The Experience Machine

By Dr. Richard Juman 11/14/14

What if a problem from Philosophy 101 could help improve our understanding of addiction? Would it make it easier for us to treat addiction without the stigma?

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One of the most well-known philosophical thought-experiments is known as the Experience Machine, construed by the Harvard philosopher, Robert Nozick in Anarchy, State, and Utopia in 1974. It serves as an interesting vantage point from which to think about addiction. 

In the experiment, the discussion that some will doubtlessly recall from an undergraduate philosophy course, we are presented with the possibility that one could be hooked up in a laboratory, to a machine that would perfectly simulate the experience of life, but with an important difference. Connected to “The Machine”, one would be able to experience the life that one dreams about, full of unalloyed accomplishments, thrilling victories, deep human connectedness, unlimited power or whatever other elements the individual views as reflective of the pinnacle of human experience. One could, for example, live the kind of life that figures such as William Shakespeare, Derek Jeter, Angelina Jolie, Hillary Clinton or Mick Jagger have actually lived. Of course, none of it would really be happening because you would be “floating in a tank, with electrodes attached to your brain” but it would be experienced as real. The question posed by Nozick is if such a machine existed, “Would you plug in?” If you’ve never heard of this experiment before, it might be worthwhile to think about it for a minute before reading on.

What I didn’t remember from my undergraduate days is that Nozick, who died in 2000, actually considered the relevance of the experiment in relation to substance use. He pointed out that some people view drugs as “mere local experience machines, and others view drugs as avenues to a deeper reality; what some view as equivalent to surrendering to the experience machine, others view as following one of the reasons not to surrender!” Nozick concludes that because people want to “be a certain way, to be a certain sort of person” they glean past the reality that “plugging into the machine is a kind of suicide.”

The discussion beautifully highlights the double-edged nature of substance use. To extend the metaphor, while many people, and for many different reasons, feel the impulse to “plug in” from time to time, addiction can be construed as a situation in which the individual, for a variety of reasons, can’t unplug—despite the fact that the machine is no longer providing the experience that was originally sought after.

The clinical practice of addiction treatment is filled with examples of this dynamic. Although most people who use drugs or alcohol manage to terminate or limit their usage, many are unable. As the great neurologist and author Oliver Sacks points out, “Every culture has found such chemical means of transcendence.” Yet, even Dr. Sacks came precariously close to a point of no return in his own relationship with substances.

In treatment, we see introspective clients whose substance use began as a way of gaining new perspectives, but ended in a narrowing vision comprised mainly of getting high and coming down. Those who seek a “sense of infinite possibilities”, but paradoxically wind up repeating the same self-obfuscating behaviors over and over. Patients who begin substance use as a form of self-medication, but end up with a problem far worse than the one they were seeking relief from. People who begin to use drugs as a social lubricant, but eventually find themselves in deep isolation from others. Those who begin recreational use as a way of relaxing, only to wind up with a life essentially characterized by anxious turmoil. Patients whose usage began as an innocuous-seeming teenage rebellion, but ended in a kind of desperate self-imprisonment. Clients begin to experiment with substances as part of a spiritual quest, but wind up with a deep sense of hopelessness. Those whose use began in search of openness and playfulness that they didn’t feel capable of without substances, but eventually led to the automatic, rote response to the world characteristic of somebody going through the motions. There are those who turn to substances in order to be able to embrace life in full flower, but wind up withered and slowly dying.

With respect to Nozick’s Experience Machine and the idea that people want to “be a certain sort of person”, one way of construing addiction would be to argue that it interferes with being that  “certain kind of person.” For example, think about the pursuit of the human condition that Aristotle defined as eudaimonia. Eudaimonia is often translated as “happiness” but may be more accurately understood as “flourishing.” Think of a person who is well-respected in the community, deeply connected to other people and making some type of contribution to the public good.  Such an individual is most likely living in an authentic manner, having an undistorted view of his life, relationships and the world. While he may occasionally enjoy the lubricating or even euphoric effect of wine, his drinking is under control and in the service of clearly defined goals. When the misuse of substances becomes prevalent, the individual’s experience becomes more distorted and dissociated, and his connection to other people is often terribly deteriorated. 

At the point where such an individual engages in treatment, the interplay between his addictive behaviors, his premorbid personality, his life experiences, his family and social connectedness and a host of other issues all walk in the door with him. In good treatment, all of these elements become aspects of the therapist’s understanding of the client.

I believe that good addiction treatment, especially the psychotherapy of addictive disorders, is characterized by just a few essential elements. Perhaps the most critical, as articulated by psychologist and psychoanalyst Debra Rothschild, is that “the object of study should be the individual, rather than the substance. Certain substances are addictive for certain people (often due to their unique combination of biology, psychology and social circumstance).” In other words, for treatment to produce a lasting impact, what is required is a careful, curious exploration of the individual’s history, relationships, personality and other factors that have conspired to create the presenting problem for the client. This is in sharp contrast to addiction treatment that presumes that all substance misusers are more alike than different, that deny the unique path of suffering that each client has taken, that label and reduce all clients to categorized treatment protocols and fail to offer opportunities for ongoing self-discovery. 

I believe there is a second element that is essential to effective treatment for addiction—non-stigmatization. There is a long history, and one that is unfortunately far from over, of stigma connected to substance misuse. People struggling with addiction have been treated as criminals and second-class citizens, and as a result, many people fail to seek treatment in the early stages of the problem, when it is more easily treated. In the past, when people did present for treatment they were often ostracized by the medical and mental health communities. Fortunately, this is now changing, and evidence-based treatment for addictive disorders is more available, but there remains a deeply embedded tendency for patients with substance use disorders to be treated in a manner that is stigmatizing. Considering that many of our patients have histories of trauma, and often have relational issues that make trust difficult, it is essential that treatment providers bend over backwards to ensure that treatment itself doesn’t recapitulate the stigma. 

A final, and related, element that appears to be essential to good treatment of addictive disorders is the establishment of a good working alliance between therapist and client. Although a solid therapeutic alliance is an important aspect in all of medicine, particularly in the realm of mental health, it seems to be especially important in addiction treatment. 

Because of the societal and self-stigma that often occurs in clients who present for addiction treatment, the first encounter with the therapist may be critical. Clients may have an expectation, based on prior treatment experiences or simply their own fears, that the therapist will be disapproving or even punitive. Furthermore, the client may expect the therapist to articulate a preconceived treatment plan that assumes that eventual, if not immediate, abstinence from all substances is the goal of treatment. This potential disconnect between the client’s goals and wishes for treatment and those of the treatment provider is unfortunately characteristic of the field’s history and partly responsible for our poor treatment outcomes. So it is essential that the therapist have the ability to “meet the patient with respect and empathy and without a preconceived set of assumptions” so that "the therapist and patient can collaborate on finding an approach that is right for the patient."

Professional Voices is designed to provide a forum for clinicians to exchange ideas about good treatment and highlight concepts, techniques and interventions that have proved important in their work with clients. What do you think are the essential elements of effective psychotherapy in addiction treatment? 

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