Tuesday 14 March 2023

The Puzzle of Addiction and Knowledge of the Good as an Achievement

Today's post is by Reinier Schuur, who is a PhD candidate in philosophy in the Department of Philosophy at the University of Birmingham. His primary research interest is in philosophy of medicine. Reinier won the 2022 Peter Sowerby Prize for his essay ‘The Puzzle of Addiction: Knowledge of the Good as an Achievement’. This is a short version of his essay for a wider audience. 

Reinier Schuur

The puzzle of addiction refers to the problem of explaining how addictive behaviour appears to be both voluntary and destructive. This puzzle arises when we assume that people will stop engaging in a voluntary behaviour if the costs outweigh the benefits, all else being equal. The main solution to the puzzle had been to argue that addictive behaviour is in fact involuntary. This solution, however, has come under criticism over the last few decades, with both empirical data and theoretical analysis arguing that addictive behaviour is voluntary in some significant sense. But this raises again the puzzle of why addicts keep using despite negative consequences.

While specific voluntary explanations have been proposed, others have argued that the puzzle of addiction can only be solved by rethinking our fundamental assumptions about the nature of voluntary behaviour as such. Gene Heyman in particular has argued that the view that addictive behaviour is involuntary is based on a wider view of voluntary behaviour as necessarily rational with respect to acting in our best interest. Heyman has argued that we should reject this assumption and instead adopt an alternative vision of voluntary behaviour as being biased towards irrationality with respect to acting in our best interest.

The purpose of my essay was not to refute Heyman’s view of voluntary behaviour. Rather, it was to argue that such a view is unnecessary once we realise that knowing what is in our best interest is an achievement and therefore that failures to act in our best interest need not necessarily be explained by voluntary behaviour being irrationally biased with respect to acting in our best interest. I drew on Hanna Pickard’s work on denial as an explanation for the puzzle of addiction, which rests on the view that addicts can fail to know what is bad for them. I build on that view and argue that people in general can also fail to know what is good for them.

In particular, Pickard’s work on denial in addiction argues that the puzzle of addiction only follows if we assume that the severe negative consequences for continued drug use are known. However, there are many cases when such knowledge is either unattainable and hard to achieve. Pickard makes this clear with the example of addicted rats, who cannot possibly know the long term negative consequences of continued drug use. 

There is therefore no puzzle of addiction with rats because they cannot know that what they are engaged in is overall bad for them. Human beings are also sometimes in a state where they cannot know the long-term negative consequences of their actions, such as when such knowledge has not yet been discovered. The causal link between smoking and cancer, for example, does not pose a puzzle for why nicotine addicts keep smoking prior to the modern scientific discovery of this causal link. Knowing when generalisable causal knowledge applies to you as an individual can also be difficult to ascertain.

Because gaining knowledge of the causal relation between one’s actions and their negative consequences can be difficult to attain, gaining such knowledge is therefore also vulnerable to forms of motivated reasoning to not gain such knowledge, such as denial. Pickard argues that denial can therefore explain the puzzle of why addicts keep using despite the severe negative consequence. Addicts may keep using not despite the negative consequences but because they keep themselves from gaining knowledge of those consequences to begin with.

Pickard’s basic insight is that while the severe negative consequences for continued drug use may appear to be obvious to the external observer, this may not be the case for the addict, and that the puzzle of addiction may in part be due to assuming that knowledge of the bad is obvious. I take this basic insight and expand it to offer an alternative framework for thinking about the puzzle of addiction in general. 

In particular, I argue that just as knowledge of the severe negative consequences of drug use is not obvious, neither are the positive non-drug alternatives that the negative consequences are an obstacle to attaining. Put simply, the puzzle of addiction arises when we assume that the costs of drug use outweigh the benefits. Pickard has argued that the overall costs are not always obvious. I argue that the benefits of drug-free alternatives are not always obvious either, these too are products of knowledge that are an achievement to attain.

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