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Addiction and Responsibility:A Survey of OpinionsHans Olav Melberg a , Edmund Henden b & OlavGjelsvik ca Norwegian Institute of Drug and Alcohol Research(SIRUS) and Institute of Health and Society ,University of Oslo , Norwayb Centre for the Study of Professions, Oslo andAkershus University, College of Applied Sciences ,Norwayc Centre for the Study of Mind in Nature ,University of Oslo , NorwayPublished online: 16 Jul 2013.

To cite this article: Hans Olav Melberg , Edmund Henden & Olav Gjelsvik (2013)Addiction and Responsibility: A Survey of Opinions, Inquiry: An InterdisciplinaryJournal of Philosophy, 56:5, 558-570, DOI: 10.1080/0020174X.2013.806143

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Inquiry, 2013Vol. 56, No. 5, 558–570, http://dx.doi.org/10.1080/0020174X.2013.806143

Addiction and Responsibility:A Survey of Opinions

HANS OLAV MELBERG

Norwegian Institute of Drug and Alcohol Research (SIRUS) and Institute of Health and Society,University of Oslo, Norway

EDMUND HENDEN

Centre for the Study of Professions, Oslo and Akershus University, College of Applied Sciences,Norway

OLAV GJELSVIK

Centre for the Study of Mind in Nature, University of Oslo, Norway

(Received 21 September 2012)

ABSTRACT This article reports the result of a survey about causal beliefs, normativeconceptions and moral evaluations of addicts and addiction in the general population.Specifically, we focused on four issues: To what extent are the normative conceptions ofaddiction current in the philosophical and scientific literature reflected in laypersons’ con-ception of addiction? How do laypersons rate addicts on perceived responsibility? Whichfactors influence laypersons’ responsibility attributions in the context of addiction?What feelings and attitudes (anger/sympathy/help-giving intentions) do laypersons havetoward addicts? We found that, although laypersons seem to assume a weakness view ofaddiction, their patterns of responsibility attributions vary depending on type of drugscombined with perceived severity of outcome, where the latter even overrides the attri-butional effects of the actor’s perceived control over events. Some explanations of thedata are suggested, and various consequences with respect to help-giving behavior, arediscussed.

Correspondence Address: Olav Gjelsvik, Department of Philosophy, Classics, History of Artand Ideas, Faculty of Humanities, Box 1020 Blindern, N-0317 Oslo, Norway. Email:olav.gjelsvik@csmn.uio.no

This article was originally published with errors. This version has been corrected. Please seeCorrigendum (http://dx.doi.org/10.1080/0020174X.2013.826886)

© 2013 Taylor & Francis

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Addiction and Responsibility 559

I. Introduction

In a survey of UK doctors, 10% of general practitioners were of the opin-ion that addictive drug users ‘deserve whatever misfortune befalls them’.1 Thepoint of this article is not to pass moral judgment on this view, but to use asurvey of the opinions of a representative population to explore the connec-tion between the moral judgments of laypersons and their underlying beliefsabout the nature of addiction and its causes.

The majority view on causal and moral issues may have little direct norma-tive force, but the first section argues that surveys nevertheless can be usefulfor at least three reasons: descriptively, explanatorily and, controversially,normatively. Surveys have normative implications not because the majorityopinion has a special status, but because they may reveal inconsistencies andfacts about how people reason, which in turn have normative implications.This section ends by noting a potential conflict between the use of surveys asa tool to explore the nature of normative reasoning versus using surveys todiscover the meaning of concepts.

The second section presents Weiner’s model of the link between causalbeliefs, emotional reactions and moral judgments.2 The findings of the sur-vey are used to argue that Weiner’s model of moral reasoning is only weaklysupported. It is also argued that the survey indicates an interesting systematicproblem in moral reasoning about addiction. In Weiner’s model the sub-jects start from certain causal beliefs. For instance, the belief that addictivedrug use is largely a result of causes that lie outside the volitional controlof the addict is hypothesized to generate more sympathy, which will inducehelp-giving behavior. The opposite belief—that addictive drug use is gov-erned by causes under the volitional control of the addict—is hypothesized toinduce more anger and less help-giving behavior. In this way causal beliefs areassumed to determine the inferences subjects make about the responsibility ofaddicts for their drug use, for example whether or not addiction is believed tobe an excusing condition. In contrast with what Weiner’s model predicts, oneof our findings was that the subjects’ causal beliefs are themselves influencedby emotional reactions to different kinds of drugs and inferences about theresponsibility of addicts.

