Summary of the impact

For several years, members of the Uehiro Centre for Practical Ethics have been engaged in research on the scope and limits of responsibility, with a particular focus on conditions that seem to subvert responsibility, such as addiction. This research has had a significant impact on public policy—most notably through Dr Hanna Pickard's invitation by the Department of Health and the Ministry of Justice to develop a module for prison staff training, but also through a report of the House of Lords Science and Technology Select Committee in which evidence given by Dr Bennett Foddy was cited and through a document prepared for the Technical Development Group of the World Health Organisation, in which work by Dr Bennett Foddy and Julian Savulescu was cited. The research has also generated active blog discussions with members of the public.

Underpinning research

For several years members of the Uehiro Centre for Practical Ethics have been engaged in research on the nature of responsibility, particularly in relation to conditions that seem to subvert it, such as addiction. They have sought to overturn a number of commonly held convictions about the scope and limits of human responsibility.

A 2006 article by Dr Bennett Foddy and Professor Julian Savulescu entitled `Addiction and Autonomy' challenges the commonsense view that the autonomy of drug addicts is somehow compromised when they are choosing whether or not to take their drug of addiction. The authors use both empirical and conceptual considerations to counter this view, arguing that an addictive desire is simply a very strong appetitive desire, on a par with hunger or thirst. This has practical repercussions for how far we are justified in protecting addicts by criminalizing the use of drugs. It also calls into question the idea that addiction is some kind of disease. This idea comes under further attack in a later joint article of theirs published in 2007, `Addiction is not an Affliction', and in Dr Foddy's 2011 article, `Addiction and its Sciences'. In the former, the authors argue that addiction is not a moral condition either, on the grounds that the most that can be said about it in evaluative terms is that addictive desires tend to be socially unacceptable for one reason or another. In a third joint article published in 2010, `A Liberal Account of Addiction', they identify a normative bias in the commonsense view of addiction that they oppose.

Given the subsumption of addictive desires under appetitive desires, it is natural to ask what potential there is for other appetitive desires to become addictive. In `Addicted to Food, Hungry for Drugs', published in 2011, Dr Foddy identifies the desire for food as a case in point. He argues that many cases of obesity have food addiction at their foundation. He concludes his article by assessing some of the implications that his argument has for policy and ethics.

In Dr Hanna Pickard's work on addiction, exemplified in her two articles `The Instrumental Rationality of Addiction' and `The Purpose in Chronic Addiction', published in 2011 and 2012 respectively, she takes up some related issues about addictive drug use. She too combats the view of addiction as a disease. One of her foci is the purpose served by drug use, which is typically to alleviate severe psychological distress. This helps her to characterize drug use as a chosen means to a rationally desired end. Dr Pickard concludes her article by drawing some lessons for future research and for effective treatment.

In `Responsibility Without Blame', published in 2011, Dr Pickard turns to some different and somewhat broader issues about the nature of responsibility. She argues that, in the case of many patients with harm-causing personality disorders, encouraging them to take responsibility for their actions is crucial to treating them, whereas blaming them is detrimental to doing so. This raises the question of how they can be held responsible without being blamed. Her answer is partly conceptual and partly practical. It involves a distinction between two sorts of blame: `detached' blame, in which judgements are directed at actions, and `affective' blame, in which emotive responses are directed at agents. It is only the latter, she argues, that is detrimental to treating these patients. But the latter can be avoided by focusing on the patients' past histories and coming to an empathetic understanding of the patients while still holding them responsible for what they have done.

Professor Savulescu has been the Director of the Oxford Uehiro Centre for Practical Ethics (sponsored by the Uehiro Foundation) since 2002. Dr Foddy has been a Research Fellow in the Centre, and also the Deputy Director of—and a Senior Research Fellow in—the Oxford Martin School's Institute for Science and Ethics since 2010. Dr Pickard has been a Research Fellow in the Centre since 2010.

References to the research

All publications listed above are peer-reviewed journals concerned with publishing work of internationally recognized quality.

