TO HELP ADDICTS, LOOK BEYOND THE FICTION OF FREE WILL

Ordinarily we don't suppose that people are to blame for their illnesses.
That is, many diseases develop independently of what the sick person does
or thinks. This is why the disease model of addiction, widely espoused in
the therapeutic community, is so controversial. Common sense suggests that
a person's choice to start using an addictive substance is often voluntary,
and often made with the knowledge, either vague or specific, of the risks
of getting hooked. Of course, some people may have a genetic predisposition
to dependence, and some are placed in environments in which turning down
that first drink or cigarette is nigh impossible, but nevertheless it's
difficult to eliminate voluntary choice in our explanations of why
individuals become addicts.

This question is now very much central to the current debate on how we
should respond to the problem of addiction. Alan Leshner, director of the
National Institute on Drug Abuse, urges that dependence is a chronic,
relapsing disease and that, therefore, we should treat addicts as sick and
not punish them for their illness. Leshner points out that the addict's
brain is radically changed by drugs--"hijacked," as he puts it--so that the
ability to resist drugs is severely compromised, if not altogether
eradicated. Punishment won't help an addict to get clean, while treatment
just might. But Leshner also recognizes that the physical, compelling
nature of full-blown dependence does not exonerate an addict from having
made the choice to start using drugs.

In a recent interview in The Scientist (12[3]:1, Feb. 2, 1998), he
remarked: "What do you say to people who suggest that there's a difference
between addiction and other sorts of brain disorders, like Alzheimer's
disease or schizophrenia, because the latter conditions don't arise from a
voluntary act of will? But lung cancer [caused by smoking] does occur from
a voluntary act of will, and we still pay to treat people for it. The
question is whether you want to fix it or not. Whether you think the person
is evil and you hate them is not relevant. ... You need to deal with it as
a health issue, even if you hate them while you're doing it."

Is Suffering Deserved?

Leshner says the issue of responsibility should be outweighed by our
obligation to cure. But in reality many feel that the disabilities
individuals bring on themselves are their just comeuppance. If an addict is
to blame for his addiction, doesn't he deserve to suffer for it? Whether or
not someone is "evil" and hated is indeed relevant to whether we feel
motivated to help them or punish them. So, we can't duck the issue of moral
responsibility when talking about addiction, and the disease model alone
won't be enough to deflect the opprobrium many feel toward addicts.

But what accounts for "voluntary acts of will"? Most would say that there
is something irreducibly personal driving the initial choice to use drugs,
something that derives neither from an individual's environment nor his
biological endowment. According to what might be called the "standard
model" of free will, we all possess the capacity to act, in some important
respect, independently of internal and external conditioning factors. It's
that capacity that justifies praise and blame, reward and punishment. If
the situation were replayed with all factors the same, the addict could
have made a different choice, so he bears an inescapable, originative
responsibility for his condition.

The problem, of course, is that the standard model is false. Although it is
not yet widely appreciated, this sort of free will seems increasingly
implausible given the rapidly growing scientific understanding of human
biology and behavior. Acts may be voluntary in the sense that they are not
compelled (most nicotine addicts don't start smoking with a gun to their
heads), but they are nonetheless fully caused, a function of personality,
motives, predispositions, and situations, none of which springs full blown
from an uncaused agent within the person. Even if we presently lack the
skill to track its causal antecedents, the will--the net vector sum of
desire--is just as determined as anything else in nature, says science. And
you won't find blameworthy free will in the residuum of what's
undetermined, since, after all, we are usually only blamed and praised for
what we intend to do. Intentional behavior of the sort we can be held
responsible for certainly doesn't include random acts that surprise even
the actor.

If the standard model of free will is false, it seems as if the addict is
completely off the hook and morally blameless; given the governing
conditions, things couldn't have turned out otherwise. Indeed, it seems
that by challenging the assumption of free will, science threatens the very
foundations of moral judgment. In his recent book How the Mind Works (New
York, W.W. Norton, 1997, p. 56), cognitive neuroscientist Stephen Pinker
confronts this dilemma and reaches a rather startling conclusion,
especially for a scientist: We must idealize ourselves as uncaused
creatures in order to have morality. In our ethical deliberations we must
pretend, contrary to science, that human behavior is in some crucial
respect independent of circumstances. For this to work, we must see that,
"Science and morality are separate spheres of reasoning. Only by
recognizing them as separate can we have them both. ... A human being is
simultaneously a machine and a sentient free agent, depending on the
purposes of the discussion. ... The mechanistic stance allows us to
understand what makes us tick and how we fit into the physical universe.
When those discussions wind down for the day, we go back to talking about
each other as free and dignified human beings."

