Addiction busts up what matters: the condition is capable of creating urges and motivations which bring about highly significant losses to a person’s well-being in spite of the person’s standing preference not to live like that. It’s possible that an addict is able, at times, to control the urge to use; but the addict also might not be able to prevent an urge to use from spontaneously arising and motivating. Other conditions, for instance bipolar or obsessive-compulsive disorders, can also create self-regulatory failures, so that episodes of self-destructive behavior are willingly engaged in which contravene the person’s general preference not to behave like that. Furthermore an appearance, at times, of control – intentionally cutting down, or temporarily stopping – can mislead the addict and others into believing that the addiction really is under control. The ability of the addict to believe that he/she is addicted also typically becomes compromised.
Well, why not just hold that addicts abandon their resolve to be abstinent simply because they change their minds, and not through some sort of compulsion? It’s common to change one’s mind when faced with temptation. Sometimes the choice to go ahead with the temptation is the result of a cost-benefit evaluation – in other words, it seems worthwhile to do it. At other times a person might gratify their desire or urge without entertaining any qualms or even thoughts about it. So although an addict’s habitual behavior might be atypical, rather than seeing it as a result of a compulsion they’re not strong enough to fight against, why not see their addictive behavior as something done in a willing manner, because the person feels like doing it, and/or they regard it as worth doing?
…Support for the moral and other willingness models has been garnered from the fact that some addicts have stopped or limited their drug use when they have had good enough reason for doing so – that is, when they regard doing so as important. For example, it is not unusual for women to stop smoking while pregnant in order to protect the fetus, but to resume smoking afterwards. Also, addicts will often limit when they engage in their addiction, for instance, not at work, or not around certain people. Addicts might also demonstrate an ability to limit their drug use, e.g., their drinking, just to prove that they can successfully control their habit. Some addicts may decide that their addiction no longer works for them, and stop using completely. Furthermore, it is often claimed, that even if there are genetic or biological factors causing an addict to have strong urges, control over them still depend on what the addict thinks it is worthwhile to do, even when the urges are intense. Urges “incline but do not necessitate,” to use an expression of Leibniz’s.
I’ve always been skeptical of the disease model of substance abuse, not out of a misanthropic “fuck ’em if they’re stupid enough to use” sensibility, but because, as with free will, I wonder about the conceptual framework of identity behind it. I wonder if it’s just simply too injurious to our moral sensibilities to accept that anyone could willingly choose to satisfy their addiction at the expense of their responsibilities to friends, family, society.
Practically speaking, I don’t see where it makes a difference. Addicts almost always will need treatment and a lot of support to change their lives. But I wonder about the way in which compulsive, destructive habits are visualized as being insidious, foreign agents that invade and corrupt the integrity of their host. How does it clarify our understanding of the phenomenon to call it a “disease” rather than simply an “addiction”?