Discourse with Owen Flanagan: Part 2

T. Virgil Murthy and Owen Flanagan talk more about addiction and philosophy.

Content warning: discussion of alcohol and drug use.

Here’s the second half of my conversation with philosopher and neuroscientist Owen Flanagan. Click below to read Part 1.

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A picture of Owen from his Duke University page. He’s wearing a black suit and a blue tie, holding a mostly-empty glass of water. He is turned to the right and conversing with someone out of frame.

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As I mentioned in the last post, Owen Flanagan is the James B. Duke University Professor Emeritus of Philosophy. In his celebrated academic career, he’s written about consciousness, philosophy of psychology, and ethics, among other things. His forthcoming book What Is It Like to Be an Addict? will be published by OUP in 2024.

In the last entry, Owen and I discussed being addict philosophers, the pluralism and multiple realizability of addiction, and more. In this post, we talk about addict oppression and testimonial injustice; moral responsibility in addiction; and how moral understandings of addicts relate to addiction policy and treatment.

Oppression

TVM: So we’ve talked at this point a bit about empirical research. I want to ask you about a topic that is maybe a bit vain—closer to my research than yours.

So, as you know, I define being an addict in terms of oppression. This is for two reasons. First, it’s agnostic about generating mechanisms, but not overly agnostic about addict status. So I’d like to think it’s kind of a Goldilocks definition in this respect. (Although of course I’d think that, since it’s my definition.) It sidelines discussions about whether various substances/processes “count,” but unambiguously permits the kind of demarcation between addicts and nonaddict heavy users that we just discussed. (That demarcation is the undergirding intention behind, for example, my description of random drug tests as a bear trap.)

What I have noticed is a general reticence to describe the oppression addicts face—the carceral-clinical seesaw, being targeted by Project Prevention, drug tests as a parole condition, exclusion from homeless shelters—as oppression that applies to them partly in light of their addiction status. Nobody really denies that these mechanisms exist. We tend to, in the social zeitgeist, be generally on board with the concept that, like, excessive carceralization of Black communities is bad. A lot of people are willing to admit that these things exist and that we should critically examine them. But for things like drug tests, economic exploitation by gambling companies, imprisonment, often they’re redescribed as entirely downstream of addicts’ membership in other oppressed groups. Homelessness, poverty, being Black or Indigenous, and so on. These other identity characteristics are made to bear all the weight.

This is a response I’ve gotten frequently since Anna and I launched the blog, and it’s one I didn't expect. “Well, there’s no such thing as addict oppression; the reason there are these laws is entirely because of racism.” I find this to be very confusing. I think addiction—maybe the apparatus of addiction, as Andrea Pitts puts it—often provides useful insight over and above what you can learn if you just look at these issues through a racial lens or a class lens. For instance, both the post-crack-panic carceralization and the current attempt to overturn the Indian Child Welfare Act function as oppressions of racialized people. Or, for the opioid crisis—rurality, economic oppression, classism. It would be silly to dismiss that the people targeted in the crack panic were disproportionately Black. But what I think is useful to recognize is that things like the crack panic draw their effectiveness from picking out a particular subset of that marginalized group (the addicts), labeling that subset dangerous and threatening, and then generalizing those predicates to the whole group. So I guess my question is this: To what extent are you sympathetic to my conceptualization of the term “addict oppression,” and why do you think there might be an inclination to dismiss the sort of analysis I’m trying to do with it?

OF: So, to start—I loved how you pointed out in one of your papers that when you did the thing we academics all do, looked up “addict” and “oppression” to see what was there, you saw a lot about how oppressed people become addicts, but nothing about the reverse. I appreciated the way you thought about it. But some of this is new to me. So, first pass: What I’m very familiar with is an epistemic injustice, which I don’t know if you’d call oppression.

One of the things that happens when you write a book like I’m writing, where you argue “You better listen to what we addicts have to say about addiction, because we have a lot to say,” is this. I was with a group of addicts recently, having coffee, telling them about a new article by a philosopher of addiction. The article says, “Guess what? Many addicts’ proximate cause of use isn’t a craving. Sometimes an addict, as long as they have a standing desire, will think something like, ‘Ah, fuck it, I’ll have a drink now.’ Or they’ll think, ‘She just pissed me off; I’m going to drink.’” Or whatever. His point was, there’s a lot of different cognitive activity that can precede use. I told this to these guys and they all gave me the universal what-the-fuck look, like, “Yeah. We’ve been saying that for like a hundred years.” There’s a multiplicity of things that happen just before you use, mentally. We all know that!

