Encyclopedia of Global Bioethics

Living Edition
| Editors: Henk ten Have

Addiction

  • Michael O. S. AfolabiEmail author
  • Solomon Umukoro
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-05544-2_6-1

Abstract

Addiction highlights the problematic question of how human desires and habits denude of rational control over harmful or potentially harmful behavior. It constitutes a chronic relapsing phenomenon typified by an overvaluation or compulsive use of a substance or the experience of an activity of interest. While this may bring about adverse personal, social, and legal consequences, such harms hardly foster a disinterest in the addictive factor. Although addiction is commonly seen as a pathological condition, its nuanced nature runs counter and contrary to this mainstream view. This entry seeks to elucidate the notion of addiction generally, as it pertains to the context of pharmaceuticals in particular, its neurobiological and sociocultural contexts as well as some of the attendant ethical issues.

Keywords

Addiction Autonomy Drug abuse Global bioethics Harm Vulnerability 

Introduction

The phenomenon of addiction highlights the problematic question of how our human desires and habits deprive us of rational control over harmful or potentially harmful behavior. It equally echoes the agelong quest for regulating selected activities considered inimical to societal interests. Indeed, contemporary society regulates ingestible substances in the cause of public health and safety. Whereas the clinical use of pharmaceuticals rests on the need to restore persons to a state of physiological flourishing, this goal is not at play when certain “drugs” or chemicals are used to achieve nontherapeutic ends related to pleasure and other forms of sensual gratification or functional enhancement. Drugs, in this vein, refer to natural or synthetic substances that achieve a spectrum of nonmedical purposes including aiding religious practices facilitating self-exploration; enhancing mood, social interaction, peer pressure and shaping creative expression.

The nonmedical use of drugs has largely provided the rhetoric which confers licit and illicit status as well as a tool with which transgressors may be morally deplored. Addiction is therefore often seen as a pathological condition warranting medical intervention via pharmacological agents including methadone, buprenorphine, naltrexone (for opiate addiction), bupropion, varenicline (for tobacco addiction), and disulfiram (for alcohol addiction) or psychotherapy. However, the fact that addiction occurs not only to drugs and the related sociocultural nuances underscores the underlying complexity which pervades the phenomenon and, by implication, the inadequacy of appealing exclusively to a disease model.

For different people, addiction raises distinct issues and generates differing interests. For health-care providers, the interest lies in the wish to help people to stop performing unwanted and unhealthy behaviors, and for scientists, it is the explication of the mechanisms involved in the generation of anomalous consumptive behaviors (Foddy 2011). Addiction also has varied meanings for philosophers, sociologists, public health experts, and pharmacists. These interests intercalate for bioethicists and acquire an ethical dynamic. Against this backdrop, this entry seeks to clarify the notion of addiction generally, as it pertains to the context of pharmaceuticals in particular, its neurobiological and sociocultural contexts as well as some of the attendant ethical issues.

Conceptual Clarification

Before engaging the ethical themes in this entry, it is pertinent to seek some conceptual clarity.

The Concept of Addiction Is Nuanced

The term “addiction” often throws up other related but different concepts such as drug abuse, chemical dependence, and substance abuse. Although each of this common alternative rendering connotes the idea that there is a dose threshold beyond which proper drug or chemical use crosses into the “abuse territory,” the fact that the “drugs” intended are those considered illicit based on drug schedules (and regardless of dose) points to the lack of conceptual homogeneity that exists in the literature on the notion of addiction. Secondly, different drugs and substances such as cocaine, alcohol, glue, cigarette, and marijuana have different addictive capacities. This echoes the limited application of the addiction concept and phenomenon. Although addiction does not occur exclusively to drugs, there is an entrenched focus on mind-altering drugs (psychoactive drugs) in the extant literature and popular culture when the term comes up. In this context, drug addiction entails a chronic relapsing neuropsychiatric disorder characterized by neurobiological changes that lead to compulsive intake of drugs despite adverse consequences. This engenders an acquired sense of pleasure and an increase in self-esteem that enable the mind to experience something which may be compared to a trip to the Garden of Eden or a regression which approximates the blissful state of childhood.

