ABSTRACT
Often we persons do things because we expect them to be rewarding or to confer benefits, although we may simultaneously know of and be willing to accept various negative aspects or consequences of what we do. I shop for a car. I need one. My old car is on its last cylinders. I discover one that I decide to purchase. It has a good consumer rating, reliably infrequent repairs, excellent gas mileage, and I can afford it. It’s not made in colors I like. Nothing but Precambrian Pink or Geothermal Green. But I believe I can put up with incredulous stares from neighbors and the occasional snide remarks of pedestrians. Situation is: Among the options for a good car that I think are open to me, this one strikes me as the best at the time. Are addictive patterns of behavior like that? When we spot a gambler living in financial debt
up to his neck, having wasted away his life savings, divorced from his spouse, separated from his children, living in a run down efficiency apartment in a dangerous part of town, waiting on tables in an all night diner, is this the life-style he has chosen? Among the options or affordances that he actually believed were open to him, did habitual gambling strike him as the best at the time? Is it wrong to suppose that there is something wrong with him? That he is the subject of a disorder? Gary Becker and Kevin Murphy (1988) propose just such a ‘no disorder’ model of addiction.
An addict, they say, may act self-destructively or objectionably by social or moral standards. And they may be ignorant of certain harmful consequences of their behavior. But, Becker and Murphy add, addictive behavior is the upshot of rational efforts to satisfy desires or preferences for various goods, given circumstantial and temporal constraints. So, while addictive behavior is something mental, for it’s a choice and deliberate, it is not a disorder or illness. An addict’s behavioral preference for drugs or wagers at a horse track just is a decision, and like any other decision maker addicts try to get as much preference satisfaction overall as believed possible. Out of bad luck, ignorance or an ill-considered or fearless devaluation of the future, they may
not succeed, of course, just as we may fail to be satisfied by our behavior. When, however, an addict consumes a drug or places a series of wagers at a track, at the time, this is a good choice from their subjective or personal point of view. Or at least it impresses them as what they should do. Yes, an addict may harm themselves, and, yes, we may try to help them to avoid situations in which they do so. But we should not help under the faulty assumption that addiction is a disorder or that something is wrong or psychologically unhealthy with them. So say some theorists. Of course, denying that addiction is a disorder depends upon just
how addiction is more fully understood. If we assume that addiction, properly so-called, puts a person’s health or welfare at serious risk, that an addict’s preferences or desires often are unsettled or in serious conflict, and that addicts are not indifferent to or ignorant of the harmful consequences of their behavior but often have difficulty (an impairment in rational or selfresponsible impulse control perhaps) avoiding such behavior, even though they wish to and sometimes do succeed (albeit temporarily), then the case for classifying addictive behavior as a type of disorder starts to become strong. Certainly, it is stronger than depicting it as mere preference satisfaction. The assumption is that the addict would not act so disastrously on their own preferences, unless an illness or disorder of sorts is responsible. So: Is addiction a disorder? Is it a mental disorder? The terms of these questions – ‘disorder’
and ‘mental’ – are subject to interpretative disagreements. In previous chapters in this book, I have tried to regiment or explicate their proper meaning. I have spoken, for example, in connection with the second term (‘mental’), of Intentionality, and in connection with the first (‘disorder’), of a-rationally gumming up the rational or reason-responsive works of mentality. If all or much of what I have said is accepted, we are in a position to decide whether a particular case of addiction is not just a disorder but (also in certain cases) a mental disorder. No mere preference satisfaction, but something wrong with a person in a manner that merits being classified as a mental disorder. I shall begin by coming to fuller terms with the main term for this chapter. Addiction. ‘Addiction’ is used by ordinary folks as well as most behavioral scientists to identify exces-
sive and deleterious behavior, behavior that is repeatedly engaged in despite its negative consequences, and often prefaced by impulses or motives that the addict wishes to control but finds difficult to consistently master, self-control or govern. The term ‘addiction’ hasn’t always had such an unfortunate reference. At one time (in Britain in the early seventeenth century) the word referred to a devotional or obligatory attachment to a particular pattern of activity (Ross et al. 2008: 4). In that sense of the word, I am addicted to philosophy, for I am devotedly attached to it. That’s not, needless to say, the reference of the term on which I plan to focus here in this chapter. Lest in this chapter we be unsure of how ‘addiction’ is being used, I offer the following out-
line of the stages of addiction or addictive patterns of behavior. I take there to be eight main stages or steps in a typical clinical coal-face case of addiction. In referring to addiction’s clinical coal-face, I mean the behavior pattern of an addict who appears in an addiction clinic or professional mental health care setting and seeks and receives treatment for addiction. Clinics for alcohol addicts, cocaine addicts, and so on, are “largely populated by people who are in the process of making a serious attempt to stop their behavior” (West 2006: 128). We may speak of such addicts as unwilling addicts as opposed to those who may, in some sense or other of
‘addiction’ and ‘willing’, be addicted but willingly or preferably so (if perhaps unaware of the deleterious consequences of their behavior or indifferent to them). Here are the eight stages or steps:
