Addiction

Perhaps you know that I’ve been trying to help folks with addiction. You can read about how I taught critical thinking and non-violence to the inmates in the local jail (there’s a link to “Teaching Addicts” on the homepage of the Advanced Reasoning Forum, http://www.AdvancedReasoningForum.org). Alex Raffi and I have written a draft of a comic book about addiction, “Addiction in the Body—Too Good Is Just Awful” (also on the ARF homepage).

There is much we can do to help. We can teach critical thinking. We can lead people to see a better life through our understanding not of theoretical ethics but of a way of non-violence. You can find how I teach a way of non-violence in my translation of “The BARK of DOG” (the Introduction of that is on the website TheBARKofDOG.org).

Though many people have approved of the essay “Teaching Addicts” and have told me that the approach is excellent and I should continue, I found that I couldn’t take the program into prisons and rehabilitation centers because they accept only “evidence-based” programs. Catch 22: you can’t teach it because there’s no evidence it works, but you can’t get evidence because you can’t teach it. Yet, the more I considered it, that wasn’t the problem. The problem is what is meant by “evidence-based program”.

So I set out to find what was meant, reading some papers and books. Then I set those aside and asked what we could do in evaluating treatment programs for addicts. First, there is the large problem of deciding what is meant by saying that a treatment program is “effective”. This involves values and goals, an analysis to make clear the assumptions behind various prescriptive claims. Some programs are deemed in need of evidence, others not, and the criteria for whether a program requires evidence are not made explicit. For example, it seems that administrators do not ask for evidence that teaching reading helps addicts. Nor do they ask for evidence that Bible classes help addicts.

Second, administrators want objective data as evidence. Yet that is rarely linked to the unstated subjective conclusions that are hidden in the objective conclusions. Ending addiction is not ending just certain behaviors, because all definitions of addiction use subjective criteria.

Third, any evaluation is an attempt to establish causal relations: this program helped this person, or this program–via a cause-in-population study–is likely to help these people. Just going from basic observations about what is meant to be studied, I found that there is very little, perhaps almost nothing that can be established in the way of causal claims about the effectiveness of any addiction treatment
program. I’ve written up a draft of that analysis, which you can get from me if you like. But it needs a lot more research to show how the analysis plays out in specific evaluations that have been done, and for that I would need funding.

Then I read the book Heavy Drinking: The Myth of Alcoholism as a Disease  by Herbert Fingarette, written in 1988. It is a superb analysis of just the issues I was worried about, though only for alcohol addiction. Fingarette uses the best of the skills of critical thinking and philosophy to piece out what we do or should consider in treating
alcohol addiction. He shows that the programs for treating “heavy drinking” have not been shown to be “effective”. The work is a masterpiece we can all learn from.

There is much that we can do to help. We can teach addicts. We can encourage addicts to find a better way. We can learn and then teach others about the nature of addiction and what can be done to lessen the problems of addiction.

To do this, we use our skills in reasoning and in philosophy, and theology and ethics. I have based my work on the analysis of cause and effect in my critical thinking books, which I have set out in scholarly form in my book of essays Cause and Effect, Conditionals, Explanation”.  I have drawn on the analysis of how to reason with\ subjective claims that Fred Kroon, Bill Robinson, and I have given in
the essay “Subjective Claims” in my book of essays The Fundamentals of Argument Analysis. And essential also is knowing how to reason with prescriptive claims, which I describe in my book Prescriptive Reasoning.  But don’t wait to read all those before you start.  Begin now, so that you can integrate your experience with what you study.

There is little that works in helping addicts quit. But some does. We need to help those who are addicted, those who are hurt by the addiction of their family or friends, and help those who must decide how to spend money on addiction programs to understand and make good decisions.

Critical thinking is not a theoretical skill but a practical guide to reasoning that should, indeed must, have an ethical basis and good goals. And for that, we need virtue.