Some models including the habitual, interoceptive, allostatic dysregulation and dual-process models attempt to explain the inherent capacity of drugs to foster addiction (Hyman 2011). These models however compete for scientific and clinical popularity. Indeed, the fact that addiction may also develop toward non-psychoactive drugs including analgesics such as paracetamol, salicylates, and phenacetin, routinely consumed substances such as tea and coffee, and seemingly harmless activities such as writing and reading as well as shopping challenges the traditional view on addiction. It also reinforces the idea that the addiction concept is nuanced. If addiction is a phenomenon that may occur to a diverse range of human experiences, activities, or other items of interest, then not all activities or substances ascribed with addictive features will produce addiction in all persons. By implication, the moral rhetoric associated with addiction misclassifies and mislabels some categories of users. Similarly, the legal rhetoric which gives social and political impetus to the moral language wrongfully denies some eligible “users” their rights to drug, chemical, or substance use.

Addiction as Compulsion or Overvaluation

Two attitudes predominate in the extant literature vis-à-vis addiction as either a compulsive behavioral phenomenon or as a continuous struggle with overvaluing the item or drug of interest. Foddy (2011) attributes the compulsive perspective to four distinct reasons: firstly, the insensitivity shown by most addicts to the costs of their drug use. Secondly, they appear compulsive because they regret and fail to reduce their drug use. Thirdly, it is believed that addicts appear compulsive because they report feeling strong desires which they feel unable to control. Finally, neuroscientists have claimed that addicts behave compulsively because their actions have identifiable neurological processes as root causes. To be sure, the major addictive drugs like cocaine, amphetamine, heroin, morphine, benzodiazepines, marijuana, and nicotine are known to alter the neurophysiological properties of the brain (Koob and Le 2001). However, these views are not without criticisms. Indeed, not all addicts ignore the pecuniary, personal, or health-related costs of their addiction, not all addicts feel regret towards their addictive act, and not all addicts are unable to limit their drug use as cravings occur not for all drugs, to the same extent and usually varies with particular drugs (Levy and Martin 2006). Finally, addicts can hardly be completely held accountable for the rewiring of their brain structure.

The second attitude views the problem of addiction as a maladaptive syndrome of the delicate balance between memory and learning in which the drugs of interest displace most valued life goals to become a chief object of focus for the addict (Hyman 2011). If this is true, then addiction may be described as a problem of individual failure to properly adjust to the complex nature–nurture interplay as well as contextual breakdown of volition in relation to drug use. These conceptual analyses partly show how problematic it is to pathologize addiction.

Dimensions of Addiction

Addiction entails two distinct phenomena which may occur separately or collectively. The first, termed psychological dependence, involves the desire to continue undergoing an addictive experience in order to forestall unpleasant psychological symptoms that may occur as a result of nonuse. In the contest of pharmaceuticals, it entails the use of a drug in order to avoid the unpleasant experiences associated with withdrawal from its use (Koob and Le 2001). Psychological dependence develops through consistent and repeated exposure to the addictive drug. Specifically, psychological dependence entails an emotional and mental attachment to the given substance, causing preoccupation with seeking its pleasurable effects. Since pleasure is linked with happiness, the absence of the drug or substance of interest engenders a subjective state of unhappiness that is curable only by using the addictive substance (Kringelbach and Berridge 2011). Because a sort of existential derangement ensues from lack of the addictive item, psychological drug addicts are prone to going to any lengths to obtain the drug, chemical, or experience to which addiction has developed. In relation to addiction to illicit drugs, this sheds some light into why addicts often engage in social vices such as prostitution, stealing, violence, and murders (Reske and Paulus 2011) in order to raise the cash for their fix.

