(Revised 23 December 2010)

Bruce K. Alexander, Professor Emeritus, Simon Fraser University

To the High Court in the Field of Addiction:

Herewith, I confess to the charge of attempted murder. My intended victim was – and is – the Official View of Addiction, sometimes known in the field by its alias, "The NIDA paradigm". The presentation below contains irrefutable evidence of my guilt. However, it also contains my plea to the High Court that any attempt to rid the world of the Official View of Addiction is justifiable and that its useful aspects can be preserved in a different framework.

I understand that a plea of justifiable homicide will require meticulous examination by the Court. The structure of my plea is as follows. I show that the word "addiction", which has a long history in the English and Latin languages, was kidnapped in the 19^th century by medical and moralistic interest groups, who gave it a new meaning. Their medical and moralistic approaches to defining and eliminating the problem of addiction failed abysmally. Despite obvious failure, their approaches have coalesced in recent decades as a doctrine which is, I submit, properly called the "Official View of Addiction." The Official View dominates discussion of addiction in the United States to this day. Although it is not as powerful elsewhere, it exerts its counterproductive influence in many other countries of the world.

My presentation shows that all six foundational elements of the Official View are untenable. Worst of all, the stultifying presence of the Official View stands in the way of a rigorous, scholarly examination of addiction. It therefore leaves the world subjected to a truly menacing addiction problem that has been rendered incomprehensible. I submit that, in cases like this, murder is a lesser evil than the continued existence of a pernicious Official View.

My presentation to the High Court is a revision of a speech initially given at an expert conference of the Social Trends Institute in Barcelona 15-17 April 2010 on the "Construction of New Realities in Medicine". It was next given, in much revised form, to an expert conference on "Addiction(s) – Social and Cerebral" sponsored by the European Neuroscience and Society Network in Helsinki, 8-11 September, 2010. A longer exposition of the ideas in this presentation can be found in my book, The Globalization of Addiction: A study in poverty of the Spirit. (paperback edition, 2010, Oxford University Press).

Respectfully Submitted to the High Court,

Bruce K. Alexander

The world faces a deadly serious problem of addiction to drugs and countless other habits and pursuits. Bringing this problem under control will require a better conceptualization of addiction than the one that is currently being globally promulgated by official sources.

This presentation approaches the task of re-conceptualization historically. It first describes the traditional way of using the English word "addiction" prior to the 19^th century, which was neither medical, nor moral, nor linked to drugs in any strong way. Then it describes the 19^th century construction of a simultaneously medical and moral definition of alcohol and drug addiction. It shows that the medical/moral/drug definition eventually crowded out the traditional definition and evolved into what I will call an "Official View"of addiction for much of the world (sometimes also called the "Official Model" href="#_edn1">[1] or, recently, the "NIDA paradigm"[2]). Then it shows that the Official View provides neither an adequate basis for understanding addiction nor a source of effective interventions.

The latter portion of the presentation describes a completely different perspective, which I call the "Dislocation Theory" of addiction. Dislocation Theory is built on the traditional definition of "addiction" rather than the medical/moral/drug definition. Although Dislocation Theory is not new, it may startle some readers, because it repudiates foundational elements of the Official View that have come to seem unquestionable because of their official support and endless repetition on the mainstream media.

Dislocation Theory draws attention to social causes of addiction that can only be remedied through deep changes in the status quo. The fact that the Official View does not threaten the status quo in any serious way helps to explain how it has become so deeply entrenched in the public mind and in officialdom, despite its conceptual weakness and practical inefficacy.

Pre-history of the Official View

(PLEASE NOTE: THIS SECTION OF THE PAPER WILL BE REVISED IN A FEW MONTHS IN ACCORDANCE WITH THE NEW DEFINITION OF ADDICTION IN THE NEW EDITION OF THE OXFORD ENGLISH DICTIONARY THAT WAS RELEASED IN DECEMBER 2010.)

The word "addiction" had a traditional meaning in the English language that was well established by the time of Shakespeare. This traditional English meaning was neither medical nor moral in character, nor was it strongly linked to alcohol and drugs. In all these ways it was similar to the ancient Latin word, addiction-em, from which it was derived.[3]

The traditional English usage was well established long before it appeared as a formal definition in the first "fascicule" of the Oxford English Dictionary (OED), published in 1884. This long-established definition reappeared, essentially unchanged, in all subsequent editions of the OED up until the autumn of 2010.[4] The first medical/moral/drug definition in the OED appeared half a century after the traditional definition, in the 1933 Supplement to the OED.

Here is the traditional definition as it first appeared in the OED (omitting a third part of the definition that the OED had already judged obsolete by 1884):[5]

Addiction... [ad. L. addicti?n-em, n. of action f. add?c-?re; see Addict.]

1. Rom. Law. A formal giving over or delivery by sentence of court. Hence, a surrender, or dedication, of any one to a master.

2. The state of being (self-) addicted or given to a habit or pursuit; devotion.[6]

Part 1 of this traditional definition refers to the judicial condemnation of a person to slavery, usually for non-payment of debt. The word "addiction", thus defined, remains a useful vocabulary item for historians because judicial addiction was once a common practice. Part 1 of the definition is important today because it deepens the understanding of part 2.

Part 2 of the definition refers to a similar state of servitude, not to a legal master, but to a "habit or pursuit". Part 2 does not refer to a court or any other external force, but rather to being "(self?) addicted". The examples of usage over the centuries provided by the OED show that addiction, thus defined, may or may not be destructive to the addicted individual or to society. Although addiction to a harmful practice can have severely destructive consequences, addiction to a worthy cause can be the foundation of a rewarding, respected life. Thus, part 2 of the definition does not assert any essential connection between addiction and disease, moral failure, or drugs. The word "devotion", which appears in the definition as a synonym for addiction, is obviously neither a disease nor a moral failure. Addiction, by this traditional definition, is simply a way that some people shape their lives -- a fact of psychology -- although addictions that are harmful, whether they are to drug use or any other habit, might well provoke medical speculation or moral exhortation.

It is important to note that the traditional definition of addiction is a social construction. The definition assumes that the expected way of living in society is broadly based and that overwhelming involvement[7] with any particular habit or pursuit is so unusual that it is comparable to slavery. Note also that traditional usage was vague on whether addiction is voluntary or not, as indicated by the OED's use of the intentionally ambiguous term "(self-) addicted".

Part 2 of the traditional definition of addiction is schematized in Figure 1 as a single circle representing a multitude of habits or pursuits to which a person may become given to, devoted, or, as I prefer to put it, overwhelmingly involved. Four contemporary uses of the word are depicted as descendants of the traditional definition: addiction₁, addiction₂, addiction₃, and addiction₄. Only addiction₁ and addiction₃ will be discussed in this short presentation. All four are explained in my book, The Globalization of Addiction.[8]

The circle representing the traditional definition can be sliced like a pie into any number of segments, because there are countless habits or pursuits to which a person can be addicted. The only important categorical division between segments is that some addictions are destructive (these are represented by the darker segments on the left side of the circle) and some are not (represented by the lighter segments on the right). Destructive addiction to drugs or alcohol (addiction₁) is one of the many dark-colored possibilities, and is neither more nor less important than any of the other segments, by the traditional definition.

