Addiction and Dependence
(See: Drugs in American Society, 5th, 6th, 7th and 8th editions, Erich Goode, McGraw-Hill, 1999/2005/2008/2012. Chapter 1)

Who and What DO we want to talk about?? (the word "addict")

Addiction and Your 'Jeans' (see also)(YouTube)

Bio-Medical

Basic Issues:

• Ideology
• Reductionism
• Science and Politics

They build their argument on:

Wikler's Two Stage Model

• Acquisition: Novice begins and continues a potentially compulsive activity because of pleasurable sensations. Environment becomes a cue (S-R). The body adapts, tolerance. Users need more of the drug to produce the sought after experience
• Maintenance: Pleasure is no longer the motivation. Continuation alleviates despair and discomfort. User is at a "break-even" level.

Is the Usefulness of the Concept of (drug) Addiction increased by defining it as Pharma-neuro-physiology vs. Drug using behavior?

Values, Ideology and Objectivity

• Compulsion
• Inadequacies
• Addicts are characterized as "weak"

Reductionist Pharmacology:

• Enzymatic changes take place impacting the rate at which neurotransmission occur. Higher dose levels of a drug are needed (tolerance).
• After stopping the use of the drug, enzyme levels slowly change, but there is a limitation to the body's ability to 'revive' old levels of activity.

Genetics, Inheritance and Enzymes

"The (inherited) enzymes' dysfunctional response to the addict's chosen drug is at the core of the concept of inherited addictive disease"

• Milkman and Sunderwirth: "Pick your parents carefully."
• Keel: What happened to understanding social behavior?

Yet, Milkman and Sunderwirth:

"...compulsive behavior problems..involve(s) the concepts of personal responsibility (the behaviors are self-induced); biochemical effects (the body's neurotransmission changes); and social reactions (society absorbs the costs and consequences of problem behaviors)."

Characteristics of "addicts" for Milkman and Sunderwirth:

• Low self-regard
• Chronic absence of good feelings about oneself
• Dependence on mood-changing activity
• Inability to accept scientific understanding of drug use (not mind expansion, but "mucking up of natural brain functions").
• Resistance and/or refusal to engage in self-criticism
• Risk taking: ignore own "inadequacy by temporarily surrendering to something outside of the self."
• Escapism
• Underlying fear of helplessness
• Issue: Inadequate Personality Theory

"Beacons of Compulsion"

Based on histories of drug "abusers" (vs. Users?)

"The key that opens the doorway to excess for the preaddict is the good feeling that he or she learns to create..."

"Incipient addicts usually experience behavioral complusion and loss of control before ever ingesting a psychoactive substance."

"We repeatedly pursue three avenues of experience as antidotes for psychic pain."

"People do not become addicted to drugs or mood-altering activities as such, but rather to the satiation, arousal, or fantasy experiences that can be achieved through them."

(I thought they said addiction was an inherited disease?)

Social Factors???

• Escapist activities (computer games)
• Advertising (indulgence)
• Parental reinforcement ("two year old having a taste of beer")
• Peer influence (conformity vs. individuality?)
• Deviant labels (stigma)

(given a rather short mention)

Keel's interpretation, based on elements of Goode's presentation:

Such broad ranging conceptualization and ideological biases (natural vs. unnatural realities) becomes meaningless. Essentially ignores the Social: Meanings, Definitions and Consequences of social behaviors. Assumes that if biological correlates to social behavior can be found, then the biological "causes" the social. Circularity in reasoning abounds: Behavior produces neuro-biological changes; the neuro-biological changes then become the source of further behavior which becomes defined as problematic because of social constructed conceptualizations of Normalness and Naturalness. Also, the crux of the argument rests on a notion of an inadequate personality without ever presenting a clear image of or understanding of the "Self."

