Addiction

Neil Levy on Addiction

In a fascinating paper presented at the St Cross Ethics Seminar in Oxford, on 27 March 2014, Professor Neil Levy (Oxford and Melbourne) sought to solve the following puzzle about addicts: on the one hand, addicts are thought to lack control, but on the other they appear to engage in the kind of reason-responsive behaviour typical of rational agents (for example, many addicts for a small financial incentive will avoid the objects to which they are addicted).

Levy’s central claim was that addicts do lack control, but that this lack of control consists in a lack of control over belief-formation, leading to a change of mind – or ‘judgement-shift’. So addicts are rational in so far as they are acting on the basis of their current beliefs about what is best for them.  Continue reading

Giving alcohol to alcoholics: not as controversial as it seems

A Dutch program pays chronic alcoholics in beer for cleaning the streets and parks. A Canadian homeless shelter provides their alcohol clients with six ounces of white wine every 90 minutes. Giving alcohol to alcoholics, it seems counterproductive from a ‘just say no’ perspective, but I would like to argue that it makes sense on many levels.
The strongest case for giving alcohol to people with chronic alcohol dependence is based on the principle of ‘harm reduction’. Canadian ‘wet-shelter’ programs have emerged for two main reasons. The first is that many homeless shelters are abstinence based which means inveterate drinks would continue to sleep rough, even in freezing winter months, resulting in tragic deaths. The second reason is that chronic inebriates often consume non-beverage alcohol like hand sanitizer, mouth wash and aftershave thereby exacerbating already severe health problems. A recent study by the Centre for Addictions Research found that a “managed alcohol program” approach reduced emergency hospital visits and arrests among participants at the Kwae Kii Win Centre Managed Alcohol Centre by 40-80%. Significant changes among program participants included an improvement in accommodation renewed contact with their families, and better diet. Whilst participants still receive their alcohol throughout the day the alcohol is given by staff in controlled doses at fixed intervals. The dose is enough to prevent withdrawal symptoms, but not high enough to cause intoxication. Although there are many formal harm reduction programs for heroin users, it is less common for people who are alcohol dependent, despite the fact that withdrawing from alcohol can be lethal. Continue reading

Is smoking morally wrong?

This week, I’ve been thinking about smoking. Full disclosure: My name is Jim and I am a smoker. I have smoked for nearly a decade now – been since around 2005 – and I only smoke menthol cigarettes. I am addicted to the sweet menthol smoke, where that touch of red fire at the end of a white stick seems so perfectly suited to almost any occasion from celebration to commiseration. I give up on average for a month or two a year, every year. I always come back, though. The reason I say this is to highlight that I am by no means one of these dour-faced moralizers, condemning smokers for their ‘filthy habit’. Like a snot-nosed child, it may be filthy, but it’s my filthy habit. Most efforts to encourage people against smoking focus on the idea that smoking is personally damaging: it causes illness and death, it costs a lot of money, it harms others, it litters the environment, and so on. This week, however, I’ve been thinking about whether the real concern is that smoking might be morally wrong. (NB: I’m discussing where whether it is morally wrong, not whether it should be legally banned or whether people should have the ‘right’ to smoke – these are distinct questions). Continue reading

The death of celebrities due to addiction: on helpful and unhelpful distinctions in destigmatising addiction

Philip Seymour Hoffman is dead. Probably due to an overdose of heroin. Hoffman didn’t have to die if he wasn’t so ashamed of his substance use that he did it in secrecy. Because he overdosed alone, no one could call an ambulance on him that would have probably saved his life. http://truth-out.org/news/item/21645-philip-seymour-hoffman-didnt-have-to-die#.UvAI48u3dcc.facebook Some are using the media attention surrounding his death to push for better drug laws. Some want to treat heroin addicts with heroin while some simply want to draw attention to a secret demographic: high educated, rich, white, middle age heroin users. Both attempts try to destigmatise heroin use. Continue reading

Are the reasons why people take illegal drugs relevant to sentencing decisions?

The laws that prohibit possession of certain drugs are ostensibly justified because they protect people from the health risks that are associated with uncontrolled or heavy use. Some have argued that criminalizing possession of small quantities of drugs for personal use is overly paternalistic (people should be free to make potentially risky choices as long as they don’t put others at risk) or even counterproductive (criminalizing drug use fuels a black market, many aspects of which present greater dangers to individual drug users and wider society). I find these arguments intuitively persuasive (although clear evidence would be needed to substantiate the claim that criminalization is in fact counterproductive).

So, if there is a justification for putting controls on personal drug use it seems that it ought to appeal solely to the physical and social harms that would result from a policy of drug liberalization. Such an approach is roughly reflected in the UK drug laws: the graded classification system, which determines the maximum penalty for possessing drugs in each class (A to C), considers only the harmfulness of the drug: punishment is linked to risk to health. Criminalization of drug use thus has nothing to do with a moral evaluation of this drug use.

