Edmund Henden

An important philosophical issue in the study of addiction is what difference the fact that a person is addicted makes to attributions of autonomy (and responsibility) to their drug-oriented behavior. In spite of accumulating evidence suggesting the role of emotional dysregulation in understanding addiction, it has received surprisingly little attention in the debate about this issue. I claim that, as a result, an important aspect of the autonomy impairment of many addicted individuals has been largely overlooked. A widely shared assumption in the philosophical literature is that for addiction to impair a person’s autonomy it has to make them (in some sense) take drugs against their will. So-called “willing addicts” are therefore usually seen as exempted from the autonomy impairment believed to characterize “unwilling addicts”, the latter being those who ‘truly want’ to stop using drugs but find their attempts repeatedly derailed by failures of self-control. In this article, I argue that the association between addiction and emotional dysregulation shows why this assumption is false. Emotional dysregulation is not only consistent with the possibility that many addicts take drugs ‘willingly’, it supports the hypothesis that they use drugs because they truly want to. The article proposes an explanation for why emotional dysregulation should nevertheless be seen as an aspect of their loss of control and an important reason why they have impaired autonomy. I end by exploring some implications of this account for addict’s decision-making capacity when they are prescribed the drugs to which they are addicted.

ABSTRACT This article reports the result of a survey about causal beliefs, normative conceptions and moral evaluations of addicts and addiction in the general population. Specifically, we focused on four issues: To what extent are the normative conceptions of addiction current in the philosophical and scientific literature reflected in laypersons' conception of addiction? How do laypersons rate addicts on perceived responsibility? Which factors influence laypersons' responsibility attributions in the context of addiction? What feelings and attitudes (anger/sympathy/help-giving intentions) do laypersons have toward addicts? We found that, although laypersons seem to assume a weakness view of addiction, their patterns of responsibility attributions vary depending on type of drugs combined with perceived severity of outcome, where the latter even overrides the attributional effects of the actor's perceived control over events. Some explanations of the data are suggested, and various consequences with respect to help-giving behavior, are discussed

There have been different interpretations of satisficing rationality. A common view is that it is sometimes rationally permitted to choose an option one judges is good enough even when one does not know that it is the best option. But there is available a more radical view of satisficing. On this view, it is rationally permitted to choose an option one judges is good enough even when a better option is known to be available. In this paper I distinguish between two possible interpretations of ‘genuine’ satisficing, a de re and a de dicto interpretation. I then argue that while de re genuine satisficing is always irrational, de dicto genuine satisficing might be rationally permissible. In fact, de dicto genuine satisficing does not appear to be covered by existing accounts of satisficing behaviour.

Deliberation incompatibilism is the view that an agent being rational and deliberating about which of (mutually excluding) actions to perform, is incompatible with her believing that there exist prior conditions that render impossible the performance of either one of these actions. However, the main argument for this view, associated most prominently with Peter van Inwagen, appears to have been widely rejected by contemporary authors on free will. In this paper I argue first that a closer examination of van Inwagen's argument shows that the standard objections are based on a misunderstanding of the notion of ‘deliberation’ presupposed in this argument. Second, I attempt to strengthen the case for deliberation incompatibilism by offering a different argument in its support

Suppose an agent has made a judgement of the form, 'all things considered, it would be better for me to do a rather than b (or any range of alternatives to doing a)' where a and b stand for particular actions. If she does not act upon her judgement in these circumstances would that be a failure of rationality on her part? In this paper I consider two different interpretations of all things considered judgements which give different answers to this question, one suggested by Donald Davidson, the other by Paul Grice and Judith Baker. I argue that neither interpretation is adequate. However, a third interpretation that combines features of the Grice/Baker view with the Davidsonian view is possible. In the final section of the paper I defend this interpretation against two objections.

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to go a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative.

Providing heroin to heroin addicts taking part in medical trials to assess the effectiveness of the drug as a treatment alternative, breaches ethical research standards, some ethicists maintain. Heroin addicts, they say, are unable to consent voluntarily to take part in these trials. Other ethicists disagree. In our view, both sides of the debate have an inadequate understanding of voluntariness. In this article we therefore offer a fuller conception, one which allows for a more flexible, case-to-case approach in which some heroin addicts are considered capable of consenting voluntarily, others not. An advantage of this approach, it is argued, is that it provides a safety net to minimize the risk of inflicting harm on trial participants.

In his target article and recent interesting book about addiction and the brain, Marc Lewis claims that the prevalent medical view of addiction as a brain disease or a disorder, is mistaken. In this commentary we critically examine his arguments for this claim. We find these arguments to rest on some problematical and largely undefended assumptions about notions of disease, disorder and the demarcation between them and good health. Even if addiction does seem to differ from some typical brain diseases, we believe contrary to Lewis, that there are still good reasons to maintain its classification as a mental or behavioral disorder.