II. Why Survey?

Survey results are interesting from a pure descriptive point of view. Althoughsometimes fascinating in itself, the description can also be useful because by

1Abed and Neira-Munoz, ‘Survey of General Practitioners’, 134. Similar attitudes were revealedin other surveys, including surveys of nurses. See Skinner et al., ‘Stigma and Discrimination’;Norman ‘Have You Got an Attitude Problem?’; Roche and Richard, ‘Doctor’s Willingness toIntervene’; Glanz and Taylor, ‘Findings of a National Survey’.2Weiner, ‘On Sin versus Sickness’.

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analyzing subgroups we may get a better idea of the forces that shape dif-ferent beliefs in different groups of professionals and non-professionals. Do,for example, the views of treatment professionals differ from those workingin the enforcement system? A descriptive analysis might in this way be animportant tool for examining the mechanisms that shape and cause differentbeliefs and inferences about the responsibility of addicts in different groupsof professionals.

Surveys are also interesting from an explanatory point of view. The generalopinion on addiction, its causes and effects on responsibility attributions, mayhelp to explain why drug laws differ across countries. It might also be used toexplain why addiction in some societies tends to be treated as a medical prob-lem, while in others it tends to be treated more as a social problem. Althoughinteresting in itself, this use of surveys is more the focus of historians andsociologists and it is not the focus in this article.

Finally, even if surveys cannot make us go from ‘is’ to ‘ought’, they mayhave prescriptive implications. They may, for instance, reveal inconsistenciesin our moral views about addicts’ normative capacities which have impli-cations for the legal system and the priorities given to treatment. Theseinconsistencies may start a reflective process or search for a more, overallcoherent and consistent moral view of addicts’ normative capacities. In thissense a survey may not give us the answers to our normative questions aboutaddiction, but it may be useful in directing us toward these answers.

As an illustration of potential descriptive and prescriptive power of surveys,consider the results presented by Nutt et al.3 After collecting and aggregat-ing answers from experts about the harm of different drugs, Nutt comparedthe answers to the classification used by the legal system (Figure 1). In theUK, drugs are classified as A (most harmful), B, C and ‘no class’, and crimesrelated to drugs in the different categories carry different punishments. Theresults clearly show that the ranking of drugs made by the political and legalsystems often was different from the ranking given by scientific experts. Manyof the substances judged to be very harmful by the experts were not classi-fied as category A drugs in the legal system, and many of the class A drugswere not classified as very harmful by the experts. This inconsistency could,and did, generate a debate about whether the categorization was correct orinfluenced by mechanisms that should be irrelevant to the classification.

In addition to pointing out inconsistencies, a survey may reveal mecha-nisms involved in actual reasoning about moral issues. Such mechanisms areimportant because they may be hidden and undesirable. For instance, we maytend to believe that our causal beliefs are not affected by morally irrelevantfactors, but a descriptive survey may indicate that there are such effects andthis, in turn, may force us to re-evaluate our views. In this sense, surveys do

3Nutt et al., ‘Development of a Rational Scale’. See also Blomqvist ‘What is the Worst ThingYou Could Get Hooked On?’.

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Addiction and Responsibility 561

Figure 1. Inconsistencies between legal classification and expert opinions about theharm of different drugs.

Notes: A is the class of most dangerous drugs as defined in the legal system. The height of thebars represents expert opinion on the mean harm score associated with the drug.Source: Nutt et al., ‘Development of a Rational Scale’ (2007).

not tell us what is correct, but they may reveal aspects of how we think aboutthe issues – mechanisms and forces that affect our moral judgments.

Experimental philosophers have suggested that survey results also are use-ful in determining the meaning of concepts.4 According to this argument,the folk view on morality affects causal judgments, and survey results basedon the general population can therefore be useful because they help us tounderstand better the folk concept of causality. This so-called ‘competenceinterpretation’ competes, however, with what is called ‘the distortionist view’.According to the ‘distortionist view’, a survey may reveal inconsistencies

4See, for instance, Knobe, Lombrozo, and Machery, ‘Psychology and Experimental Philosophy’.

