Tag Archives: John Rawls

Recovery capital and capital

blindjusticeartFrom the UK Advisory Council on the Misuse of Drugs second report of the recovery committee [emphasis mine]:

…our optimism about recovery should be tempered. Evidence suggests that different groups are more or less likely to achieve recovery outcomes. For some people, with high levels of recovery capital (e.g. good education, secure positive relationships, a job), recovery may be easier. For others, with little recovery capital or dependent on some types of drugs (especially heroin), recovery can be much more difficult and many will not be able to achieve substantial recovery outcomes.

It’s great that people are discussing recovery and looking at outcomes, but I have a few important concerns.

At what point does recovery capital become a proxy for class?

I’m increasingly concerned that recovery capital is becoming a proxy for social class. Whenever I discuss health professional outcomes, the typical response is something like, “Yeah, well, they have a lot more recovery capital than most opiate addicts.” The implication is that health professionals (and people like them) are capable of achieving drug-free full recovery while other opiate addicts are not. This is particularly troubling as maintenance becomes the de facto treatment for opiate addiction and significant financial resources become more important for accessing drug-free treatment of adequate duration and intensity. (Like health professionals get.)

This question brings John Rawls and his “original position” to mind.

In the original position, the parties select principles that will determine the basic structure of the society they will live in. This choice is made from behind a veil of ignorance, which would deprive participants of information about their particular characteristics: his or her ethnicity, social status, gender and, crucially, Conception of the Good (an individual’s idea of how to lead a good life). This forces participants to select principles impartially and rationally.

We have a situation where the experts provide one kind of treatment to their peers and another kind of treatment to the rest of their patients. If these experts had to assume the original position and operate from behind the veil of ignorance–if they were to be reborn an addict of unknown class, race, gender, economic status, etc–what would they want the de facto treatment to be?

If it’s not maintenance, then we have a social justice problem.

Evidence for what?

The other important question concerns the evidence. I have several questions about discussions about evidence.

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Filed under Controversies, Harm Reduction, Policy, Research, Treatment

Rights, morality and drug policy

Morality

Morality (Photo credit: dietmut)

 

Mark Kleiman recently wrote a great post on morality in drug policy:

 

Jonathan Rauch, who heads the Brookings side of the project, found that line of argument troubling. He asked me whether the interests of the responsible 80% should really have to yield to the interests of the irresponsible 20%. (Since the two groups aren’t distinguishable at a glance, there’s no way of restricting the consumption of problem users without somewhat inconveniencing non-problem users.)

That question, asked by someone whose intellect and ethical sensibility I have come to respect, led me to reflect on the difference between a moralistic or rights-based approach to a problem such as this one and a policy-analytic or outcomes-based approach. If you think of problem users and non-problem users as different people, it’s natural to ask which group’s interests ought to make way for the other’s. That seems to be a moral or constitutional question. But if you think of yourself as a potential user of a drug (or, as Jonathan suggested to me, the parent of a potential user), unable to know in advance whether your (or your child’s) use will remain controlled or will instead progress to dependency, and ask how much inconvenience in controlled use you want to sacrifice for protection against a bad habit, then you confront a practical problem rather than a moral one.

(Some readers will recognize in this Schelling’s solution to the puzzle of why it’s justified to save a larger rather than a smaller number of lives, when that’s the choice; if you imagine yourself as a member of one of the two groups, without knowing which one, it’s obvious you’d prefer a higher probability of survival to a lower one. Jonathan instead recognized this as a Rawlsian veil-of-ignorance argument, which also seems right to me.)

Of course, this same approach can be applied well beyond drug policy. Asking “How much do the non-poor owe to the poor?” is a moral question. Asking “How much protection would a reasonable person want against the risk of poverty?” sounds more like a computation. Of course, if you think of yourself as naturally immune to the risks of drug abuse or of poverty, you’ll be more inclined to let the drug abusers, and the poor, go hang. But that seems to me compatible neither with the Categorical Imperative nor with the Golden Rule. If we accept arguments from symmetry in physics, why not in ethics?

 

I found it noteworthy than none of the comments addressed the use of the word “irresponsible”, even Keith Humphreys. Hmm.

 

 

 

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Filed under Controversies, Policy