As a lot of addicts say, “Anything in the class of really good things makes me want to use, and anything in the class of really bad things make me want to use.” Sometimes people think a lot about it, with determinate thoughts and a plan—

TVM: And there can be very, very arcane justificatory structures. Absolutely the weirdest bullshit. People call this “the alcoholic brain,” “addict rationalizations.” You’re right—we’ve been talking about this for a hundred years.

OF: And this is where the epistemic injustice comes in. “We’ve been saying this! The first 164 pages of the Big Book are all about it. And then this guy gets government money to do research to tell us what we already know”: that was the reaction I got from these guys.

TVM: Yeah. I’m very sympathetic to that.

OF: Interesting question: is this hermeneutical or testimonial injustice? I guess the whole point is that we have the hermeneutics, we know how to describe this, more or less. So it’s testimonial injustice. A certain kind of smart addict, like you and me, might be trusted by scientists to talk, because we’re legit. Then people will pat us on the head and say, isn’t it adorable that those two addicts came here to talk. They like to have us around and give us the imprimatur. But they’re not taking in the testimony of addicts in general—because they think they’re fucked up.

TVM: If you Google “trust addict”—I’m sure you know what you’ll find. “Never trust an addict,” “addicts are manipulators.” Not just rehab websites but scientific studies and academic papers too, purporting to show these things. And it facilitates the bifurcation into the good and the bad addict. Those who sign off on the establishment view are tokenized, while those who don’t are demonized.

OF: So, my question for you then, if I understand what you’re saying—do you want to use the word “oppression” to describe this sort of testimonial injustice against all addicts? Or is that a different thing?

TVM: That’s a good question. I suppose it depends on what particular work I want the term “oppression” to do in some specific use. In at least some contexts, it’s very clear that certain kinds of disclosure or testimony facilitate oppression, or that their interpretation is used in oppressive ways. For example, medical—like, telling your clinician that you’re an addict. And then there’s more stuff about this hermeneutical gatekeeping. I talk a lot about the ritual self-flagellation addicts are frequently expected to do testimonially: frame our stories as confessionals, wring our hands at the great damage we’ve done the world. So, sure, the systematic devaluing of testimony, or acceptance of testimony based on whether it converges with the views people want to hold is oppressive. It coheres well with a lot of the ways oppressed groups have historically been allowed to self-advocate so long as it’s not real advocacy. “Oh, we have these couple of Black people, or disabled people, or gay people, whom we’re platforming because they agree with this dominant narrative,” while the people from the same group who are fighting injustice are demonized. It’s very conducive to the success of the mainstream views: look, these good Black people are agreeing with us, and then look over there at those bad people who want material change. But then the good can only be the exception, not the rule. And by aligning yourself with the critical view you sustain a category shift into the bad group.

OF: With respect to the kind of oppressions you describe more generally: I think the term is very useful. Some people in older age groups will object, I imagine, that “oppression” is about the systematic structures that pick on a superficial unchosen property of a person and push them down. Sex, gender, race, ethnicity. Then someone might say, with respect to alcoholics, we never pick them out antecedently by any phenotypic trait; we pick them out once they fuck up.

TVM: Exactly—this is why I give the bear-trap story as an analogue for addict oppression, likening it to stop-and-frisk. The mainstay of addict oppression is being entrapped into, and then blamed for, behavioral patterns.

OF: Then someone might say there are certifiable kinds of oppression. Addicts may face various injustices given the state of the law, but overall “oppression” isn’t the right word—

TVM: Stigma. People like to say “stigma,” and that really bothers me.

OF: Right. I’m just trying to project myself into the various responses you might get. One of the reasons I’m relatively privileged in the type of alcoholic or addict I was, or am, is that I’m wealthy, white, have good medical insurance. In a lot of ways I never experienced these things.

I have looked into, a lot, the opioid crisis. I read both of Beth Macy’s books, including Dopesick. About the introduction by Purdue Pharma of opioids into West Virginian communities.

TVM: I used to work in protest art activism against the Sacklers, similar to what Nan Goldin does, so I’m very familiar.

