The Normative Assumptions Embedded in the Redefinition of "Addiction"

The American Society of Addiction Medicine (ASAM) recently redefined addiction as a chronic neurological disorder of a general type (irrespective of the particular trigger for the addictive reward pathways), and one that is essentially incurable and merely treatable.

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."

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?

More specifically....

My current thinking can be entirely encapsulated in the contrast between the following images:
http://www.forsalebyowner.com/images/large/21100042-1.jpg
http://en.wikipedia.org/wiki/File:Blv-haussmann-lafayette.jpg
I am for the latter and against the former. (If you've ever been to Paris, you know in your gut what I'm alluding to).

To elaborate....What does the first image represent?
*Pre-modernism
***Religion
***Family as the essential economic unit
***Private society (as opposed to mass society or public society)
***Narrow-mindedness
***Provincialism
***Exclusionism and hierarchy according to the following criteria:
*****Nation
*****Race
*****Gender
*****Class
***Nepotism
*****Non-transparency in life
*****Arbitrariness

What does the second image represent?
*Modernism
***Secularism in the public sphere (which will be expanded to include any relation between two people...genuinely-private

spirituality, residing only in one's thoughts and solitary actions, will be the only socially-acceptable form of irrationality. Convicing other people to do something or feel a certain way based on supernatural evidence will be laughed at outright).
***Family no longer as an economic unit (children and non-working family members not economically dependent on the family, but rather supported by the public). Family as a provisional instrument for raising citizens, with children and other family members (girls, women, mothers) who are traditionally told to keep to the private sphere being transformed into fundamentally public citizens, ultimately answerable not to any head of the household, but to the public citizenry in general from the basis of being an equal fellow citizen.
***Mass society or public society (as opposed to private society)
*****People addressing each other in the political/economic sphere not as friends, pals who are owed favors or privileges, etc, but as equal citizens.
*******Friendship and love freed from any instrumental, mechanistic political/economic duties, and liberated to function truly as bonds of affection between mutually-consenting peers, without the strategic calculations of former times
***********The strategic calculations are instead relegated to the formal, transparent public political/economic sphere. People argue for policies, renumerations (not favors), etc., as citizens meeting in ultra-democratic workplace, municipal, and national councils.
***************All citizens vote directly on all laws applying to their jurisdiction (workplace, town, or countryewide).
***************Drafting committees are elected to guage concerns and propose, but not pass, legislation. Others may draft legislation and petition it for the general ballot.
***************Ballots are not taken once every few years, but are accessible continuously. That is, there will be a permanent ballot office in each precinct. You will have a safety-deposit box with your ballots that you have filled out. Whenever you want to change your vote or vote on something new, you go there, get out your old ballots, change your vote, get the vote recorded, and put the ballot back in your safety-deposit box as a record of your vote. No need for "nay" votes. When a bill gets 55% of the registered voting citizenry to vote "yea" for it, the bill becomes law. If enough people who supported the bill ever change their votes such that the bill drops below 45% approval, the law is revoked.
***************Elected, instantly-recallable judges and jury duty as before.
***************Elected, instantly-recallable officials of the executive branch.
***************This is mob rule. If you fear the consequences, you need to go to work on your fellow citizens, whipping them up into shape to take on these adult responsibilities in a rational manner.
***************All adult citizens will also have militia training and militia duty for a few weeks out of every year.
****************The citizenry's vote will be required for a formal declaration of war, and a formal declaration will be required in all cases for an extended conflict. The (recallable) executive may exercise provisional powers for only a short period of time. The professional, standing army will be minimal--enough to resist a surprise attack for a short while. In the case of a real war, the military will use a ruthlessly undiscriminating "Levée en masse" (draft). Only the disabled, young, elderly, and resisters will be exempted. Resisters will lose their citizenship if they resist, but it would be illogical to force them to fight. Gays will be included.
*******************In the military, to be eligible to be an officer, one must have a certain qualification of training. From this pool, officers are to be elected by their inferiors by secret ballot. But while they are officers, they are to receive strict obedience. Officer votes (recalls) will occur only at certain intervals. Generals are to be elected by the citizenry and are to be instantly recallable.
******************As long as citizens perform their basic jury, militia, and (if need be) military duty, they will be provided with basic food, housing, and healthcare. What renumeration they receive beyond that will depend on the judgment of their workplace council.
***Broad, farsightedness.
***Internationalism. The entire world may even be conceived of as "one nation of humans."
***Inclusive of everyone who makes effort to ally with your cause. Integrating races, ethnicities, genders, and classes into one equal citizenry so as to strengthen society and free it from being riven by internal divisions.
***Impersonal workplace councils as the key to "success," not nepotist favors or informal favors from family or friends (which breed their own dependencies and power relations). Friends and family members can still give and receive gifts, but no citizen will be dependent on such charity because each citizen will have his/her essentials provided for, in addition to extra renumeration from their workplace.
*****There will be no bosses or owners in the economic sphere. In this sense, it will be post-capitalist.
*******There can be competition, though. People will compete at being citizens. The better the work they do, and the better they are impersonally rated by their co-workers, the more renumeration they will receive. But under all circumstances, all citizens will have equal *power* to contribute to these decisions.
********New companies will can be launched and given starting capital by municipal votes. Workplaces will compete against each other. There will be a market exchange mechanism. But nobody may buy another's labor-power. Those involved in an enterprise must always be treated as equal citizens with equal decision-making power.
*********Workplace delegates (instantly-recallable) may be elected.
**********This movement sees the daily struggles between workers and employers as irrelevant to our interests. We will take sides with neither one. We are not for any class above any other. We want workplace democracy for all citizens. We are not interested in the particularistic battles benefitting one trade union or another. We want equal power. Once we have equal power, we will each be in an equal position to judge whether particular situations warrant equal *conditions* or renumeration for those involved. Insofar as communist groups are striving for these same things, they are our allies. If they relegate themselves to narrow reformist battles, they are irrelevant.