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Why Cost-Benefit Analysis Cannot Be the Basis of Ethics

An article about morality and ethical choices has just appeared in Think, number 50, pp. 85-89, “Organ Donor or Gratuitous Moral Failure” by Luke Semrau. It provides an excellent example of what can go wrong in ethical analyses if you don’t know how to reason with prescriptive claims.

Semrau first introduces an example from Peter Singer. “Imagine walking past a pond in which a small child is drowning. You can safely save the child’s life but only at some expense to yourself: your shoes will be ruined. There is widespread agreement that in this situation you ought to save the child. . . . The cost to you is simply so low, and the benefit secured is so high, that on any plausible view you should perform the rescue.” Semrau makes a similar case for why one should be an organ donor: the benefits far outweigh any likely costs to the person who checks a box on his or her driver’s license to donate organs in the event of death.

In “Reasoning with Prescriptive Claims” in my book of essays Prescriptive Reasoning I present two distinct ways to evaluate prescriptive claims. In the first, one accepts a prescriptive claim, like “You should not torture dogs”, on the basis of some standard. Perhaps in this case it might be standards from the Bible or the tenets of Buddhism. Or one might take the claim to be itself a standard, not depending on another. Debates about whether to accept a prescriptive claim then focus on our basic standards, which typically can be compared for their consequences but cannot be directly judged as better or worse any more than metaphysical claims can, beyond the issue of coherence. How we derive a prescriptive claim from other claims requires an analysis of what counts as a good inference that involves prescriptive claims, for simple validity is not sufficient nor perhaps necessary, as
I show in my paper.

In this approach, we ask why a cost-benefit analysis should be adopted, for that is the standard from which Semrau (and Singer apparently) derive “You should save the child”. But reliance on cost-benefit analyses does not seem to be an irreducible standard, a basic belief that we can (or should) all agree on. That’s because we must ask what counts as cost and what counts as benefit?

For someone who has never had shoes in her whole life, who has just got her first pair of shoes, whose whole life is summarized in her pride or satisfaction in having shoes, the cost of saving the child’s life seems very high (compare Gogol’s “The Overcoat”). To dismiss the cost of losing one’s shoes reflects a culture in which everyone can have a pair of shoes, either purchased cheaply or given from some charitable organization. For someone who believes that the only hope for humanity is to reduce the number of people on the earth, saving a child’s life seems a gratuitous insult to all of us. We can dismiss or minimize the significance of such views, but not with another cost-benefit analysis–only on the basis of more substantial prescriptive standards.

The cost-benefit analysis works even worse with organ donor choices. Semrau does not consider that for some religions it is a prescriptive standard that a person must be buried with all his or her body parts. No benefit to oneself or others can possibly outweigh that.

The other approach to reasoning with prescriptive claims is to justify them as best leading to satisfaction of certain aims. Thus, “Dick should close the window” is justified because it is the best way (in context) for Dick to stop shivering from the cold breeze. There can be subjective, intersubjective, and objective aims. I do not see what aim could justify us in adopting cost-benefit analyses as the basis of making moral choices. It is not just the problems of what counts as cost and what counts as benefit. On what intersubjective or objective basis can we say that always doing what comes out positive in a cost-benefit analysis should be done? That is not so far from the whole approach to adopting aims as the basis for evaluating prescriptive claims, but each step of such an evaluation must be justified in a way that Semrau does not. Absent a clear conception of cost and benefit, we are left to ask why the person should save the child, what aim does it satisfy? And for that I can conjecture: saving lives, being an example of good, . . . or one of many other possible aims that we might agree on.

It seems to me that to employ a cost-benefit analysis we must rely on other more fundamental ethical standards, comparing them through
prescriptive reasoning. Or else we must rely on adopting some ultimate aims that are intersubjective or objective. In my paper, I show that
there is no (obvious) translation between evaluating claims according to standards and evaluating claims according to aims.

I take it as a basic standard that we should reason well in making ethical choices; or as an ultimate aim, to reason well in making ethical choices. The cost of learning to reason well with prescriptive claims is small in compared to the benefit of making better ethical choices.

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