http://www.shroomery.org/forums/showflat.php/Number/14961098
On the face of it, this move appears as a humane and liberal response to the question of, "Why can't addicts of X, Y, or Z just quit?" It seems to pave the way for addiction treatment programs rather than an iron-fisted, penally-oriented strategy of prohibition of substances like heroin, methamphetamine, etc.
However, there are aspects of the way in which the ASAM is redefining addiction that are more far-reaching philosophically and more troubling in terms of their social implications.
Consider the implications of this passage:
"The statement [from ASAM] conforms, in its general outlines, with the prevailing premise in cutting-edge addiction science that the natural reward system designed to support human survival becomes overtaken or highjacked by the chemical payoff provided by substance use or addictive behaviors. “The reward circuitry bookmarks things that are important: eating food, nurturing children, having sex, sustaining intimate friendships,” says Dr. Mark Publicker, medical director of Mercy Recovery Center in Portland—Maine’s largest rehab—and former Regional Chief of Addiction Medicine for Kaiser Permanente Mid-Atlantic Region.
When we use alcohol or drugs, Publicker says, the chemical reward—the "high"—is many times more powerful than the natural circuitry’s reward, and the neurological system adapts to the flood of neurotransmitters. “But because we didn’t evolve as a species with OxyContin or crack cocaine, that adaptive mechanism overshoots. So it becomes impossible to experience a normal sense of pleasure,” he continues. “Use of the substance then happens at the expense of what otherwise would promote survival. If you think about it from that standpoint, it begins to account for illness and premature death.” An active addict has a very high risk of early death via sickness or suicide."
When we use alcohol or drugs, Publicker says, the chemical reward—the "high"—is many times more powerful than the natural circuitry’s reward, and the neurological system adapts to the flood of neurotransmitters. “But because we didn’t evolve as a species with OxyContin or crack cocaine, that adaptive mechanism overshoots. So it becomes impossible to experience a normal sense of pleasure,” he continues. “Use of the substance then happens at the expense of what otherwise would promote survival. If you think about it from that standpoint, it begins to account for illness and premature death.” An active addict has a very high risk of early death via sickness or suicide."
The passage rightly acknowledges that we are essentially addicted to certain things like food, sex, family, and social interaction, for if we did not compulsively seek these things out, we would die and/or not pass on our genes...at least in the vast majority of the evolutionary context in which the human brain has come to be, which is to say, in hunter-gatherer society. The entire dopamine circuitry is essentially an exercise in assigning addiction to various things. The lucky among us get brains that make us addicted to things that are beneficial to our long-term happiness. The unlucky of us get brains that make us addicted to things that seem to payoff in the short run, but which do damage to our happiness and objective health in the long run.
However, where I take issue with this passage is that the ASAM implies an is/ought relationship that doesn't exist. Just because (most) people do compulsively do these things, has no bearing on whether most people *ought* to. Nature cares not about such normative constructions. These constructions are our own. We construct them as normative imperatives (just in case the biological imperative fails some people) because we don't want to see others around us, in whom we have invested much materially and socially, to die. It also tickles our brains to see people around us develop a lasting and sustainable source of happiness, and it makes us feel secure that they have this secure happiness because happy people tend to be nice in return.
Liberal democracy has always been unsure of which approach it should take to people who engage in self-harm (either of the limited variety or, as in the case of suicide, the complete one). On the one hand, liberal democracy has the ideal that people own themselves and should be the author of their own actions, except to the extent that they infringe on others. The common assumption is that this last caveat only applies in a limited number of circumstances, but an astute observer will recognize that EVERYTHING one does affects others to a certain extent. (If you want to take this to its most philosophically pedantic extent, you could say that the twirling of my thumbs could set off a chain reaction in the chaos of physics and lead to a hurricane in China...the "Butterfly Effect."