Details of the impact

(i) Dr Pickard's Module for Prison Staff Training

In 2011, Dr Pickard was invited by the Department of Health and the Ministry of Justice to develop a training module based on her work on responsibility without blame. This was for the Knowledge and Understanding Framework (KUF) for Working Effectively with Personality Disorder in the Prison System, a joint NHS and National Offender Management Service (NOMS) initiative which, in the words of Guy Cross, the Mental Health Act Approvals Manager, is `to increase awareness of personality disorder and improve capacity of staff to work effectively and create more psychologically informed and rehabilitative environments within the prison system' <sup>[1]</sup>. Dr Pickard's contract was with NOMS, and her brief was to develop her work into training for prison staff <sup>[2]</sup>. After initially setting up some focus groups within prison and high-security hospital settings, she presented a proposal to the Department of Health and Ministry of Justice in 2012, and was invited to develop a module for prison staff training. In February 2013, she delivered a pilot of the module. Feedback from those who attended included the following comments: `[The training] was relevant and insightful.' `[It] gave practical help in how to address issues which staff will be able to practise.' `I will be more mindful of residents' background, why they may... behave in a certain way, [and]... how I respond to specific behaviours.' In March 2013, Dr Pickard delivered something similar for prison officers at HMP Gartree. Feedback from those who attended included the following comments: `[The training] expanded my understanding to a higher level.' `[It] has enhanced my understanding and I believe given me an extra tool to help explain to prisoners when I have to challenge them.' `[It] gave me insight into some of the offenders that I work with and how I engage with them... [I] will look at how I interact with prisoners and how I challenge them and react to them.' `[It] will help when discussing difficult prisoners to consider how not to blame them but get them to take responsibility.' Dr Pickard later worked on this material in preparation for further training of those who would eventually be doing the training. Guy Cross writes, `We expect the KUF Prison System training to be... rolled out nationally over the coming years... One of the potential values of Dr Pickard's training is its capacity to address directly the natural tendency to blame offenders for criminal and/or problematic behaviour that staff need to manage within the prison system, and the anti-rehabilitative effect that blame has'^[1].

(ii) Other Impacts on Public Policy

Dr Pickard's work on responsibility has attracted attention in other ways. In 2013, she was invited to become a member of the National Mental Health Development and Policy Innovation Group Initiative. This is a collaborative venture by the Department of Health, the Institute for Mental Health at the University of Nottingham, and the Centre for Mental Health, to create policy in connection with mental health. In 2013, Dr Pickard also spoke at the International Association of Forensic Psychotherapy Workshop on Treating Evil. Later in the same year, she spoke, at the invitation of the Governor, at the Grendon Annual Forum to around eighty officers, prisoners, and policy makers. The Governer subsequently invited her to write an article on responsibility without blame for the Prison Service Journal in light of how well her presentation had been received.

Dr Pickard's work has also received attention by those concerned with drug laws and clinicians. Her paper `The Purpose of Chronic Addiction' is cited as recommended reading by the Australian Drug Law Reform Foundation<sup>[i]</sup>, and her ideas are discussed in Mirror of Justice, a blog dedicated to the development of Catholic legal theory<sup>[ii]</sup>. Hilary Richards, a graduate student in the School of Social Work at Wayne State University, having consulted `The Purpose of Chronic Addiction' while finishing her clinical internship at a residential substance abuse treatment facility, wrote to her saying, `[This] outstanding article... has broadened my understanding and perspective on addiction, which I believe will improve my clinical approach in the field of substance abuse.'^[3]

In 2011, Dr Foddy was invited to participate in a seminar on `Ethics and Behaviour Change' in the House of Lords. His evidence was subsequently cited in a report of the House of Lords Science and Technology Select Committee, which stated, in the context of the citation, `Witnesses who gave evidence to us agreed that the behaviours which lead to obesity are a consequence of a number of interacting influences working at various levels... and involving social and environmental factors'^[iii]. In 2011, Dr Foddy also gave a talk at 'Develop Liverpool', a conference for videogame developers, on videogame addiction^[iv]. This talk was subsequently reported in the popular computer and video game magazine Edge and on the website of Videogamer.com, where there was an accompanying interview with Dr Foddy. Later there were two blog posts, in which participants discussed his findings and applied his analysis to their own experiences of video game addiction.

The research has also attracted the attention of international organisations concerned with addictions. In a background document for the third meeting of the Technical Development Group for the World Health Organization `Guidelines of Psychosocially Assisted Pharmacotherapy of Opioid Dependence', Adrian Carter cites Dr Foddy's and Professor Savulescu's article `Addiction and Autonomy' and adverts to the misleading picture of addicts as `internally coerced by an irresistible force' (p. 25)<sup>[v]</sup>. The Food Addiction Institute, an independent non-profit organisation whose mission is to support the healing of all food addicts, cites Dr Foddy's and Professor Savulescu's article `Addiction is not an Affliction' in its `Bibliography on the Science and Treatment of Food Addiction'<sup>[vi]</sup>. And an article in Psychiatric Times, a news resource aimed at clinicians, cites their article `A Liberal Account of Addiction' and discusses the idea that psychiatry is sometimes vitiated by a suspect normative element ^[vii].

