Saturday, April 14, 2012

Sociology and the Addiction Kaleidoscope

Snippets from the draft introduction to "Critical Perspectives on Addiction" for the series, Advances in Medical Sociology.

photo by Lucy Nieto on Flickr
“Addiction” is increasingly being used to explain all manner of human behavior.  Just a few recent headlines from the New York Times reveal how varied and expansive our ideas about addiction have become. 

“When is gambling an addiction?”
“A wave of crime and addiction with the medicine cabinet to blame”
“Miss G.: a case of internet addiction”
“When tanning turns into addiction”
“In the cave: philosophy and addiction”
“Is sex addiction an excuse?”
“Can food be as addictive as a drug?”

Although addiction appears to be becoming a dominant interpretive framework, what we mean by “addiction” if far from clear.  Sociologists have characterized attempts to classify and define “addiction” variously as a “shifting kaleidoscope” (Room, 1997), “taxonomic unruliness” (Keane, 2002), and “conceptual acrobatics” (Reinerman, 2005).  Lindesmith, widely considered to be the founder of the sociology of addiction wrote in 1938: “The problem of drug addiction has been an important one in this country for several decades and has proved to be a difficult one to handle from a theoretical as well as from a therapeutic standpoint (593).”

Unfortunately, it appears that neither the passage of time nor the advent of new technologies and scientific frameworks have done much to clarify theories of addiction.  In 1980, the National Institute of Medicine published a monograph that included 43 separate theories of addiction from a range of disciplines.  Ever malleable, addiction takes on the latest scientific theories of the day; just in the past 50 years it has been described as a metabolic, genetic, and, most recently, a neuroscientific problem.  As this volume will demonstrate, the malleability and chameleon-like qualities of addiction give it a conceptual elasticity that allows it to be deployed strategically to not only explain an ever-widening array of behavior, but also as a targeted tool of social coercion and control.

From a sociological standpoint, addiction is important because it engages a number of core theoretical issues – each of which is taken up in this volume.  First, addiction– often defined by a loss of control -- troubles issues of structure, agency, and free will.  Second, drug use – or at least some drug use -- remains stigmatized and criminalized, and thus addiction plays an important role in our systems of social control and racial segregation.  Third, addiction, especially as its meaning has expanded, engages key questions about pleasure, rationality, and self-control in ways that reinforce new forms governance and neoliberal citizenship.  Fourth, there is an ongoing and vigorous debate over whether addiction exists purely as a cultural, social and representational phenomenon (a social construction) or has some “real,” material, or biological basis – a key tension in sociology more broadly.

Finally and related, addiction has long been understood as having both medical and moral component making it an especially interesting and important topic for a series on medical sociology. There has been no graceful arc from deviance to medicalization – from badness to sickness -- in the case of addiction.  Although the medical model of addiction has gained in prominence in the U.S. over the past thirty years, scholars have noted neither alcoholism (Appleton 1995; Valverde 1998) nor drug dependence (Smart 1984) fit easily into the medicalization model. The slippage between medicine and morality, a characteristic of many medicalized conditions, has been especially pronounced and problematic throughout the history of addiction and has contributed to the ambiguity in how we understand addiction and addicts.   This ambiguity plays out in real, materials ways that have shaped an often chaotic and inconsistent approach to drug policy, specifically, and response to addiction more broadly.

While the medical and the moral are often pitted against one another rhetorically, our responses to addiction often contains elements of both.  As May (2001) explains “clinical constructions of addiction still engage a set of moral questions” (386).  These moral questions are often directly built into addiction treatment programs, many of which have explicit crime control functions (Fox 1999) but rely on medical language to describe addiction. Medical and moral views of addiction have also increasingly blurred through criminal justice practices such as drug courts, where defendants with drug-related offenses are mandated to drug treatment (Tiger 2008).

Even when addiction is understood as a disease, because it is a disease that involves the “loss of control,” it often used to justify extreme forms and systems of coercion and social control. As Reinerman (2005) puts it:

[T]he disease concept sometimes serves as a human warrant for the right of access to services, but is also serves, paradoxically, as the key justification for punitive prohibition…. It is a weapon that helps justify – ‘for their own good’—the suspension of the Bill of Rights … and the mass incarceration of the powerless (317).

Indeed, even as disease models of addiction have gained traction, criminalized approaches to drug use have continued to play a large role in drug control policy, especially in the U.S.  The increasing criminalization of drug use over the past thirty years, as evidenced by lengthy mandatory sentences for drug convictions and dramatic increases in federal funding for the “War on Drugs,” has had a significant impact on the number of people incarcerated in the U.S., now exceeding 2,000,000 (Glaze and Palla 2004) and has become a firmly entrenched and powerful tool of racial control (Alexander, 2010).  Although Black Americans are no more likely than whites to use illicit drugs, they are for more likely to be incarcerated for drug offenses (Rich et al. 2011).  Black men in the U.S. are more likely to have been in prison than to have graduated from college or joined the military by middle age (Rich et al 2011). 

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