OF: One of the reasons I was interested is that besides West Virginian miners, Maine fishermen were the other group they targeted. And you can see why; it’s a perfect storm. If you’re marketing opioids, you’re thinking, what industries get a lot of injuries? Mining and fishing, right away. What happened was—I don’t know if I’d call it oppression—we produced large groups of people addicted to OxyContin, communities were ruined, and so on.

TVM: I would definitely call it oppression. And the death toll is still rising today. Actually, I’ve gotten in various fights with people who try to distinguish the fentanyl crisis, “Oh, the fentanyl is coming from Mexico”—no, it isn’t. Where we are today with fentanyl overdoses is a result of the Sacklers. You can trace it back, both on the supply side and, more importantly, in our cultural conception of pain and norms about opioid availability, to the demand for OxyContin that was deliberately created as a marketing strategy. I think trying to call fentanyl something else, trying to pin it on Mexican cartels, is just misguided. And with the ongoing fentanyl panic, which Anna’s written about on here—

OF: It’s a scare. I know a lot of people, including alcoholics in remission, who have fentanyl patches and don’t abuse them, and it works. But now we’ve created, just as we’ve done before, a terrible set of outcomes for people with chronic pain.

On the more general topic here: One of my friends, Peg O’Connor, took me to drug court to watch a drug court proceeding, which gave me the heebie-jeebies.

TVM: Can you just do that?

OF: At least in Minnesota. It was very interesting. I thought this particular judge was very good and supportive, but it was almost like AA. It’s kind of disturbing, the degree to which the courts play into that. On the one hand, the people who work in harms reduction and the science of addiction, they like to say out of the side of their mouth, “AA isn’t real treatment.” But then the drug courts use it all the time. The judge, who was not one of us, she kind of knew a language which you only would know from AA. It felt like you were in a room. She was talking to the people who have to keep clean or else they go back to jail, but using AA-isms. I thought, wow, it’s this really interstitial space. And it involves—you know, carceral threats are right next door for all these people who are being asked to comply with these concepts.

TVM: I don’t know what the norms are here around showing up at drug court. I’ll look into it. But what you just said, that carceral threats are right next door in the midst of this AA-speak. This is exactly why I coined the term “carceral-clinical seesaw.” There’s this weird, multiple-objectives calculus by which it’s decided whether you go to inpatient treatment or jail. And it’s not just for addicts; it’s a big thing for Mad people more generally. The way you just described it, with the judge, talking in AA-speak or empowerment mental health language, almost—but then, also there’s an implicit threat of being imprisoned.

OF: If you walk out the door and don’t pass a piss test, then there’s hell to pay.

Moral responsibility in addiction

TVM: So, maybe we should talk a little bit about moral responsibility. Some of your forthcoming book, to my understanding, is about moral responsibility in addiction. You think it’s more complicated than is often given credit for, in philosophical treatments, and that the first-person perspective is sorely needed. But you nonetheless think the discussion is important and that evaluating the moral responsibility of addicts can bring interpersonal and policy questions about addiction forward. That’s, I suspect, the one respect in which you and I profoundly disagree.

OF: So, now, let’s see if we actually do.

It’s not that I think minds have any spooky parts, the hard problem of consciousness or anything like that. I’m a great believer in interdisciplinary synthesis of scientific perspectives on addiction, including sociology, economics, anthropology, psychology, and neuroscience. All of these things, I think, we need to bring together.

With respect to responsibility and reactive attitudes—emotions like shame and guilt—I’ll start by saying this. Not once in my book do I use the term “free will.” And I would never! In 2000, in The Problem of the Soul, I said that if I were the benevolent dictator of philosophy, I would ban the words “free will” and “determinism” for a hundred years and then see how we’re doing. I think we’d go back to old concepts that are entirely helpful, spectrums of voluntary/involuntary action, and things like that. So I don’t buy into the philosophical vocabulary that discusses different positions on free will. I think it’s a very idiosyncratic discussion that we have in Western philosophy, and its own thing.

One of the reasons I like Strawson’s work on reactive attitudes is that he says, putting aside your position on free will, we humans have affective responses toward others built in. In fact, he says in a footnote that the reactive attitudes are like induction: they come with the equipment. We start the human project with all that emotional equipment. What we do with it will depend on the ecologies that we’re in. What practices seem to be working well? We’ll have to evaluate whether they are oppressive or unjust. We know there’s a lot of asymmetry in how people are allowed to express emotion: elders can yell at the kids, but the kids can’t yell back, or gendered asymmetries, and so on.

