El 15-M y el cambio del ecosistema mediático

Views on alcoholism fall roughly into one of four positions, viz., the willpower or moral model, the disease or medical model and the lay position (Foddy & Savulescu 2010). The main differences that arise out of these models are the causes they attribute to alcoholism and the role of free will.

151 The willpower model

The willpower model is arguably the oldest account of alcoholism, which according to Wilbanks (1989), emerged as a result of the significant influence of religion in people’s lives. Consequently, this position of alcoholism is rooted in the idea that alcoholics wish to “abstain, but their will is not strong enough to overcome an immediate desire to temptation” (Foddy & Savulescu 2010). In terms of this view, alcoholics are merely weak-willed people who should act otherwise, but lack the moral character or motivation to do so (Pickering 2006).

The weakness model appeals to our common sense because it is consistent with our notions of free will and individual autonomy. Alcoholics are seen as free-willed individuals who make rational choices to consume alcohol, and alcoholism, a choice based on bad values. The implication of the willpower model is that people is that people are responsible for creating and solving their problem.

The willpower model can be traced back to Aristotle’s discussion of an akratic (i.e. incontinent) person. In his Nicomachean Ethics, Aristotle (2009) describes an incontinent person as someone who cannot master his or her passions and lacks a required character disposition, viz. self-control. To remedy the deficiency or inability to choose differently, Aristotle argues that the incontinent person must regain or develop self-control. In Christian ethics, alcoholism is also understood in terms of sin and virtue, vice and godliness (Madueme 2008). Lack of self-control and weakness of will or lack of willpower are generally seen as moral dispositions and feelings to be avoided with divine help. One shortcoming of the willpower model is its failure to sufficiently capture the phenomenon. For example, it does not seem able to account for how even people with good or strong morals can and sometimes do become

152 alcoholic. Consequently it ignores the range of social and psychological factors that influence alcohol use and alcoholism.

The disease model

In contrast to the willpower model, the disease conception of alcoholism sees alcoholism as “a condition of primary biological causation and predictable natural history, conforming to accepted definitions of a disease” (WHO 1994). Alcoholism is seen to be a consequence of physiological changes – i.e. a desire to consume more - that drinking may cause (Wilbanks 1989).

The disease model views alcoholism as a disease and alcoholics as victims of disease, and patients that require treatment. Underpinning this view is the belief “that there is some normal process of motivation in the brain and that this process is somehow changed or perverted by brain damage or adaptation caused by chronic drug use” (Savulescu & Foddy 2010). The alcoholic is no longer rational and consumes alcohol as a result of a fundamentally non-voluntary process because he or she has no choice but to drink. Leschner (1999; 1997) and Hyman (2007; 2005) have for instance defended the view that an alcoholic’s “actions are the direct result of brain adaptations caused by chronic drinking and that their actions are more like reflexes than rational behaviors” (Foddy & Savulescu 2010:2).

The disease-model, in particular, highlights the questions concerning alcoholics and moral responsibility, because it implies that alcoholics cannot be responsible for their addictive acts because their addiction to alcohol (chronic drinking) is a disease, i.e. something over which they do not have proper control, at least in the sense necessary for moral responsibility. This view challenges the traditional understanding that normal adults have control over their choices and actions, and gives rise to a situation or phenomenon that Buchman, et al. (2010) refer to as “the paradox of neuroscience”.

153 This “paradox” is that while the disease-model of alcoholism gives alcoholics access to treatment and support as well as compassion from other people, it, at the same time, also undermines an alcoholic’s moral responsibility because it views the alcoholic’s capacity for free choice and action, as fundamentally different to that of non- alcoholics. Because they suffer from a disease (i.e. alcoholism) and because the alcoholic’s neurobiological and pharmacological mechanisms differ substantially from that of non-alcoholics, we cannot therefore condemn them because of their habits or hold them morally responsible. Because alcoholics cannot choose otherwise, they have no control over their actions and therefore cannot be held responsible. Rather than blame, condemn or otherwise punish the alcoholic, the alcoholic should be handled in accordance with this characterisation.

Like the willpower model, the disease model has been criticised. The implication of the disease model of alcoholism is that alcoholics cannot be held responsible for their alcoholism because they are compelled to drink and consequently have reduced or no control, in the sense required for responsibility ascriptions. On this conception, the alcoholic is no more responsible for their condition than say a cancer patient. The implication of the disease model is that alcoholism could be “used to excuse wrongdoing or to exculpate individuals from responsibility for their actions. After all illness implies incapacity of some kind over which an individual has no control” (Bonnie 2002:252). Consequently, the disease model has been criticised for taking responsibility away from alcoholics by characterising alcoholics as victims. Furthermore, Bonnie (2002) describes the model as being incomplete and premature. “Incomplete because it fails to communicate the whole story about the behavioural and contextual components of addiction... [and]… premature, because research has not connected the observed changes in the brain to behaviour…. It is still not possible

154 to explain the physiologic and psychological processes that transform the controlled use of drugs into addiction” (Bonnie, 2002:406).

Lay view

Finally, the lay account of alcoholism holds that people consume alcohol “because they are morally corrupt hedonists who value immediate pleasure above all else and who rely on others to handle their ensuing health and survival difficulties” (Foddy & Savulescu 2010). By this account of alcoholism, alcoholics are rational agents who act on normative reasons and simply choose the pleasure (and pain) of alcoholism. Alcoholism is “nothing more than a species of strong appetite” (Foddy & Savulescu 2010) or desire toward pleasure behaviour. Alcoholics are not necessarily incompetent or impaired in their decision-making capacity. In a sense they may be described as rational agents making irrational choices. On this view, the best solution to alcoholism is for alcoholics “to choose to accept their responsibilities” (Foddy & Savulescu 2010).