Hard Disease View

When making a decision to act in any way, one must evaluate the consequences of that action by deciding whether or not that the actions positive outcomes outweigh the negative outcomes, by their own standards of good or bad. A ‘liberal account’ of addiction may use this final premise in order to claim that an addict is procedurally autonomous and therefore their actions have no difference from ordinary human actions. However, I aim dispute this claim on the grounds that an addict’s capacity to process and rationalise information is weakened. Although I acknowledge that a hard disease view, such as Leshner’s, goes too far in asserting that actions, for addicts, become mere reflexes, to deny the importance of the lack of stimulation in regard to the planning and
motor systems seems naive.
Throughout this essay, I aim to prove that a soft disease view, such as Hyman’s is most appropriate in talking about addiction. In order to do this, I shall first assess and criticise Leshner’s view through criticisms asserted by a liberal account; secondly, I aim to display how these criticisms also go too far in their assertions. Following from this, I aim to assert that the lack of stimulation of the planning and motor systems is sufficient enough to prove a soft disease view, accordingly proving that there is a difference between actions that an addict performs and ordinary human actions. One who believes a hard disease view will assert that the fundamental difference between an action an addict performs and an ordinary human action, is that an addict’s actions are non-voluntary. Consequently, actions become mere reflexes as opposed to rational behaviour. In order to assert that addiction is a “chronic recurring illness”, Leshner uses the premises that drug use “acutely modify mood, memory, perception, and emotional
states” and “using drugs repeatedly over time changes brain structure and function”. The premises of Leshner’s argument are easily provable through neuroscience on drug use. When an individual consumes cocaine, the drug blocks the re-uptake of dopamine; heroin increases the release of dopamine by joining onto the opioid receptors. Consequently, when one consumes drugs they activate and strengthen their reward pathways, increasing the likelihood of repeat behaviour. Due to this, Leshner claims that the normal process of motivation gets distorted; However, this is where Leshner’s argument becomes too assertive. It appears reasonable to claim that planning and motor systems become less stimulated through repeated drug use due to a higher emphasis on the reward systems, however, the former systems are still present. In the UK it is possible to get NHS funding for rehab centres on the condition that the individual proves “time and time again that they are highly motivated and deserving of a place in rehab”. Moreover, in the UK it is not possible to send someone into rehab without their consent. Evidently, it appears that to go into rehab one must desire to, this act of desire is obviously not coming from one’s reward system and accordingly must come from one’s planning systems. Therefore, it appears Leshner’s notion that the ‘normal process of motivation is distorted’ is too strong. In addition to the former criticism, Foddy and Savulescu put across several further criticisms to the the disease view, in aim to prove that the actions that an addict perform are in fact the same as ordinary human actions. In A Liberal Account of Addiction, Foddy and Savulescu acknowledge Kalives and Valkow’s notion that addicts have an extra motivational mechanism; they further acknowledge Everrit and Robbins idea that the dopamine releases change an addicts actions from voluntary to compulsive. Foddy and Savulescu have a pragmatic response to the former notions in relation to the fact that non-drug addictions cause the same response in the brain. For example, when one consumes sugar or has sex, the dopamine in the brain increases, stimulating the same reward pathways as drugs. Moreover, it is not the drug itself that creates the addiction, but instead the repeated stimulation of the reward pathways. The argument being that since we would not call addiction to sugar or sex a disease, it seems unfair to claim that drug addiction is a disease.