'I can't help myself': addiction as ideology (From: Human Psychopharmacology, Vol. 11, S21-S32 (1996)) - Part 1


Author: John Luik
Article Published: 1996


In one sense it is perhaps curious that a symposium on addiction should include a paper by a philosopher. Addiction, as we are constantly told, is, after all, a medical, indeed a scientific issue for which the tools of the philosopher might seem ill-suited or out of place.

But to allow that addiction is a medical problem, a disease to use the vocabulary favoured by some, is to concede precisely the point which is at issue, namely, what should we mean when we use the word `addiction', or more importantly, do we mean anything at all when we use the word. And if the question is genuinely one of the meaning of or the appropriate employment of a word, the philosopher might well have something useful to say.

The philosopher has legitimate business here, however, not simply because the problem of addiction is a problem about meaning: he has a role in the debate because the problem of addiction goes to the heart of our conception of what human beings are like - what philosophers like to call the free will problem. What the proponents of the concept of addiction as disease assert is that addiction is a condition wherein a subject's actions are caused by something over which he literally has no control.

In the grip of an addiction his actions cease to be voluntary in any meaningful sense so it is correct for him to say `I can't help myself'. Such claims are certainly not trivial for those things over which I have no control are those things for which I cannot reasonably be held accountable. Nor, it should be added, are such claims normal. One of the most important things to note about the addiction as disease model is how radically at odds it is with our normal, everyday concepts about ourselves and others. Most of the time both individually and as a society we believe exactly the opposite of what the disease model claims: we believe that individuals can choose, can do otherwise, and can be held responsible for their actions.

Now the concept of addiction is both too vast and too complicated to be dealt with as a generality. I want to focus my attention on one particular way in which the idea is used - in the claim that smoking tobacco is addictive. More specifically, I want to argue that the claim (1) smoking is addictive is an ideological as opposed to a properly scientific claim and that (2) as an ideological claim it suffers from several irremediable weaknesses that make it inappropriate as a basis for public policy on smoking.

ADDICTION AS IDEOLOGY


Let us begin with addiction as ideology. What does it mean to call addiction an ideology? What I do not mean is that the concept of addiction is without meaning or that it is necessarily untrue. What I do mean is that in calling smoking an addiction one is making an ideological as opposed to a scientific claim. By ideology I mean an unchallenged, unexamined set of beliefs, ideas, and claims that are formulated and advanced by a group of people both to explain something and to shape the behaviour of others, but which are open to serious challenge. The ideologue is thus the 'true believer', the creator of a social truth that is beyond inquiry and doubt.

The claim that smoking is addictive is ideological in two senses: one in terms simply of the debate about addiction and second in terms of what one might call the ideology of smoking. In the first sense, the claim smoking is addictive is ideological in that it is an explicit attempt to change how it is that we both conceive and regulate smoking. It is an attempt to move the explanatory framework for smoking from 'I smoke because I choose to' to 'I smoke because I have no choice but to'. It is, in short, an attempt to explain smoking not as the product of reasons but as the product of causes that lie beyond the volition of the smoker. Smoking is to be understood not as a decision on the part of the smoker but as an irresistible pharmacological property of a drug. People smoke, the ideology suggests, because they are addicted: smoking is never a choice, only a disease. Despite the fact that such a claim is advanced as scientific it is really ideological. It is ideological because the concept of addiction is not itself a scientific definition. It is ideological because the criteria for addiction has been created and consistently manipulated not by science but by politics, or more precisely by politicized science designed to serve ideological as opposed to scientific ends. It is ideological because once advanced it is unquestionable: anyone who raises a question or dissent is accused of being a puppet of the tobacco industry. It is ideological because in the end its purpose is to control behaviour and manipulate public policy -- not to arrive at the truth.

But the claim that smoking is addictive is ideological in a second and larger sense that it is the last piece that completes the carefully constructed ideology of smoking. The ideology is founded on the claim that smoking is morally illegitimate, both with respect to what it does to smokers and what it does to non-smokers. Only if it can be demonstrated that smoking is morally illegitimate can smoking be criminalized. At first glance it would appear that the chances of convincing society that smoking was morally illegitimate, as opposed to merely silly or even unwise, were minimal. After all, smokers possessed what were thought to be two impregnable defences. In the first case, while the decision to smoke might be seen as in some sense irrational, it was nevertheless the smoker's own choice. And in a democracy this aspect of personal autonomy counted significantly against the legitimacy of any legal sanctions against smoking. In the second case, the smoker's actions, even if posing risks to himself, did not pose risks to others. The smoker's harms were harms confined to himself.

Despite the seeming strength of this position, the success of the smoking ideology over the last 25 years is directly attributable to its ability to undermine both of these claims about smoking. Using carefully selected physical and social science evidence, the advocates of the smoking ideology have managed to obtain significant public and government support for the following:

  • (1) Smoking poses significant risks to the health of non-smokers;
  • (2) smoking imposes significant social costs on non-smokers;
  • (3) smoking is precipitated not by personal choice but by careful advertising;
  • (4) smoking is best understood as a disease explained and treated by medical science.


Together these claims significantly undermine the claim that smoking is a rational choice made by the smoker and the claim that smoking does not pose a risk to others. But what is needed for the ideology of smoking to triumph conclusively, that is to show without equivocation that smoking is morally illegitimate, is clear evidence that smoking is involuntary. Hence the crucial importance of addiction. With addiction, smoking loses both its crucial rational and moral defences. It is not a rational, free choice, instance of autonomy, but rather an instance of pharmacological compulsion.

