Recovery from a range of common medical conditions requires patients to have the will to change their behaviour. The authors argue that the proper recognition of the role of willpower in recovery is necessary for effective treatment.

Philosophers and psychologists have been attracted to two differing accounts of addictive motivation. In this paper, we investigate these two accounts and challenge their mutual claim that addictions compromise a person’s self-control. First, we identify some incompatibilities between this claim of reduced self-control and the available evidence from various disciplines. A critical assessment of the evidence weakens the empirical argument for reduced autonomy. Second, we identify sources of unwarranted normative bias in the popular theories of addiction that introduce systematic errors (...) in interpreting the evidence. By eliminating these errors, we are able to generate a minimal, but correct account, of addiction that presumes addicts to be autonomous in their addictive behavior, absent further evidence to the contrary. Finally, we explore some of the implications of this minimal, correct view. (shrink)

In 1969 Harry Frankfurt published his hugely influential paper 'Alternate Possibilities and Moral Responsibility' in which he claimed to present a counterexample to the so-called 'Principle of Alternate Possibilities' ('a person is morally responsible for what he has done only if he could have done otherwise'). The success of Frankfurt-style cases as counterexamples to the Principle has been much debated since. I present an objection to these cases that, in questioning their conceptual cogency, undercuts many of those debates. Such cases (...) all require a counterfactual mechanism that could cause an agent to perform an action that he cannot avoid performing. I argue that, given our concept of what it is for someone to act, this requirement is inconsistent. Frankfurt-style alleged counterexamples are cases where an agent is morally responsible for an action he performs even though, the claim goes, he could not have avoided performing that action. However, it has recently been argued, e.g. by John Fischer, that a counterexample to the Principle could be a 'Fischer-style case', i.e. a case where the agent can either perform the action or do nothing else. I argue that, although Fischer-style cases do not share the conceptual flaw common to all Frankfurt-style cases, they also fail as counterexamples to the Principle. The paper finishes with a brief discussion of the significance of the Principle of Alternate Possibilities. (shrink)

The topic of irresistible desires arises with unsurprising frequency in discussions of free agency and moral responsibility. Actions motivated by such desires are standardly viewed as compelled, and hence unfree. Agents in the grip of irresistible desires are often plausibly exempted from moral blame for intentional deeds in which the desires issue. Yet, relatively little attention has been given to the analysis of irresistible desire. Moreover, a popular analysis is fatally flawed. My aim in this paper is to construct and (...) defend a new analysis of irresistible desire. Although, to render the discussion manageable, I shall keep the issues of freedom and responsibility to one side, readers will see them in the background at every major turn. (shrink)

It is often claimed that the autonomy of heroin addicts is compromised when they are choosing between taking their drug of addiction and abstaining. This is the basis of claims that they are incompetent to give consent to be prescribed heroin. We reject these claims on a number of empirical and theoretical grounds. First we argue that addicts are likely to be sober, and thus capable of rational thought, when approaching researchers to participate in research. We reject behavioural evidence purported (...) to establish that addicts lack autonomy. We present an argument that extrinsic forces must be irresistible in order to make a choice non-autonomous. We argue that heroin does not present such an irresistible force. We make a case that drug-oriented desires are strong regular appetitive desires, which do not compromise consent. Finally we argue that an addict’s apparent desire to engage in a harmful act cannot be construed as evidence of irrational or compulsive thought. On these arguments, a sober heroin addict must be considered competent, autonomous and capable of giving consent. More generally, any argument against legalisation of drugs or supporting infringement of the liberty of those desiring to take drugs of addiction must be based on considerations of harm and paternalism, and not on false claims that addicts lack freedom of the will. (shrink)

This chapter presents a reflective, critical position toward the author’s own addiction and toward himself as an addict. It presents the question of whether addressing addiction as a disease is useful; the idea of addiction as a disease seems less useful in describing “what it is like” for the author than to say that his being was physically, psychologically, and relationally disordered. Despite his desires, he could not find a way to regain order and harmony within himself. It was only (...) the phenomenological possibility of feeling and being better that kept hope alive. The solution to addiction is social; other people who cared for the author personally, together with those with professional knowledge, assisted him in regaining some control that he alone had either lost or could not find. (shrink)

Heroin prescription involves the medical provision of heroin in the treatment of heroin addiction. Rudimentary clinical trials on that treatment modality have been carried out and others are currently underway or in development. However, it is questionable whether subjects considered for such trials are mentally competent to consent to them. The problem has not been sufficiently appreciated in ethical and clinical discussions of the topic. The challenges involved throw new light on the role of value and accountability in contemporary discussions (...) of mental competence. (shrink)

This paper argues for the replacement of the Principle of Alternate Possibilities by an alternative principle, the Principle of Possible Non-Performance, which it is argued represents an important improvement on the Principle of Alternate Possibilities in the context of Frankfurt-style examples. The suggestion that the principle offers only the possibility of something insufficiently 'robust' to supply a decent replacement to PAP is countered.