Audio: See interview with Walter Sinnott-Armstrong on addition too: http://tinyurl.com/386ltlx
Walter argues that addiction is:
1. a disorder of self-control that comes in degrees. It is essentially pathological self-control, like compulsive hand-washing, where the addict has limited control in some circumstances but not enough self-control.
2. a mental disease.
Bennett Foddy and I have argued that while addicts may have poor self-control and act imprudently, poor self-control and imprudence are not diseases. They are features of the human condition. People become addicted to all sorts of things: heroin, alcohol, nicotine, gambling, sugar, sex, the internet and food. What is common to all these addictions is that involve the reward system. Heroin may be more potent at activating this system than sugar, but they all act in a similar way. There are differences in degree, not kind.
It is true that addicts can come to be driven by cues, want their drug rather than like it, take drugs to relieve distress, boredom, anxiety or loneliness. But so too for all addictions.
People can choose to stop. Addicts offered $100 dollars to stay clean in the Virginia study stayed clean. This is not a disease. You cannot receive $100 and cure your own cancer or schizophrenia. They are diseases; addiction is not.
Many people have poor self control and our ability to exercise self control varies according to our nature and environment. Some people have an uncontrollable temper. They don’t have a disease, even if psychiatrist invent such a category.
There is no doubt that drug addicts harm themselves. But so too do young men who drive too fast and recklessly. Risking harm and poor self control are not diseases.
The reward system drove human learning and development. It is no surprise that this powerful force can run amok. There is no surprise we can become addicted or prey to it. But that is a part of being human, not having a disease.
We should help addicts to lead better lives or realise their goals. But this is an enhancement not treating a disease.
If we accept addiction is not a disease, it is easier to accept harm reduction strategies to enable people to use the pleasure inducing effects of drugs in good life. We would not think we need a war on food because some people become addicted to food. Why then do we need a war on drugs? What we need is a rational approach to addiction and drugs of addiction. The first place to start is to demedicalise addiction and accept its place in normal human behaviour. It may be bad and ruin lives. But that does not make it a disease.