However, a news story this month raises the question of whether moral considerations are sometimes playing a role in the sentencing of those convicted of possessing illegal drugs. Continue reading

Do we have a right to drink? On Australian thugs and French hedonists

It has been an interesting week awaiting the announced reforms on the alcohol laws in New South Wales, Australia. After another incident with alcohol fuelled violence where a young boy died due to an unprovoked single punch, the family of this young man, Thomas Kelly, submitted a petition asking for intoxication to be taken into account in sentencing as a mandatory aggravating factor, rather than a mitigating factor, which is now sometimes the case. While the government reflected on what to do about alcohol induced violence, the discussion in the media sparked up high.

1. Should intoxication be an aggravating or mitigating factor?

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Pursuing your dreams when drunk

For a long time I wanted to go to Indonesia on a holiday, to see the rice fields, the buffalo’s and the wayang puppets. But for some reason it took me actually years to realize this. The reason why I didn’t go had nothing to do with practical difficulties: I had money, time, a travel companion, it was more a psychological threshold: the travel seemed so important to me that I felt I couldn’t just book it, I was thinking that people would find it decadent to just book a trip to Indonesia, and there always seemed to be some other travel destination that had more priority. Now this story became very popular in the news and on twitter. Luke Harding, a 19-year-old youngster went clubbing in the UK and woke up in the destination of his dreams, Paris.

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We should stop punishing addicted people for being addicted

Earlier this month, a BBC news magazine report explored a new, controversial drug law in Australia’s Northern Territory targeting alcohol problems among aboriginal people. In short, the new law entails that problem drinkers can be forced into treatment. Drinkers who go on to escape from rehab three times face a jail sentence. This will cost around $95m (US) over three years. The measure is presented in the article as an initiative that originates (at least partly) from the aboriginal community themselves, who are fed up with the effects of alcohol, in particular alcohol- related violence. Aboriginal people in the Alice Springs area are 31 times more likely to die from alcohol-related causes than other Australians.

So, as the article wonders, is forced rehab a solution for Australia’s aboriginal problem drinkers?

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‘Losses disguised as wins’: Slot machines and deception

Last week, Canadian researchers published a study showing that some modern slot machines ‘trick’ players – by way of their physiology – into feeling like they are winning when in fact they are losing. The researchers describe the phenomenon of ‘losses disguised as wins’, in which net losses involving some winning lines are experienced in the same way as net wins due to physiological responses to the accompanying sounds and lights. The obvious worry is that players who are tricked into thinking they’re winning will keep playing longer and motivate them to come back to try again.

The game set up is as follows: players bet on 15 lines simultaneously, any of which they might win or lose. A player will accrue a net profit if the total amount collected from all winning lines is greater than the total amount wagered on all 15 lines. Such an outcome is accompanied by lights and sounds announcing the wins. However, lights and sounds will also be played if any of the lines win, even if the net amount collected is less than the total amount wagered on all 15 lines. If a player bets 5 credits per line (5 x 15 = 75) and wins 10 back from 3 (= 30), then the player has actually lost money, even though the lights and sounds indicate winning. The loss, the researchers claim, is thus disguised as a win. Continue reading

Casinos should say: ‘Enough. Go home.’

Over about 14 months, Harry Kakavas lost $20.5 million in a casino in Melbourne. It could have been worse. He put about $1.5 billion on the table. He sued the casino. It knew or should have known, he said, that he was a pathological gambler. It shouldn’t have continued to take his money. It should have protected him from himself. Nonsense, said the High Court of Australia.

Here’s why:

Even if, contrary to the findings of the primary judge, the appellant did suffer from a psychological impairment, the issue here is whether, in all the circumstances of the relationship between the appellant and Crown, it was sufficiently evident to Crown that the appellant was so beset by that difficulty that he was unable to make worthwhile decisions in his own interests while gambling at Crown’s casino. On the findings of fact made by the primary judge as to the course of dealings between the parties, the appellant did not show that his gambling losses were the product of the exploitation of a disability, special to the appellant, which was evident to Crown.

Equitable intervention to deprive a party of the benefit of its bargain on the basis that it was procured by unfair exploitation of the weakness of the other party requires proof of a predatory state of mind. Heedlessness of, or indifference to, the best interests of the other party is not sufficient for this purpose. The principle is not engaged by mere inadvertence, or even indifference, to the circumstances of the other party to an arm’s length commercial transaction. Inadvertence, or indifference, falls short of the victimisation or exploitation with which the principle is concerned.‘ (paras 160-161 of the judgment).

So it all turned on findings of fact (it wasn’t ‘sufficiently evident’ that his losses were the result of a disability, and if they were, they weren’t the product of a disability ‘special to the appellant.’)

That last criterion is interesting. The court seems to be implying that everyone who puts themselves in the position of losing large amounts of money in a casino is necessarily not quite right in the head. To establish liability you need a degree of vulnerability over and above that possessed by the ordinary punter. By accepting the trial judge’s finding that Kakavas did not suffer from a ‘psychological impairment’, the court was presumably saying: ‘Right: so Kakavas is weak and easily exploited: but that’s true of everyone who walks through the door, buys some chips and sits down at the table. That sort of weakness is within the general bell curve of human flabbiness. But Kakavas wasn’t particularly, dramatically, visibly weak.’ Continue reading

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