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Addiction in public health and criminal justice
system governance: neuroscience,
enhancement and happiness research
Genomics, Society and Policy, 2 (1) pp 92 – 109 2006
Not Published Version
Present regulations and prohibitions relating to psychoactive
substances rest upon socio-historically contingent and hence
arguably irrational foundations. New evidence bases located in postgenomic genetics and neuroscience hold the potential to disrupt them through demonstrating a lack of congruence between the regulations and prohibitions and the alleged and actual harms. How far might we use such knowledge to drive policy? What limits, if any, should be placed on our choices, and what attempts to influence these may be seen as acceptable? This article seeks to address these questions in relation to criminal justice system and public health governance of psychoactive substance use. It will explore the implications of justifications employed in both areas to restrict free choice on the grounds of harm to the self and to others. The central argument made is that the current categorisation of psychoactive substances as lawful or unlawful is likely to become disrupted as the result of several separate discourses which converge over psychoactive substance use: enhancement, cognitive liberty and the degree to which subjective experiences of pleasure, well being and happiness might enable us to improve and maintain our health as individuals and that of society as a whole. In my view, the strategic deployment of concepts of addiction which has enabled the public health and criminal justice systems to be able to share governance over psychoactive substance use is likely to become destabilised by these discursive developments. In that policy in the United Kingdom and elsewhere now draws upon happiness research, while reformers advocate freedom of choice over means of enhancing our states of being, a new focus upon the rational evaluation of psychoactive substances governance seems plausible.
Introduction This paper will explore the impact of happiness research, cognitive liberty, enhancement, post-genomic genetics and neuroscience discourses on strategic deployment of concepts of addiction in public health and criminal justice system governance. Current thinking frames governance over citizens in neo-liberal consumer societies as resting upon our making rational choices over consumables and
activities in the name of freedom in order to maximise our health, wealth and happiness.1 These aspirations may conflict. Research reveals that although if we are unemployed or in ill-health we are less likely to be happy, once we have achieved a modicum of wealth becoming richer renders us only slightly happier, whereas psychoactive substances and activities may increase our happiness, but only sometimes our health.2 Psychoactive substances, or those which alter the way our minds function and how we feel, are diverse. Any substance ingested, like food, and many activities, like exercise, alter our moods and hence how we perceive the world and experience our lives. Some, like opiates, may make us feel better in a dual sense, in that they may form the basis of medical treatment as well as enhancing our subjective experiences. Yet when many are taken to excess, feeling good may turn to feeling bad. Too much sugar makes us sick, too much amphetamine makes us paranoid and too much exercise makes our joints give out.
This complex potential renders psychoactive substances uniquely central to governance strategies which focus upon inculcating rational choice. Both public health and criminal justice systems rely upon justifications of harm to oneself or to others and notions of addiction to regulate or prohibit our consumption of psychoactive substances. Training us to eschew the short-term pleasures of a sugar rush for the long-term happiness of good health provides a template for rational consumer choices and the conservation of healthcare resources. Coding pleasure as risk encourages us to measure enjoyment in terms of degrees of harm posed to ourselves and to others. Thus we should calculate that the pleasure obtained from too much of a lawful psychoactive substance, or any amount of an unlawful one, leaves us vulnerable to risks associated with addiction and/or criminal liability. Yet present regulations and prohibitions relating to psychoactive substances rest upon sociohistorically contingent and hence arguably irrational foundations. Thus new evidence bases located in post-genomic genetics and neuroscience hold the potential to disrupt them through demonstrating a lack of congruence between the regulations and prohibitions and the alleged and actual harms.
How far might we use such knowledge to drive policy? What limits, if any, should be placed on our choices, and what attempts to influence these may be seen as acceptable? This article seeks to address these questions in relation to criminal justice system and public health governance of psychoactive substance use. It will explore the implications of justifications employed in both areas to restrict free choice on the grounds of harm to the self and to others. The central argument made is that the current categorisation of psychoactive substances as lawful or unlawful is likely to become disrupted as the result of several separate discourses which converge over psychoactive substance use: enhancement, cognitive liberty and the degree to which subjective experiences of pleasure, well being and happiness might enable us to improve and maintain our health as individuals and that of society as a whole. In my view, the strategic deployment of concepts of addiction which has enabled the public health and criminal justice systems to be able to share governance over psychoactive substance use is likely to become destabilised by these discursive developments. In that policy in the United Kingdom and elsewhere now draws upon happiness research, while reformers advocate freedom of choice over means of enhancing our states of being, a new focus upon the rational evaluation of psychoactive substances governance seems plausible. In addition, policy moves to encourage the biotechnological industry to join public/private partnerships, taken together with the
