Ordinarily we don't suppose that people are to blame for their illnesses. That is, many diseases develop independently of what the sick person does or thinks. This is why the disease model of addiction, widely espoused in the therapeutic community, is so controversial. Common sense suggests that a person's choice to start using an addictive substance is often voluntary, and often made with the knowledge, either vague or specific, of the risks of getting hooked. Of course, some people may have a genetic predisposition to dependence, and some are placed in environments in which turning down that first drink or cigarette is nigh impossible, but nevertheless it's difficult to eliminate voluntary choice in our explanations of why individuals become addicts.

This question is now very much central to the current debate on how we should respond to the problem of addiction. Alan Leshner, director of the National Institute on Drug...

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