The other dimension of addiction, physiological dependence, occurs when the human body becomes physiologically dependent on an addictive substance to the extent that the drug molecules become so necessary to body homeostasis. It results from the upregulation of the cyclic adenosine monophosphate (cAMP) second messenger pathway found in several neurons. This upregulation and the resulting activation of the transcription factor CREB (cAMP response element-binding protein) facilitate aspects of physiological tolerance and dependence (Chao and Nestler 2004). In addition, most psychoactive drugs cross the blood–brain barrier, hence, interact with neuropeptides such as dopamine and serotonin (Brown and McCormick 2011) and compete with brain receptors. This may either cause the endogenous neuropeptides to no longer optimally modulate associated responses, or the repetitive stimulation of brain receptors via a given psychoactive substance may gradually fail to elicit the usual dose–response effect such that more of it is needed to achieve the same results. Physiological dependence manifests in the absence of the addictive substance or drug due to physiological adaptations in the brain. Symptoms are usually tied to the drug type, but increased blood pressure, sweating, diarrhea, and tremors are common. More serious symptoms such as confusion, seizures, and visual hallucinations indicate a serious emergency and the need for immediate medical intervention.

The psychological and physiological dimensions of addiction further highlight the nuanced nature of the addiction phenomenon, which by implication reinforces Shaffer’s (1986) idea that addictive behaviors are among those activities that defy satisfactory explanation. To be sure, addiction to different drugs, substances, or experiences does not necessarily embed both of these dynamics. For instance, while addiction to work, shopping, and reading probably entails only an underlying psychological dependence, addiction to cocaine, glue, and alcohol often entails both psychological and physiological causation. Against the background of the conceptual clarification offered in this section, it is not surprising that there is an enormous scholarly dispute about the nature of addiction (Husak 2013).

Ethical Issues

Having clarified most of the thorny conceptual issues related to addiction, this section of the entry explores some of the attendant ethical issues.

Autonomy

Autonomy may be moral or personal. Since personal autonomy relates directly to self-governance, it is more relevant in relation to such activities as drug taking, experience seeking, and their possible bearing on addiction. In this regard, autonomy relates to a moral agent’s hierarchy of desires (Levy and Martin 2006) and embeds having the capacity to decide for or against a given course of action or a choice without any undue external influence. For Beauchamp and Childress (2013), it involves three elements: intentionality, understanding, and non-control. Since ideal autonomy may not be possible for all to realize, some scholars have proposed the notion of basic autonomy, the minimal state of being responsible, independent, and possessing the capacity to speak for oneself (Levy and Martin 2006). If the traditional and entrenched conception of the addicted individual as fundamentally irrational in relation to making choices is true, then addiction (whether a derivative of the psychological or physiological dynamic) threatens and shortchanges autonomous capacity. In other words, being addicted erodes the capacity and will to decide against the use of the substance, drug, or experience in question, thereby making continued use and dependence the default state.

However, if addiction does not elicit compulsive use for all persons and for all drugs, then the loss of autonomy can hardly be found in all persons that would fit the technical description of “addicts.” Autonomy is also considered to be hindered by addiction in the sense of the presence of conflicting desires. For instance, that alcoholics have a desire to drink as well as a higher-order desire to stop drinking is often considered an evidence of the erosion of autonomy. Yet, it is possible to have some alcoholics or other types of addicts for whom the first and second desire to use the object of their addiction is always the same, and therefore for whom there occurs no dissonance in the parameters of autonomy and who therefore gladly decide to use their objects of addiction all the time. It is likewise plausible that the conflict of desires may occur sometimes and not at other times giving rise to occasional and contextual gratification of the object of addiction. Scholars like Husak (2013) have noted that it is only infants or those with severe mental handicaps that are nonautonomous by fiat of being totally unresponsive to reasons. Since addiction hardly puts people in this primitive state of being impervious to the currents of reason and reflection such that they defy the status of moral agents in a Kantian sense, the notion that addiction erodes autonomy becomes difficult to sustain.

