Conceptualizations of addiction in harm reduction strategies for effective and ethical UK drug policy

This thesis will deal with the different conceptualizations of the problem of addiction to illicit psychoactive substances, as well as the ethical question of how persons who are addicted to such substances ought to be treated in society. I will attempt to provide an answer to the question of how addiction ought to be conceptualized from a philosophical perspective, what the advances in neuroscientific research can tell us about said conceptualization, and finally what this conceptualization means for the construction of more ethical UK policy strategies aimed at dealing with addicted persons and drug-related crimes. I propose that bioethics is the discipline best suited to study the inherently transdisciplinary phenomenon of addiction, with the emerging biopsychosocial view of addiction being the most adapted paradigm of addiction, and which must form the basis of research into addiction and the development of legal and political strategies for the treatment of addicted persons moving forward, negotiating between the benefit of the legitimization of addiction as a medical condition, with the pitfalls of neuroreductionist thinking and the undermining of the complexity of a phenomenon such as addiction. I will situate my argument within a bioethical approach, the school of thought that recognizes the complexity of addiction as a multifaceted phenomenon and considers free choice and moral responsibility within the neurobiological, social experience and political and historical context of the society in which the individuals find themselves. This thesis will be constructed along the following structure: 1.Review the philosophical concepts of agency and action in the context of addiction This will be the focus of chapter 2, wherein I will develop a theoretical framework for the understanding of a particular kind of agency in the context of addiction. In discussing the ontology of what an addicted action is, I will draw on the standard concept and theory of action, as it has developed in analytic philosophy within the second half of the 20th century. The purpose of this will be to lay the foundation necessary to better incorporate such a philosophical concept into the strategies of harm reduction aimed at dealing with addiction in political/policy discussions. 2.Review the neuroscience of addiction, the ensuing Brain Disease Model and what it can and cannot tell us about the nature of addicted persons' agency This will be the focus of chapters 3 and 4, which will first present a review of the latest developments in the neuroscience of addiction, in order to critically assess the paradigm known as the brain disease model of addiction (BDMA), and then provide a discussion of the dialogue between the philosophical foundation of compromised agency established in chapter 2 and said neuroscientific paradigm. The purpose of these chapters will be to present a transdisciplinary methodology of conceptualizing of the disorder from which addicted persons suffer. This will in turn help situate the moral framework from which I will critique and review the policies geared towards drug-related crime in the UK and how they affect addicted persons. 3.Review a Criminal Law account of addicted persons' responsibility, its effect on UK drug policy strategies, and assess whether a Harm Reduction Model can be better suited to the treatment of addicted persons in society This will be the focus of chapter 5 and 6, which will first lay out the account of criminal responsibility within which drug policy has been constructed in the UK over the past century, and then provide a critical assessment of the ethics of said drug policies. The purpose of this will be to establish a foundation for the normative claim of the thesis, which is that drug policy construction in the UK has created greater harm to addicted persons than their purported objective of protecting society (including those suffering from addiction) from drug-related harm. These final two chapters will attempt to address the question of "How ought addicted persons be treated in society?", first by reviewing the legislative history around drug control in the UK, in order to understand the socio-political circumstances of why certain substances become illicit, while others remain perfectly legal; and finally by proposing a conceptualization of how drug control policies come to be shaped, arguing that a local model based on clinical trials and ground-up data collection serves as a more effective method of shaping public health policy strategies that address the needs of addicted persons, thereby helping to reduce a lot of the harm associated with addictive substance abuse. I will finish this thesis by presenting the argument concerning UK drug policy strategies and the ethical analysis of the different constructs employed in building said policies. I will present what I call the 'Difference in Effectiveness in Harm Reduction', a distinction between two types of policy construction frameworks, 'External to Local' (E-L) and 'Local to External (L-E), providing arguments for their varying levels of effectiveness in reducing the societal harms of addiction. I will argue that the distinction between policy-construction frameworks comes from the epistemological dissonance in their philosophical conception of addiction, and specifically the behavior of addicted persons. I will propose that a traditional view of addicted persons as agents making irrational choices, and its erroneous philosophical conception of the addicted person's condition is at the root of the asymmetry in effectiveness of policy constructs dealing with addiction.