Further Reading

Why do you use 'addiction' in the title of your web site?

Dear Dr. Peele

I am a Swedish researcher working on an article about social work and drug abuse. My question concerns the concept "chemical dependance" which seems to be used to a very large extent in the US. I notice that you don't use it but speak of "addiction" instead. Does the usage of "chemical dependance" mean that you subscribe to a medical or disease model of drug abuse? Is the use of "addiction" instead a sign that you are more or less opposed to those models?

Bengt Svensson


Dear Bengt:

Good question! It must be strange trying to come to grips with these concepts in America, like trying to figure out our stance on needle exchange and family planning.

  1. The politically correct term in the U.S. today is "chemical dependence." It is the rubric under which hospital programs treat adolescents and others who have taken drugs (in addition to people with a wide range of alcohol problems) as though they have a disease. Thus, it is a more "scientific" sounding way to do what they've always done.
  2. The whole dependence concept, as I describe in detail in the first chapter of "The Meaning of Addiction" (see "Addiction as a cultural concept" at my Web Site), never held water, and was a shell game to move categories around to be able to say "We disapprove of certain drugs because they produce dependence" when actually people become dependent on different drugs (and other involvements) in ways we cannot legitimately distinguish pharmacologically.
  3. Griffith Edwards gets a separate booby prize for inventing and propagating the term "alcohol dependence," which has led people to propose, incorrectly, that objective categories outweigh subjective and cultural factors in the development and remission of drinking problems (see my "Why do controlled- drinking outcomes vary..." at my Web Site and "What Project MATCH actually found" in the Controversy section).
  4. But my use of addiction is still idiosyncratic, even (or especially) among people who actually are closest to my positions. They say, based on evidence like that in (1), (2), and (3), that the concept is useless. I couldn't disagree more. For one thing, most of those who have discarded the concept (particularly pharmacologists) have replaced it with dependence notions that are equally as preposterous as popular uses of the term addiction.
  5. Instead, I build on the strong meaning that addiction already has for most people, and for which we can describe a useful phenomenology (a pattern of action and feeling). That it is not at its heart a biological phenomenon and that perceptions of its etiology are badly screwed up, even by researchers labelled as addiction experts, is no reason to jettison a perfectly good term. In fact, I've built a career on it, and the need for my work shows no signs of flagging.

Best regards, Stanton


From: Dr. Jeffrey A. Schaler <JSCHALE@AMERICAN.EDU>
To: CD@MAELSTROM.STJOHNS.EDU

Stanton, sweetheart, you keep reifying addict, alcoholic, alcoholism, treatment, etc. Do you, in your heart of hearts, believe such animals exist? Do you disagree with Tom Szasz on this one?

Careful here. As Yoko Ono once sang, "I want the truth and nothing more."

Best,
Jeff


Jeff:

I disagree with you and some others who share some of my positions on this one. There is addiction -- it just isn't carved in stone by God, but emerges as a swirl of attitudes and cultural meanings. I mean, people feel and act in a way that fits the description "addicted." When people describe themselves as, subjectively feel, and act as though out of control, we can call that addiction. Only out of control has a lot to do with how you think about yourself, what you think addiction is, how you see the involvement driving you to lose control, and the cultural setting of all these concepts. When people seek treatment saying they are "out of control" or "addicted," do we try to persuade them they're nuts, or misinformed? Not usually. We work within their conception of addiction, broadened by our knowledge of its meaning.

Best, Stanton


After reading the discussion between Jeff and Stanton, I think there is only the apppearance of a disagreement and not a true philosophical divide. When Jeff says there is no "addiction", he actually says "There is no [medical disease] of addiction." He only objects to the medical connotations of addiction, not to the fact that some people use drugs and alcohol in unhealthy ways. When he says there can be no "treatment" for addiction, just add "medical" and his meaning is clear.

When Stanton talks about the "existence" of addiction, I believe he understands addiction as a bad habit. When he talks about "treatment" for addiction, he means creating an environment where the person has an easier time to change their pattern of behavior. Either way, both condemn the medical model, and its deterministic, reductionistic premises. The main disagreement is stems from perspective.

Jeff, (and Thomas Szasz) attempt to refute the claims of the mental health industry mainly on philosophical and ethical grounds. Only infrequently will references to the empirical literature be found. They can be considered total "heretics" because they reject the way common vocabulary of the mental health professional is used. Using that vocabulary only reinforces it, in their view.

Stanton, on the other hand, tries to beat the opponent at his own game. He makes numerous references to the empirical literature and shows how the studies are either flawed or support an opposite interpretation of the data. He makes comments about various "treatment" approaches, not because he thinks addiction is a disease, but because he thinks it is possible for one person to help another person get over a bad habit. The term treatment is used only for convenience and easy communication.

I think Szasz's (and Jeff's) strategy for calling mental illnesses and addictions "myths" while useful in the past, only obscures issues and areas of contention now. Strictly speaking, all mental disorder categories are constructs. Constructs do not exist. Therefore, it is silly to argue that constructs which do not exist are "myths." Constructs can only be thought of as more or less useful. When debating medical model proponents in the future, I think it might be more useful to take this approach, arguing that this model for understanding human behavior is not useful, and only leads to more problems and paradoxes. All of Szasz's arguments would be the same, but the catchy "Myth of Mental Illness" phrase would have to be used sparingly.

Robert Ryley