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indicating that something went wrong in the subjects’ reasoning. These twoviews may conflict, but they need not be mutually exclusive. Both interpreta-tions are possible because sometimes there really may be systematic mistakesin the reasoning process at the same time as the terms truly are different fromwhat philosophers have thought them to be. A third possibility is that surveysare not well-enough designed to draw one conclusion or the other. In thispaper the questions we address do not present the same asymmetries thatKnobe et al. and others have investigated, and we will not go into the complexissues they face.5

III. Attribution of Moral Responsibility

Social psychologists, like Brickman, have argued that people’s view of indi-viduals’ moral responsibility for behavior is a function of their beliefs aboutthese individuals’ causal responsibility for their behavior.6 One implication ofthis is that the degree of helping behavior will be lower when perceived causalresponsibility is high.

Weiner refined this theory by arguing that the link between causal beliefsand helping behavior was intermediated by emotions (see Figure 2).7 Forinstance, according to Weiner’s theory, the belief that drug use is largelycaused by external and uncontrollable circumstances generates sympathytoward addicts and this, in turn, induces help-giving behavior. The oppositebelief—that drug use is governed by factors believed to be under the con-trol of the addict—will induce anger and less help-giving behavior. In thisway, causal beliefs play an important role in attributions of responsibility andblame for addictive drug use. These causal beliefs are important because theymay affect drug laws and regulations, which have significant consequences formany people on a daily basis.8

Based on the theory of responsibility attributions in Brickman andWeiner, our survey asked a set of questions about causal beliefs, normativeconceptions and moral evaluations of addictive drug use. Specifically, wefocused on four issues: How do laypersons rate addicts on perceivedresponsibility? Which factors influence laypersons’ responsibility attribu-tions in the context of addiction? To what extent are the normative con-ceptions of addiction current in the philosophical and scientific literaturereflected in laypersons’ conception of addiction? What feelings and attitudes(anger/sympathy/help-giving intentions) do laypersons have toward addicts?

In addition to asking general questions about addiction, we also wantedto investigate two more specific aspects. First, we wanted to extend the

5Ibid.6Brickman et al., ‘Models of Helping and Coping’.7Weiner, ‘On Sin versus Sickness’.8Fingarette ‘Addiction and Criminal Responsibility’, and Morse ‘Addiction, Genetics, andCriminal Responsibility’.

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Addiction and Responsibility 563

Is the cause controllable?

Yes No

By the individual?

Yes No

Anger Sympathy

Less help More help

Figure 2. Weiner’s theory of attribution of moral responsibility.

framework by examining the pattern of responses to different types of addic-tion and not only addiction in general. By asking about different types ofaddiction, we wanted to examine whether the perceived causation differsdepending on the type of addiction and whether this corresponds to differ-ences in responsibility attributions. Second, we also wanted to examine ifthe causal and moral reasoning changed if the respondents had more expe-rience with addicted individuals. We therefore asked questions about therespondents’ own background and whether they had experienced any closerelationships with addicted individuals in their course of work.9

The survey was conducted in Norway in 2011. A total of 2,961 individualswere asked to respond to a list of statements using a scale from 1 (stronglydisagree) to 7 (strongly agree). The respondents were part of a representativepanel that had been recruited by a large survey company to participate inanonymous surveys on the Internet.

IV. Which Concept of Addiction do People Subscribe to?

Corrardo has argued that there are at least three different normative concep-tions of addiction: addiction as rational, as duress and as irrational.10 Each

9Closeness is defined as having experience with drug users as part of their work. This is importantsince personal closeness might lead to very different responses.10Corrardo, ‘Addiction and Responsibility’.

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0

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Cannabis Heroin

Figure 3. ‘In your opinion, being addicted to . . . (cannabis/heroin) represents . . . ’

Note: 0, Strongly disagree; 7, Strongly agree.

view of addiction corresponds to beliefs about how best to explain addictivebehavior, and these, in turn, are connected to views about the ‘excuse value’ ofaddiction. Different authors have used different terms to describe this, and inorder to examine the beliefs of the respondents we asked to what extent theyagreed that ‘Addiction is a disease’, ‘Addiction is a strong desire’, and severalother concepts found in the literature.

Clearly, people may have different interpretations of the terms ‘desire’,‘disease’, and so on, but the results nevertheless indicate a common under-standing and some interesting differences (Figure 3). First of all, most peopledo not believe that addiction is a medical condition. Second, compared withcannabis use, there was larger agreement that heroin use could be labeledas obsessive, compulsive and strong, but interestingly even the differencebetween these two was relatively small with respect to the disease charac-terizations. In general most of the respondents did not view addiction as adisease, regardless of the type of drug specified in the question.

