Relating Addiction to Disease, Disability, Autonomy, and the Good Life

Concepts

We thank all three commentators for extremely constructive, insightful, and gracious commentaries. We cannot address all their valuable points. In this response, we elucidate and relate the concepts of addiction, disease, disability, autonomy, and well-being. We examine some of the implications of these relationships in the context of the helpful responses made by our commentators. We begin with the definitions of the relevant concepts which we employ:

• • Addiction (Liberal Concept): An addiction is a strong appetite.

• • Appetites: An appetite is a disposition that generates desires that are urgent, oriented toward some rewarding behavior, periodically recurring, often in predictable circumstances, sated temporarily by their fulfillment, and generally provide pleasure.

• • Disease (Naturalistic Concept): A disease is some biological or psychological state that results in subfunctioning of the organism in a given set of environmental and social circumstances, C. The reference class is a natural class of organisms of uniform functional design; specifically, an age group of a sex of a species. A normal function is a part or process within members of the reference class and is a statistically typical contribution by it to their individual survival and reproduction (Boorse 1977, 1997).

• • Disability (Welfarist Concept): A disability is a relatively stable biological or psychological state that tends to reduce the amount of well-being that this person will enjoy in a given set of environmental and social circumstances (Savulescu and Kahane 2009; Kahane and Savulescu, 2009).

• • Autonomy (Rationalist Concept): A person rationally desires or values some state of affairs if and only if he or she desires that state of affairs while (1) being in possession of all relevant, available information, (2) evaluating that information without making relevant, correctable error of logic, and (3) vividly imagining what that state of affairs and its alternatives would be like for him or her (Savulescu 1994). One necessary condition for a desire to be an expression of a person's autonomy is that it is a rational desire of that person or that it satisfies a rational desire of that person.

• • Well-Being: A person's life goes well, or contains well-being, when he or she is engaged in objectively valuable activities (such as developing talents, gaining knowledge, achieving worthwhile things, engaging in deep personal relationships, leading an autonomous life, and raising children), which she values (or rationally desires) or which provide pleasure (Parfit 1984, 494).

On Our Definition of Addiction

Nordenfelt's commentary challenges us to define addiction. Perhaps our definition of addiction is hard to see in our paper because it is so simple. It goes like this: Addictions are strong appetites. Addicts are people who have a strong appetite. Appetites generate desires, and the satisfaction of these desires generally provides pleasure. A drug addict has strong appetites for some drug, and, indeed, a person with a strong appetite for Internet use is an Internet addict.

Our definition casts a net around some of the people who the Willpower theorists call addicts, and some of the people who the Disease theorists call addicts. We argue in our paper that disease theorists are wrong about the factual matter of whether drug-oriented appetites are unique in kind. And we argue that Willpower theorists have often been wrong about the real-life capabilities for autonomous action of those who have strong appetites. Some addictions, like addiction to work or to exercise, could be rationally endorsed, valued, or serve rational desires. Nevertheless, we believe we are referring to the same type of things as these two groups of theorists when we use the term 'appetite': An acquired strong, urgent, recurrent desire for some rewarding activity.

Our definition is minimal, but it is not quite as minimal as Nordenfelt suggests. It is not enough for an addict to simply 'regularly seek drugs.' To regularly take a bath is not to be addicted to taking baths. To be an addict, you need to possess a particular kind of desire: an appetitive desire. It must be urgent, it must be oriented toward some rewarding...