But so do people who eat junk food, drive over the speed limit, have a sedentary lifestyle or practice base jumping. Of course, nobody denies that addicts tend to pursue behaviors associated with risk and self-harm. Such evidence, it is argued, shows both that addicts can be persuaded to exercise their capacity for self-control if they are given what appear to them to be sufficiently good reasons, and that statements regarding loss of control are – at least to some extent – factually inaccurate and motivated by a desire to shift attribution of behavior from choices to circumstances.
How drug users describe loss of control depends variously on the appearance and characteristics of the person surveying them ( 12), and if we are to believe the experimental evidence it is the believed alcohol content rather than the actual alcohol content that influences how much alcoholics drink. studies of addictions in the general population find moreover that most addicts quit drugs by their mid-30s, often without assistance ( 2, 4). Indeed, under close scrutiny the drug-oriented behavior of addicts is shown to be less unusual than it may appear: it is influenced by a variety of incentives such as financial concerns, fear of arrest, values regarding parenthood, etc. Against this, the critics point out, there is plenty of evidence that addictive behavior involves voluntary, intentional, even rational actions. Whereas strong desires ordinarily do not remove a person’s ability to control her behavior, addictive desires do, so the argument goes. The assumption is that this reveals the neurobiological effects of drug use to be significantly different from the seemingly similar effects of other desired activities or goods. The second type of empirical evidence relates to the alleged compulsive patterns of self-destructive behavior often observed in addicts, and frequently accompanied by strong ambivalence: the addict expresses a desire not to consume drugs prior to, after, or even during the drug intake ( 8–, 11). There is nothing pathological about strong desires. Sweet food, lottery prizes, sex, and exercise all create strong desires oriented toward some reward, and all essentially involve the same type of brain changes. The biological evidence is of neurobiological correlates of drug use such as increased levels of the neurotransmitter dopamine, but these correlates are common to most forms of pleasurable experience ( 2, 3, 5). But this is insufficient, the critics claim, to warrant a conception of addiction as a disease. This includes biological evidence of changes to the normal operation of the brain caused by regular consumption of drugs as well as observational evidence of addicts’ repetitive self-destructive behavior. According to the empirical criticism, the disease view is not supported by the empirical evidence appealed to by its proponents. 1 Their critique is partly empirical, partly conceptual. The view of addiction as a neurobiological disease characterized by compulsive and relapsing drug use has come under renewed attack by several philosophers and psychologists ( 1–, 7). We present a third model that neither rules out the view of addictive drug use as compulsive, nor that it involves voluntary chosen behavior. In this article we argue that although they are right about something, both views are mistaken.
Against this view, proponents of the moral model provide ample evidence that addictive drug use involves voluntary chosen 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. 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.
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 behavior under the control of the addict.
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