What is self-control and how does the concept of self-control relate to the notion of will-power? A widespread philosophical opinion has been that the notion of will-power does not add anything beyond what can be said using other motivational notions, such as strength of desire and intention. One exception is Richard Holton who, inspired by recent research in social psychology, has argued that will-power is a separate faculty needed for persisting in one's resolutions, what he calls 'strength of will'. However, he distinguishes strength of will from self-control. In this paper I argue that will-power is essential also to a certain form of self-control. I support this claim by arguments showing that the traditional philosophical accounts of self-control run into difficulties because they pay insufficient attention to will-power as an independent source of motivation.

Does addiction to heroin undermine the voluntariness of heroin addicts' consent to take part in research which involves giving them free and legal heroin? This question has been raised in connection with research into the effectiveness of heroin prescription as a way of treating dependent heroin users. Participants in such research are required to give their informed consent to take part. Louis C. Charland has argued that we should not presume that heroin addicts are competent to do this since heroin addiction by nature involves a loss of ability to resist the desire for heroin. In this article, I argue that Charland is right that we should not presume that heroin addicts are competent to consent, but not for the reason he thinks. In fact, as Charland's critics correctly point out, there is plenty of evidence showing that heroin addicts can resist their desire for heroin. These critics are wrong, however, to conclude from this that we should presume that heroin addicts are competent to give their voluntary consent. There are, I shall argue, other conditions associated with heroin addiction that might constrain heroin addicts' choice in ways likely to undermine the voluntariness of their consent. In order to see this, we need to move beyond the focus on the addicts' desires for heroin and instead consider the wider social and psychological circumstances of heroin addiction, as well as the effects these circumstances may have on the addicts' beliefs about the nature of their options

How should addictive behavior be explained? In terms of neurobiological illness and compulsion, or as a choice made freely, even rationally, in the face of harmful social or psychological circumstances? Some of the disagreement between proponents of the prevailing medical models and choice models in the science of addiction centres on the notion of “loss of control” as a normative characterization of addiction. In this article I examine two of the standard interpretations of loss of control in addiction, one according to which addicts have lost free will, the other according to which their will is weak. I argue that both interpretations are mistaken and propose therefore an alternative based on a dual-process approach. This alternative neither rules out a capacity in addicts to rationally choose to engage in drug-oriented behavior, nor the possibility that addictive behavior can be compulsive and depend upon harmful changes in their brains caused by the regular use of drugs.

This study aims to develop and defend an account of practical rationality and intention that explains how weakness of the will is conceptually possible. I first present two sceptical arguments against the possibility of weakness and then distinguish two different responses to scepticism that defends its possibility. Both sceptical arguments are motivated by what many have believed is an analogy between theoretical and practical reasoning. This analogy holds that the conclusion of practical reasoning is an intention just as the conclusion of theoretical reasoning is a belief. The particular version held by what I call the Socratic theorists claims, in addition, that the value of desirability is transferred from premisses to conclusion in practical reasoning, just as probability is transferred from premisses to conclusion in theoretical reasoning. One example of an author who takes the analogy as a basic premise and seek to explain how weakness of the will still may be possible, is Donald Davidson. Critics of Davidson object that the the kinds of difficulties that his account runs into shows that the Socratic version of the analogy must be false; not only is this account phenomenologically implausible, it also exaggerates the degree of irrationality of the weak agent. In this study I suggest the possibility of a weaker version of the Davidsonian account. The main source of difficulty for the Davidsonian account, I argue, may not be its reliance on the Socratic version of the analogy between practical and theoretical reasoning, but rather its particular understanding of this analogy in terms of an analogy between practical and inductive-statistical reasoning. This understanding may lead one to accept too “rationalistic” a picture of the reasoning processes behind weakness of the will which, in effect, may make the account vulnerable to objections that it is phenomenologically implausible and exaggerates the irrationality of the weak agent. The weaker version of the Davidsonian account that I propose, ties in the account of weakness with the notions of “satisficing” and “default reasoning”. Although it preserves the central idea of the stronger version that intentions are unconditional evaluative judgements, it proposes a different view of the contents of these judgements, as well as of the reasoning process that lie behind them. It is not difficult to motivate this weaker view: given our human finitary predicament, both satisficing and default reasoning seem to be likely results of an optimal trade-off between the speed and reliability of our computational processes. The question is how these notions may shape the concepts we use to understand weakness of the will. I argue that if we modify the account usually ascribed to Davidson in the light of these notions, the result is a less rationalistic picture of weakness of the will. The gains are more phenomenological credibility as well as a less extreme view of the degree of irrationality involved.

