A New Approach to Addiction and Choice: Akrasia and the Nature of Free Will. By Reinout W.Wiers, New York, USA: Routledge. 2025. ISBN: 9781032631615

In A New Approach to Addiction and Choice, Reinout Wiers synthesizes an expansive literature on the philosophy of free will with contemporary addiction science, offering a novel perspective on the nature of addiction and the challenges in its treatment and prevention. Wiers’ argument, that the majority of addiction cases should be understood as special instances of biased choice, begins with the ancient philosophical concept of akrasia, the state of mind in which someone acts against their better judgement. As an example, a person trying to quit smoking may consider the long-term risks of lung cancer and heart disease when deciding whether to smoke a cigarette, judging it best to refrain but nonetheless choosing to smoke. Wiers frames the biased choice approach to addiction through the lens of akrasia, gradually building his theory over nine chapters. The introductory chapter contextualizes addiction within its historical and cultural dimensions, briefly highlighting the societal and medical progression from the ‘moral failure’ view of addiction to the contemporary view of addiction as a chronic relapsing brain disease that results in an impaired will to abstain [1]. This provides the foundation for chapter 2, where Wiers efficiently summarizes key debates in the philosophy of free will and the concept of akrasia. He defends a compatibilist position on free will (in contrast to ‘libertarian’ or ‘hard determinist’ positions), which holds that although neural processes shaped by genetics, environment and prior experiences influence behavior, humans have an evolved capacity for reasoned higher-order thinking, such as judgments, goals or values about what one ought to do. Free will is exercised under this account when actions align with higher-order beliefs [2]; thus, akrasia occurs when a person fails to act in accordance with his or her best judgements, choosing to act instead on a conflicting first-order impulse. Critical to theories of addiction is whether such failures in the context of excessive consumption truly reflect a chronic relapsing brain disease. Chapters 3 and 4 critically evaluate the brain disease model of addiction, highlighting its strengths in considering the unique neuroadaptations common across addictions, and its limitations, namely that a primary focus on neuroadaptations does not account for the extensive heterogeneity in the progression and experience of addiction [3]. These chapters conclude that addiction is ‘a problem involving multiple levels of description’ (p.96). Although neurobiology plays a critical role, focusing purely on neurobiology undermines the fact that addiction is also a psychological, social and cultural problem [4]. Notably, modern proponents of the brain disease model also acknowledge the influence of such factors, arguing that the view of addiction as a chronic brain disease may be primarily appropriate for certain populations but much less so for others, necessitating efforts to delineate these distinct groups [5]. In chapter 5, Wiers presents his alternative to the brain disease model, centered on biased choices that promote excessive consumption. The biased choice perspective broadens the focus from specific neuroadaptations to system-level factors that shape an individual’s decisions. These factors include a person’s social and physical environment, motivation, self-image and the meaning ascribed to potential actions, all of which dynamically influence neuroadaptations [6]. This theory posits that, like other human behavior, addiction is goal-driven, but the neuroadaptations associated with addiction bias decision-making toward first-order desires. This approach may more accurately delineate the majority of addiction cases, and fortunately a growing body of research highlights effective ways to prevent and treat biased decision-making. Chapter 6 discusses early prevention strategies targeting adolescents, emphasizing the need to address developmental vulnerabilities to promote ‘resilience’ [7]. Chapter 7 reviews pharmacological and talk-based treatments, noting their mixed efficacy but underscoring the value of helping patients imagine a better life as a motivator for recovery: ‘Recovery starts with being able to imagine a better life, which you can then work toward with a variety of techniques’ (p.184). In chapter 8, this leads to an exploration of cognitive training techniques that aim to enhance people’s ability to make choices aligned with their higher-order goals and values for living a better life [8]. The final chapter extends the biased choice theory to contexts like the overconsumption of meat and fossil fuels in the context of climate change, and to emerging behavioral addictions such as excessive smartphone use and social media. Indeed, the biased choice theory may be particularly useful in addressing a range of behavioral addictions to technologies that include features designed with the aim to bias consumer choice [9]. The extent of philosophical and empirical ground covered in A New Approach to Addiction and Choice is impressive, to say the least. The synthesis of philosophical literature on free will with contemporary addiction science makes a compelling case to define addiction as primarily a systems-level phenomenon that emerges from an interplay of biological, psychological and environmental factors that bias choice. The quality of argument and comprehensive presentation of evidence make this work valuable to a wide range of stakeholders in the field of addiction, including researchers, treatment providers and policymakers.