Responsibility for addiction.

Abstract

In summary, to characterize addiction as a disease is not necessarily morally incompatible with saying that addicts are responsible for yielding to it. This is admittedly a demanding approach to responsibility, but our criminal law has always set the bar pretty high. Holding addicts responsible is also strongly supported on utilitarian grounds because the threat of sanctions provides leverage to press them into treatment and to keep them engaged while therapeutic efforts are undertaken. Such a stern approach may be thought to be both unfair and unduly paternalistic. However, focusing on relapse suggests a more gentle, less jarring way of thinking about the addict's responsibility: After the period of detoxification and acute treatment, the addict is responsible for taking steps to manage the addiction. In this connection, the similarity between addiction and other chronic diseases, which lies at the heart of the brain disease claim, becomes particularly pertinent. Yes, addiction is best understood as a chronic relapsing disorder. This helps to establish realistic expectations for the benefits of treatment, but it also emphasizes the important role of behavior in disease management and points in the direction of a theory of responsibility for managing one's own illness.