It is common to think of addiction as involving behavior which in some sense is ?out of control.? But does this mean addictive actions occur because of compulsion or because of ordinary weakness of will? Many philosophers argue that addictive actions occur because of weakness of will, since there is plenty of evidence suggesting that they are not caused by irresistible desires. In fact, addicts seem, in general, to perform these actions freely in the sense of having the ability to refrain from doing so. In this paper I argue, first, that it is not the addiction-as-compulsion view that is mistaken, but rather the view that irresistible desires are a defining feature of compulsion. Second, drawing on some results in addiction neuroscience, I construct and defend a new analysis of compulsivity that distinguishes addictive from weak-willed actions in a way that is consistent with the view that addictive actions are performed freely

Some authors have argued that, in order to give an account of weakness of the will, we must assume that the mind is divisible into parts. This claim is often referred to as the partitioning claim. There appear to be two main arguments for this claim. While the first is conceptual and claims that the notion of divisibility is entailed by the notion of non-rational mental causation (which is held to be a necessary condition of weakness of the will), the second is explanatory and claims that the notion of divisibility is required for the causal explanation of weak-willed action. In this paper I want to argue that the partitioning claim remains unsupported, no matter how it is interpreted, and that weakness of the will can be made perfectly good sense of without the idea that the mind is divisible into parts. In fact, there are available various explanatory models each of which characterizes different psychological mechanisms that may be involved in weakness of will, none of which depends on any claims about mental division. I describe three familiar mechanisms and argue that weakness of will may occur as the result of any one of them.

The problem of weakness of the will is often thought to arise because of an assumption that freely, deliberately and intentionally doing something must correspond to the agent's positive evaluation of doing that thing. In contemporary philosophy, a very common response to the problem of weakness has been to adopt the view that free, deliberate action does not need to correspond to any positive evaluation at all. Much of the support for this view has come from the difficulties the denial of it has been thought to give rise to, both with respect to giving an account of weakness, as well as explaining the future-directed nature of intentions. In this paper I argue that most of these difficulties only arise for one particular version of the view that free, deliberate action must correspond to a positive evaluation, a version associated with Donald Davidson's account of weakness. However, another version of this view is possible, and I argue that it escapes the standard objections to the Davidsonian account.

Normative thinking about addiction has traditionally been divided between, on the one hand, a medical model which sees addiction as a disease characterized by compulsive and relapsing drug use over which the addict has little or no control and, on the other, a moral model which sees addiction as a choice characterized by voluntary behaviour under the control of the addict. Proponents of the former appeal to evidence showing that regular consumption of drugs causes persistent changes in the brain structures and functions known to be involved in the motivation of behavior. On this evidence, it is often concluded that becoming addicted involves a transition from voluntary, chosen drug use to non-voluntary compulsive drug use. Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen behaviour. In this paper we argue that although they are right about something, both views are mistaken. We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. -/- .

A familiar objection to restrictive consequentialism is that a restrictive consequentialist is incapable of having true friendships. In this paper I distinguish between an instrumentalist and a non-instrumentalist version of this objection and argue that while the restrictive consequentialist can answer the non-instrumentalist version, restrictive consequentialism may still seem vulnerable to the instrumentalist version. I then suggest a consequentialist reply that I argue also works against this version of the objection. Central to this reply is the claim that a restrictive consequentialist is capable of true friendship if the value she aims for is not merely seen as a function of her self-regarding desires, but includes as a central constituent a form of objective value often referred to as 'flourishing' or 'self-realization'.

In an earlier article in this journal I argued that the question of whether heroin addicts can give voluntary consent to take part in research which involves giving them a choice of free heroin does not – in contrast with a common assumption in the bioethics literature – depend exclusively on whether or not they possess the capacity to resist their desire for heroin. In some cases, circumstances and beliefs might undermine the voluntariness of the choices a person makes even if they do possess a capacity for self-control. Based on what I took to be a plausible definition of voluntariness, I argued that the circumstances and beliefs typical of many vulnerable heroin addicts are such that we have good reasons to suspect they cannot give voluntary consent to take part in such research, even assuming their desire for heroin is not irresistible. In a recent article in this journal, Uusitalo and Broers object to this on the grounds that I misdescribe heroin addicts' options set, that the definition of voluntariness on which I rely is unrealistic and too demanding, and, more generally, that my view of heroin addiction is flawed. I think their arguments derive from a misunderstanding of the view I expressed in my article. In what follows I hope therefore to clarify my position