I start from the position that we are animals that have these sorts of normative attitudes toward each other. So the question, for me, involves a kind of realistic look at the practices among addicts who got healthy, how we held ourselves to account. What did we think we could change about ourselves? “Virgil, she did kind of a Ulysses-and-the-sirens thing; when she gets to town, she always announces ‘Don’t let me go to the bar.’ It’s a way she holds herself responsible.” Without getting into the metaphysics, there’s two different senses of responsibility. One is the backward-looking sense, which needn’t be retributive. “Shit, I noticed this pattern; if I do it like that again, things will go bad.” Then there’s the forward-looking sense of having the hope that we could respond differently in the future. That’s a conception of responsibility you see in John Dewey and in Dan Dennett. It’s not metaphysically loaded, and it also doesn’t require any retributive or punitive instincts. So my overall view is just if we look at the way things go on in the communities where addicts get better, or in healthy communities that welcome addicts back or exclude us for cause for now, this can be done in loving, compassionate, and empathic ways. It’s not an all-or-nothing thing about the agency of addicts.

TVM: That’s really cool, and dovetails well with my experience. I was one of those ADHD kids who causes a lot of trouble. Even now my brain is at DEFCON 2 all the time, but you see I’m not, like, running around the room bouncing off the walls. I’ve learned to keep it in check. Same for alcohol. My relationship to alcohol is—in the Foucauldian sense—abnormal. I live in a society where, if you have the relationship to alcohol that I do, then you are fucked. Hence I’ve developed, on purpose, a bunch of sophisticated choice mechanisms. I’ve cultivated the desire to define myself as an alcoholic because it keeps me safe from relapse. Because until I figured that out, I was relapsing over and over.

OF: That’s just what I mean by holding yourself responsible. And then people who love and care for you can help implement those and suggest more. I think one of the things people get out of twelve-step rooms is the wisdom of little workarounds like that. You’re trying to figure out how to get there and there might be all sorts of obstacles because of your wiring or your upbringing—the past can’t be changed, but it’s an extended-mind kind of thing. You’ve extended who-Virgil-is in terms of ways of tying yourself to the mast, and getting involved in work like this. And it helps you stay away from the roads you don’t want to go down.

Then the second part of my investigation is: how do we investigate particular emotional attitudes? Some people will say, well, shame is a really terrible thing for an addict to feel.

TVM: You have a paper on the shame of addiction, arguing against that view.

OF: Right, I think that’s wrong. In a lot of other cultures, shame doesn’t involve the totalizing self-loathing attitude we often regard it with. So as a general point, I think we view shame as worse than it is. So, now, tell me how much we disagree—I bet it’s not as much as you thought before!

TVM: It’s not as much as I thought. I find the machinery you describe to be very helpful. I’m not an eliminativist. It’s not that I think we should view addicts as not moral agents. My attitude toward the whole moral-responsibility-of-addicts debate is not so much that I think either side is right—I’m not sure what it would even mean for one side to be right, because I think the idea that this is an important question in the first place is fundamentally misguided. My central claim is that this is a discussion neither by nor for us addicts: it reflects a primarily nonaddict-oriented sensibility of what is philosophically interesting about being an addict. (Now, of course, that claim is heavily problematized by the fact that you are one of the major players in this debate. So, you know, ignore that.)

The addict moral responsibility literature is somewhat new—it’s an artifact of contemporary analytic. It starts with Frankfurt’s dichotomy between the willing and wanton addict. I trace the genealogy like so: both Strawsons at some point get pretty close to talking about it; we see it run through the late-twentieth-century moral responsibility paper trail. Then at some point a change in motivation happens. Up until around maybe 1980, addicts show up in philosophy papers as an edge case meant to problematize some preconceived deep-self moral theory. Then we start seeing moral responsibility papers that appeal to deep-self machinery in order to make sense of the weirdness of addict behavior. Describing us became the primary objective rather than merely an illustrative case study. It’s one of these Hacking looping phenomena where at first people were only thinking about us as a strange thought experiment for a preexisting debate. (The relationship of addicts to decision theory is very much like that.) Then it becomes, well, I want to talk about whether addicts have responsibility, so I’m going to reach for the deep-self apparatus. You, Owen, wouldn’t be lumped in with the theorists I criticize on these grounds. You have a much more nuanced view—and anyways, being an addict yourself, you obviously aren’t coming at this from a desire to understand a behavior you view as pathologically strange. That’s mostly what I take issue with: certain presuppositions about what elements of addict experience are strange that would only ever occur to someone who has the nonaddict standpoint.

