Positive liberty and addiction

I saw a Facebook comment today referencing “freedom to” and “freedom from”. It got me thinking about positive and negative liberty and harm reduction.

Negative liberty is the absence of obstacles, barriers or constraints. One has negative liberty to the extent that actions are available to one in this negative sense. Positive liberty is the possibility of acting — or the fact of acting — in such a way as to take control of one’s life and realize one’s fundamental purposes.

The reason for using these labels is that in the first case liberty seems to be a mere absence of something (i.e. of obstacles, barriers, constraints or interference from others), whereas in the second case it seems to require the presence of something (i.e. of control, self-mastery, self-determination or self-realization).

There seems to be two (maybe more) approaches to harm reduction. One that adopts what Scott Kellogg referred to as gradualism, (I’ve frequently discussed something I refer to as recovery-oriented harm reduction.) an approach that does not limit itself to the goal of the harm that results from addiction or other risky behaviors, but rather seeks to facilitate change away from active addiction or other risky behaviors. The other approach limits itself to reducing harm and often adopts and affirms the culture of tribes of drug users. The implicit message often seems to be that drug use is a lifestyle choice that is to be accepted, if not respected.

To a significant extent, many disagreements about harm reduction and legalization come down to this philosophical issue. Are these people free?

I say that they are not. However, Berlin, the philosopher who fleshed out the concept of negative vs. positive liberty, warned about the potential consequences of governments taking this view,

Once I take this view, I am in a position to ignore the actual wishes of men or societies, to bully, oppress, torture in the name, and on behalf, of their ‘real’ selves, in the secure knowledge that whatever is the true goal of man … must be identical with his freedom.

To be sure, this a very real danger in adopting my view of the problem, but fear of infringing on another’s liberty is not a reason to ignore this truth. Gradualism seems to navigate these waters well and, in a previous post, I put forth a set of principles for recovery-oriented harm reduction:

I’ve been thinking about a model of recovery-oriented harm reduction that would address the historic failings of abstinence-oriented and harm reduction services. The idea is that it would provide recovery (for addicts only) as an organizing and unifying construct for treatment and harm reduction services. Admittedly, these judgments of the historic failings are my own and represent the perspective of a Midwestern U.S. recovery-oriented provider:

  • an emphasis on client choice–no coercion
  • all drug use is not addiction
  • addiction is an illness characterized by loss of control
  • for those with addiction, full recovery is the ideal outcome
  • the concept of recovery is inclusive — can include partial, serial, etc.
  • recovery is possible for any addict
  • all services should communicate hope for recovery–recognizing that hope-based interventions are essential for enhancing motivation to recover
  • incremental and radical change should be supported and affirmed
  • while incremental changes are validated and supported, they are not to be treated as an end-point
  • such a system would aggressively deal with countertransference–some people may impose their own recovery path on clients, others might enjoy vicarious nonconformity through clients