Virtual Handouts on Addiction

Going Back to Rebuild a Sociological Understanding of Addiction

Goode's Classic Definition:

• Based on opiates
• Withdrawal
• Use sufficient quantity over a sufficient time and stop
• Knowledge doesn't matter
• Biological and CNS compensation

Withdrawal Symptoms

• chills
• fever
• diarrhea
• muscle cramps
• nausea
• aches and pains

The above definition is rooted in the concept of the Addictive Triad

• Tolerance
• Morbid Craving
• Withdrawal

And , this may be a bit problematic, too! So, we'll keep trying:

Alfred Lindesmith: Sociological Definition (1938)

• Knowledge of the withdrawal symptoms being caused by absence of the drug.
• Conscious use of the drug to avoid or suppress the withdrawal symptoms.
• Many addicts do not know what is wrong with them the first time they experience withdrawal: 1938 vs. 1995?

Addict:

• One who knowingly uses a drug for "maintenance"

Addiction:

"A process which goes on, on the level of 'significant symbols'-- it is, in other words, peculiar to man living in organized society in communication with his fellows." (Lindesmith)

Reinforcement Theories of Addiction (closely related)

The relative "purity" of Lindesmith's sociological definition has become muddled by the more recent concept:

Dependence

• A concept created to deal with drugs and drug use which do not produce the classic symptoms of withdrawal (circa 1950)
• Goode: Attempt to stigmatize other drugs
• Physical and Psychological Dependence
• DSM IV: Substance Abuse and Dependence Diagnostic Criteria

Problems of Mind/Body Dualism??

1. Not all heroin users are physically addicted.
2. Most users who go through withdrawal and treatment return to heroin use (9 out of 10 in 2 years).
3. Non addicting drugs are used in the same way as classically addicting drugs.
4. Cocaine and animal studies.
• Use cocaine rather than food
• Keep pressing the bar repeatedly even after drug ceases to be administered
• Develop stable pattern of heroin use but erratic with cocaine (use till die- 90%)
5. Biological Determinism
6. "Addiction is not a Disease of the Brain," Alva Noé, NPR

Ray and Ksir (1990)

"Psychological dependence based on reinforcement is apparently the real driving force even behind narcotic addiction."

The Phenomenology of Addiction

(from On Drugs, by David Lenson, University of Minnesota Press, 1995)

Note: I'm still trying to organize my thoughts on this book, but I find it extremely insightful, so for now I'd like to share a few lines from the book. I'll discuss them in class.

Drugs and Drug Use constitute a threat to "straight consciousness" (consumerism):

• Impedes "downloading" (socialization) and memory.
• "Turns a commodity into a state of mind rather than vice versa"
• "Circumnavigating civil law, and creating a de facto political opposition." (this was selectively quoted from page 30)

Addiction is about Time!

• A reordering
• A movement from being caught up in the flow of time, to grasping it in discrete, repetitive moments Therapy often involves: "..(a) third scheme, what is cultivated is a kind of contemplation without pleasure, a passivity in relation to temporal passage. Alcoholics Anonymous slogans like "One Day at a Time" and "Easy Does It" illustrate this." (page 34)
• The rhythmic patterns of daily breaks are the essence of "desire."
• "Cigarettes become the commas of daily life..." (page 37)

Teenagers, Cigarettes, and Addiction

• "Horizontal time or chronos dominates teenage consciousness in an inexorable progression of minutes and hours."
• "Cigarette smoking is imagined as filling the long and brutally dull day with an endless succession of happy occasions"
• "...it is clear that the only way to combat the beginning of cigarette addiction is to make young people's lives less boring, and since that would require nothing less than a social revolution, it is hard to imagine that cigarette smoking will ever be eradicated." (pages 41-42)
• It's not the drug. It's the "process" that is significant. The way we see and define our world. Chronic drug use suggests a "Way of Being" (a Way that "goes against the grain" of conforming society), not just a state reducible to neuro-electric/bio-chemical connections.