I find this all to be a fundamentally confused endeavor. I really don’t think that the uncritical deep-self view ever reached the degree of sophistication where it even makes sense to think that nonaddicts, or people by default, satisfy its conditions. Why would addicts be pretheoretically a suspicious case? Who isn’t a suspicious case, given the Basic Argument? I feel like Galen Strawson nuked the debate, and then we stopped talking about moral responsibility in that way. That some theorists are now bringing all that questionable machinery back, but only for addicts, is just bizarre to me.

OF: I have a little bit of a different genealogy, but I agree with you, actually. You’ll see in my forthcoming book. I talk about the whole deep-self versus real-self literature, Watson and Wolf, people like that. I don’t like these toy experiments any more than you do. I think they’re disrespectful. Like the wanton: there aren’t any human addicts like the wanton. And furthermore, the description of the willing and unwilling addict in Frankfurt, which I talk about, is just ridiculous. The willing addict loves it, and the unwilling addict hates every minute of it.

TVM: Very extremal representations, yeah.

OF: They’re toys, and we’re dealing with real people—it’s not respectful.

In my book The Geography of Morals, I talk a lot about both Strawsons—Galen is one of my best friends—in a chapter called “A Tale of Two Strawsons.”

TVM: I have a tremendous amount of respect for Galen Strawson.

OF: He’s fantastic.

So I think I’m with you there, too, on the thought experiments. I kind of don’t explore what Hanna Pickard says about responsibility without blame, but I domesticate it in roughly the way I said. Just because you hold yourself responsible doesn’t mean you blame yourself for what you just did. It just means that you’re thinking, hopefully, that you can respond differently in the future.

TVM: Right. The way you described it when you recontextualized the thing I do as a sort of Ulysses pact—it sounded like you were saying, “Well, moral responsibility can be as reductionist as just recognizing that there is a certain future eventuality that lies within the scope of an action you can take now.” There doesn’t need to be anything spooky there; there doesn’t need to be an attribution of blame or praise. There’s no punishment. It is, I think, very Deweyan.

OF: That’s the way I’m thinking about it. I don’t touch the apparatus of free will, and I mention that the apparatuses of deep-self and real-self aren’t that helpful. They have some components that might be useful. But mostly what I bring in responsibility for is that some people will say, “Ah, the reason everyone should accept that addiction is a disease is because then there’ll no longer be any stigma attached to being an addict and we won’t blame addicts.” I find that kind of glib.

TVM: Yeah, I think it’s ridiculous. We deeply stigmatize and materially oppress many disabled people we regard as diseased. Take leprosy.

OF: This is something you’ll face in your academic career: sometimes you’re interested in a topic, and there’s literature on it, but you find it kind of unhelpful, and that entering into that way of speaking and conversing before you know it then you’re giving too much attention to that whole preexistent way of speaking. So, I use moral-responsibility talk, but I don’t bring in the metaphysics or even the philosophical psychology of people like Frankfurt at all.

Moral responsibility and policy

TVM: So, given that you’ve dispelled my disagreement, I want to push further. Do you ever worry that this hotly contested choice/disease debate doesn’t really map onto different policies, treatment strategies, anything? I mean, there are disease theorists who recommend CBT. There are choice theorists who recommend harms reduction. It doesn’t travel with anything. I suspect that in regards to political interventions—decriminalization, involuntary institution laws, the various ways in which policy can affect the lives of addicts—the choice/disease dichotomy doesn’t do much work. It distinguishes different justifications for endorsing already-accepted policies, rather than predicting what policies the theorists will actually endorse.

