Addiction and the Public Interest in Liberal Democracies

1
Addiction and the Public Interest in Liberal
Democracies

• UAB Conference Presentation
• Peter Collins
• University of Salford and South African National
  Responsible Gambling Programme
• May 6th 2007

2
Overview

• Preliminaries Why am I here?
• The Political Background the special difficulty
  of regulating allegedly dangerous pleasures in
  liberal democracies
• The Abuse of the Concept of addiction in Public
  debate
• What should we be doing now about problem
  gambling, including gambling addiction, given
  both what we know and what we dont know.

3
Preliminaries Who am I and Why am here?

• As an academic, with a background in politics and
  philosophy, interested in the development of good
  public policy generally and especially in
  relation to the regulation of gambling
• As someone who is quite often asked about what
  Governments and Gambling Companies should do
  about the issue pf problem gambling
• As the executive director of the South African
  National Responsible Gambling Programme concerned
  in a very practical way with the question of what
  is the best way to spend available money on the
  prevention and treatment of problem gambling as
  well as on research which will enable us to do
  these things better
• I also do private consulting for public bodies
  and private companies

4
My interests here

• On the basis of what I learn here about work
  completed and work in progress
• To understand, generally, the best that science
  can tell us about what addictions are and the way
  they work and whether and when it is most
  accurate and/or most useful to treat excessive
  gambling as a form of addiction
• To explore what the implications of this might be
  in relation to public policy in relation to
  gambling and other allegedly addictive behaviours
• To formulate judgments, given the limited nature
  of current knowledge about how best to allocate
  scarce resources now on research, treatment and
  prevention activities

5
Funding

• All my funding both in UK and in SA comes from
  the gambling industry
• IN SA it is a voluntary contribution to fund a
  programme of research, treatment and prevention
  which is overseen by an independent Trust,
  composed of 4 regulators and 4 industry managers
  and chaired by an independent public figure
• In UK the Centre for the Study of Gambling is
  funded by a variety publicly acknowledged
  gambling companies. Its work is, however, subject
  to all normal university and government rules
  designed to preserve independence, integrity and
  quality.
• Even so we have to struggle with the perception
  that our work can be dismissed as mere PR because
  it is industry-funded.
• I, also, am aware that periodically I find myself
  wondering should I omit some opinion or express
  some finding differently so as not to offend my
  funders in the industry and/ or in government. I
  do my best to resist temptation but am aware of
  unspoken pressures from industry and often spoken
  ones from governments.

6
Four Components of Addiction as it is relevant to
Politics

• For practical purposes it seems to me fairly easy
  to identify the main criteria for addiction of
  the sort which governments should do something
  about. There are four in particular
• All addictions involve people engaging in an
  activity mainly because it affords them pleasure
• They also all involve doing something to excess.
  But we can speak quite reasonably of mild
  addictions, of harmless addictions, of being
  addicted to golf, newspapers etc
• But we only get interested politically and demand
  government action addictions refer to excessive
  behaviours which cause substantial harm primarily
  to the addict but also often to to others
• And where the addict seems powerless to refrain
  from engaging in the damaging behaviour or start
  engaging in it harmlessly

7
Other interesting features

• Other signs of sever addictions include
• Thinking (obsessively) about the activity and
  past and future engagements most of the time when
  not actually indulging
• Using the activity as a means of escaping the
  pain of existence instead of enhancing its
  pleasures
• being incapable of being happy except when under
  the influence or at least assured of the next fix
• Really believing fantasies about being attractive
  and powerful or even possessing an identity at
  all only when indulging in the addictive
  behaviour of choice.

8
Bad Pleasures From Utilitarianism to Puritanism

• All these features locate addictive pleasures as
  ones which it is bad to indulge in excessively
  because of the harm which excessive indulgence
  does to the well-being of the individual indulger
  and potentially other innocent third parties.
• Unfortunately, many people commit the twin
  fallacies of thinking that
• - because all addictive pleasures can be bad,
  these pleasures are bad when enjoyed harmlessly
• - all pleasures that they disapprove of must be
  addictive
• Because there are quite a lot of such people in
  electorates this creates a major problem for the
  regulation of enjoyment in liberal democracies

9
Sin, Crime and Vice

• The political trouble in liberal democracies
  arises when, in their moral thinking, people
  start to discriminate between
• - sin wrongdoing towards God
• - crime wrongdoing towards society
• - vice wrongdoing towards oneself
• The problem is compounded when there is a
  widespread puritan belief that all pleasure is,
  or at least many pleasures are, wrong in
  themselves
• This causes trouble because, for example. you
  have to distinguish the question Is gambling
  immoral? From the question Is the banning of
  gambling immoral? A liberal might answer yes
  to both