Alcohol, Addiction, and Time

• "Almost all alcoholics have a certain hour of the day after which it is permissible to begin drinking..."
• "Time is contiually reorganized for the drinker as the habit deepens."
• From Jack London's John Barleycorn: "Thereafter, whenever I was in a hurry, I ordered double cocktails. It saved time."
• "Prohibitionists often made their arguments against alcohol in temporal terms: husbands stopping for drinks after work were late getting home.....Since repeal, bar and liquor store hours have generally been closely regulated..."
• "When one drinks all the time, that relativity is lost, and the drinker is 'bottoming out.'" (pages 43-44)

Addiction, Recovery, and the War on Drugs

• "A person addicted to any drug may very well come to value the organizational aspect of the habit."
• "...the nicotine patch...is the first antismoking device to address the question of time in addiction....It allows the user to concentrate on learning to live with an altered sense of time before he or she has to learn to live without the drug."
• The addict (whatever the drug) becomes the "other," living within a different "time" and supported by a community of others.
• "This otherness has been eagerly exploited by the generals in the War on Drugs, who have often linked users to other categories of otherness in race, sexuality, and class." (see also, Thomas Szaz)
• "...regardless of the direction the recovering addict goes, the time of addiction remains in a particular and self-contained precinct all its own, so that it is impossible to forget."
• "The drug-seeking behavior seems to totally independent of the presence of tolerance or physical withdrawal" (quoted from Solomon Snyder. )
• "To overcome addiction completely would mean at least partial amnesia,..."
• "If the rhythm of supply were matched to the rhythm of an addicts desire, servicing the habit would not require all of life's energy,.....(as with tobacco until recently)...since the social problem of addiction lies not so much in drugs as in the lack of them." (pages 44-50)
• "..it may appear... that an addict is 'out of control' ..., in fact the management of a drug habit confers on its owner at least an illusion of control."(pages 44-50) (i.e. whose perspective do we accept, the user's, the researcher's, or the counselor's?  And, why?)
• "The only recognized remedy for addiction, then, is to acknowledge that everything is out of control, including oneself, and to become passive and quiescent." (pages 44-50)

The Myth of Addiction by John Booth Davies

Drug Use and Context
The evidence from studies of the attributional nature of addiction implies that the meaning, experience and implications of using mind-altering substances vary according to context. In most of the experimental and quasi-experimental studies reviewed in previous chapters, the level of contextual variation achieved was usually only a trivial representation of the possible larger contexts for drug use; for example, a different style of interviewer, or a different label on a questionnaire. In the real world, these simple differentiations are represented by major structural components of the legal, medical and social systems within which drug use and misuse take place. Within a given context, the reality of drug taking assumes a particular form or 'social reality' (Cohen 1990). Change the context, and the reality also changes.

Consequently, a society has the capacity to create a drug problem in whatever image it wishes. Surrounding drug use by tougher legislation, longer and more frequent prison sentences (see for example Haw 1988), unhelpful health messages based on fear arousal (see Davies and Coggans 1991 op cit) and alarm and outrage in the media (see Royal College of Psychiatrists Report 1987 op cit) creates a system characterised by fear, moral censure, crime, and an escalating black economy. Within such a system, particular forms of explanation have survival value. Attribution studies of drug users show, in a microcosm, how such a context produces a form of 'addicted explanation' which is inextricably intertwined with that context. The story does not stop there, however. Attributional research shows how forms of explanation can be related to future behaviour and expectancies. Consequently, having created the circumstances within which a particular form of explanation is adaptive, we can reasonably expect consequences to flow from that form of explanation. Since a climate has been created, with respect to drug problems, within which explanations that remove personal responsibility are strategically the best, we would expect that services might be provided on those terms; and we could anticipate that users would then require to present themselves to agencies in the same terms in order to receive whatever benefit was to be had.

More specifically from Goode:

1. Psychological and Physiological Dependence are separate, independent and overlapping phenomena
2. Substances vary in potential for causing either dependency. For psychological dependency (read chronic, consistent use), Reinforcement is a key (understand both positive and negative reinforcement).
3. Psychological dependence exists along a continuum. Physiological dependence is either/or.
4. Problem of "immediate sensuous appeal" versus the need for learning or other cognitive processes.
5. Route of administration (cultural norms) is related to number four.
6. Individuals vary in propensity to both psychological and physiological dependency

Issue, perhaps==>

Behavioral and psychological dependence.

• Psychological dependence: potential and actuality--a continuum of drug seeking behavior and desire.
• Behavioral dependence: only actuality
• Versus "Addiction"  as an either/or phenonmenon: It (like so many things) refers to a continuum of behavior and physiological/psychological states.