Finally, it is possible to have a conflict among the hierarchy of desires in some addicts who ultimately decide in favor of ceasing to gratify their previous addictions. For instance, mothers with dependent children are much more likely to give up their drug addictions. Indeed, the evidence that drug users do in fact respond to powerful incentives is a strong indicator that their behavior is not compulsive and that addiction does not bypass the agent’s will, but it works through it. Whereas it can be generally argued that addiction may diminish voluntariness for some people and by implication autonomous capacity, the sets of preceding analyses show how the rhetoric of autonomy cannot adequately address the ethical issue embedded in addiction.

Harm

Harm embeds interfering or shortchanging another party’s interests. The presence of diverse and differing interests in any given society however entails the possibility that some minimal interference of interests may not necessarily constitute harm. In bioethical discourses, harm is often synonymous with non-maleficence which has the following elements: (1) do not kill, (2) do not cause pain or suffering, (3) do not incapacitate, (4) do not deprive others of the goods of life, and (5) do not impose the risks of harm (Beauchamp and Childress 2013). In relation to addiction, personal, social, and legal kinds of harm come to the fore.

At the individual plane, addiction has several direct and indirect devastating consequences. Lysergic diphenylamine (LSD) causes chromosomal damage, rage, and psychotic experiences, while several drugs disrupt varying aspects of life and shape predisposition to mental illnesses, infectious diseases, and cardiovascular disorders. In addition, addiction to tobacco facilitates higher incidence of lung cancer, and dementia may result from opium use. Addiction likewise harms the personality of the addict. Indeed, public perception holds the addict with a negative image as a person of low moral character who willfully engages in antisocial and violent behaviors. Although this social stigma reflects the extant gap between scientific knowledge and public perception of drug addiction, that the scientific community adopts a one-size-fits-all approach which holds addiction as a neuropsychiatric disease requiring medical interventions also reflects the inattention that mainstream science pays to the nuances surrounding addiction.

The legal harms associated with addiction include the resort by some addicts to engage in socially prohibited activities such as stealing, murders, and prostitution in order to raise the cash to finance their addiction. It also relates to the use of legally restricted drugs and how certain manners of drug use including shooting and sharing of hypodermic needles may foster the incidence of infectious diseases such as hepatitis and HIV/AIDS. The social harms engendered by addiction thus revolve around how the actions of an individual or some individuals run against the interests of the larger society. This development conflicts public interests with individual interests and demands some form of resolution whether via the utilitarian benefits of drug and chemical use (if any) or a libertarian emphasis on individual freedom to use drugs provided harm to others is minimal or nonexistent.

However, it is doubtful and may be contested if legal harm should always trump possible social benefits of illicit drugs and controlled substances. If such legal restrictions were to have been in place, then poems like Kubla Khan and the scientific elucidation of the ring structure of benzene which were done under the influence of psychoactive drugs may probably never have seen the light of day. This may be taken a notch higher to infer that legal restriction has probably stifled the expression of socially beneficial creativity in a number of other epistemic domains. Since psychoactive and controlled drugs such as LSD may be clinically used for treating alcoholism based on clinical indication enabling beneficial use to trump legal and personal harms (such as chromosomal damage), one wonders why the use of similar drugs based on personally perceived functional or creative “indication” should not override selected legal considerations of harm.

Vulnerability

Another ethical issue raised by addiction is tied to the vulnerability of humans generally and that of specific groups. Vulnerability is linked with the experience of human nature and human finitude; as such, by belonging to the human community, humans regardless s of race and clime are vulnerable beings. Vulnerability to addiction is first underscored by the fact that prescription medications used for clinical purposes such as morphine and codeine may engender addiction in some patients. Since all currently healthy persons are potential patients, this echoes the vulnerability dynamic of addiction and how everyone is a potential victim.