Figure 1. The Traditional Definition of Addiction and Modern Derivatives

Both in its destructive and non-destructive forms, "addiction" could be a weight y word in traditional usage.[9] Shakespeare, for example, used the word with gravity in The Life of King Henry the Fifth, written around 1600 CE. In a tense moment near the start of the play, the Archbishop of Canterbury describes Henry V as a great sovereign and intellectual, adding that this is "a wonder" because, as a younger man:

... his addiction was to courses vain,

His companies unlettered, rude, and shallow,

His hours filled up with riots, banquets, sports;

And never noted in him any study,

Any retirement, and sequestration,

From open haunts and popularity.[10]

As the play unfolds, knowledge of Henry V's youthful addiction to raucous socializing to the detriment of his kingly studies gives unwise confidence to his archenemy, the Dauphin of France.[11] It is not until King Henry proves invincible at the battle of Agincourt and magnanimous in victory that his earlier addiction is forgotten, in the final act. Henry's addiction is not discussed in a medical, moral, or alcohol and drug context during the play. It is, however, discussed in a strategic context. Both friends and enemies of England are concerned about the possible effects of the king's youthful addiction on England's military strength.

The weight of the word "addiction" when used in a positive sense is seen in the King James Version of the Christian Bible, originally published in 1611. This was the standard Bible for English-speaking Protestants until the mid-20^th century. The word "addicted" appears in 1 Corinthians, a letter from St. Paul to the early Christian community at Corinth written about 55 CE. In this letter, Paul chastises Corinthian Christians for moral laxity, finding it necessary to address them as children rather than "mature Christians". Toward the end of the letter, he urges them to emulate the members of the family Stephanas, whom he praises for being addicted, as follows:

16:15 I beseech you, brethren, (ye know the house of Stephanas, that it is the firstfruits of Achaia and that they have addicted themselves to the ministry of the saints,)

^{16:16 That ye submit yourselves unto such, and to every one that helpeth with us, and laboureth.[12]}

In Paul's eyes, the fact that members of the Stephanas family "addicted themselves to the ministry of the saints" did not make them either sick, immoral, or drug abusers. On the contrary, it made them role models for the wayward Corinthians. Although 20^th century translations[13] of these verses make the same point, they do not use the word "addicted" which by the late 19^th century had begun to evoke images of sickness, moral failure, and drug and alcohol misuse that would confuse Paul's laudatory intent. Although "addiction" is still a literally correct term to apply to devout Christians according to the Oxford English Dictionary, it has become more polite to avoid it.

Beyond Shakespeare and the authors of the King James Bible, countless other masters of the English language used the word "addiction" in the traditional way. The traditional meaning of addiction, in both the destructive and non-destructive forms, is still used today outside the literature on drug addiction. In everyday usage, "addiction" is an indispensable word because it denotes two basic facts of psychology (1) Human beings sometimes undergo a kind of psychological metamorphosis, becoming so overwhelmingly involved with a particular habit or pursuit that their involvement can be compared to slavery and (2) it is difficult to say whether this transformation is voluntary or not.

Use of alcohol and drugs was well known throughout Western history, and the fact that some users became addicted was well understood. But drug addiction was not a matter of sustained concern to either physicians or moralists before the 19^th century.[14] Berridge and Edward's detailed history of opium use in England provides an illustration of this historical generalization.[15]

Opium use in England was not usually discussed in a medical and moral context until the mid-19^th century. Opium was legal and large numbers of people from all social classes used it. Regular opium users were most often called "opium eaters". Not all opium eaters fit the traditional definition of addiction, but some definitely did.[16] Even as late as 1821, when Thomas DeQuincy first published his Confessions of an English Opium Eater in London Magazine, the public's reacted with interest and literary excitement, but not "fear or a desire for control".[17] No matter what word was used for it, opium addiction was not generally situated in a medical or moral context until later in the century. Berridge and Edwards summarized the imminent construction of the medical/moral/drug perspective on opium later in the 19^th century in this way:

Regular opium users, 'opium eaters', were acceptable in their communities and rarely the subject of medical attention at the beginning of the century; at its end they were classified as 'sick', diseased or deviant in some way and fit subjects for professional treatment…[T]he establishment of a whole new way of looking at drug use…requires analysis.[18]

The Medicalization and Moralization of Alcohol and Drug Addiction

The 19^th and early 20^th centuries witnessed the rise to prominence of modern scientific medicine, a colossal acheivement that conquered diseases that had long cursed the human race, including small pox, cholera, typhoid, and rheumatic fever.[19] It also witnessed an extended moral panic over increases in excessive drinking and, later, excessive use of opium, morphine, chloral hydrate, cocaine, heroin, and other drugs. In this historical context, the word "addiction" was gradually medicalized, moralized, and oriented towards drugs, relative to its traditional usage[20].

Historians do not find it surprising that the definition of addiction was medicalized and moralized at the about same time. Although the physical medicine and Christian moralism of the 19^th century were rooted in opposing metaphysics, they had similar views of human nature.[21] Often the same people were members of medical associations, temperance societies, and anti-drug movements.[22] The medical approach to excessive drinking and drug use was at first neither dramatic nor particularly successful and it did not readily capture the public imagination right away. However, the moral approach did, and a mass movement was born.

The powerful temperance movement in North America and Europe proclaimed that liquor, characterized as "ardent spirits", "hard liquor", or "demon rum",[23] was breaking down civilized society. Notwithstanding its moralistic hyperbole, the temperance movement's perception of a mass problem was well founded. Although most Europeans and Americans drank prudently, a growing minority, particularly visible in the working class, was adopting the socially abhorrent, drunken lifestyles that the temperance movement decried.[24] The movement first spoke of excessive drinkers as "inebriates", "drunkards", "sots", and the like, but the word "addicts" gradually came into use as well.[25] At about the same time that the temperance movement began appropriating the word "addiction" as the name of a moral failure, the medical profession began appropriating it as the name of a disease. "Alcoholism" later became another name for the same disreputable disease/moral failure.

Although the way that the doctors and moralists increasingly used the word "addiction" did not directly contradict the traditional definition of addiction, their usage was both narrower and more dramatic. It limited addiction to people who were overwhelmingly involved with distilled spirits (and later other drugs) and it was to be understood as a disease, a moral failure, or both. This narrowed and dramatized understanding of addiction corresponds to "addiction₁" in Figure 1.

The medical/moral use of the word addiction was only confined to drinkers for a short period. By the end of the 19^th century, the sensational images of the temperance movement had become archetypes for new anti-drug movements, first the anti-opium movement and, later, popular movements that aimed to rid the planet of many other drugs.[26] Like the temperance movement, the anti-drug movements increasingly conflated all drug users with the most destructive and intractable addicts, ignoring the fact that the majority of drug users were not anti-social or addicted. All drug users were perceived to be on the verge of becoming "hooked" by their drug and of abandoning their family, work, community, self-respect, and religion. All drug addicts were said to be dishonest and ruthless in the compulsive pursuit of their drug. People hooked on drugs were given labels like "drug fiends", "opium drunkards", "morphinomaniacs", "hopheads", and "junkies" as well as "drug addicts". Simultaneously with their moral ruination, addicted people were said to suffer from the disease of addiction and to be in urgent need of medical treatment.[27]

Images of medically and morally ruined alcoholics and junkies were engraved in public consciousness by the new photographic newspapers of the 19^th century[28] and the electronic media of the 20^th. In North America, these images were most often associated with opium in the decades around World War I,[29] heroin in the decades surrounding World War II,[30] "crack" cocaine in the 1990s,[31] and, at the beginning of the 21^st century, with methyl amphetamine, often familiarized as "crystal meth", "crystal", or "ice".[32]

When a medical/moral/drug definition of "addiction" finally made its way into the Oxford English Dictionary in the Supplement of 1933 and later in the 1989 2^nd edition, it was worded as follows:

^{2. b. The, or a, state of being addicted to a drug (see Addicted ppl a. 3b); a compulsion and need to continue taking a drug as a result of taking it in the past. Cf. drug-addiction s.v. Drug sb.1 I b.}[33]

The new, narrowed definition encompasses addiction to drugs (including alcohol[34]), but with no other habits or pursuits. Moreover, the new definition situated drug addiction in both medical and moral domains. Discerning the depth of this medicalization and moralization requires close examination of the definition, along with the text citations and cross-references linked to it in the OED. The new definition was medical because, unlike the traditional definition, it had the qualities of a medical diagnosis: It was a "compulsion" that had a physical cause – taking a drug – and was accompanied by "withdrawal symptoms". (Withdrawal symptoms appeared in definition 3b of the word "addicted" which was cross-referenced within the new definition of "addiction".) The new definition was moral because there was no possibility that addiction, as redefined, could be anything but an evil. No benign words like "devotion" appeared in definition 2.b, and the word "drug-addiction" that was cross-referenced with this definition was explained with a variety of moralistic terms, including "drug evil" and "drug fiend".[35] In short, the medical/moral/drug definition in the OED was equivalent to addiction₁ as defined on p. 8 of this presentation.

Although medical/moral/drug definition descended from the traditional definition logically, it had a new character. Moreover, unlike the traditional definition, the medical/moral/drug definition included a causal theory. Addiction had been re-defined as a pathologically compulsive use of a drug that is caused by prior use of the drug (see definition 2.b on p. 9.)

The new definition of addiction provided the core of an increasingly influential medical/moral/drug perspective on addiction, which, by the late 19^th century, was shaping public policy and inspiring many forms of treatment for the new disease/moral failure.[36] The balance between medical and moral emphasis repeatedly shifted throughout the late 19^th and the 20^th centuries, although the preponderant tilt was toward the medical. The current form of the medical/moral/drug perspective on addiction can be called the Official View.

The Official View of Addiction: Theme and Variations

The medical/moral/drug perspective on addiction gradually worked its way into the view of politicians, of the mainstream media, of school curricula, of agencies that fund research, and of those addiction experts who are accorded the greatest public visibility.[37] All of this had coalesced into something that historians have called an "Official Model" by the 1930s in the United States.[38] This Official Model continued to evolve and gain strength. Today, it is most authoritatively promoted at the global level by the American National Institute of Drug Abuse (NIDA), an organization with billion dollar budgets that claims to fund 85% of all drug addiction research in the world.[39] It expresses a strong affinity with the worldwide twelve-step movement. All this support gives the Official View (as I prefer to call it) a seemingly unassailable quality in the United States. Although the Official View finds less support outside the United States, it has strong advocates in most countries, particularly at the official level.[40]

The contemporary Official View was comprehensively and authoritatively summarized for the public in a 2007 American media package entitled Addiction: Why Can't They Just Stop? This media package includes a series of broadcasts on the American television network HBO including a 9 part documentary series with 13 supplementary documentary films and four independent films, a series of DVDs offered to the public, a profusely illustrated book, a website, and highly advertised public meetings in major American cities.[41] The media package was based on interviews with twenty-two of the most highly placed American experts in addiction medicine,[42] featuring Nora Volkow, the director of NIDA. It also contains contributions from authors who are best-selling exponents of the twelve-step movement.[43] The project was funded by HBO, NIDA, the National Institute of Alcohol Abuse and Alcoholism (NIAAA), and the Robert Woods Johnson Foundation.[44] The series won the Governors Award from the Academy of Television Arts and Sciences in 2007. The same ideas appear in more condensed form in many other materials for the general public that are distributed free by the National Institute of Drug Abuse.[45] The ideas also provide the framework of NIDA-sponsored professional publications where they are developed in more detailed and technical language.

It is important to distinguish between the Official View, which bases itself primarily on research in neuroscience, and the neuroscientists who produce this research. The Official View is presented in a simple way and with great authority, with an eye to shaping popular discourse, whereas the great majority of neuroscientists are much more aware of the limitations of their research and less inclined to simplistic proclamations. As historian Nancy Campbell puts it:

Neurobiological claims are used in public discourse to stabilize a particular set of claims about innate differences and irreversible alterations of brain structure and function. Yet most neuroscientists in the substance abuse field have a considerably more mulitple and elastic view… [46]

The Official View, as summarized in the media package described above, can be distilled down to six foundational elements, some of which are stated explicitly and some of which are assumed.

The first foundational element is that addiction is fundamentally a problem of drug or alcohol consumption. Even where other habits are recognized as addictions, they are judged to be addictions by what they have in common with recognized drug addictions.

Second, so-called addictive drugs have the power to transform all, or at least some, of the people who use them into drug addicts, overcoming their normal will power. Thus, the psychology of addiction is not the same as the psychology of other kinds of behaviour. Addicted people are under the control of an external force -- a drug.

Third, a major portion of people's vulnerability to addiction comes from inherited predispositions to addiction.

Fourth, people who become addicted suffer from a chronic, relapsing brain disease. The terms "chronic" and "relapsing" are taken to mean that there is no more possibility of a complete cure for this disease than would be expected for diabetes, asthma, or Alzheimer's disease.[47]

Fifth, although people cannot be cured of the disease of addiction, their disease can be successfully managed through professional treatment or membership in self-help groups.[48] If addicted people refuse treatment or self-help group membership, it is said that they will further damage themselves and society.[49]

Sixth, addiction is the problem of dysfunctional individuals within an otherwise well-functioning society. The possibility that addiction might be a general tendency of human populations trying to adapt to a dysfunctional society is not considered.

Beyond the six foundational elements, the Official View is built on an apparently religious faith in Science and Medicine: The claim that the Official View is based on objective science is assumed to guarantee that the current foundational elements of the Official View are correct and certain.[50] It is said that generous funding of medical research will surely produce a more effective treatment for addiction, which will probably be pharmacological.[51] Table 1 is a summary of the Official View.

Table 1. Summary of the Official View
Foundational Element	Official View of Addiction
1	Addiction is fundamentally a problem of drug or alcohol consumption.
2	"Addictive drugs" have the power to transform some or all of the people who use them into addicts, overcoming their normal will power.
3	A major portion of people's vulnerability to addiction comes from inherited genetic predispositions
4	People who become addicted suffer from a chronic, relapsing brain disease, which is essential incurable.
5	Although people with the disease of addiction cannot be cured, they can be successfully managed through professional treatment or membership in self-help groups.
6	Addiction is an illness of deviant individuals within otherwise well-functioning societies.
Scientific Faith	Commitment to objective science guarantees that the foundational elements of the Official View are correct and certain.
Medical Promise	Medical research will soon find an effective treatment for addiction, which will probably be pharmacological.

Because the Official View conceptualizes addiction as a disease rather than a crime, its advocates claim that it has no connection to the War on Drugs. However, many drug researchers and policy experts have noted that the Official View, as expressed by NIDA, offers tacit support to the War on Drugs on a variety of levels.[52]

The Official View is schematized in Figure 2. The term "Drug Addict" in the Official View corresponds to addiction₁ as defined on page 8 and pictured in Figure 1.

Figure 2. The Official View of Addiction

Although the Official View is promulgated with the resonance of unimpeachable authority, it changes continually. Numerous variations, some quite incompatible with others, have accumulated.[53] Although all six of the foundational elements of the Official View apply within the most current variation, some are contradicted in earlier variations.

Variations

The 2nd Foundational element of the Official View has both a strong and a weak version. The strong version holds that "addictive drugs" quickly transform every drug user into an addict, overcoming their will power. This idea may seem to be a relic of the 19^th century, but it was still the conventional view of heroin when I entered the addictions field as a young researcher in the 1970s, and it re-asserted itself at full strength during the panics over crack cocaine in the 1980s and methamphetamine around the turn of the 21^st century. Both drugs were said for a time to be instantly and universally addicting.

The 2nd Foundational element takes a weaker form in today's Official View, which now acknowledges that many drug users will not become addicted even if they use the most feared drugs over lengthy periods.[54] A great variety of environmental and genetic risk factors are said to predispose certain people to take drugs and to become addicted if they do, overcoming their normal will power. There is no way to confidently predict who will actually become addicted. Therefore, everybody is at risk.[55]

The weak form of the 2^nd foundational element and the strong form share the same fundamental idea. The drug itself is the active agent that transforms a person into an addict, overcoming the person's will power.

In some variations of the Official View, the emphasis is shifted toward the person and away from the drug. When this is done, the image shifts from a drug-induced disease toward either a moral or a genetic disease.

As a moral disease, addiction is said to reflect a pathological lack of the moral strength that gives others unbending resistance to drug euphoria. This moral version is not as vehement in today's Official View as it was in the 19^th century. However, Jim Orford has shown that the moral version is implicit in the practice of many types of conventional therapy, even when the explicit theory is not at all moralistic.[56] As well, the moral version has a central role in the twelve-step doctrine, starting with the Twelve Steps themselves.[57]

In the most current version of the Official View, the moral content is reconfigured to be almost blameless. Although addicted people act immorally, they are not to be blamed because they have lost their will power after drugs rewired, hijacked, or took over their brains.[58] "The disease makes them do terrible things but it doesn't make them terrible people."[59] "No one wants to be a drug addict, after all."[60] Or it can be said that their moral turpitude is a result of suboptimal choices caused by a lack of proper conditioning, rather than willful, evil intent.[61]

At the fringe of the Official View, the moral version takes another turn which holds that the addicted person's lack of moral strength to resist drug addiction is most often caused by early childhood trauma, usually some form of child abuse. If child abuse is the expected cause of the moral weakness that characterizes addiction, addicted people cannot be blamed. This child abuse form of the moral version is at the heart of some of the most evocative writings in today's popular twelve-step literature.[62] Taken to the extreme, this child abuse version can imply that child abuse, either in overt or subtle form, is a primary cause of the global flood of addiction. It is, however, uncertain whether the child abuse version is really part of the Official View because child abuse is only occasionally regarded as a predominant cause of addiction in NIDA publications,[63] although it has received powerful emphasis in the mass media.[64]

In the genetic version of the Official View, a person's addiction is said to occur in large part because of a genetic predisposition inherited by some individuals. Hundreds of genes have been associated with addiction in a great variety of experimental studies. It is common to say that 50% or more of a person's vulnerability to addiction is due to genetic predisposition.[65]

The drugs that have been caught in the spotlight of the Official View have shifted over the last two centuries, beginning with alcohol in the 19^th century, and later including opium, morphine, chloral hydrate, cocaine, heroin, marijuana, amphetamine, barbiturates, meprobamate (Miltown), nicotine, industrial solvents and glue, benzodiazepines, crack (i.e., cocaine again), and crystal meth (i.e., amphetamine again). There are growing signs that the opiate, oxycodone, with the prescription medication OxyContin® as its vehicle, may be the next big thing within the Official View.

Just as various drugs have shifted in and out of the spotlight over time, so have the mechanisms by which any particular drug is said to cause addiction. For example, in the oldest versions of the medical/moral/drug view of addiction as applied to heroin in the United States, individuals were said to be transformed into heroin addicts because of moral weakness (i.e., inability to resist its euphoria or to endure the painful withdrawal symptoms that it produces). For a time around World War I, immunological theories based on the idea that heroin and other drugs were "toxins" becamse popular, although psychoanalytic theories were probably dominant in that era.[66] In the 1950s, pharmacologists held that all users were equally helpless to resist to the conditioned and unconditioned withdrawal symptoms that were ultimately produced by heroin. In the 1960s behavioural pharmacologists used Skinner boxes to argue that certain drugs were irresistibly reinforcing, whether they produced withdrawal symptoms or not.[67] In the 1970s, heroin was said to cause addiction in any user by providing a pharmaceutical substitute for natural endogenous pairnkillers or endorphins and by crippling the brain's ability to produce its natural supply of endorphins. In today's Official View, heroin and other "addictive drugs" are said to "flip a switch in the brain" (but only of genetically predisposed people) by augmenting the brain's normal release of the neurotransmitter, dopamine. The augmented dopamine supply is said to transform the brain so that the person is unable to experience the sense of well being associated with dopamine's normal release. Moreover, heroin and the other "addictive drugs" are said to weaken those parts of the brain that are normally charged with learning from experience to inhibit destructive behaviors.[68]

In sum, many explanations of addiction to heroin and other drugs have come and gone within the Official View, some quite incompatible with others.[69] It is safe to predict that new explanations will continue to proliferate as the older ones fall victim to skeptical examination.

Why the Official View is Untenable

Although the current Official View receives unswerving support at the top of the power pyramid in the United States and in many other countries, it is untenable by normal rules of evidence and logic. There is only space here to briefly review some of the missing evidence, counter-evidence, and logical contradictions that currently perplex it. These are examined further in The Globalization of Addiction[70] and in many other sources that are cited there.

1. Addiction is not primarily a problem of alcohol and drugs. In fact, alcohol and drug addiction is only a corner of the vast, doleful tapestry of addiction. This contradicts the 1^st foundational element.

The Official View of addiction grew out of the 19^th century obsession with alcohol and drugs that eventually made it seem that people can become addicted to nothing else. Now that it has become impossible to deny that addictions to gambling, eating, sex, love, shopping, power, Internet games, and countless other habits and pursuits can be as prevalent, dangerous, and intractable as drug addictions,[71] this element of the older Official View is no longer tenable.

Efforts are now being made to stretch the Official View's explanations for alcohol and drug addiction to encompass a few of the other habits and pursuits to which people can become addicted.[72] However, these efforts create new logical knots. For example, if a person shows all the psychological and social signs of being addicted to a particular habit that does not affect the brain's function in the way that cocaine and heroin do, is that person considered not really addicted within the current Official View?[73] If so, addiction as defined by the Official View contradicts the contemporary experience of addiction as well as the traditional meaning of the word "addiction" in the English language. If habits are judged to be addictions by whether or not the brain responses that accompany the habit fit the current brain theories of the cause of drug addiction, will they still be considered addictions when the current brain theories are replaced by others? Why are people who become addicted to drugs not automatically addicted to everything else that might augment the supply of dopamine their brains lack after they become addicted according to many current versions of the Official View? Fancy footwork is required to dance out of these and other logical entanglements.

2. The large majority of people who use "addictive drugs" do not lose their will power to resist theses drugs, and do not become addicted. This contradicts the strong form of the 2^nd foundational element.

There are now many documented cases of life-long use of a supposedly "addictive drug" by eminent people whose lives were unblemished by the addictive problems that were inevitably associated with use of these drugs in the Official View.[74] Many other studies show that people of every social class can use "addictive drugs", including crack cocaine and methamphetamine, for very long periods without becoming addicted have been published.[75]

The evidence that "addictive drugs" can be used safely was not only officially ignored for many years, it was also actively suppressed. The Guardian newspaper on June 13, 2009 reported the re-discovery of a fourteen-year old World Health Organization study on cocaine, which showed that large numbers of people all over the world used cocaine and crack without addiction, medical harm, or anti-social behavior. Although this was the largest study of cocaine use ever conducted, with data reported from 22 sites in 19 different countries, its existence and the fact that it was politically suppressed are still officially ignored by the mainstream media and by official sources.[76]

3. There is no substantial evidence that the minority of drug users who do become addicted lose their will power, and strong reasons to think that they do not. This contradicts the weak form of the 2nd foundational element of the Official View.

Although it is sometimes convenient for street addicts to let police, their parents, or other power figures believe that they have lost their willpower or had their brains "hijacked", they are not, in fact, drug-zombies. Clinicians and drug counselors who listen carefully in situations of trust know that many people who are addicted to drugs, as well as other habits and pursuits, can explain in great detail why they lead the life style of an addict. They can detail the functions that their addictions serve for them, and explain why socially acceptable life styles are so difficult for them to achieve.[77]

This is not to claim that addiction is simply a matter of "free will". The freewill vs. determinism debate is an irresolvable philosophical dispute not only about drug addiction, but about all human actions. However, there is no substantial reason to think that addicted people have less control over their actions than anybody else, even though some of them sometimes claim that they are out of control, especially when they are explaining themselves to their parents or to a judge.

Some addicted people probably do sincerely believe at times that they are out of control and cannot comprehend their own behavior, but these beliefs are readily understood psychologically in terms of psychological attribution theory,[78] Freudian defense mechanisms,[79] or a simple desire to avoid being punished. Furthermore, addicted people are aggressively taught to believe that they are out of control by the omnipresent rhetoric of the Official View and of many treatment programs and self-help groups. The current doctrine of the Official View holds that any thoughts addicted people may have of not being out of control are themselves results of a disease process, such a denial, or drug-induced brain damage.[80] Many addicted people cannot bear to attend 12-step groups precisely because they know that they are not out of control.

4. Genetic research provides no substantial evidence of a genetic predisposition to addiction. This contradicts the 3^rd foundational element of the Official View.

Addiction, like all other human activities is influenced in various ways by the shared genetic endowment of the human species and by the particular genetic complement of each individual. Therefore, evidence of some genetic effects on addiction is not surprising. However, neither the experimental evidence that hundreds of genes can influence the likelihood of addiction in some species and in some situations, nor the reports of substantial heritabilities of alcoholism from human adoption and twin studies comprise evidence of an inherited predisposition to addiction. Genes can effect various risk factors. For example, a gene that affects the sensitivity to a particular drug may make an experimental subject more or less vulnerable to addiction to that drug. A gene that affects one of the qualities expected in a particular human group, the absence of which predisposes a person to social exclusion, can increase the probability of addiction in the persons that carry the gene. These kinds of genetic effects could have measurable effects on the frequencies of some addictions in some situations, but they comprise no evidence at all for a genetic predisposition to addiction in general.

Moreover, there are many reasons to question claims of heritability of addiction of as high as 50% that have come from some human adoption and twin studies. These claims are being vigorously disputed by many biomedical researchers on a variety of grounds.[81] For example, there is no way to control for prenatal and perinatal stressors produced by alcoholic parents whose children serve as subjects in adoption studies. Such factors could have a major effect on future addiction which would be incorrectly counted as genetic variance, under current experimental designs.

5. Natural recovery is the most likely outcome of addiction. This contradicts part of the 4^th foundational element of the Official View.

Large-scale field studies and clinical studies of "natural recovery" show that about three-quarters of the people who become addicted to a drug in their youth recover, usually without receiving any addiction treatment at all. More than half of them recover by the time they are 30.[82] The relapse rate for people who go through treatment is much higher than the relapse rate for those who overcome addiction without treatment.[83] This difference in differential relapse rate does not reflect badly on treatment, since the people who present for treatment are those who did not recovery naturally, and are therefore more resistant to change.

The basis of natural recovery without treatment is no mystery since so many case have been documented. Natural recovery occurs because people establish stronger relations with the community, or find a strong sense of meaning in a new life.[84] Addicted people who do not recover on their own fill the treatment agencies and social service centers. A large number are refractory to treatment, creating the illusion of a chronic disease, which has been incorporated into the Official View to explain the marginal success of treatment regimes built on its doctrine.

6. Despite countless interventions carried out under the rubric of the Official View, the prevalence of addiction has continued to rise throughout the 20^th century and into the 21st. This shows the futility of the 5^th foundational element and of the Official View as a whole.

When an analysis of an urgent problem provides no realistic hope of success, pragmatism dictates that it is time to try a different analysis. Yet, failure to control addiction is built into the logic of the Official View. Since the Official View deems addiction a chronic disease, addiction cannot be overcome permanently. Addicts who have become "clean and sober" through treatment are still fully addicted and never more than a single slip away from a potentially catastrophic relapse. As long as addiction was thought to be limited to drugs, it could be supposed that society could overcome the rising tide of addiction when drugs were successfully prohibited or when voluntary drug abstinence became universal. But now it has been established that successful drug prohibition and universal abstinence are pipe dreams and that people can become addicted to innumerable habits and pursuits that can neither be prohibited nor foresworn. Under the Official View there is no way left to substantially reduce the prevalence of addiction, apart from the long-promised, but still-undelivered pharmacological cure.

The outcome of society's long acceptance of the Official View is as dismal as the underlying logic. The dedication of the practitioners who have carried out the interventions sanctioned by the Official View is unquestioned. However, their interventions, including prevention programs in the schools, twelve-step groups, conventional psychotherapy, behavioral therapy, pharmaceutical interventions, methadone maintenance, and so on, have had limited success in individual cases, and have failed to stem the rising flood of addiction around the world.[85] Even treatment programs that are supported with unlimited funds succeed only in a minority of cases. No matter how wealthy you are, you can't buy your way out of addiction, even at the most expensive private treatment facilities.

It is because addiction has proven so resistant to treatment interventions that the Official View has characterized it as a chronic (i.e., incurable) disease. But this characterization is not tenable either, as explain in point 5 above.

7. Addiction cannot be understood simply as an affliction of certain individuals with genetic or acquired predispositions to addiction in otherwise well-functioning societies. The most powerful risk factors for addiction are social and cultural rather than individual. This contradicts the 6^th foundational element of the Official View.

Although addiction manifests itself in individual cases, its prevalence differs dramatically between societies. For example, it can be quite rare in a society for centuries, and then become common or almost universal when a tribal culture is destroyed or a highly developed civilization collapses.[86] When addiction becomes commonplace in a society, people become addicted not only to alcohol and drugs, but also to many other destructive pursuits: gambling, love, food, shopping, power, and on and on.[87] Extensive historical evidence for this is summarized in The Globalization of Addiction and will be further developed later in this presentation, in the section on Dislocation Theory.

8. The Official View has drawn its principles more from moralistic social movements than from scientific discoveries. This contradicts the claim that the Official View is based on dispassionate science and seriously undermines part of the 4^th foundational element.

Medieval Christians thought that consorting with demons produced an irreversible loss of willpower, which they called "demon possession". Similarly, the religious temperance movements of the 19^th century spoke of "demon rum" as producing an irreversible and reprehensible change in people's behavior, turning them into "drunkards. Medical experts of the late 19^th century held a similarly vehement view of people who were transformed into alcohol and drug addicts, a process that they expressed in now-archaic technical language, including esoteric references to "malfunctioning brain structure", "failure of the higher ethical brain", inheritable "degeneration", and "retrograde evolution".[88] Early 20^th century moralists thought heroin permanently changed people into despicable "drug fiends". Mainstream biomedical researchers of the 21^st century speak of "addictive drugs" as "flipping a switch in the brain" or putting people "beyond will power" or "hijacking the brain",[89] thus causing a chronic brain disease that has essentially the same behavioral effects as being possessed by a demon or becoming a drunkard, degenerate, drug fiend, or a failure of the higher ethical brain. What has really changed over this period?

In the second half of the 20^th century, the Official View was largely justified with animal research that turned out to have been misinterpreted.[90] Today, the claim that addiction is a brain disease is most often justified with brilliantly colored brain scans[91] that non-neuroscientists cannot hope to understand or critique. However, it is well for non-neuroscients to not be overawed by these colorful displays, partly because some brain imaging technology, notably functional magnetic resonance imaging, has proven unusually vulnerable to error,[92] partly because high tech biomedical research is so often shaped by the values of the scientists who perform it and the institutions that fund them,[93] and partly because science itself is no more capable of certainty than any other human institution.[94] On simple logical grounds, the brain imaging studies do show that drug use produces changes in the brain, some of which are long lasting. But many events in life produce measurable effects on the brain, especially early in life. It probably that some of these other externally imposed brain changes will eventually tell more about the cause of addiction than those that directly result from drug use,[95] since most people who use drugs do not become addicted.

Despite all the scientific razzle-dazzle in support of the Official View, the idea that drugs cause the chronic disease of addiction by re-wiring the brain is not an established fact, and it is not a new scientific paradigm, although the proponents of the Official View claim that it is.[96] Rather, it is a neurologized form of a folk theory that has periodically appeared and re-appeared in Western literature for millennia before modern neuroscience existed.[97] You do not need a PhD in neuroscience to make up your mind about it. The foundational elements of the Official View can be evaluated with a normal understanding of the rules of evidence and the facts of history. The Official View of addiction, even when bolstered with the latest biomedical images, warrants no more uncritical faith than the officially sanctioned models that provided apparently unassailable mathematic proof – until 2007 – that the market for subprime securitized mortgages would not collapse.[98]

9. Contrary to the child abuse version of the Official View, childhood abuse is not a primary cause of the flood of addiction, although it is very important in some individual cases.

Quantitative research reveals a strong relationship between childhood abuse and later addiction to alcohol and drugs, especially for women.[99] However, the relationship becomes very much smaller when abused children are compared with children from families that are equally distressed but did not abuse their children.[100] In general, sustained family and community dysfunction are far more powerful predictors of addiction than traumatic child abuse alone.

Even the fact that an addicted person was physically or sexually abused as a child does not necessarily mean that the abuse was the cause of their addiction. Families of abused children typically have other severe problems in addition to child abuse. Several of these other problems, for example drug abuse by parents or spousal abuse, appear to predict later addictive problems as well, or better, than sexual or physical abuse of the child.[101]

At the other end of the social spectrum, "From Grief to Action" is a group organized by well-off parents of drug addicts who were not abusive to their children and are horrified to discover that many people automatically assume that they must have been, in the context of dramatic presentations of the child abuse version of the Official View.[102] As an addiction specialist at a large university, I have worked with severely addicted youths who were children of non-abusive faculty families that were not dysfunctional in any ordinary sense of the term.

Horrific and traumatic as it is, child abuse is simply one of a large number of risk factors that predict addiction. It is neither a primary cause of the global flood of addiction, nor more powerful than many other predictors, some dramatic and some subtle, that can be discerned within the families and communities of people who later become addicted.

10. Contrary to the claims of its advocates, the most up-to-date form of the Official View is intrinsically moralistic and punitive, most obviously by providing justification for some of the violent excesses of the "War on Drugs".

Most contemporary versions of the Official View construct addicted people as sick rather than immoral, thus apparently absolving them of blame for being addicted. For example, it follows from the Official View that drug traffickers and producers are more heinous criminals than "drug fiends" were formerly thought to be. They are said to achieve obscene wealth by deliberately inducing a ruinous, incurable disease in their victims.[103]

As the Official View gained acceptance, the punishments for drug-addicted people became milder in most jurisdictions, while the punishments for traffickers and producers became more severe. The Official View has been used to justify very long sentences for drug traffickers in the United States as well as military destruction of drug-producing peasant farms in South America. This transfer of blame from addicted people to traffickers and far-away farmers may seem to be an improvement from the point of view of addicted people on the street in the developed world – until they find themselves forced by a drug court to chose between coercive treatment or jail or until they realize that they too are traffickers, as it is legally defined. Canada's Controlled Drugs and Substances Act, for example, is written in such a extraordinarily broad way that virtually every street drug user is certain to be guilty of the heinous crime of trafficking at some times.[104]

The most moralistic aspect of the Official View is rarely recognized. Addicted people are said to have had their brains "rewired" or "hijacked" by a drug. Therefore they are not to be blamed for their immoral actions for they are "beyond willpower".[105] But what does it actually mean to be beyond willpower? In the plainest language it means that drug addicts are no more to be blamed for their reprehensible actions than a medieval person whose soul is possessed by a demon or a cinematic zombie whose humanity has been overwhelmed by monomaniacal lust to consume human brains. Addicted people are said to have permanently lost their critical judgment, which would normally mean that they are no longer fully human. Can a more devastating moral judgment than this be passed on a human being? Of course, it can be said that the Official View only casts this judgment on the minority of people who are addicted to drugs. But now that it is becoming recognized, even within the Official View, that people can be addicted to many habits and pursuits other than drugs, the extent of this dehumanizing judgment on people is revealed to be monumental and terrifying.

A Slightly Premature Funeral Eulogy for the Official View

There is no point in being disrespectful of the Official View at a time like this. However, its demise, although sad, will probably prove to be the best for everybody.

Many talented scientists and practitioners have tried valiantly to make a success of the Official View, with the best of intentions. They were absolutely right to try to make it work, because the fact that it medicalizes and moralizes addiction is not, by itself, a fatal flaw. Often people find it useful and comforting to think of their own addictions as a physical disease,[106] and why not? It probable that addiction can be understood, ultimately, in physiological terms as well as psychological and social terms. Moreover, addiction surely does have important moral implications and these need to be explored carefully.

The downfall of the Official View was that it was a particular medical and moral analysis that is narrow, ineffectual, incompatible with basic facts about addiction, unstable, and internally inconsistent over time. Both its origins and its implications were dehumanizing and punitive. It exacerbated its problems by masquerading as an impartial scientific discovery, when it was actually a contrived scientific justification for a particular set of folk beliefs. It has to expire because it stands in the way of a rigorous analysis of an extremely important human problem, addiction.

Simply labeling a condition as medical does not stand in the way of exploring a variety of measures that might control it. For example, bovine spongiform encephalopathy (BSE), popularly known as "mad cow disease", was quickly labeled a disease when it appeared in human beings. Neither the disease label nor the now well-understood disease mechanism, however, enabled clinical physicians or pharmaceutical companies to cure BSE in animals or human beings. Mad cow disease cannot presently be controlled without thoroughly analyzing modern agricultural practices and carrying out population health measures which include rigidly controlling animal feed preparation, maintaining an intense system of feed surveillance on an international level, and eliminating potentially infected cattle.[107]

Nothing about being understood as a disease interfered with the broad analysis and the effective preventative measures that have been undertaken to control BSE. In the case of addiction, the key problem is that the Official View has interfered with the broad social analysis, which the remainder of this presentation will show to be the most promising approach. I call this broad social analysis the Dislocation Theroy of Addiction. As well, the moralistic aspects of the Official View allow it to co-exist comfortably with the cruel and futile War on Drugs.[108]

But, why did the Official View stand in the way of the broad social analysis of addiction and the humane corrective measures that needs to be undertaken? This question will be re-visited at the end of this presentation, after a look at the Dislocation Theory of addiction.

Dislocation Theory: A Non-Medical, Non-Moralistic View of Addiction

An alternate view of addiction is coming to the fore that is at least as well grounded as the Official View in Western philosophy,[109] and is better grounded in history,[110] social science,[111] and public health research.[112] It does not have as much support in high tech biomedical evidence, but this may be only because its supporters do not have billion dollar research budgets to work with, whereas NIDA does. I call this alternate view the "Dislocation Theory" of addiction. I am convinced that it provides a level of explanation for addiction that will prove far more useful than the Official View in the long run. I do not mean to claim that the Dislocation Theory is the only alternative to the Offical View. However, I believe that it is a level of analysis that conforms well with the existing historical and biomedical evidence and, also points the way to promising forms of intervention, whereas the Official View does neither.

Like the Official View, the Dislocation Theory is not an outcome of pure, dispassionate science, but a social construction, with deep roots in western philosophy.[113] Beyond this, however, Dislocation Theory differs from the Official View in almost every way, beginning with who supports it. It's essential ideas are currently spreading upward, rather than being broadcast downward from officialdom. Its main proponents are the front-line addiction counselors, social workers, and public health advocates who respond pragmatically to people with serious addiction problems.[114] As well, a great many addicted people think of their own addictive problems in a way that accords with Dislocation Theory, disregarding the omnipresent voice of the Official View. Within academia, support for Dislocation Theory draws primarily from the work of social scientists and public health researchers, rather than from the brain scientists and molecular biologists at the top of the academic pecking order. In fact, high-ranking members of the media, government, medical, and academic hierarchies may be the last to learn about this re-conceptualization of addiction, although they may not be able to avoid it much longer. I consider the "high commendation" given to my book, The Globalization of Addiction, by the British Medical Association in its 2009 annual book awards to be one of the tectonic rumbles of a paradigm starting to shift.[115]

The Dislocation Theory of addiction can only be briefly sketched in this short presentation, in combination with a few gestures toward the supporting evidence. A more detailed summary of Dislocation Theory and the evidence supporting it can be found in The Globalization of Addiction.[116]

Figure 3. The Dislocation Theory of Addiction

Rather than attempting to explain only drug and alcohol addictions[117] as the Official View has until very recently, Dislocation Theory explains the full range of destructive addictions (i.e., addiction₃ as pictured in Figure 1). Addiction₃ can be defined as "overwhelming involvement with any pursuit whatsoever that is harmful to the addicted person, to society, or to both." Although addiction₃ encompasses addictions to drugs and alcohol, it gives them no special stature among addictions, because drug and alcohol addictions do not differ from other harmful addictions in their psychological dynamics or their potential for harm.[118]

Like the traditional definition, addiction₃ does not refer to a medical condition. It is not a pathological transformation of the brain, the will, the unconscious, or any other hidden aspect of a person. Rather, it is a way of living that a person adopts to a greater or lesser degree. Because addiction₃ is not a disease, there is no diagnostic manual that separates mild instances of addiction₃ from severe ones that warrant intervention.

Also in contrast to the Official View, Dislocation Theory does not focus on single individuals, but on the social causes of globalized mass addiction in the modern era. Of course each addicted individual's story is unique, but Dislocation Theory provides a framework within which the individual struggles of addicted and recovering individuals can be more deeply understood.

Dislocation Theory easily encompasses the many problems that beset the Official View. This is easy to check, and readers of this presentation may want to revisit the ten reasons that the Official View has become untenable after they have been introduced to Dislocation Theory. This short introduction, however, is mostly limited to an overview of historical and anthropological evidence that supports Dislocation Theory.

Dislocation Theory starts with the historical fact that societies everywhere have become fragmented in the last few centuries. The mechanization of farming and the industrial revolution began to overrun and crush European agrarian cultures a few centuries ago. Then, colonialization crushed pre-industrial and aboriginal cultures around the globe. Then the technological revolution and all-powerful multinational corporations overran the industrialized societies that were emerging from the ruins of agrarian, pre-industrial, and aboriginal cultures. Beneath the steamroller of modernity, nuclear families have grown unstable and dysfunctional, extended families have scattered, traditional religions have been lost or transformed into fundamentalist caricatures, cultures and ethnic groups have lost cohesion, and ancient traditions have been pulverized. The social fragmentation of society that began in the early modern era continues unabated amidst the globalization of free-market capitalism, neoliberalism, and the debt and currency crisis that began in 2007.[119]

The key concept is "dislocation". Figure 3 shows dislocation as both the psychological consequence of social fragmentation and the precursor to mass addiction. As the psychological consequence of social fragmentation, dislocation denotes the rupture of enduring and sustaining connections between individuals and their families, friends, societies, livelihoods, rituals, traditions, nations, and deities. These dislocations destroy the normal bases of individual identity, purpose, belonging, and meaning.[120] Dislocation does its destructive work at every stage of human development, from the very earliest to the very latest. Intrauterine consequences of maternal stress can make a child less socially competent years later.[121] Lack of stable housing in volatile real estate markets can make settled family and neighbourhood life difficult or impossible. Lack of family and community support can leave elderly people in solitude and despair.

This critical view of modern society is not mere romantic moralism. Modernity is not more evil than the social eras that preceded it but, like every social innovation, it brings both new opportunities and new problems to be solved. Mass dislocation is one of several new problems that modernity has brought.

The word "dislocation" in this context refers to much more than geographic displacement. Dislocation is a ubiquitous psychological malaise that afflicts people who stay home in fragmenting societies as much as people who have been driven continents away from their roots. Dislocation is also much more than material poverty. Although hunger and other material deprivations can crush the spirits of isolated individuals and families, these deprivations can be borne with dignity by people who face them together as a psychosocially integrated society. On the other hand, dislocated people become demoralized and degraded even if they are wealthy.[122] No amount of food, shelter, or accumulating riches can restore their well-being.[123]

Severe, prolonged dislocation is unbearable. It precipitates anguish, suicide,[124] depression, disorientation, and domestic violence.[125] This is why forced dislocation (in the form of exile, ostracism, excommunication, etc.) has been a dreaded punishment from ancient times, and why social isolation remains an essential component of the modern technology of torture.[126] As Figure 3 indicates, people who are suffering from dislocation display all the behaviors that are considered consequences of addiction in the Official View[127] except, of course, the side effects of specific drug habits, such as cirrhosis of the liver and opiate withdrawal symptoms.

Dislocation can have many causes other than social fragmentation caused by modernity. It can arise from an earthquake that destroys a person's village or from a personal idiosyncrasy that a society cannot tolerate. It can be inflicted violently by abusing a child or ostracizing an adult. It can be voluntarily chosen if a person turns from a balanced social life into the single-minded pursuit of wealth in a "gold rush" or a "window of opportunity". But, most importantly for this presentation, dislocation can become the global norm if the steamroller of modernity systematically fragments society everywhere. Quite often, causes of dislocation that are identified as individual or family problems turn out to be effects of dislocation, when they are traced back a step further. For example, for example, abuse of a child can often be traced back to unbearable social conditions that make parents less able to control their hostility.

Just as the prevalence of dislocation tracks social fragmentation, the prevalence of addiction tracks dislocation. A wealth of historical, clinical, and quantitative evidence shows that people who lose their identity or their sense of purpose, belonging, or meaning are very likely to become addicted, because addiction provides them with some relief and compensation.[128] Because it is an overwhelming involvement, addiction provides a partial substitute for people who can be said not to "have a life". Of course addiction is not the kind of life that addicted people anticipated, or that their societies anticipated for them, but it at least provides them with some meager sense of identity, purpose, belonging, and meaning. Without their addictions, many people would have terrifyingly little reason to live. When "junkies" wake up, they at least know who they are and what they must accomplish that day, and they can draw on a junkie mystique,[129] to make their existence seem less banal than it is.

Thus, far from being a disease, the modern flood of addiction is an adaptation to dislocation, and, indirectly, a way of adapting to the social fragmentation of modernity, which is the root cause of most of today's dislocation. It is because addiction is adaptive that people who cannot find better ways of relieving their dislocation cling to their addictions – even very harmful ones – with such reckless desperation.

The feedback arrows in Figure 3 reveal two other reasons why addiction is so hard to overcome in modern society. When people adapt to dislocation by becoming addicted, their addictions often reciprocally increase their dislocation by further undermining their families and communities. As well, many addicted people contribute to further expansion of today's out-of-control capitalism and the dislocation that flows from it[130] in many roles, from wasteful shopaholics to insatiably greedy CEOs.[131] In these ways, addiction perpetuates itself.

Although this self-perpetuating cycle is difficult to break in global free-market society, many individuals do overcome their personal addictions. Adapting to dislocation by becoming addicted is not an irreversible transformation, as the Official View maintains. If addiction does not prove to be a successful adaptation in the long run, many people eventually find some other way of either reducing their dislocation, perhaps by changing to a less harmful addiction or by abandoning addiction altogether for another way of living. Thus, the literature on natural recovery[132] that perplexes the Official View fits comfortably with the Dislocation Theory. On the other hand, some people do not succeed in finding ways to cope with their dislocation other than ruinous addictions. Their addictions are intractable to treatment and punishment, although they can sometimes be managed successfully with intensive treatment and participation in self-help groups.

Although Dislocation Theory puts primary emphasis on social antecedents of addiction, it recognizes the individual suffering and courage of individuals struggling to overcome or manage addictions. It deepens the understanding of individual struggles by showing that the more fragmented a society is, the more obstacles there will be to prevent dislocated individuals from winning these struggles and the more likely that a person will lapse, or relapse, into addiction.

Dislocation Theory also deepens the understanding of genetic factors in addiction. Some people are genetically less suited than others to their cultures or subcultures and are, therefore, more likely to become first dislocated and then addicted. As well, some people are genetically intolerant of alcohol consumption and less likely to become addicted to it. The same kind of tolerance and intolerance would probably apply to many of the habits and pursuits to which people might become addicted. The available data on heritability of addiction, with several hundred genes showing some statistical relationship to one addictive habit or another, in one situation or another, is best understood in these indirect ways, rather than by positing an inherited "predisposition to addiction".

Although the connection between dislocation and addiction is easily demonstrated in historical studies of aboriginal people and agrarian societies, it is by no means confined to pre-modern settings. Throughout the developed countries, dislocation plays havoc with delicate ties linking all classes of people to society, nature, and spiritual values. Although globalized free-market society produces both winners and losers as gauged by economic success, it ultimately produces only losers when dislocation is the measure. Karl Polanyi perceived the growing dislocation among the rich as well as the poor from the earliest beginnings of the free-market system:

^{… the most obvious effect of the new institutional system was the destruction of the traditional character of settled populations and their transmutation into a new type of people, migratory, nomadic, lacking in self-respect and discipline – crude, callous beings of whom both labourer and capitalist were an example.[133]}

As the basic markets in goods, labor, and capital become securely established in the globalizing world economy, new kinds of markets for services, intellectual property,[134] popular culture,[135] and intimate relations[136] have further amplified dislocation at every social level.[137] As these markets continue their encroachment into social life, rich and poor people alike are finding themselves not only commodified but also capitalized. Formerly commodified as "labor", they are now capitalized as "human resources". People's friends can be calculated along with other assets as "social capital".[138] The tenor of their inner life can be calculated as "emotional capital".[139]

As markets extend their reach into society, governments of rich countries employ carefully engineered techniques to keep people buying, selling, working, borrowing, lending, consuming, moving, learning, immigrating, reproducing, and saving in ways that seem to maximally benefit the markets, increase the GDP, and aid the latest economic "recovery".[140] This economic engineering invisibly undermines what remains of traditional culture as well as new traditions that might otherwise spontaneously arise, thereby further increasing dislocation and fostering addiction.

Ironically, free-market society not only destabilizes people's personal and social lives in the interests of the economy, it also destabilizes the economy itself. For rich and poor alike, in great cities and small towns_,[141] people's jobs disappear on short notice_,[142] life-long employees' pensions disappear_,[143] families and communities live with financial uncertainty, and people routinely change neighborhoods, occupations, co-workers, technical skills, status, reference groups, languages, nationalities, therapists, spiritual beliefs, corporate loyalties, and ideologies as their lives progress.[144] Deregulation of finance capital in the 1980s has enormously inflated the global free market in stocks, bonds, and debt obligations. Unregulated speculation in these global markets has brought devastating volatility and long-term uncertainty into local and national economies.[145] The cataclysmic, worldwide economic emergency that began in 2007 multiplied dislocation because many people who lost their jobs, homes, savings, or pensions found they could no longer trust the institutions that had symbolized economic security, especially governments, banks and regulatory agencies.

Contemporary forms of dislocation even among the affluent have been brilliantly analyzed by many contemporary authors. For example, the French philosopher Dany-Robert Dufour has shown how dislocation of prosperous citizens in wealthy countries has accelerated between World War II and the present because of the increasing dominance of globalizing market economy.[146]

A simple way to summarize the paradigmatic difference between the Official View and the Dislocation Theory of addiction is to compare the six foundational elements of the Official View and its scientific faith and medical promise with the way those same issues are understood within Dislocation Theory. This comparison appears in Table 2.

Table 2. Comparison of the Official View of Addiction and the Dislocation Theory of Addiction
Elements	Official View	Dislocation Theory
1	Addiction is fundamentally a problem of drug or alcohol consumption.	People can be addicted to innumerable habits and pursuits. Addiction has no special connection with drugs and alcohol.
2	"Addictive drugs" have the power to transform some or all of the people who use them into addicts, overcoming their normal will power.	People who are living as addicts are exercising as much willpower as anybody else.
3	A major portion of people's vulnerability to addiction comes from inherited genetic predispositions.	Various genes have measurable effects on the likelihood of addiction in various situations. None of the known genetic effects comprise a predisposition to addiction
4	People who become addicted suffer from a chronic, relapsing brain disease, which is essentially incurable.	Rather than a disease or a moral failing, addiction is a way that some people adapt to severe dislocation. People often change their ways of adapting during their lifetimes.
5	Although people with the disease of addiction cannot be cured, they can be successfully managed through professional treatment or membership in self-help groups.	Most addicted people get over their addictions on their own. Professional treatment and self-help groups are only marginally effective in helping those that do not.
6	Addiction is an illness of particular individuals within otherwise well-functioning societies.	In modern times, most addiction arises because of the dislocation caused by fragmented societies. In fragmented societies, addiction leaves few people untouched.
Scientific Faith	Commitment to dispassionate science guarantees that the foundational elements of the Official View are correct and certain.	Science is only one of the ways of investigating addiction. History, philosophy, economics, and social science are equally important. Advocates of the Official View have used the prestige of science to create an illusion of correctness and certainty.
Medical Promise	Medical research will soon find an effective treatment for addiction, which will probably be pharmacological.	Medical treatment cannot substantially reduce addiction, because addiction is a form of adaptation, rather than a disease.

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