(iii) Blog Discussions and Other Exposure for the Research

The research has also given rise to several active on-line blogs and discussion threads^[viii]. These include the `Conversation Blog', which to date has had 63 comments, 189 Facebook Likes and 64 tweets. Dr Simon Rippon, whilst a Fellow of the Uehiro Centre, further promoted this research on `Practical Ethics', where he initiated a debate on whether drug addiction is a lifestyle choice: this has so far had nearly 1700 views, of which over 1400 were unique. Further exposure for the research, helping to draw it to people's attention and thereby furthering its impact, has included the following: an on-line interview with Professor Savulescu and Professor Walter Sinnott-Armstrong, a Distinguished Fellow of the Uehiro Centre, by Nigel Warburton, on whether addiction is a disease, in 2010^[ix]; a keynote address by Dr Pickard to the Oxfordshire Friends and Family of Personality Disorder Conference on responsibility without blame, in 2010 (along with many talks that she has given both on this topic and on addiction to clinical groups and psychotherapy groups); an interview with Dr Pickard for the BBC radio programme `The Moral Maze' on sex addiction and the medicalization of misbehaviour, in 2011^[x]; and an article by Dr Foddy on designed addictions in Wired, in 2011^[xi].

Sources to corroborate the impact

Testimony

[1] Letter from Mental Health Act Approvals Manager.

[2]Corroboration on Dr Pickard's training pilot at HMP Gartree can be provided by the Clinical Lead of the Psychologically Informed Planned Environment Unit, HMP Gartree.

[3] Email from graduate student in the School of Social Work at Wayne State University.

Other Evidence Sources

[i] The recommended reading for the Australian Drug Law Reform Foundation is at:
http://adlrf.org.au/research/

[ii] The Mirror of Justice blog can be found at:
http://mirrorofjustice.blogs.com/mirrorofjustice/2012/09/responsibility-without-blame.html

[iii] The report of the House of Lords Science and Technology Select Committee, which cites the evidence of Dr Foddy at §7.4, can be found at:
http://www.parliament.uk/business/committees/committees-a-z/lords-select/science-and-technology-committee/news/behaviour-change-published/

[iv] The reports on Dr Foddy's talk at `Develop Liverpool' and the subsequent blogs can be found at:
http://www.edge-online.com/news/ethics-game-addiction/
http://www.videogamer.com/features/article/what_can_the_science_of_addiction_tell_us_about_gaming_2.html
http://muslimgamer.com/ethics-addiction-games-develop-conference/
http://addictoffiction.com/oxford-uni-on-game-addiction

[v] The document for the third meeting of the Technical Development Group for the World Health Organisation `Guidelines of Psychosocially Assisted Pharmacotherapy of Opioid Dependence' can be found at:
http--www.who.int-substance_abuse-activities-ethical_use_opioid_treatment.pdf

[vi] The Bibliography for the Food Addiction Institute can be found at:
http://foodaddictioninstitute.org/FAI-DOCS/Full-Bibliography.pdf

[vii] The article in the Psychiatric Times can be found at:
Must Mental Illness Be Uncommon - Psychiatric Times

[viii] Two examples of the blog contributions cited are:
http://theconversation.edu.au/a-moral-argument-against-the-war-on-drugs-6304
http://blog.practicalethics.ox.ac.uk/2012/02/is-drug-addiction-a-lifestyle-choice/

[ix] The podcast interview with Professor Savulescu and Professor Sinnott-Armstrong can be heard at:
http://virtualphilosopher.com/2010/05/addiction-nigel-warburton-interviews-walter-sinnottarmstrong-and-julian-savulescu.html

[x] The interview with Dr Pickard for `The Moral Maze' can be heard at:
http://www.bbc.co.uk/iplayer/episode/b00zf34d/Moral_Maze_The_Medicalisation_of_Misbehaviour/

[xi] Dr Foddy's article in Wired can be found at:
http://www.wired.co.uk/magazine/archive/2011/09/ideas-bank/bennett-foddy