For example, this week I was looking at literature from various different choice/disease perspectives in relation to positive drug test penalties for parolees. Now, to be clear, reincarceration for parolees who fail a drug test is one of the paradigm cases of what I’d call bear-trap oppression, and I, obviously, don’t think we should be drug-testing parolees at all. So, there’s a 2014 paper by Satel and Lilienfield, edited by Pickard, arguing against the brain-disease theories. They talk about Project HOPE in Hawaii—if you’re caught using, you’re reincarcerated for a short period, then, sort of, tagged and released into the wild, if you will. They are, obviously, adherents to the choice view. And defending Project HOPE isn’t really the purpose of their paper. But, crucially, in presenting the evidence, they appeal to the claim that the Project HOPE enrollees had a much lower recidivism rate at the one-year mark than the control group. The relevance of endeavors like Project HOPE for the choice view, apparently, is that their success is evidence for the underlying theory. It’s framed entirely as “This is conducive to remission, thus supporting the choice model.” Nothing whatsoever about desert, or what you are or aren’t permitted to do to punish a blameworthy behavior. No discussion of whether things like Project HOPE are, by the lights of the choice view, morally acceptable. This already made me think, hmmm. What work is the choice view actually doing here? Because you can’t at the same time claim your theory supports certain empirical practice and use that empirical practice as evidence of your theory’s truth. You have to pick one. But if the claim is that this intervention is conducive to remission, then the moral content totally divides out. Actually, everything divides out. Claiming that addicts’ behavior isn’t responsive to our own deliberate interventions totally underdetermines whether our behavior is responsive to, say, our clinicians or law enforcement. (It even underdetermines whether our behavior is responsive to what we are given to understand by choice theorists about what our behavior is responsive to!) There’s no reason disease theorists can’t seize on that same evidence and recommend drug tests as a policy.

So I started looking for discussions of random drug tests of parolees in empirical studies by researchers who endorse the disease view. And sure enough, there are studies in which the authors state the party-line platitude “It’s a chronic relapsing condition” and then go on to sanction random drug tests or suggest that remission-directed interventions make use of their effectiveness, just as the choice theorists do. Same recommendation: “Yeah, this really helps people get sober.” And these people are all citing each other—choice theorists, disease theorists, legal scholars, law enforcement personnel. So this is why I say, I don’t see why discussion of whether addiction is choice or disease matters at all. Except maybe to someone who has a really bizarre causal metaphysics on which, if you have a disease, then nothing can impact your behavior!

OF: I think you’re just totally right. You can’t mount all the arguments fully in one text or volume, but what I would say about it is this. When Heyman wrote the book Addiction: A Disorder of Choice, what is the evidence therein based on? To some extent, an obvious thing all of us knew, but that he confirmed: there’s all kinds of scheduling, both strategic and in terms of health and well-being, dosing, that goes on in addicts’ use.

TVM: Right, the careful distribution of bottles around the house, drawing lines on them—we all knew about that!

OF: So then the question is, what does this entail? Is this a holy-mackerel moment where the philosophers say, “Ah, libertarian free-will is real?” Or where people say, “And therefore, this kind of policy is the right one?” No. It’s kind of a local finding that pushes back in some ways against the view that if you have a disease, there’s nothing you can do about it. But that doesn’t establish much. Nobody ever thought addiction was that kind of disease.

TVM: Even most diseases aren’t that kind of disease!

OF: Do people in AA rooms still draw comparisons between alcoholism and Type II diabetes?

TVM: I’ve never heard that. I’ve once or twice heard the allergy metaphor, but never diabetes. Although, take that with a grain of salt, because rooms are very different between cities. For example—are you aware of the ongoing infighting in NA circles about MAT?

OF: Yeah, that’s right—I know about that.

TVM: Maybe Pittsburgh twelve-step communities are just rather progressive. A lot of the same people go to twelve-step groups as harms reduction meetings. I’ve seen people talk about how getting on the right meds can be really important. Very different milieu.

OF: I’ve gone to meetings in different cities, continents, and the differences can be amazing. But you’re making me think about things I usually put aside, like, what are the holistic implications of considering addict testimony? I don’t know what the implications are in practice. I don’t think anything follows straightforwardly from having a choice or disease view in the way you’d expect. You put it nicely. If you have a disease, there might be various different sites of interventions and steps you can take.

The reason I bring up Type II diabetes is it used to be mentioned in meetings—it’s not congenital, it’s brought on by a certain lifestyle, is what people think. Therefore you can control it by lifestyle changes, maybe diet and so forth. But I agree with you. Just as I don’t see how a disease model eliminates stigma while a choice model brings it—stigma is just something humans are really good at doing—I don’t see how the two models predict particular policy.

Conclusion

TVM: Owen, thanks so much for participating in this discussion, and for your ongoing support of this project.

OF: Of course! I love that we’re having this conversation, helping each other think about these things.

TVM: Me too. I hope that endeavors like this will bring much-needed attention to the addict perspective.

Thanks to all of you for reading and listening, and a tremendous thank you to Owen!