Young adults and adolescents also tend to be more vulnerable to some types of addiction than other adults due to the nature of their brains. To be sure, the adolescent brain is in a unique state of transition as it undergoes progressive and regressive changes that afford a biological basis for the unique adolescent behaviors and the associated changes in behavior during maturation to adulthood (Crews et al. 2007). In this vein, the nucleus accumbens of adolescents has been shown to function differently from that of adults such that the former is less able to resist the volition-erosion of addictive substances. This suggests the idea that adults have stronger wills compared to adolescents as well as reinforces the nuanced nature of addiction in the sense that non-pharmacological parameters influence whether or not addiction will develop in some individuals and not in others. However, since the presence of a fully developed nucleus accumbens in adults does not spare them from being victims of addiction, this biological parameter does not fully account for its linkage to addiction.

Stress is another parameter that may foster addiction. Stress – processes involving perception, appraisal, and adaptive response to harmful, threatening, or challenging events or stimuli – is a well-known risk factor in the development of addiction and in addiction relapse vulnerability (Sinha 2008). Because prolonged or chronic stress lowers the degree of adaptive response and thereby facilitates greater magnitude of stress response and higher risk of homeostatic dysregulation, chronic stress ultimately increases the likelihood of drug use as a coping mechanism and, as such, the possibility of addiction. Specific stressors in this regard include loss of parent, parental divorce, loss of child by death, and emotional and sexual abuse (Sinha 2008). Individuals who have issues with self-esteem, self-control, willpower, and family life are also more susceptible to addictions when they use psychoactive substances.

This is however not to say that everyone who becomes addicted to drugs does so as a result of pressing physical or psychological stressors. Stress is indeed an inadequate parameter for explaining addiction to non-pharmaceuticals since it is difficult to explicate how stress alone would foster addictive habits such as gambling, internet pornography, cell phone texting, obsessive consumption of potato chips, and engagement in coitus (Husak 2013). This conceptual stalemate therefore demands exploring other possible insights on addiction.

Contexts and Addiction

If, as shown in the previous section, the rhetoric of autonomy, individual, social, and legal harms, and vulnerability hardly account for the moral issues tied to addiction, then a broader perspective becomes exigent. In this vein, an approach which considers different specific contexts offers interesting insights. This section engages this theme.

Addiction as Derangement of Enhancement

Perhaps, it might be useful to ask two related but distinct questions. Firstly, why do people use drugs to which they may become potentially addicted? Secondly, why do people engage in other social activities such as reading and going to work to which addiction may also develop? To the first question, a possible response might be that person A uses a drug of addiction because the social group or class to which they belong uses it. In this vein, smoking and alcohol consumption by teenagers might constitute a symbolic ritual of adulthood or liberation from parental control. However, some other person B may use alcohol, caffeine, or marijuana for specific purposes including reducing anxiety as well as enhancing concentration and information retrieval from the subconscious (Reske and Paulus 2011). Another local psychoactive agent, mbanje, is fruitfully used in Zimbabwe in the winter for warmth generation via the adipose tissue and by children to stave off pangs of hunger.

The distinction between these two possibilities lies in the purposive or nonpurposive end to which the drug is put to use. On the other hand, reading and working are activities that also serve specific ends as these may facilitate obtaining a university diploma or degree and fulfilling financial obligations to self and/or family, respectively. The purposive use of a drug to expedite capabilities or the purposive engagement in social activities such as reading and shopping may therefore be described as some form of enhancement. If this is true, then the development of addiction to such activities constitutes a derangement of enhancement. This notion needs further conceptual elaboration.

