The Epistemic Prerequisites of Reliable Abstinence in Addiction

The distinction between first- and secondorder ability in the philosophy of action enables new clarity in the discussion of behavioral control in addiction. Addiction involves automated patterns of thought and behavior that undermine the first-order ability to reliably abstain. However, addicts retain a second-order ability to reliably abstain if they remain able to learn the “epistemic prerequisites” of reliable abstinence, including addiction-specific metacognitive skills and cue-avoidance strategies. The second-order ability to reliably abstain depends to a significant extent on socio-economic situation and access to the right social resources. This “Epistemic Prerequisites Model” supports the view that addiction is a compulsion, and suggests that moral responsibility in addiction depends on factors relating to both orders of ability.