Abstract
•Addictive behavior may result in blameworthy moral and legal harms.•Blame for harmful behavior may contribute to addiction stigma.•Acceptance of determinism can mitigate blame and addiction stigma.•Mitigation of stigma can improve access to effective addiction treatment.•Determinism does not eliminate accountability for moral or legal harms.
Addictive behavior sometimes involves harmful moral transgressions for which the addicted individual may be blamed. However, blame may motivate addiction stigma, which has its own harmful consequences, including failures to provide or seek out treatment and recovery resources. Minimizing blame and stigma, while acknowledging the moral dimension of addictive behavior, thus recommends itself as a worthy public health objective. The disease and choice models of addiction both face difficulties in reducing stigma, the latter because harmful choices are considered culpable. By challenging the widely held libertarian conception of human agency, an explicitly deterministic understanding of the genesis and expression of addiction, including voluntary choices, can help keep reactive attitudes to wrongdoing in check. This will mitigate the perceived blameworthiness of addicted individuals, thus reducing stigma and increasing the chances of finding compassionate and effective care. Such an approach to addiction will recognize the need for moral accountability but not include punitive attitudes and policies justified by belief in libertarian agency.