A violinist who uses beta-blockers to overcome the anxieties of stage performance, for instance, merely employs the drug purposively to enhance musical performance via the elimination of the distractive anxiety (Glannon 2011). Similarly, a musician may decide to use another psychoactive agent such as marijuana to enhance musical creativity. While the development of addiction in any of these instances may reflect a derangement of enhancement, there are at least three implications of this scenario: firstly, the need to understand the willingness of creative individuals who engage in highly socially beneficial activities to take on risky activities to achieve their tasks and how employing the introspectory and metacognitive properties of psychoactive drugs and substances readily fit into such a rubric; secondly, how the enhancement use of drugs may evolve into addiction for some members of one group and not others; and thirdly and pragmatically, how the development of an enhancement window as a form of therapeutic index may help hinder the progression of enhancement into addiction for vulnerable populations, thereby enabling much more benefits to accrue from some contextual drug use (specifically, for facilitating functional and creative capabilities) as opposed to harms.

Addiction as a Neurobiological Phenomenon

If addiction is a derangement of enhancement and has an underlying neurobiological facet, then addiction may indeed be described as a neurobiological phenomenon. In this vein, a disruption in the delicate balance among neurotransmitters such as dopamine, glutamate, serotonin, acetylcholine, and noradrenaline is understood to be the major causal factor associated with withdrawal symptoms and compulsive use of illicit drugs. A number of bioethicists subscribe to and engage the addiction discourse from this perspective.

For Leshner (1999), compulsory use of the drug of addiction becomes entrenched to the point of constituting an involuntary action. In relation to the heroin addict, Charland (2002) notes that such addicts experience a compulsive need to seek and use heroin to the extent that they are unable to say no to it because their brain has almost literally been hijacked by it. If this is true, then a neurobiological manipulation would offer a means of intervention. Indeed, the major goals for pharmacotherapy of addiction lie in reestablishing normal brain function, preventing relapse, and diminishing cravings for drugs of addiction.

If the neurobiological account of addiction is correct, one thorny ethical issue revolves around why addicts more often than not quit without treatment (Husak 2013). Another concerns the process of neuroplasticity which underpins addiction. To be sure, the process of synaptic neuroplasticity constituting changes in neural interconnections via repeated activation of similar-firing neurons and neural pathways influences the onset of addiction by altering neural mechanisms via the neurotransmitter system. Since plasticity is a normal and largely beneficial characteristic of human brains, if changes in brain structure and function constitute a sufficient criterion for disease, it follows that everyone should be described as diseased (Foddy 2011). Another challenge arising from the neurobiological construction of addiction concerns nondrug dependence to such inherently harmless but socially useful experiences like reading, working, and shopping.

Addiction as a Sociocultural Phenomenon

The nuanced nature of addiction implies the notion that the inherent pharmacological properties of drugs alone do not account for the phenomenon. In other words, people may use supposedly drugs or substances of abuse and fail to be addicted to it. Some cultures such as the Native American Indians, for instance, have fruitfully used peyote and mescaline for religious purposes. Also, LSD may be used for religious ends without harm. The Edo tribe in Nigeria likewise use marijuana leaves for cooking, and there is no report in the literature of people becoming addicts as a consequence of such. Historically, marijuana was employed for religious purposes and for aiding monastic contemplation in Ethiopia and for healing therapy in Zimbabwe. In Sierra Leone, indigenous midwives employed cannabis as a general anesthetic agent during difficult childbirth and other people used it for arduous labor such as farming and fishing (Akyeampong 2010). These observations underscore the sociocultural dimension to some of the positive meanings surrounding the capacity of one drug to induce addiction in one cultural context and not in another. It likewise reechoes how the restrictive use of psychoactive drugs via the medical and moral label of addiction or the legal label of drug abuse may indeed encapsulate the prevention of socially beneficial ends.

However, there is also a possible social construct to the addiction phenomenon. For instance, it is possible to take to drinking when people fall on difficult financial times and are unable to meet social obligations as husbands and parents. The drinking habit often disturbs hitherto relations with family and community, but once the underlying motivation for drinking (e.g., unemployment, singlehood, marital conflicts, etc.) disappears, such problem drinkers usually quit (Akyeampong 2010). This lends some credence to the thesis that addiction is more wrapped around the personality of the addict rather than the chemical or physiological properties of the addicting agent.

