This post continues the series (started here) on “addiction”. While the discussion of second-order preferences mostly stands on its own as an independent point, some bits will make more sense if you have read the series.
The last of the likely answers to your question “what do you mean by addiction” invokes the concept of second-order preferences (though presumably without using that jargon):
6. Someone is addicted when he keeps choosing to take a particular action even though he wants to quit.
I have thought and written quite a bit about the concept of second-order preferences as it relates to smoking and THR, much of it in collaboration with my THR.o colleague, Catherine Nissen. The concept is that someone may prefer a particular choice (their preference), but would prefer to not prefer that choice (their preference about preferences, aka a second-order preference).
It is commonly claimed that most smokers want to quit. The surveys that support this are actually quite suspect, since smokers know that they are supposed to say that, and thus often just give that answer as cheap talk. But while this explains a large portion of the responses, there are definitely some people who sincerely assert that they want to not smoke, even as their actions show that they are choosing to smoke. But what can this obvious contradiction possibly mean? It almost certainly means, in most cases, that their second-order preference is to be someone who wants to not smoke, even though the reality is that they are someone who really wants to smoke.
This, unlike most of the previous notions of what “addiction” means, is a very real and common phenomenon with practical implications. But those implications are not what those who use “addiction” as a negative epithet might think.
There is nothing horrible, or even the slightest bit unusual, about this second-order preference pattern. We all have countless preferences for different preferences. I would prefer to like going to the gym as much as I like playing computer games, and I would prefer to like unsweetened iced tea as much as I like Coke.
It is sometimes perfectly ethical and otherwise reasonable to implement public policies that help people achieve their second-order preferences in spite of their actual preferences. But justifying this is complicated. It clearly cannot just be taken as a given that such policies are good, as is sometimes implied. In particular, there is no obvious reason why we (as a society) should favor someone’s second-order preferences over their actual preferences, let alone an obvious justification for policies that inflict costs in order to push that choice.
Most people who support such policies have clearly never thought through the ethical questions, and frankly appear mostly to be lying about their stated motives. There are those who argue that such policies help make everyone “better” people, but that is only by their own measure. These are usually busybodies who would push the particular choice even if it were not someone’s second-order preference. How many active supporters of anti-smoking efforts ever say, “if someone does not want to quit, then we should avoid interfering with that choice”? Their real motives are wanting to force particular actions, not to help people fulfill their own second-order preferences.
A particular clear justification for some types of interventions can be found in how I phrased my personal second-order preferences. Notice that I do not want diminish my enjoyment of computer games to the point that I prefer the gym; I want to raise my enjoyment of gym-going to that of computer games. If there were an action that accomplished that, making gym attendance better without diminishing the value of any alternative, there would be no question that this was an improvement in the world. But, of course, for most actions, particularly those where there is profit to be had by improving quality, there is no such magical cost-free improvement that no one has bothered to implement. You can sweeten and flavor the iced tea, but only at the cost of making it nutritionally about the same as Coke. My gym options are much nicer than the university weight rooms I frequented for a few decades, thanks to the wonders of the free market, but those wonders are still not enough to change the fact that staying home is nicer still, and there is no reason to expect magical further improvement.
Many anti-smoking efforts can be characterized as attempts to cause people’s preferences to align with their second-order preferences. But this is done by lowering the net benefits of smoking until quitting is the preferred option. That is ethically justified if (and those of us who believe in individual liberty would argue, only if) those who are affected genuinely want an external actor to do that to them, and they understand that the action is not going to make being abstinent as good as smoking, but is going to make smoking as bad as being abstinent. So, a drug like Chantix that makes someone not want to smoke is fine (ignoring, in this analysis, the side effects), so long as someone understands that it probably will not make the experience during long-term abstinence as enjoyable/productive/etc. as life when they smoked, but is merely going to lower the benefits of smoking in the short run to help achieve a new habit of abstinence that is in line with the second-order preference that the individual cannot bring herself to act upon.
Yes, there are a lot of conditionals and caveats in that ethical analysis. Notice that those conditions are clearly not met for policies that try to make smokers miserable through punitive taxation, forcing them out of pubs, and otherwise increasing the costs of smoking. Many of those who suffer the inflicted costs do not actually want to quit, and the rest have not consented to someone making one of their choices less pleasant in order to try to try to align their preferences. Moreover, even many of those who would consent to have their preferences forced into alignment, as they do with voluntary drug therapy, have been tricked into believing that the result will be that they will be just as happy or happier once they are abstinent.
This last bit is critical and rather more subtle than the other conditions that are more often discussed. Most people (smokers and nonsmokers alike) have been tricked into believing that every smoker will be just as happy as a nonsmoker, once they get over some hurdle (which is often called “addiction”, but is really better labeled “dependence” or even just “withdrawal” — see the discussion under #4 in the previous post). Some ex-smokers are happier, certainly, but these are probably the ones who just decide to quit and end up staying abstinent. Those who are seeking extra help because just deciding to quit does not work are typically misled into believing that once those tools cause them to quit, they will be happy about being abstinent, but that is often just not so.
When the ANTZ defend policies that make smoking more costly and less pleasant with language like “helping smokers quit”, a standard response is that this is utter crap: Intentionally inflicting pain on someone to try to modify their behavior is called “torture”, not “help”, and it violates all accepted modern Western rules of ethical behavior. But while this response is solid, and the ANTZ position is indeed crap, there is a bit more to it. The missing nuance is important not just for getting the argument completely right, but for understanding why non-ANTZ might buy into the ANTZ position (and thus, coming back to the theme of this series, how to respond).
When the ANTZ claim that torture is help, they are invoking the implicit (and clearly false) claim that everyone affected by the torture has second-order preferences for quitting, and also invoking the implicit (and clearly false) claim that they want someone to use force to align their preferences with their second-order preferences by inflicting torture until quitting is preferable to smoking. In addition, the ANTZ are making the implicit (and clearly false) claim that all of these smokers who want to be forced really understand that when they are abstinent they are likely to be less happy/productive/etc. compared to when they were smoking.
If all three of those implicit claims were actually true, then there would be a legitimate argument that the current anti-smoking approaches are ethical, and perhaps even an argument that anti-THR is justified (though anti-THR lies are never justified). To be sure, under those conditions the position would be defensible, but there would still be some strong ethical arguments against it (which I will not address in this series). But a lot of people, having never thought seriously about the ethics, have a gut notion of ethics that says that under those three conditions, that position is Right. The biggest problem is that they have been tricked into believing that those conditions are met, and that is optimal point of response.
And with that, I have to leave the issue of how to try to un-trick them until the next post, having already passed our “no post longer than…” limit.