Addiction: Disease or Morale Failing? the Ethics of Forced Treatment

A drug addiction occurs when an individual takes a drug a number of times and becomes dependant on it. The addicted individual will compulsively seek and take drugs, to the extent where the activity will take precedent over all other activities. The individual will find themselves unable to stop taking drugs and, if they do manage to quit, relapse is highly likely. Whether such behaviour should be viewed as an individual’s ‘morale failure’ or as a ‘disease’ is an important question as it affects how such individuals should be dealt with. If they are suffering a disease, therapy is necessary; if it is a result of a ‘morale failure’, punishment, as, in this case, the individual would be in control of their behaviour and so responsible for their actions. Traditional explanations of drug addiction have suggested addicts continue to use drugs because they enjoy the pleasure received from them and to avoid the withdrawal symptoms experienced upon discontinuation. However, research has shown that addicts will continue to take drugs even if there is no pleasure to be experienced and, in regards to avoiding withdrawal symptoms, many addicts relapse long after withdrawal symptoms have stopped. Incentive sensitization theory helps explain these two phenomena and it states that addiction is caused by hypersensitivity of neural systems involved with drug taking. If drug addiction is akin to a disease, and so to be treated therapeutically, it poses the question as to whether addicts should be forced to partake in addiction treatment programmes, even if the therapy involves the use of pharmacotherapies. To determine an appropriate answer to this question the effectiveness of current pharmacotherapies used for addiction should be considered.

Incentive sensitization theory states that repeated intermittent drug use leads to hypersensitivity (sensitization) of neural systems involved with drug taking/seeking. The sensitization affects neurons that modulate ‘wanting’, but not liking. ‘Wanting’, in this sense, refers to a sub-conscious desire to take drugs that only becomes conscious through cognitive processes and is known as the process of incentive salience. Usually ‘wanting’ and liking are associated, but in certain cases, such as drug addiction, the ‘wanting’ neurons are sensitized while the liking ones are not, leading to dissonance of the two. This dissociation is demonstrated in Lambert et al’s study in which ‘recovered’ heroin addicts were given the opportunity to press a lever to receive an injection of either morphine or saline solution. The morphine varied in strength, some being very low doses, while other doses were intermediate or high. After receiving the injections the participants rated how much they liked it, how much morphine they believed it contained and the street value of it. The saline solution was rated as worthless and of containing no morphine and the participants quickly stopped using it. The intermediate to high doses were seen as valuable and enjoyable and participants were motivated to use it. The most interesting finding was that while every participants rated the low doses as worthless and of having no morphine content, four out of five of them were as motivated to continue using it as they were for the higher dose injections. This shows that the ‘wanting’ was occurring at a subconscious level. The neural sensitization responsible for ‘wanting’ has been shown, in rats, to last for over a year and perhaps for life (1). While repeated drug use may cause incentive sensitization in some individuals, such activity is in no way ensured to lead to it for everyone (2). The likelihood of an individual’s neurons becoming sensitized through repeated drug