10
Why this is not a problem for non-liberal-democrat
ic governments

• Most political theory, especially Plato, has not
  supported liberal democracy but totalitarian
  aristocracy. This means that
• it is the business of government to ensure that
  in all areas of their lives, subjects live as
  well as possible and therefore governments must
  legislate for all aspects of human conduct,
  including all pleasures (totalitarianism)
• Political power should be concentrated in the
  hands of the best, (aristocracy) i.e. the
  wisest and most virtuous should rule because they
  know both what the best life consists in and how
  best to ensure that as many people as possible
  participate in it.
• Government thus consists in the implementation of
  a sacred or secular ideology (cp Platos
  Republic, religious empires, Marxism,
  Nationalism)

11
Addiction in totalitarian aristocracies

• Excessive indulgence in any type of pleasure is
  morally wrong
• Some pleasures are morally wrong whether or not
  they lead to excess
• Some pleasures have a particular propensity to
  lead to excessive indulgence
• All the above may be vices because they involve
  harming oneself as such they are contrary to the
  will of God (or Karl Marx) i.e. they are also
  sins and, since it is the business of government
  to remove wickedness and vice (BCP) i.e. stop
  people from engaging in naughty pleasures, they
  should be made into crimes
• The government knows which pleasures are vicious
  and sinful and what activities should
  consequently be criminalised and how they should
  be punished

12
The Principles of Liberalism in Liberal
Democracies

• Governments exist to secure the maximum equal
  freedom principle i.e. that everyone should have
  as much freedom to choose for themselves how to
  live as is compatible with everyone else having
  the same freedom (Hobbes. Locke)
• Provided they dont wrongfully harm others,
  individuals should be free to choose for
  themselves how to live their own lives (and spend
  their own money) even if others think (rightly or
  wrongly) that their choices are foolish or
  dangerous or immoral
• This implies also that trade should be based on
  exchanges between willing buyers and willing
  sellers neither of whom use force (incl monopoly
  power) or fraud (incl disparities of
  information), and do no harm unfairness to third
  parties (e.g. by polluting the environment,
  tolerating discrimination)

13
The Principle of Democracy in Liberal Democracies

• Decisions to curtail liberty in the interests of
  all should be as few as possible and should only
  be taken in accordance with the will of the
  majority of citizens through voting procedures in
  which each counts for one and none for more than
  one
• Free, fair and frequent elections compel
  governments constantly to conform their conduct
  to what they think we be sufficiently acceptable
  to public opinion to prevent them from being
  voted out of office.

14
The Problem of Addiction in Liberal Democracies

• The core value of liberty (individual choice)
  sometimes conflicts with the core value of
  democracy (political equality which requires
  conforming to the will of the majority)
• The principle of liberty suggests that we should
  allow people to make whatever choices they please
  even if these choices are disastrous for them
  (compare marriage)
• The principle of democracy says that if most
  people think an activity should be banned or
  otherwise severely restricted, it should be and
  most people do think this in respect of most
  euphoriant drugs much gambling and all commercial
  sex
• This means the problem of legislating for
  allegedly addictive behaviours gets settled in
  terms of arguments about interests and values,
  not arguments about empirical facts.

15
A Possibly Rational Policy for Liberal Democracies

• Provided they dont wrongfully harm others,
  people ought to be able to choose for themselves
  how to enjoy themselves (it is immoral to deny
  this because to do so violates the unique dignity
  which human beings posses in virtue of being
  autonomous agents)
• They should be fully informed of the risks
  involved in pleasures available to them
• If they get sick or otherwise need the help of a
  compassionate society they should get it to the
  extent that the electorate supports provisions of
  safety-nets

16
How the Addiction issue is abused to prevent the
emergence of liberal policy

• You cant win votes in a plural democracy by
  arguing that governments ought to ban activities
  which are against your religion, your convictions
  about personal morality or your aesthetic tastes
• Still less, can you hope to win by arguing openly
  that government ought to ban activities which,
  if permitted, would undermine the protection from
  commercial competition which prohibition affords
  you or would put you out of a job with the DEA or
  the Gambling Commission
• Therefore you have to use liberal arguments to
  promote your illiberal policy preferences, i.e.
  prohibition or restriction.
• All these arguments rely on making false claims
  about addiction

