Recent developments in neuroscience suggest, as Cynthia M. A. Geppert observes, that “chronic addiction causes changes in the function and structure of the brain that make it extremely difficult for the individual to resist the craving, cues, and compulsions of addiction” (5). But what is addiction? To what extent is the addict responsible and accountable for their choice to abuse substances at the outset of use, as use becomes habitual, and once brain structures have been compromised by long-term abuse? What interventions by medical, psychological, and religious professionals might best address the dysfunctional behavior and the human suffering of the long-term addict? What public policies might best prevent or treat addiction, and ameliorate the social damage caused by substance abuse? These questions are as perennial as the fermentation of grain and as immediate as today’s epidemic of opioid abuse.
Arguably, no other Western thinker has investigated more perceptively the capacity and limitations of human choice than Augustine of Hippo, the fourth-century Christian bishop, theologian, and doctor of the church. Augustine’s concept of the captive will, of the human capacity for free choice vitiated by original sin, and further degenerated by an individual’s habitual harmful choosing, seems tantalizingly similar to the neurological changes described in the brain disease model of addiction, yet where scientific theory suggests diminished autonomy, Augustine insists on culpability.
Geppert constructs a carefully nuanced conversation “to identify how insights regarding the concept of the captive will, as formulated primarily in the Confessions of Augustine of Hippo, can potentially inform the three modern models of addiction: the choice model, the learning model, and the BDMA (Brain Disease Model of Addiction)” (5). Geppert is well qualified to undertake such an ambitious project. Professor of Psychiatry and Internal Medicine and Director of Ethics Education at the University of New Mexico School of Medicine and Adjunct Professor of Bioethics at Alden March Bioethics Institute, Albany Medical College, she also holds graduate degrees in religious ethics, public health, bioethics, and law, and is an ordained priest. She has written widely on the biological, psychiatric, social, and spiritual treatment of addiction. Her analysis is grounded in years of clinical experience treating patients in late stages of addiction and in the personal experience of a family member with an addiction, all of which inform writing that is at once engaged and cogent.
Geppert’s assessment of current addiction theory, viewed through the lens of Augustine’s concept of the captive will, brings needed order and clarity to addiction studies. The scientific insights limned from her review of addiction theory provide fresh approaches to some of the most vexing critical issues in Augustine’s theology of freedom, sin, and grace in the Confessions. Her application of Augustinian insight to the treatment of chronic addiction reinvests patristic studies with immediacy and practicality. Her conclusions provide specific recommendations for the integration of biological, psychological, and spiritual treatment approaches for the benefit of both addicts and caregivers.
For Geppert, the weakness of all current models of addiction is that these purely naturalistic approaches have rendered desire as “an epiphenomenon of cognition,” reducing “the wildness of grace to the solipsism of self-actualization.” Her Augustinian reflection concludes that “… addiction at bottom is an emotional affliction of disordered loves and perverted willing. Christians need to reclaim that affective and volitional message as a desperately needed antidote to the rationalism of modern medicine, analytic orientation of philosophy, and even much of modern theology” (229).
In Addiction and the Captive Will, Cynthia Geppert draws disparate academic disciplines and professional cultures into creative conversation, and by so doing offers a more integrated approach to the treatment of people suffering from advanced addiction. As a work of theology, her book is a testament to the revolutionary power of God’s grace to reintegrate the captive will to choose the love of God over all lesser affections, including drugs and alcohol. The audience for this book is upper division undergraduate and graduate students, scholars, medical practitioners, and pastoral ministers.
