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  • “The Drugs Didn’t Mix”:On the Overvaluation of Misvaluation
  • Benjamin R. Lewis (bio)
Keywords

addiction, akrasia, misevaluation, psychiatric nosology

In this well-researched, articulate, and compelling paper, Summers presents the position that addiction is a misvaluation upon which a pattern of behavior is based and which resists contrary evidence. This inability to change one’s values in response to contrary evidence is the prime wrong at stake, given its implied diminishment of rationality (and hence adaptive functioning). In approaching this conflicted set of issues, Summers carefully surveys an impressive range of sources—from clinical DSM-based diagnosis (and inherent limitations thereof) to neurobiological underpinnings of decision making and attention, to social determinants influencing the question as to what counts as ‘addiction’—and settles on the more modest goals of elucidating why difficult cases are difficult and what set of factors would be important insofar as settling the questions at stake.

And the questions as to what counts as an addiction certainly are difficult, beset by social mores, classification limitations, and no clear demarcating neurobiological boundaries between so-called passions and addictions. I am reminded of a quote from Butch Trucks, drummer for The Allman Brothers, describing a collaborative concert they played with The Band and The Grateful Dead: “It’s one of the only times I can remember where the jam didn’t work because the drugs didn’t mix. The Band were all drunk. The Dead were all tripping. And we were all full of coke. So we tried to jam, but there was just no common ground” (Edwards 1999). The permutations here as to enhancing/inhibiting, adaptive/maladaptive, socially acceptable/unacceptable, and passion/addiction are truly complex (and perhaps unlikely to be parsed philosophically by the musicians themselves).

The concept of akrasia, or weakness of will, is often invoked in philosophical discussions of addiction. This is not examined explicitly here, but is nonetheless active both in the discussion of misvaluation as well as the associated moral judgments. From the outset, Summers takes a broadly internalist position: motivation (and hence behavior or action) is driven by evaluative judgements. In this case, an addict’s behavior is determined by a wrongfully held value or values: say, the immediate hedonic pleasures of intoxication over and above the more abstract and long term values that sobriety may present (i.e., employment, maintenance of relationships, avoidance of legal issues, financial stability, health outcomes.) For Summers, [End Page 41] it is the fact that the addict ought not to hold this set of values that determines it to be ‘addiction’: it is a misvaluation. This misvaluation in inferred from a pattern of behavior that is maladaptive or dysfunctional: “Using ‘value’ and ‘valuing’ in an ordinary way, we can further distinguish as we must, between the value we claim to have and the values we in fact do have, those we demonstrate in our actions” (Summers 2015, 33). For Summers, the proof is in the pudding: your chosen actions announce your values. Had you valued differently, you would have acted differently.

This is essentially the same internalist position presented by R. M. Hare, which precludes the possibility of akratic action in the first place. If an agent does action x, it necessarily follows that he judged x to be the best option available at the time: “it becomes analytic to say that everyone always does what he thinks he ought to [if physically and psychologically able]” (Hare 1952, 169). If an addict chooses to relapse on heroin, it necessarily follows that he determined this to be his best available option (at least at the time). Although resolving the seeming paradox of akratic action, this position is unsatisfying in that it fails to capture the clear apparent clinical reality of individuals struggling with substance use disorders: that they can indeed place full value in sobriety and yet still have difficulty acting in accordance with that value (all of the time).

Externalist positions, such as that described by Alfred Mele (2002), argue that evaluative processes and motivational processes dissociate: action can be driven by more proximate rewards in a motivational sense despite having vague, unclear, inadequate, or conflicting reasons for action. Ainslie’s notion...

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