V. Do Beliefs about Causation Translate to Views about Responsibility?

When studying how people reason about the responsibility of addicts, a nat-ural assumption is that the respondents start by assessing the degree to whichtheir drug use is caused by external uncontrollable versus internal control-lable factors and then attribute responsibility based on that. Once again,the respondents may well have different interpretations of ‘external uncon-trollable’ and ‘internal controllable’, but, based on their own interpretation,the first pattern that emerges is that most of them attribute a high degree of

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Addiction and Responsibility 565

Cannabis

Alcohol

Gambling

Smoking

Amph.

Sedatives

Snus

Heroin

3.0

3.5

4.0

4.5

5.0

5.5

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Degree of external cause

Figure 4. Relationship between belief in external cause and assigned individualresponsibility.

Notes: 0, Strongly disagree; 7, Strongly agree. The questions asked were ‘To what degree to youbelieve the person should be held responsible for his or her addiction to . . . [different drugs andactivities]’ and ‘Do you believe the cause of the addiction for . . . [different drugs or activities] isexternal to the person?’ (1, ‘very little’; 7, ‘very much’). Amph., Amphetamine.

responsibility to addicts for their drug use (Figure 4). On a scale from zero toseven, the average was above four for all the substances, and with the excep-tion of sedatives the level of agreement was above five for all the substances.

The answers also reveal a connection between the perceived degree of theexternal cause and views on responsibility. Addicts using substances that arebelieved to be associated with a high degree of external cause are assigneda lower degree of responsibility for their behavior. This might be taken asan argument for the view that beliefs about causation are the major deter-minant of responsibility attribution for addictive drug use, but it should benoted that, although the pattern is consistent, the tendency is weak. A largechange in perceived degree of external causation does not lead to an equallylarge change in perceived degree of responsibility. With the exception of seda-tives, one might argue that the differences in assigned responsibility are verysmall compared with the differences in believed external causation. This sug-gests that, although the perceived degree of external causation affects viewson responsibility, the trend is not strong or linear and there are other forcesexcept for views on causality that influence views on responsibility.

One potentially interesting suggestion about other factors that may affectthe assignment of responsibility can be found by comparing the answers fordifferent substances. For instance, the substances assigned the highest degreeof internal causation, and most individual control, is smoking and the use

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of snus (a form of dipping tobacco), while heroin use is assigned the low-est degree of internal causation and little internal control. This is interestingbecause there is evidence that smoking is highly addictive and that it is verydifficult for nicotine addicts to quit. Heroin is also difficult to quit, but thereis evidence that it is not as hard as is commonly assumed. Obviously, thedegree of ‘addictiveness’ is difficult to quantify, but one indicator may bethe share of users who continue to use the substance after trying once ortwice. Based on this, surveys have shown that 35% of those who try heroinebecome addicted to heroin, while 80% of those who try cigarettes becomeaddicted to smoking.11 This difference between the data on quitting andpeople’s actual perception of internal causation and control regarding thedifferent substances suggests that the perception of the latter is likely to becolored by other factors, such as emotions (‘heroin is disgusting’), the per-ceived size of the consequences, or the current legal status of the substancesabused. In other words, it seems likely that perceptions of responsibility mightbe influencing people’s causal beliefs rather than vice versa. The evidence isnot strong enough to conclude that this is the case, but the differences betweenpeople’s causal beliefs regarding different substances compared with moreobjective evidence certainly indicates that it might be a possible explanation.If so, it would represent an example of a distortion in our reasoning about therelationship between addictive drug use and responsibility.

VI. The Relationship between Beliefs and Help-Giving Behavior

Folk opinion on responsibility for addictive drug use seems to suggest thataddictive drug use is caused by internal factors over which the individualhas a high degree of control, and hence that they are responsible them-selves to a high degree for their addictive drug use. Despite this, when askedwhether they agreed that addicts deserve to receive external help in the formof treatment, most respondents agreed (Figure 5). The differences in agree-ment about addicts’ deservingness of receiving external help with respect tothe different substances correspond to the differences in perceived degree ofinternal causality, with snus being the lowest on both external causation anddeservingness of external help and sedatives being the highest (Table 1).

