Thursday 16 February 2017

Addiction and Choice

Today's post is by Nick Heather and Gabriel Segal on their new edited collection Addiction and Choice: Rethinking the Relationship.

Nick Heather (pictured below) is a clinical psychologist by training and is now Emeritus Professor of Alcohol and Other Drug Studies at Northumbria University. He has over 500 publications, mostly in the area of addictions, with an emphasis on treatment and brief intervention for alcohol problems.

Gabriel Segal (pictured below) is Professor Emeritus of Philosophy at King’s College, London. He has published extensively in philosophy of psychology, cognitive science and philosophy of language.

In 1997, Nick Heather, together with Ian Robertson, published the 3rd edition of a book called ‘Problem Drinking’. It argued that there is no such thing as ‘alcoholism’ in the sense of a discontinuous form of drinking problem and that it was not helpful to see problem drinking as a disease. Rather, people drink in problematic ways for a variety of reasons that can be understood from the point of view of social learning theory.

15 years later, Gabriel Segal began working on a paper (‘Alcoholism, Disease and Insanity’) defending the view that alcoholism, and substance addiction generally, really is a bona-fide disease. The paper included an extended critique of ‘Problem Drinking’. The journal, Philosophy, Psychology and Psychiatry, accepted the paper for publication and asked Nick Heather to write a reply, which he did.

Nick Heather and Gabriel Segal began to dialogue. They collaborated on a paper ('Is addiction a myth? Donald Davidson's solution to the problem of akrasia says not') arguing that addiction is a real-world phenomenon and centrally involves akrasia: agents acting against their best interests and, in some sense, against their wills.

They continued to dialogue about the nature of addiction and spent much time and effort arguing about whether or not it is a disease. After a while, it came to seem to them that that issue could fruitfully be set aside, at least for the time being. There was much that they agreed on and much else to be discussed. They agreed that addictive using is intentional action, and typically the effect of a choice to use. And they agreed that the choices involved are not completely free, in the way of normal quotidian ones, like whether to read a newspaper or watch TV.

They believed that the truth lies between these two extremes of no-choice and normal, free choice. They felt that disputes between proponents of these extreme positions have hampered theory, research and practice in the addiction field for too long and have prevented us from approaching the truth about addiction. They decided it would useful to address all the major, fascinating addiction topics from this perspective: that addiction is, in some sense, a disorder of choice. So they brought together an edited collection of chapters and, somewhat ambitiously, asked some of the most distinguished authorities in the field to contribute. They were delighted when most of them accepted the invitation.

Addiction & Choice: Rethinking the Relationship is the result.

Following an Editors’ Preface, the book comprises 25 chapters organised in 7 sections: ‘Introduction’, ‘Philosophical foundations’, ‘Perspectives from neuroscience’, ‘Perspectives from behavioural economics and cognitive psychology’, ‘Implications for treatment, prevention and public health’, ‘Implications for the public understanding of addiction and for legal responsibility for addictive behaviour’ and plus concluding chapters by the Editors.


  1. In my life time I have yet to see anybody or hear anybody say I am going to be an alcoholic today or I am going to be an addict today. Instead I have heard it said I do enjoy drinking and it solves my problems at the moment and don't realize how much I actually consumed and look at me know I CANT STOP. Ive also heard it said that I tried it a few times at a party but never realized how much I liked it and how often I was actually using in reference to drugs. yes it is a choice whether or not one chooses to try something for the first time but as to whether or not one has an addictive personality can play a major factor in the problem. As so much to say that a skinny woman can eat chocolate all day and never gain a pound and an over weight girl has chocolate twice a month but is considered to be overweight because she tries some. life sucks in general so instead of finding blame lets help to resolve and get out the messege of prevention and awareness.

  2. Hmmm "turning on the television" as "normal choice." It's the World Cup finals. You've played football (soccer for US types) until you were 40 and even did a stint with your own native German team. Germany is one of the finalists. The other team is France. How "free" is your choice to turn on, or turn off, the TV?

  3. Hi Hank,
    Whether our 'normal choices' are ultimately free or constrained is an enormous topic which Gabriel and I would not dream of trying to answer, even assuming it can be answered. But the point about addictive choices, and how they may be considered constrained in a special way, is that they contradict previously made resolutions to choose otherwise. If you had previously resolved never to watch football on TV again because of the harm it was for some reason causing you, or if you had specifically vowed not to watch this particular match, but you then went ahead and watched it anyway, you would be subject to the kind of constraints on choice addicts experience. (I should speak for myself here, not necessarily Gabriel).

    Did you really play football for Germany? Crikes!


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