Addiction and Disability: Moral and Policy Issues

Abstract

This article discusses the conceptual, ethical, and policy issues raised by the legal classification of drug addiction as an impairment, and of some nonusing drug addicts as people with disabilities. It focuses on the questions of (1) what moral judgments, if any, underlie the classification of addiction as an impairment; (2) whether it makes sense to apportion the burdens of drug addiction between chemical, biological, social, political, and other causes; (3) how considerations of distributive justice may compel or constrain measures to ease the burdens of drug addiction; and (4) whether it is justifiable to deny the current users of illegal substances legal protections available to the current users of legal substances.

• Addiction
• Disability
• Distributive justice
• Impairment
• Discrimination

Notes

^aFor example, a chain-smoking Orthodox Jew, forbidden to smoke on the Sabbath, may be addicted but rarely manifest or complain of the “classical” withdrawal symptoms after a full day of religious-based withdrawal.

^bIt is not clear that there would be any practical difference in treating a predisposition to addiction as an impairment. Because the addiction itself is treated as an impairment, a person who acquired it in the absence of such a predisposition would still be regarded as impaired, as there is no exception for “voluntary” impairments. And it is not clear that a predisposed individual would qualify as disabled in the absence of addiction, unless their predisposition was known (e.g., by genetic testing), and was itself a source of substantial limits on life activities. Of course, there could be adverse consequences for the individual who was screened as “predisposed,” such as the denial of employment or insurance.

^cThis view has gained the strongest following among people who are deaf, bolstered by their acquisition of a distinctive language and culture. Many deaf people do not regard themselves as having an impairment or disability at all, and regard medical interventions like cochlear implants as a form of cultural imperialism (Dolnick, 1993). They would treat deafness, like homosexuality, as a stigmatized variation, whose demedicalization is a critical step towards equality.

^dCritics of state-sponsored or -authorized gambling have made similar claims (Galston and Wasserman, 1996). Although both state lotteries and legalized casinos are more often promoted as revenue-generating than addiction-accommodating, they also raise issues about fairness and well-being. Their critics have pointed out that the former are profoundly regressive, with the poor being induced to pay more than they can afford for services for which they should have as a matter of right, and for tax reductions from which they do not benefit. Critics point out the similarly regressive impact of casino gambling, both in the disproportionate number of poor people who frequent casinos and in the disproportionate impact of their inevitable gambling losses on themselves and their families.

^eThe ADA does require that employers provide “otherwise qualified” practicing alcoholics “reasonable accommodation,” unless (a bit redundantly), such accommodation would pose an “undue hardship” on the employer (ADA Title I, sec. 101 (9)). While I am not aware of any case law on the subject, I suspect that such accommodation would include not firing an alcoholic employee for tardiness due to occasional off-duty benders, and not sending him home just because he stank of gin. The ADA's exception for “direct threats” to safety (ADA Title I, sec 101 (10)) sharply limits the accommodations that need to be made for any job posing safety risks, but in this postindustrial era, most jobs do not.

^fAs we become more discriminating about the goodness of various kinds of food, we may become differentially tolerant of the hunger for them, and of illegal acts committed to satisfy that hunger. A “junk food addict” who steals a bag of Doritos may expect less sympathetic treatment than a “food addict” (a label we would hesitate to apply) who steals a loaf of (whole-grain) bread to satisfy a craving of equal intensity.

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David Wasserman

David Wasserman, B.A. (Philosophy), Yale University; M.A. (Psychology), University of North Carolina; J.D., University of Michigan, is a research scholar at the Institute for Philosophy and Public Policy in the University of Maryland's School of Public Affairs. He has written about the moral underpinnings of criminal law and legal practice, the concept of discrimination, and issues in procedural and distributive justice. His present research focuses on ethical and policy issues in disability, health care, reproduction, and genetic technology. In addition to numerous articles and book chapters, he has published A Sword For the Convicted: Representing Indigent Defendants on Appeal (Greenwood, 1990). He has coauthored Disability, Difference, Discrimination with Anita Silvers and Mary Mahowald (Rowman and Littlefield, 1998), and coedited Genetics and Criminal Behavior, with Robert Wachbroit (Cambridge, 2001).