Consider a more relevant example: I am free to choose to work a 7-Eleven job and scratch by a living while not contributing my fullest to society, or I am free to choose to become a brilliant nuclear physicist who solves the problems of fusion power and rescues industrial civilization from collapse. Assume that I am a person with this potential. Then is it not an infringement on others--a harm against them--to not offer my fullest capabilities to them? Objectively, the world in which I don't solve the problems of fusion power will be a much more miserable one for everything. But nevertheless, liberal democracy gives me that choice to be a 7-Eleven worker, although there will be an incredible amount of informal pressure to be more ambitious than that if society recognizes that I have the potential for benefiting it to a higher degree by working on fusion power. But if you can wall yourself off from that informal pressure emotionally and find refuge in the small joys of your existence as a 7-Eleven worker, liberal democracy ultimately says that you can do that...as long as those small joys that motivate that career decision are things like food, sex, family, and friendships.
But what if one of those small joys is a weekly adventure with methamphetamine? What if the pleasure I receive from my weekly jaunt with methamphetamine outshines all of the pleasure I could derive from any combination of family, sex, friendship, or career ambition? Let us imagine that I am a responsible user who uses it in the safety of my own home, in reasonable amounts, in a way that does not impede my ability to work at the 7-Eleven during the week, such that I can pay for my own habit and don't have to resort to stealing from other people to do so. In one sense, by the explicit standards of liberal democracy, I am not harming anyone else. However, by the implicit standards of liberal democracy (which pay less attention to philosophical principle and more attention to the objective effects of one's actions), I am harming society by finding pleasure in methamphetamine rather than in a career ambition that would contribute much more positively to the world.
Our capitalist society essentially presents us with a social contract. It says, "We have invested time and effort in raising you to adulthood. Before we are going to allow you to enjoy the pleasures of family, sex, and friendship (or the status and income needed to maintain them), you must give something back to us that we value in return." Then along comes a drug like methamphetamine that says, "For a much smaller price than the money needed to obtain the status and income necessary to support a life of family, sex, and friendship, I can give you pleasure directly." From the pragmatic point of view, assuming that the qualities and durability of both sources of pleasure (meth and socially-approved things like family or career) are equal, then it makes more sense to go with the methamphetamine for one's pleasure. From the viewpoint of others, it appears that you have cheated their incentive system that they set up to ensure that you ended up repaying them for your upbringing..
Now, many people will dispute that the pleasure of something like meth is of the same quality and durability as that of something like family, career, or friendships. People will have different opinions on this according to their experiences. I will just say that, according to my experiences, it does not strike me as implausible to imagine that responsible use of something like methamphetamine, ALL SOCIAL FACTORS BEING EQUAL, could lead to a pleasure with the same or greater quality and durability as that derived from something like family or career.
Now, a big caveat is the phrase, "all social factors being equal." Obviously the legal prohibition of something like methamphetamine artificially creates certain negative effects from its use--legal risk, dealing with shady people, risk of using a batch of unknown purity or concentration and thereby encountering greater health risks, etc. These risks are real, but what we must always keep in mind is that these risks are contingent on a social situation that we have created around this drug (and one which we could change very easily if we wanted to).
When the ASAM states that addicts have a much higher risk of early death via sickness or suicide, they are not disentangling the contingent socially-created risks of the addiction from the physical ones. Is a person who consumes a known quantity of heroin each day of known purity and concentration in a situation without legal risk or associated criminal risks significantly more likely to die or come to harm than someone else? That is to say, is there anything physical about this addiction that significantly endangers the health of the person, or is the social situation that we have created around the drug (for the purposes of making sure the person can't cheat the incentive structure we have built to get people to repay society for their upbringings) that creates the risk to health?
The basic problem with the ASAM's redefinition of addiction is that it contains implicit definitions of which addictions are normative (family, sex, career) without giving sufficient justification for why these addictions should be considered normative (and others not). I don't doubt that one *could* offer convincing justifications for why these activities should be considered normative. It's just that the ASAM has not done that, and therefore their whole attempt to redefine maladjusted addiction falls to bits on the point of, "What does not consider a "maladjusted" adddiction?"
Is an addiction to methamphetamine that delivers a steady stream of pleasure far in excess of that derivable from family, sex, career, or other socially-approved pursuits maladaptive for that person? Or is it, all other things being equal (assuming we remove the socially-contrived dangers around its use caused by legal prohibition), an addiction that pays off, and that only makes sense for the brain to reinforce?
No comments:
Post a Comment