Science and Morality Linked

Since Pinker thinks that the "machine" view of ourselves undermines moral
agency, naturally he is forced to keep science and morality in separate
spheres. But is this dramatic and artificial disconnection of our
explanatory powers and our ethical intuitions really necessary? The example
of addiction will show that it is not.

First, it's clear that knowing that the voluntary choice to start using
drugs is not a matter of uncaused free will doesn't invalidate our judgment
that such a choice is bad. After all, addiction destroys lives, rendering
addicts unproductive and unhappy. We have excellent reasons for expressing
disapproval of drug abuse, since such disapproval can help dissuade those
who aren't in the grip of nicotine or alcohol or heroin from taking that
first, second, or nth hit. Precisely because the decision to drink or smoke
or shoot up is, at first, voluntary--not internally compelled by
addiction--stigmatizing that decision can reinforce the resolve to abstain
or cut back.

Second, seeing that the traditional notion of free will is false may have
an effect on just how much stigma we want to dispense, as well as its
timing. Knowing that voluntary choices are just as determined as knee jerks
undercuts the moralistic self-righteousness of those who suppose that they
would never have succumbed to the temptations of crack or speed: there but
for the contingency of life go I. Our anger at moral failure might be
tempered, and seeing the causal necessity behind choices to use drugs might
lead us to de-emphasize punitive measures with little or no utility (e.g.,
cutting welfare and health benefits for addicts) and increase our
commitment to prevention, treatment, and outreach programs that actually
reduce addiction and its harms. At the very least, seeing through the
fiction of free will should lead us to re-evaluate the effectiveness of
punishment, since it isn't deserved in the traditional sense.

We all know the power of stigma; just ask any youngster if he or she wants
to grow up to be a junkie or a crackhead. But, as investigations of what
works in treatment have shown, direct shaming of addicts is usually
counterproductive: they need to learn that, despite the mistakes they have
made, they are worthy of rehabilitation. What brings them and keeps them in
treatment is knowing that someone cares, that they possess some kernel of
dignity that merits praise and support, not continued condemnation. Stigma
may play a useful corrective role in the early stages of drug abuse, but
not after addiction has taken hold.

It's a Matter of Degrees

Although a thorough understanding of what causes addiction may lead us to
reconsider the utility of stigma, it doesn't change our basic moral stance
toward addicts and potential addicts: your choices were bad; do better next
time or suffer the consequences. But such an understanding can
significantly fine-tune the practical ethics of blame. To repeat: the
vehemence of stigmatization will be kept in check by understanding that the
choice to use drugs isn't a matter of uncaused free will, and its timing
will be informed by how far along in the addictive process the individual
has progressed. Such are the virtues of not compartmentalizing science and
morality.

The growing scientific consensus that all human behavior lies within the
natural realm has implications far beyond the study of addiction, of
course. Whenever individuals are given all the blame or take all the credit
for who they are and what they do, we can defeat such claims by pointing
out the causal antecedents of their faults and virtues. Responsibility for
good and bad doesn't inhere within some special, uncaused internal agent,
but is distributed over the influences that create character and motive.
Nevertheless, we must still praise or condemn an individual's behavior,
because that, in part, is how people are shaped. Even though we can't any
longer suppose that rewards and sanctions are deserved, in the
pre-scientific sense of that word, they must still be applied, judiciously
and compassionately. People are moral beings that should be held
accountable--that is, be subject to rewards and sanctions--just to the
extent that they have the capacity to anticipate and be influenced by them.

This model of morality ensures that, in the event a naturalistic,
scientific self-understanding takes hold, excuse-mongering will not
flourish. It will be generally conceded that we are all, in all respects,
products of environment and heredity, but for that very reason social
sanctions (and some hurt feelings, unfortunately) will be deemed essential
to bring out the best in us, and inhibit the worst. On the other hand, it
is likely that this same understanding will moderate the excesses of our
all-too-punitive culture, transmuting our zeal for punishment into a
concern for changing the conditions that produce destructive behavior in
the first place. In a culture more fully informed by science, it will be a
good deal more difficult to become an addict, and a good deal easier to
find help, not rejection, should the unfortunate choice to abuse drugs arise.

Thomas W. Clark is a research associate at Health and Addictions Research
Inc. in Boston. The views expressed here are strictly his own. He can be
contacted at www.naturalism.org.

Checked-by: Mike Gogulski