Addiction

In his revealing book “The Urge: Our History of Addiction”, author and doctor Carl Erik Fisher states addiction is not a purely medical or scientific issue, but rather a culturally contingent function of unprocessed pain, “a brain disease, a spiritual malady, the romantic mark of artistic sensibility, a badge of revolution against a sick society, and all of these things at once” (2022, p. xiv).

Fisher traces addiction’s early roots with alcohol and drugs such as morphine through and including the nineteenth-century Temperance movement, twentieth-century Prohibition, Alcoholics Anonymous, and the War on Drugs, up to the current Opioid epidemic. The social stigma attached to addiction continues to be the biggest hurdle to a compassionate response in its treatment, where sufferers are seen as morally corrupt people often with a genetic predisposition to the addictive effects of various substances (2022, p. 124).

The early twentieth-century Harrison Act in the United States led to hard enforcement through regulation and a corresponding increased use of harder drugs, which themselves fell both into categories of “narcotics” associated with minorities and the poor, and into regulated “medicines” which often included prescribed versions of the same substances for consumption by the rest of society. The pejorative moniker “junkie” ascribed to destitute urban addicts who scoured junkyards for scrap metal in order to purchase street drugs, worked both on this literal level, and as a reference to how “respectable” society viewed them as human trash (2022, p. 145).

The pharmacologizing of psychiatry, which appeared to have “cracked the biological code of mental illness” with a growing panoply of medications, changed its scientific model from electrical neurotransmission, to efforts at altering chemical neurotransmission with pills that could ostensibly provide the solution to a wide range of mental health issues (2022, p. 234). In terms of drug tolerance, can the numbing effect of medicines quell physical and mental pain over the longer term, and how does this relate to addiction?

Only recently has the study of addiction been willing to consider whether behavioural adaptations, including to power, sex, eating, exercise, gambling, and the internet in general, qualify as falling within its sphere. Critics of this broad-brush view claim that over-pathologizing behavioural addictions can wind up adversely classifying them as mental disorders “merely because we like doing them a lot and miss them a lot when we stop” (2022, p. 117).

Certain approaches of addiction treatment favour abstinence, while newer research suggests “too rigid a focus on abstinence can cause an ‘abstinence violation effect’ wherein resuming substance use after a period of self-imposed abstinence, those who experience guilt, shame, and hopelessness are more likely to return to harmful use” (2022, p. 249).

In a report titled “A Hole In The Head: Can a Brain Implant Treat Drug Addiction?” (September 2022), author Zachary Siegel examines the implications of a surgical technique originally developed to treat chronic pain known as Deep Brain Stimulation (DBS) in addiction treatment. He observes that 6-inch long ‘metal chopsticks’ inserted through a nickel-sized skull hole and into a patient’s nucleus accumbens can deliver continuous electrical impulses which in theory give people with addictions more control over their impulses. After reporting on this research, Siegel concludes it is not a panacea, and that “Addiction might be more a symptom than a disease, a powerful compulsion generated by a matrix of pain and conflict within us” (September 2022, p. 32). Carl Erik Fisher echoes this sentiment in the closing words of his book:

Addiction is profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering. If addiction is part of humanity, then, it is not a problem to solve. We will not end addiction, but we must find ways of working with it: ways that are sometimes gentle, and sometimes vigorous, but never warlike, because it is futile to wage a war on our own nature” (2022, p. 300).


Fisher, C. E. (2022) “The Urge, Our History of Addiction”. Canada: Allen Lane – Penguin Random House Canada

Siegel, Z. (September 2022), “A Hole In The Head: Can A Brain Implant Treat Addiction?” in Harper’s Magazine, Volume 345, Number 2068 (pp. 25 – 32). New York, United States: John R. MacArthur / Harpers.org

Alienation

According to Carl Erik Fisher in his book “The Urge: Our History of Addiction” (2022), despite evidence that North American Native populations used drugs and alcohol prior to European contact, they did not experience any apparent addictive harms until after they had suffered the schismogenetic effects of war, disease, poverty, and forced relocation. The European colonists and traders “swapped whiskey for crushing debt and mortgages on Native land” in efforts to pacify and tie Natives to the new economy (p. 34).

Psychologist Bruce K. Alexander’sDislocation Theory of Addiction” (December 2010) states that the fundamental cause of addiction is not the biological effects of a broad swath of substances and destructive behaviours themselves, nor an inherent vulnerability in particular individuals, but rather, in Fisher’s paraphrasing, “society’s wounds” (2022, p. 37). Dislocation can refer to the effects of being torn from culture and society, the loss of freedom and sustaining connections between individuals and their families, or the loss of opportunity for self-determination and expression, and wherein addiction is defined as a means of adapting to the increasingly onerous and dominant nature of modern life. Social fragmentation results from these adaptations as having become excessive in many individuals. Not surprisingly, the compulsive drug use observed and reported in research on animals, including Alexander et. al’s “Rat Park”, was itself demonstrated to be an artifact of “the radically isolated conditions of the standard experimental situation” (July 2014).

The so-called Official View of Addiction drawing from nineteenth-century moral and medical perspectives sees it as a genetically-predisposed incurable disease of “deviant individuals within otherwise well-functioning societies” (2014). The problem with this view, according to Alexander, apart from stigmatizing addiction, is its apparent unassailability due to the force of rhetorical presentations and their corresponding shaping of popular opinion, notably in the late twentieth-century War on Drugs, as well as scientific community entrenchment including the widespread identification with hi-tech neuroscience, all of which continue to largely undergird addiction criminalization, policy, and treatment.

In an essay titled “Man neither Free nor Responsible” (1958), philosopher John Hospers uses examples of criminal activity and the legal notion of a guilty mind to state that maladaptive behaviour more generally can have deeper roots in trauma, as it is often “brought about by unconscious conflicts developed in infancy” of which the individual had no control or perhaps even knowledge (1958, p. 292).

Eminent sociologist Émile Durkheim refers to alienation as “anomie”; “the social breakdown of norms and values resulting in an existential lack of connection to meaning and purpose. Both this sense of dislocation and the actions of addiction supply industries, some scholars argue, are the core drivers of today’s opioid epidemic” (2022, p. 38).


Alexander, B. K. (December 2010), “Dislocation Theory of Addiction”, Simon Fraser University, Canada, [HTML document] retrieved from https://www.brucekalexander.com/articles-speeches/dislocation-theory-addiction/250-change-of-venue-3

Alexander, B. K. (July 2014), “The Rise and Fall of the Official View of Addiction”, Simon Fraser University, Canada, [HTML document] retrieved from https://www.brucekalexander.com/articles-speeches/277-rise-and-fall-of-the-official-view-of-addiction-6

Fisher, C. E. (2022) “The Urge: Our History of Addiction“. Canada: Allen Lane – Penguin Random House Canada

Hospers, J. (1958) “Man Neither Free Nor Responsible” in Hook, S. (Ed.), Determinism and Freedom in the Age of Modern Science (1958), reprinted in Minton, A. J. & Shipka, T. A. (Eds.), Philosophy: Paradox and Discovery Third Edition (1990), (pp. 292 – 299). New York, United States: McGraw-Hill.