17
Addiction and Freedom of Choice

• Prohibitionists (Economic Protectionists in
  unholy alliance with ideological puritans) have
  to be able to rebut the claim that provided they
  dont wrong others, individuals should be free to
  decide for themselves how to spend their own time
  and their own money in pursuit of pleasure
  (happiness?)
• They try to achieve this by arguing that 1)
  Addicts arent free 2) Addicts harm many others
  3) Governments ought to stop addicts from harming
  themselves
• None of these arguments are without merit in some
  forms but they typically rely on greatly
  exaggerating beyond what the (exiguous) evidence
  will support
• - the incidence of addiction
• - the costs which addiction imposes on society
  as a whole

18
Are addicts really free to choose?

• This is a hugely complex philosophical question
  but for present purposes
• I doubt that even EGMs create addictive gamblers
  de novo through operant conditioning otherwise
  all slot-players would be addicts
• This might be a prima facie argument for
  prohibition of cigarettes, absinthe,
  methamphertamines which induce addiction in the
  overwhelming majority of consumers it would not
  be an argument for banning alcohol, ecstasy or
  gambling
• Perhaps we should concentrates into turning
  addictive and self-destructive indulgers into
  harmless recreational indulgers
• The majority of non-addicts have rights too

19
Do Addicts harm Society?

• Cost benefit analysis suggests that the claims
  that the costs to society outweigh the benefits
  are simply false
• If consumer surplus is taken into account the
  benefits in dollar terms far outweigh even the
  most pessimistic estimates
• Taxes on legal vices cigs, booze, gambling
  far exceed the money spent on health, law
  enforcement and welfare services thats why
  electorates and their governments like them
• Most cost-benefit analyses of legal vices
  ignore the huge costs of enforcing prohibition
  for wholly undemonstrated and almost certainly
  negligible gains in reducing addiction

20
Should addicts be prevented from harming
themselves?

• Even if the answer is yes on compassionate
  grounds, this may be an argument for compulsory
  exclusion of addicts or for compulsory treatment.
  
• It is not an argument for prohibition unless it
  can be shown e.g. that the availability of
  casinos or bars is, in itself, a major cause of
  widespread addiction such that addiction rates
  would decline dramatically with prohibition.

21
Conclusion on Prohibitionism vs Permissivism

• We should only prohibit addictive activities
  which are almost universally addictive and
  severely harmful and where prohibition is likely
  to lead to significantly reduced consumption
  (Absinthe, Crack. High prize slot machines in old
  age homes for the poor).
• Otherwise we should, on moral grounds, adopt
  permissivist policies while doing everything that
  reasonably can be done to reduce the incidence
  of, and harm caused by addiction

22
Arguments in the democratic consensus not based
on alleged addictiveness

• The democratic consensus about the need to
  restrict gambling opportunities is not wholly
  based on worries about addiction
• Gambling, sex and drugs also provoke widespread,
  if not very articulate, unease that if we permit
  too much of it we will somehow detract from the
  quality of individual or community life and/or
  undermine the moral fibre of individuals and the
  moral fabric on which society is founded
• This probably has profound evolutionary roots in
  the notion that societies wont survive if people
  can get sexual pleasure, money, or happiness
  without earning it as a result of taking on
  responsibilities and , whats more they can get
  more of these things if they dont take on the
  relevant responsibilities.

23
So does the liberal democratic case recommend?
Policy

• Have some but not too much restrict supply
• Regulate more strictly than elsewhere for
  potential negative impacts
• Secure public benefits for non-indulgers, through
  various forms of high taxes
• Ensure that everything reasonably is done to help
  people to indulge safely and to ensure they can
  get expert, confidential, affordable and
  effective help if they need it

24
Treatment (Gambling)

• Pharmacology for \-1 with neurophysiological
  disorder as and when available
• Meanwhile , additional 4 who are not ill but
  dont really understand what they are doing need
  individual and group talk therapies which focus
  on what client is really doing, really wants, and
  is really able to do. (Most treatments work with
  people who want to get well). This is treatment
  as an aide to self-generated recovery.
• The trouble is that most who would benefit from
  treatment dont seek it

25
Prevention

• Educate all potential gamblers in how gambling
  works (like a roller-coaster ride) what are its
  dangers and how to avoid them (budgeting etc)
• Educate all potential gamblers in recognition of
  signs of trouble and how to access cheap,
  confidential, expert help
• Educate target vulnerable groups the young, the
  poor and uneducated likely to be preyed on by
  loan sharks
• Educate specialist professionals social workers
  GPs police etc

26
Conclusions from this Conference

• Does our treatment or prevention work do any
  good? Unclear
• Are we doing anything obviously wrong? Hope not
• What could we be doing better? Probably a lot
  with a better research base
• What should we do in the meantime? Keep going.