Dr. David Epstein - Let's agree to agreeDr. David Epstein - Let's agree to agree
The Addiction Psychologist
Dr. David Epstein talks with Dr. Noah Emery and Dr. Sam Acuff about why addiction is too varied for a single, competing theory to make sense. The discussion focuses on clearer definitions, diverse causes, boredom, and practical ways to better support recovery.
1:11:09•13 Jul 2026
Dr. David Epstein on Why Addiction Needs More Than One Theory
Episode Overview
- Addiction can arise from multiple pathways, so no single theory or model explains all cases.
- Clear operational definitions, such as DSM substance use disorder criteria, are needed before testing causes or treatments.
- Causes of addiction and effective interventions do not always match directly; the most useful "mechanism" is often the most practical lever for change.
- Boredom and the absence of positive emotion may be important, underused targets for understanding and supporting recovery.
- People in recovery, clinicians and policymakers benefit from staying open to varied routes out of addiction rather than enforcing one rigid pathway.
“There are many pathways into and out of addiction, and most of them are probably right for somebody.”
How do people find strength in their journey to sobriety? This conversation on The Addiction Psychologist digs into that question from a refreshingly practical, scientific angle. Addiction researcher Dr. David Epstein joins hosts Dr. Noah Emery and Dr. Sam Acuff to talk about why arguing over "the one true theory" of addiction may be doing more harm than good.
Instead of pitting brain disease models against choice or social models, Epstein suggests a more cooperative approach: accepting that addiction is complex, varied, and often context-dependent. He points out that researchers frequently jump to explanations without clearly defining what they mean by addiction, stressing the importance of operational definitions like the DSM criteria. As he puts it, you can't test what causes "thing X" if you haven't first agreed on who actually has "thing X".
You'll hear a lively discussion about how definitions, causes, and treatments are three separate tasks that often get muddled together. Epstein argues that chasing a single mechanism can lead us to overlook what actually helps people in real life. Sometimes the best "mechanism" is simply the most practical lever we can pull to improve someone's wellbeing, whether that's medication, contingency management, or meaningful changes in their environment.
The episode also touches on his newer work around boredom, cannabis use, and ecological momentary assessment, highlighting how everyday experiences like feeling bored can be a genuine risk factor for substance use, but also a chance for curiosity and engagement to grow.
For people in recovery, clinicians, and trainees alike, the core message is simple but powerful: "There are many pathways into and out of addiction, and most of them are probably right for somebody." Rather than forcing everyone into one model or one pathway, this episode asks a different question: what mix of ideas and tools actually fits the person in front of you?
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