Due to the global market for addictive substances such as cocaine, heroin, and amphetamine, it has been possible to also socially induce or construct addiction in people. In other words, by deliberately supplying targeted groups with addictive drugs and substances, addiction has been created in different social groups. Such forms of addiction partly serve as the engine which drives the economic wheel of the international illicit drug trade.

Global Ethical Dimensions

The idea and practice surrounding the phenomenon of addiction have certain global dimensions. This generally revolves around what substances are socially construed as addictive, and what substances or drugs are given licit or illicit status, and the attendant moral rhetoric that are consequently associated with users. For instance, if alcohol addiction is real, then it follows that some forms of addiction to certain locally produced but non-proscribed alcohol-containing substances such as pito, dolo, and utshwala (made from sorghum and millet in West Africa and South Africa, respectively) and palm wine are probably being overlooked. Otherwise, nonaddiction to such alcoholic beverages provides further proof to the nuanced and varied dimensions to addiction.

On the other hand, the licit nature of marijuana in Colorado in the United States not only de-emphasizes what potential harms may result from its use but also creates an ambience where addiction may flourish. Marijuana is however also legal (though in measured quantities) in some other countries such as Jamaica, the Netherlands, Argentina, Colombia, and Spain. In the Netherlands, the addiction phenomenon is engaged differently. For instance, while the use of mind-altering drugs is not generally encouraged, heroin addicts are provided with safe supplies of the drug as well as sterile needles with a view to providing a monitoring mechanism as well as partly protecting the health of the collective society. This underscores how societal values shape the interpretation of addiction, the extent of its problematization, and attitudes toward users of drugs with addictive properties.

Lastly, the nuanced nature of addiction calls for the development of more objective forms of assessment, at least as it relates to some drugs and nondrug objects of addiction as well as the particular features of the addict or potential addict. In this regards, emerging illumination about the role of genetic and nongenetic factors in the development of tolerance, dependence, and withdrawal symptoms may not only lead to the development of pharmacogenomic diagnostic and interventional tools but also a better clarification of what really constitutes “addiction.” This would ultimately reshape the associated moral, social, and legal rhetoric and praxis.

Conclusion

The phenomenon of addiction often portrays the erosion of personal autonomy, thereby raising the idea of how drug use may denude or interfere with the expression of free will. Although other ethical issues including vulnerability and balancing different forms of harm between individual and collective interests come to the fore in relation to addiction, the development of addiction to nondrugs and seemingly harmless nondrug substances such as water and social experiences such as reading and working suggests how the phenomenon hardly embeds clear-cut ideological and scientific perspectives. An examination of different contexts such as the sociocultural, the neurobiological, and enhancement angles on drug use likewise shed useful insights into the tenuous nature of what constitutes addiction, potential social benefits that may be lost via solely medicalizing the phenomenon, why some individuals and not others develop it, as well as the problematic nature of pathologizing a natural process that derives largely out of a nature–nurture interplay.

Cross-References

Notes

Acknowledgments

Michael Afolabi acknowledges the Global Initiative Center for Scientific Research & Development in providing logistical support and the conducive intellectual ambience in which the article was written.

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Further Readings

  1. Heather, N. (1992). Why alcoholism is not a disease. Medical Journal of Australia, 156, 212–215.Google Scholar
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  3. Vice, S., Campbell, M., & Armstrong, T. (1994). Beyond the pleasure dome: Writing and addiction from the romantics. Sheffield: Academic.Google Scholar
  4. Yaffe, C. (2002). Recent work on addiction and responsible agency. Philosophy and Public Affairs, 30, 178–221.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Center for Healthcare EthicsDuquesne UniversityPittsburghUSA
  2. 2.Global Initiative Center for Scientific Research & DevelopmentIbadanNigeria
  3. 3.Department of Pharmacology & Therapeutics, College of MedicineUniversity of IbadanIbadanNigeria