VII. Does Experience with Drug Users Affect the Answers?

Being close to people with addictions, either in work or privately, may influ-ence the process or responsibility attribution. To investigate whether personalexperience is an important mechanism in shaping lay persons’ beliefs aboutaddicts’ responsibility, we asked whether the respondents were or had been

11Cited in Linden, Compass of Pleasure, 82.

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Figure 5. ‘Ignoring current legal rights and humanitarian obligations, how much helpand assistance do you believe a person addicted to . . . [different drugs and activities]deserves?’ (1, ‘very little’; 7, ‘very much’). Amph: Amphetamine.

Table 1. Variations in laypersons perceived external and internal cause and control,responsibility and views on helping behavior for different types of addictions.

Cannabis Alcohol Gambling Smoking Amph. Sedatives Snus Heroin

Internal cause 5.7 5.7 6.1 6.1 5.7 4.8 6.4 5.6External cause 4.1 4.2 3.8 3.9 4.3 4.8 3.2 4.6Control 5.6 5.6 5.7 5.9 5.4 5.8 5.8 5.2Responsibility 5.7 5.3 5.7 6.0 5.3 4.1 6.1 5.1Help 4.8 5.3 4.7 4.1 5.1 5.5 3.4 5.4

Notes: In addition to the wording for the questions already reported, control was measuredby asking the respondents to imagine a person addicted to various drugs and activities andthen ‘Do you believe it is possible to do something about the cause [of the addiction]?’. Amph:Amphetamine.

close to addicts in their work. The answers revealed some, but often surpris-ingly small, differences. Respondents close to addicts gave almost the sameanswers when asked about what normative conception they had of addictionas respondents who were not close to addicts (Figure 6). For example, whenasked whether addiction was a medical condition, most respondents closeto addicts disagreed with this. The only point of real disagreement betweenrespondents close to addicts and those not close concerned whether addic-tion was a psychiatric condition. Here respondents close to addicts agreedwith this statement to a larger extent than respondents who were not close.

Similarly there was a surprisingly large agreement about the importanceof external causation for addictive drug use. Respondents close to addicts

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Figure 6. Does experience of working with addicted people affect views on differentnormative conceptions of addiction?

Figure 7. Effect of experience working with addicts on assessment of external cause.

were on all accounts slightly more likely to agree that external causation wasimportant, but the difference was very small and overall the impression isthat distance did not matter for the respondents’ causal beliefs (Figure 7).The margin of error in these surveys is about 2% and differences below thatare not statistically significant.12

12The concept of ‘margin of error’ must be treated with care here since there may be many othersources of unrepresentative answers in addition to the pure statistical chance that the sample isskewed.

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Addiction and Responsibility 569

VII. Conclusion

It has been argued that

Science cannot tell us . . . what it means to say that an addict cannot helphimself, and it cannot tell us how the law ought to respond if in fact theaddict cannot help himself. These are questions for the philosopher andfor the lawyer.13

The same may be true of surveys, but we have argued that, although sur-veys cannot give us the answer, they may be useful in directing us towardsthese answers by informing us about the process of people’s moral reasoningabout addiction and its potential pitfalls. The results reported in this arti-cle show that most people do not view addiction as a disease. Instead theytypically believe that the individual addict is responsible for their addictivedrug use – but also that addicts deserve to receive external help to quit.The pattern of responses to the different types of addiction was consistentwith the hypothesis that belief in a lower degree of internal causation wasassociated with lower assessed responsibility, but the tendency was weakerthan expected: large changes in believed internal causation of addictive druguse did not lead to equally large changes in attribution of responsibility foraddictive drug use. Finally, the survey revealed two interesting facts about theprocess of moral reasoning about addiction: first, that people’s causal beliefsseemed to be matched and influenced by other factors such as moral or emo-tional views or the current legal status of different addictions; second, havingexperience of being close to addicts in professional life had less effect on viewsabout the nature of addiction and its causes than one might have expected.

Acknowledgements

The authors thank Jostein Rise from the Norwegian Institute for Alcohol andDrug Research for organizing the survey and for very valuable comments andsuggestions. We also thank the participants at the CSMN, Oslo Universityworkshop on ‘Addiction and Responsibility’, on 11 November 2011. Theresearch was funded in part by the Norwegian Research Council.

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