September 13, 2018: Addiction, Public Policy, & Personal Responsibility
Summary
Consumption of addictive substances affects every nation, socioeconomic status, race, and gender.
Social costs of addiction: healthcare expenditures, loss of life, impaired productivity, motor vehicle accidents, crime & law enforcement.
Substance use is the result of decision-making malfunctions. Use among addicts is sometimes a mistake and is also sometimes rational. Addicts understand their susceptibility to triggering cues and may try to manage the process.
Popular economic theory: what is good/bad for society should be rooted in notions of good/bad held by affected individuals. Each person is the best judge of if a policy helps or hurts him, and their choices reveal their idea of good/bad.
“Theory of rational addiction:” addictive substances are distinguished only by a pattern of benefits/costs they deliver, else they’d be like other goods.
We don’t outlaw activities because they’re dangerous. We let individuals decide if the risks are worth the benefits.
Revealed preference is attractive because it protects individual sovereignty. Once we relax this doctrine, we potentially legitimize government condemnation of any chosen lifestyle on the grounds that it is contrary to an individual’s “true” interests.
Consumers are better served by policies that help avert mistakes while preserving their decision to choose.
One important role of government is to moderate the consequences of uninsurable risks.
Potential policy approaches to addiction substances: criminalization, education, taxation, harm reduction, selective legalization & controlled distribution, restrictions on advertising/market, provision of counter-cues, regulation of use.
Discussion
What might we hope to accomplish through public policies regarding addictive substances?
Can anyone become an addict? What role does predisposition play?
Different substances have different risk factors, and different individuals are more prone to using certain substances, especially in the face of underlying medical issues.
Is it possible to have policy be on a drug-by-drug basis, or according to amount?
Decriminalization might have the potential to expose more people to substances, but criminalization decreases regulation on them and makes them more dangerous.
What would rehabilitation for sufferers look like?
Rehabilitation is preferable to punitive solutions. Problems aren’t solved in prisons.
Addiction is a health equity problem and relapse is often environmentally triggered.
Harm reduction is not enough.
Under what conditions should policy makers recognize that voluntary actions may be ill-considered?
You can’t force a person to seek treatment. We can’t trample on autonomy.
Do people have the right to self-harm?
Competency standards. Could a professional revoke one’s competency to make their own medical decisions on the basis of addiction?
How do we distinguish between good and bad policy outcomes?
Can we really classify drug use as a mistake?
Mistake: an action or judgment that is misguided or wrong.
Are we paying attention to the opioid epidemic because of the demographic of people it is affecting?
Resources
Alexander, B., Beyerstein, B., Hadaway, P., & Coambs, R. (1981) Effect of early and later colony housing on oral ingestion of morphine in rats. Pharmacology, Biochemistry, and Behavior 15(4), 571-576.