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Rise and Fall of the Official View of Addiction

The Rise and Fall of the Official View of Addiction
Bruce K. Alexander, Professor Emeritus
Simon Fraser University
Revised January 17 2014
 
Submission to the High Court in the Field of Addiction:
Herewith, I confess to the charge of attempted murder. My intended victim was – and still 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 expresses my plea to the High Court that ridding 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 attempted 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 language, was kidnapped in the 19th century by medical and moralistic interest groups, who gave it a new meaning. Despite the obvious failure of their treatment methods and their so-called War on Drugs, their approaches have coalesced in recent decades as a doctrine which is, I submit, properly called the "Official View of Addiction," which is usually couched in the language of high-tech neuroscience. 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. Worse still, 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". A revised version of this speech is published as Alexander, B.K. (in press). Replacing the official view of addiction. In Davis, J.E. and Gonzalez, A.M. (Eds.). To Fix or To Heal: Conflicting Directions in Contemporary Medicine and Public Health. New York, NY: NYU. The presentation 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). The presentation has been updated and revised repeatedly since 1910. Respectfully Submitted to the High Court, Bruce K. Alexander


Summary

     The world faces a deadly serious problem of addiction to drug use and countless other habits and pursuits. Bringing this problem under control will require a better conceptualization of addiction than the Official View 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 19th century, which was neither medical, nor moral, nor linked to drugs. Then it describes the 19th 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 way of using the word and became the core of what I will call the "Official View" of addiction for much of the world. Then it shows why the Official View, even in its most up-to-date form, provides neither an adequate basis for understanding addiction nor a basis for effective intervention.

     The latter portion of the presentation describes a completely different perspective, which I call the "Dislocation Theory" of addiction. The Dislocation Theory is built on the traditional meaning of "addiction" rather than the medical/moral/drug definition. Although Dislocation Theory is not new, it may be startling to some readers, because it repudiates foundational elements of the Official View that have come to seem unquestionable because of their justification by high-tech neuroscience, their widespread professional support, and their endless repetition in the mainstream media.
Dislocation Theory draws attention to social causes of addiction that can only be remedied through deep changes in the status quo of modern society. The fact that the Official View does not threaten the status quo in any serious way may help 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

     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 ever strongly linked to alcohol and drugs. In all these ways it was similar to the ancient Latin noun, addiction-em, from which it was derived.[1]

     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 firmly-established definition reappeared, essentially unchanged, in all subsequent editions of the OED until 2010 when the wording was brought up to date.[2]

     Here is the traditional definition as it appears in the 2010 edition of the OED (definition 1a). This is how the word “addiction” was used by Shakespeare, the authors of the King James Bible, David Hume, Jane Austin, Charles Dickens, and other great masters of the English language, as well as everyday writers and speakers over the centuries:
  
 The state or condition of being dedicated or devoted to a thing, esp. an activity or occupation; adherence or attachment, esp. of an immoderate or compulsive kind.
     The invention of Google nGram viewer in 2011 [3] makes it relatively easy to examine many thousands of uses of the words “addiction” and “addicted” in the printed English language since about 1600. In the great majority of cases, the word was used to assert that a person was doing something regularly and predictably, without any implication of moral turpitude or medical illness and without any reference to alcohol or drugs. For example, George Smollett Tobias (1815) published an account of a trip to post-revolutionary France in the English Critical Review in the early nineteenth century. He spoke good-humouredly of “French peculiarities” as follows:
… versatility, or universal love of change; female superficiality; competence and content of the peasantry; addiction, in all ranks, and at all places to dancing; and the general propensity to talk, and to act, in public. (p. 614).

     Traditional usage was sometimes more weighty. