Demons: Our Changing Attitudes to Alcohol Tobacco & Drugs

Citation

Ian Wardle (2015), "Demons: Our Changing Attitudes to Alcohol Tobacco & Drugs", Drugs and Alcohol Today, Vol. 15 No. 2, pp. 121-122. https://doi.org/10.1108/DAT-03-2015-0009

The basic claim presented by Professor Berridge is straightforward. In the mid-nineteenth century, opium, tobacco and alcohol were broadly acceptable, and embedded in our social, economic and everyday cultures. From this convergent state, each drug subsequently became problematized and demonized: we entered a long period where our social responses to illegal substances, tobacco and alcohol diverged. In the late twentieth and early twenty-first century “there have been signs that all are now becoming ‘drugs’. The matrix of factors which drew them apart in the early twentieth century seems to be operating to draw them closer together”.

Berridge’s account is complex and political. It does not avoid the ideological role that substances have played over the past 150 years; neither is she reluctant to examine the ever-present influence of vested interests. The role of social movements is given real prominence in her descriptions of the nineteenth century Temperance Movement and the twentieth century movement to restrict the impact of tobacco smoking.

Her final chapters examine how we have recently embarked on a series of repositionings and fresh approaches which together point to re-convergences in the way we approach drugs, alcohol and tobacco. These chapters demonstrate to the reader that existing knowledge is being added to and enriched at the same time as understanding is being fundamentally rewired. They repay several readings: each strand developed throughout the narrative is drawn out and simultaneously entwined with the others.

Professor Berridge shows how the emergence of the new public health, with its population-wide approaches, was decisive in the post war “deculturation” of smoking. This epidemiological approach informed and shaped treatment and policy responses to alcohol and drugs. In the alcohol field, Berridge describes the impact of epidemiological approaches and the emergence of psychology, resulting from the 1970s international expert collaborations. These new directions were facilitated by the fashioning of “dependence” as the condition-to-be-studied, rather than the more biological and physical notion of addiction.

The drug field adjusted its condition-to-be-studied as it moved from addiction to dependence to problem use, a term advanced in the ACMD’s 1982 Treatment and Rehabilitation report. The report fashioned the notion of problem drug use in order to cement closer inter-disciplinary and inter-agency responses to the population-wide threat posed by the new heroin users. By the end of this decade the full impact of a population-wide harm-reduction approach was realized by the drugs field as it responded to the real danger of an HIV/AIDS epidemic.

Throughout this period the anti-smoking lobby acquired a harm-reduction dimension through its gradual acceptance of a treatment focus. Its embrace of nicotine replacement augmented its previous marketing and promotion of abstinence-oriented behaviour change as it became apparent that the notion of addiction was of real value in tackling smoking.

In the 1990s, new approaches in psychopharmacology “brought the substances together, not least through its powerful visual representations of the addicted brain”. The alliance of neuroscience and psychopharmacology has begun to influence political and policy approaches to problem drug and alcohol behaviours. Berridge describes how the Recovery Movement has helped facilitate a realignment around a rehabilitated concept of addiction: addiction has re-emerged as the condition-to-be-understood from its new concern with tobacco smoking.

“Demons” is the most authoritative social, political and cultural account we have of the complex interrelationship of drugs, alcohol and tobacco. Reading and digesting Berridge’s narrative leads us to abandon narrow analyses based on a substance’s legal status and an interpretation of the history of our field as the onward march of science. Virginia Berridge shows us how “ideology and evidence always march in step”. For all these reasons, Demons is the most accomplished and sophisticated historical and contemporary account we have; it is also the most subversive.