Autonomy, responsibility and the oscillation of preference

This chapter argues how the claim that the behaviors characteristic of addiction are voluntary does not entail either that the disease model of addiction is wrong or that addicts are fully responsible for their actions. Autonomy is a term with multiple meanings. There is a maximal sense of autonomy, according to which an autonomous being has only the desires and beliefs they want to have and makes choices uninfluenced by any factor they have not chosen or endorsed. The evidence available clearly demonstrates that actual addicts' behavior is sensitive to incentives that are not extraordinary in nature, and that therefore they are not subject to irresistible desires. There is a growing body of evidence that addicts cannot trust themselves to act prudently in these ways. Though the addict may choose to do what she does when she does it, she is subject to regular and predictable preference reversals, which undercut her ability to impose her will on her own behavior across time.