Or, maybe it's just all in our heads.

See: "Through a Blue Lens," a 1999 film on the streets in Vancouver, BC by Veronivca Alice Mannix

See, "The Discovery of Addiction: Changing Conceptions of Habitual Drunkeness in America."

From the conclusion:

The invention of the concept of addiction, or the discovery of the phenomenon of addiction, at the end of the 18th and beginning of the 19th century, can be best understood not as an independent medical or scientific discovery, but as part of a transformation in social thought grounded in fundamental changes in social life--in the structure of society. For those interested in criticizing and transcending the addiction model of drug use, it is important to understand that the medical model has much deeper roots than has previously been thought. A.A., and Jellinek's and Keller's formulations are only the most recent articulations of much older ideas. Further, the structural and ideological conditions which made addiction a "reasonable" way to interpret behavior in the l9th century have not disappeared in the 20th: Many people still face the problem of controlling their own "compulsive" behavior. The proliferation of "Anonymous" groups, based on the A.A. format, is testimony to the continued effectiveness of such organizational methods of helping people control themselves. In all cases, the focus is on the interaction between the individual and the deviant activity (drinking, eating, smoking, gambling) and with helping the individual to stop being deviant.

On the other hand, there is the beginning of what I would call a "postaddiction" model of drug and alcohol problems emerging --based in part on developing critiques of the medical model of deviance in general. A new formulation of drug and alcohol problems does not look primarily at the interaction between individual and drug, but at the relationship between individual and social environment. Deviance, therefore, is not simply defined as an issue of individual control and responsibility, but can be seen as a social and structural process. Indeed, exactly who or what is deviant can now be problematic. In part, the rise of a new popular and scientific "gaze" is rooted, as the old one was, in changes in the organization of daily life. The different conditions facing people in the 20th century, in particular the obviousness of giant organizations and of the degree of human interdependence, begin to make it possible to see the "social" nature of what had formerly been viewed as "individual" problems.

(Levine, Harry G. "The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America." Journal of Studies on Alcohol 15 (1979):493-506.) (another version)

Is the addiction doctor the voodoo priest of Western man? by Peter Cohen:

The addiction doctor is the voodoo priest of Western man
The concept of 'addiction' does a great deal for us. It re-establishes our world view. Time after time, the validity of our theories of the individual is established, with each perception of an 'addict'[13] or the establishment of the 'addictive' power of a substance. It grounds our individualistic world view in the construction of 'evidence' about loss of control. Just as it is impossible to argue the myth of Spirit power with any person living in a culture of voodoo causation, it is impossible to argue that 'addiction' is a myth with any lay person or any doctor in Liverpool or Osaka. Modern man needs the concept of 'addiction', and its evils, as Mediaeval men needed the devil or the heretic. Both — the heretic, the addict — are the different sides of the singularly important same coin (God is good, the individual can control his or herself). This is why the concept of 'addiction' in our western industrial culture is universally shared within the cultural language of the individual. It is as deeply religious as it is data proof because its function is to manage our fears about how much 'we are in control'.

We have chosen some drugs to be supremely undermining of our 'self control' (but not some other drugs, or car driving, power, working, ambition, or looking at the stars). I do not understand why. It might be that their foreign origin helped to create the necessary emotions of alienation and fear. We have a need to constantly see new drugs as even more powerful, even more threatening to our self-steering powers when the old drugs seem to lose their teeth. Or, we imbue new powers into old drugs, as soon as the old drugs seem to become tame and not even evil any more (like marijuana in the United States of America). This is what underlies the drug scares that continue to appear in our field of vision, certain like the faces of the moon.[14]

Related Ideas from the work of Stanton Peele

• The Meaning of Addiction
• The Implications and Limitations of Genetic Models of Alcoholism and Other Addictions

Back to Drug Use as a Social Problem

Why people use drugs.

URL: http://www.umsl.edu/~keelr/180/addict.html
Owner: Robert O. Keel rok@umsl.edu
References and Credits for this Page of Notes
Last Updated: Monday, June 25, 2012 10:52 AM