By now, all of us have been touched in some way by the opioid epidemic in the United States. While there is ample medical science, social science, and political science to explain the phenomenon of addiction, our anecdotal personal experience shapes our ethical judgments. Is addiction a choice or a disease? If it is a disease, is it acquired because of voluntary behavior, or caused by biological or societal factors? Can addicts simply stop using drugs?
People seem to answer these questions by appeal to personal experience, not objective science. If your answer to these question is that addiction is a choice, and addicts can stop this destructive behavior if they want to, you are relying implicitly on an understanding of free will most clearly defended in the 12th century by St. Anselm of Canterbury.
I recently found a man passed out in the front seat of his car in a church parking lot, where I send my daughter to daycare. His daughter was strapped into her rocket seat in the back, quietly waiting for daddy to regain consciousness. If you know with absolute certainty that you would never do that, if you know that you would have the strength of will to resist whatever temptation or despair this man experienced, Anselm says you may be right.
Anselm is best known for his ontological argument for the existence of God. For 900 years, students have puzzled over That-Than-Which-No-Greater-Could-Be-Conceived. His theory of free will is much simpler and more persuasive. The power of the will is unlimited. No temptation or circumstance can overcome our will. Anselm’s “On Free Will” is a short dialogue between himself and an unnamed student. The student raises all the obvious objections. The student argues that coercive circumstances can force one to make a bad choice. If someone threatens to kill you unless you do something immoral, the student asks, aren’t you forced against your will?
Anselm denies this. For him, a person is always able to make the right choice and take the consequences, including great suffering and death. The student argues that under great temptation, the power of the will itself is weakened. Anselm will hear none of this. “Coercive circumstances” or “overwhelming temptation” are just comforting rationalizations. We comfort ourselves with these excuses when we want to explain away poor choices. According to Anselm, we are never overwhelmed by temptation; we choose not to fight some temptations as hard as we could. We always kind of know that we did not exert enough effort to resist.
How does he know the will has the power? Quite literally, for any temptation you can name, some person has resisted that temptation. Anselm believes that every human being can resist every temptation because, for every temptation, some human being has resisted that temptation. He does not claim to have always exercised this power himself. However, he believes definitively that he could have. For him, it is logically possible that each person always uses the power of the will to choose what is right in the face of any temptation. Not everyone who gets an opioid prescription becomes an addict, after all. Some addicts recover.
I doubt many people have been directly influenced by St. Anselm on this point. But he gives the most thorough defense of this common, if extreme, view of free will. It is easy to see the appeal. As a middle-aged man, my cohort of friends is in the sports-injury sweet-spot: too old to compete like we used to, too young to know better. We are like toddlers with brittle bones and health insurance. We had no aversion to non-medicinal drugs when we were young. I worry every time one of us gets a back injury and an oxycodone prescription.
It comforts me to think that we have self-control. None of us would ever become that middle-aged white-guy passed out in the daycare parking lot. I can blame him for his poor choice because I know I’m strong enough to resist. This is probably the real culpable, comforting rationalization. Aristotle notes we are bad judges in our own cases. How many people who confidently assert that they would never make such a choice have never been in the circumstances?
There is another problem with Anselm’s view of free will. Our physical differences have always been obvious. There are obvious mental difference between people as well. We are not equally creative, focused, intelligent, witty, organized, etc. There is no reason to believe that the power of the will is the only thing that is exactly the same for all people.
Is it best to treat addiction as disease or as a behavioral choice? I’m not qualified to discuss this scientific question. The medicalization of behavior troubles me. But the changes opioids cause in the brains of users are startling. Either way, there are people who will never accept that social and environmental factors can determine the initial use of drugs, or that physical changes in the brain amount to a physical condition that preempts free choice to change behavior. Like Anselm, many people firmly believe that they have the power to resist any temptation. Like Anselm, they conclude that the guy passed out in the parking lot made his choice.