Between them, advertising and addiction now provide a complete explanation as to why anyone smokes. As Robert Goodin puts it:

'People begin smoking before they are responsible adults: by the time they are responsible adults their nicotine addiction will have rendered their continued smoking largely involuntary. Policies justified as aids in preventing harms to oneself are bound to be opposed as paternalistic. But helping addicts who want to break the habit is not offensively paternalistic... '. (Goodin, 1989)

Addiction thus provides the crucial piece of missing evidence and argument against smoking. With addiction, public policy interventions to prevent smoking, even to the extent of criminalization are morally justified in that they are reasonable actions designed to save the vulnerable from irreversibly bad decisions. Indeed, they are justified by the principle of autonomy itself in that they are designed to preserve and enhance, not erode autonomy. With addiction public policy is allowed to turn its attention as well to the truly wicked - those who make and market tobacco all the while showing compassion to the helpless smoker. In one sense addiction is an ideal ideology: it allows one to prescribe something immoral whilst offering solace and compassion rather than condemnation for those caught in the immorality.

However attractive as an ideology, addiction is insupportable as public policy for five reasons:

  • (1) it is an instance of corrupted science;
  • (2) it exhibits faulty logic;
  • (3) it is confused in its claims;
  • (4) it cannot deal with counter-examples; and
  • (5) it is non-falsifiable.


CORRUPTED SCIENCE


Without question the most disturbing aspect of the smoking is addictive claim, and the one that characterizes it most indisputably as ideology is its dubious scientific character. In effect, the smoking is addictive claim is not science but what we have called elsewhere corrupted science - science that serves the ends of politics rather than the ends of truth (see Luik, 1994).

In a sense the centrality of `science' in the ideology of addiction should not be a surprise, for `science' is perhaps the most important component of the late 20th century campaign against tobacco.

Whether with respect to the dangers of smoking to smokers, the alleged risks of Environmental Tobacco Smoke to non-smokers, the alleged effects of tobacco advertising on tobacco consumption, or the alleged addictive qualities of nicotine, in each instance it is science - whether natural or social science - that provides the case against tobacco. Indeed, if the government and the anti-smoking movement are to make their case against smoking it is imperative that they establish that smoking poses a range of dangers that are demonstrated, compelling, unequivocal and significant. And it is only science that can deliver dangers with the requisite pedigree. Without science, or more precisely, without scientifically credible dangers, the case against smoking collapses. Everything depends upon science. And with so much at stake the pressure to adjust, shave, create, ignore, reevaluate, even manipulate, is enormous.

What emerges from these pressures is corrupted science, science that is not merely incompetent or flawed, but characterized by a cluster of pathologies. First, corrupt science is science that moves not from hypothesis and data to conclusion but from mandated/acceptable conclusion to selected data back to mandated/acceptable conclusion. That is to say it is science that uses selected data to reach the `right' conclusion, a conclusion that by the very nature of the data necessarily misrepresents reality. Second, corrupt science is science that misrepresents not just reality, but its own process in arriving at its conclusions. Rather than acknowledging the selectivity of its process and the official necessity of demonstrating the right conclusion, and rather thanadmitting the complexity of the issue and the limits of its evidence, it invests both its process and its conclusions with a mantle of indubitability. Third, and perhaps most importantly, whereas normal science deals with dissent on the basis of the quality of its evidence and argument and considers ad hominem argument as inappropriate in science, corrupt science seeks to create formidable institutional barriers to dissent through excluding dissenters from the process of review and contrives to silence dissent not by challenging its quality but by questioning its character and motivation. In effect then, corrupt science is science that is flawed in both its substance and its process and that seeks to conceal these essential flaws. It is essentially science that wishes to claim the policy advantages of genuine science without doing the work of real science.

The history of the smoking as addictive claim exemplifies the process of corrupted science in three ways. First, the concept of addiction is itself not a scientific term. In fact, it is a term that is specifically excluded from the scientific and medical vocabulary. Neither the Diagnostic and Statistical Manual of the American Psychiatric Association nor the World Health Organization use the term addiction. Indeed, it would appear that the only scientific body recommending the use of the word is the Royal Society of Canada in a 1989 report prepared at the request of the Government of Canada. We will return to this report later as its process and conclusion provide an ideal case study in the workings of corrupted science in the addiction and smoking debate.

Addiction, of course, does have a popular meaning, a meaning that carries a tone of moral reproach suggesting weakness or absence of the will and lack of discipline. The result of labelling smoking as addictive is thus a very potent combination of `science' and morality: the use of the term appears to be scientifically legitimate and compelling because it appears to issue from the scientific community and is backed by Government while at the same time the term casts a moral stigma either on smokers or on those who produce tobacco.

Addiction is allowed to do the partisan work of morality while appearing under the neutral banner of science. In this sense it summarizes the entire anti-tobacco strategy which is designed to cover a paternalistic moral campaign of imposing certain people's values on others with the patina of scientific objectivity. It is instructive to return to the only public policy question which has any weight in this debate: `What is wrong with smoking?' The answer to that question offered by science, not science and morality, but science is that smoking is a risk factor for certain diseases which may shorten some smokers' lives. The assumption that the possibility of a slightly longer non-smoking life is preferable to the possibility of a slightly shorter smoking life is not the assumption of science, but of morality, indeed a particular version of morality.

...continued...




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