Addiction Trajectories

Citation

Edward Day (2016), "Addiction Trajectories", Drugs and Alcohol Today, Vol. 16 No. 2, pp. 176-177. https://doi.org/10.1108/DAT-04-2015-0020

The concept of “addiction” both fascinates and disturbs, conveying as it does the idea of enslavement to a substance or behaviour, loss of control, and the undermining of the fundamental notion of free will. Any attempt to understand it requires attention to multiple domains – biological, social, medical, legal, cultural, political […] to name but a few. As a clinician and researcher I am fascinated by the frequent desire to simplify the issue, portraying it as a “black or white” problem. This book leaves no room for polarisation, providing a seemingly endless stream of different perspectives and nuances on well-established beliefs. Originating in presentations at a workshop on the anthropology of addiction held at McGill University in Canada, its ten chapters cover a range of substances or behaviours (opiates, alcohol, stimulants, gambling), in a variety of settings (communities, treatment centres, criminal justice agencies, the media). Each uses data collected in ethnographic or anthropological studies to contemplate an aspect of what it is to be addicted in a particular setting at a particular time. These have been connected by a convincing narrative linking them to the theme of movement in the form of a “trajectory”. The editors write: “every case reveals motion and change in how the concept of addiction has been used and defined, how it has been treated and how it is experienced”.

Many of the chapters occupy the space between neurobiology/pharmacology and alternative perspectives or approaches, illustrating that the potential gulf between them is not as large as is often imagined. Such is the richness of the historical and social material presented it is hard to do the content justice, but two related examples may help. First, a Russian study describes patients being given an injection (known as a “torpedo”) they are told will keep Disulfiram in their bloodstream for a year. What they actually receive is khimzashchita, a form of placebo therapy where doctors rely on elaborate rituals and mechanisms of suggestion. The technique is widely used – and highly contested – in Russia. It emerged from a style of reasoning specific to Soviet-era psychiatry “itself the product of contested Soviet politics over the knowledge of the mind and brain”. Disulfiram is utilised more as a behavioural treatment than a pharmacotherapy. This method does not encourage patients to see themselves as “alcoholic”, as is common in North America, but instead works by harnessing their pre-existing ideas, beliefs and affects to allow them to experience a change in behaviour (managing drinking binges) without a change in self.

In contrast, another, North American, chapter explores the interface between neurobiology and popular lay discourses on addiction. An episode of the Oprah Winfrey Show is described where research scientist Anna Rose Childress presented her work on the role of contextual cues that trigger craving, often without a person’s conscious awareness, and the search for pharmacotherapies to calm the brain and “bring things into a manageable range”. Despite being an eloquent and persuasive speaker utilising the full range of tools available to the scientist (including colourful and impressive neuroimaging pictures), Childress’ argument was drowned out by the lay therapeutic discourse of personal choice, responsibility and self-control, and by the confessional style favoured by Winfrey. The author highlights the humane efforts of scientists to portray addiction in a manner that reduces stigma, and concludes that “the pharmacological optimism” of neuroscientists may not simply be a measure of neurological determinism or reductionism, but rather a “respect for the complexities represented by relapse” that is significantly greater than that expressed by those who see addiction as a matter of choice and self-control. Such are the paradoxes present within this complex subject.

This book has much to offer clinicians, researchers and policy makers, reminding us of the evolving nature of the concept of addiction, its multifaceted explanations and implications, and above all the importance of open minds when considering its management.