The key word is modernism.

The key manifestation is mass society.

The key method is direct democracy. Mob rule.

Calling all hardcore "vrai(e)s républicain(e)s": let us fulfill the promise of 1793.

The catchphrase: "The French Revolution on steroids."

Okay, why is this fascist?
*The political/economic community is defined in terms of citizenship instead of class (although it is a citizenship that is willing to embrace any race, nation, gender, etc., and that only discriminates based on a person's views and willingness to fulfill the duties of a citizen of this society, and it is a citizenship that inherently dissolves class).
*It calls for strict self-discipline and coldly-nihilistic rationality in the public sphere (when political/economic issues aren't involved, when you are in what private sphere is left, when you are not using a social relation for instrumental advantages, you can be as irrational and emotional as you want). How else could this mass public citizenry not descend into emotivism, irrationality, and mob rule?
*It is motivated by a desire to modernize and strengthen one's society, to make it more dynamic, just as fascism was, in part, motivated.
*It calls for allegiance to the public before allegiance to the family or any other personal, private relations. When the two conflict (when you must disagree with your friend or lover on policies, or when you must judge them concerning a criminal wrongdoing), your duties as a citizen carry more weight than your duties as a friend or lover. (But as long as they remain good citizens as well, everything's peachy).

How does this differ from traditional fascism?
*It's more modern than fascism. It is not saddled with absurdly obsolete racist biology, primitive leader-worship, or pre-modern enshrinement of the family.
*Allegiance to the public and occasional sacrifice is ultimately justified on transparently, farsightedly-egoistic grounds rather than on supposedly-altruistic ones (which usually turn out to be egoistic anyways when you pull away the rhetorical disguises).
*This does not seek to protect capitalism, but to supersede it. It does not just call for "respect" between employers and workers, or even better conditions for workers. It calls for the abolition of employers and workers, and the institution of equal economic citizens at each workplace (and by the way, if you want to change workplaces, you have to get voted on at the next one, but you assume your position with equal powers at the new workplace just as everyone else. Perhaps not equal expertise right away, but equal powers. And if you want to kick a miscreant co-worker out of the workplace, you can vote on that and do that as well. That worker will just have to subsist on the citizen rations for a bit and join another workplace sometime later).

This new "state" is obviously not authoritarian as it is in fascism. Instead, it is directly-democratic. However, this new "state" in this new modern mass society is still just as totalitarian, perhaps even moreso, because it "intrudes" into the private sphere perhaps even more than in fascism (or, rather, it robs the private sphere of territory...when it comes to the family, when it comes to dispelling nepotism, when it comes to providing for economic survival, when it comes to confining religion or spirituality to an ultra-private domain, etc.). It is totalitarian in the same way that the French Revolution was totalitarian.

Finally, I must mention that the new Spartan state will be in favor of all forms of mutually-beneficial organic pleasure, so consensual homosexual love and sex will be celebrated just as much as heterosexual love and sex. Similarly with transgender love, etc.....people pursuing their organic desires with nihilistically-rational determination. That's what I'd like to celebrate.