commercial potential of ‘biovalue’,3 or profit generated by products anchored in the biological characteristics of life itself, enhancement technologies and ‘cosmetic neurology’, provide an economic environment hospitable to this.4 Policy, happiness research and harm to oneself and to others Deriving the normative from evidence bases poses perils for policymakers. Yet, nonetheless, recent calls for them to draw upon national indicators of subjective wellbeing, or how people evaluate their lives in terms of happiness, to craft policies which will maximise happiness are proving increasingly influential.5 For instance, governance in the United Kingdom has been informed by the work of Professor Lord Richard Layard, who has reread utilitarianism in the light of neurochemical and social science research to provide a justification for recommending wide ranging policy changes such as minimising income and social inequalities in order to maximise our health and happiness.6 He contends that since we innately seek to feel good, and experience happiness, pleasure or wellbeing through altruism, trust and fellow feeling, policies which support our happiness when this does not harm either us or others may promote individual and social flourishing.7 Not only does happiness cause success,8 both feelings of happiness in the sense of pleasure, as well as the eudaimonic wellbeing we experience when our lives make sense to us, are good for our health.9 Nonetheless, not all happinesses are equal. For instance, as those involved in public health and criminal justice system governance wish us to maintain our health and to remain within the law, we must be persuaded to find happiness in choosing to consume carrots rather than cake or crack cocaine. Such decisions are commonly distinguished in terms of sub-optimal choices of short-term pleasures as opposed to rational adherence to practices promoting long-term happiness. Thus policymakers are likely to seek to influence how we define and experience happiness as opposed to pleasure, and may take a pick and mix approach to the results of research according to how well these match their political views.10 Although happiness researchers may disagree over how far policy interventions should engage in social engineering to modify our less than optimal choices, governance inevitably seeks to shape them.11 Thus while proposals by the Secretary of State for Health to raise our levels of happiness and conserve healthcare resources by restoring our mental health, getting us off incapacity benefits and back into the workplace as advocated by Lord Layard demonstrate the potential for post-genomic genetics and neuroscience to anchor public health and social policy, they also suggest how far this potential might support coercive social measures.12 Nor is drawing upon happiness research as a basis for policy measures straightforward where criminal justice system policy over psychoactive substances is concerned. Whereas Lord Layard’s proposals rest upon demonstrable measures of happiness which permit a degree of normative extrapolation, many things which make us happy or provide us with pleasure are criminalised. Some sanctions may be justified in terms of harm caused to others: while my happiness might be increased by my stealing your Ferrari Testarossa, this would cause you harm so I should be punished or deterred from doing so. Other offences may provide happiness without necessarily harming others. Many clubbers who take ecstasy achieve happiness without apparent damage to themselves or others, or, at the very least, with less harm than that caused to and by those who consume alcohol within the law. While Lord Layard has adverted to this issue in passing, it has not formed a major focus of his Published version available in ‘Genomics, Society and Policy, 2 (1) pp 92 – 109’
-3Kent Academic Repository – http://kar.kent.ac.uk rereading of utilitarianism.13 Nonetheless, it has anchored other initiatives which seek to reform the present categorisation of psychoactive substances as legal or illegal.
Supporters of legalisation or decriminalisation of at least some currently unlawful psychoactive substances allege that the harms caused by rendering certain drugs illegal far exceeds that the drugs themselves might pose to individuals who consume them or to society at large, although many regard this claim as unproven or unproveable.14 Current controversies over the ethics of human enhancement approach the area of harm and psychoactive substances from a different perspective. Pharmaceuticals which hold the promise of making us ‘better than well’ risk being proscribed as designer drugs unless they can be sold as medicines.15 Thus they have the potential to alter our perception of what it is to be healthy. In that they may be made available to the public only via prescription, their manufacturers promote them as medications to treat a plethora of new ‘lifestyle’ disease entities such as female sexual dysfunction, allegedly experienced by almost 50% of women.16 Underpinning this situation is the assumption that while we may ethically intervene in order to remedy harms such as illness to restore sufferers to a state of natural health, to seek to move beyond therapy to enhance our capacities, particularly where this involves irreversible change, is selfish, unfair, threatens human nature and compromises human dignity.17 This stance has been challenged. Those who favour enhancement see anti-meliorist views as philosophically suspect bioconservatism, based upon overly narrow conceptions of humanity, dignity and autonomy.18 Transhumanists, characterising humanity as a work in progress, assert a right to self-transformation which may or may not involve psychoactive substance use.19 Such a right is allied to that put forward by supporters of cognitive liberty, who argue that the First Amendment on Freedom of Thought of the United States Constitution is ‘meaningless without an inherent right to autonomy and self-determination over one’s own functional neurochemistry’.20 This right would entail not only the right to autonomous decisions over consuming psychoactive substances but also the ability to refuse pharmaceutical intervention in the form of compulsory pharmacotherapy, such as vaccines which would block the pleasure inducing effects of illegal drugs.21 Claims to a right to cognitive liberty also draw upon post-genomic genetics and neuroscience to assert aspirations to enhancement by pharmaceutical means. Exercising such rights or aspirations may well involve the consumption of unlawful psychoactive substances, yet prohibiting our doing so is alleged to be difficult to justify in terms of harm to others outweighing our freedom to seek personal happiness. Indeed, the notion of harm may be deployed to suggest that we suffer significant harm if we are prevented from exercising rights to autonomy over how we pursue happiness, selftransformation and cognitive liberty.
Thus post-genomic genetics and neuroscience reveal potentials for us to reinvent ourselves, to enhance our happiness, health or humanity and to experience cornucopias of pleasures. As Wolpe explains, ‘[n]eurological biotechnologies differ from others in that they ask us to explicitly consider the kind of ‘self’ we want to have; or, to put it less dualistically, perhaps, the kind of self we want to be’.22 In similar vein, the rereading of utilitarianism spurs us on to engage in choices which will maximise our happiness. Extant or future psychoactive substances afford us with opportunities to do so, yet our availing ourselves of these may conflict with public health and criminal justice system governance. Ways in which conceptions of
addiction are used strategically to resolve or conceal these contradictions will now be explored.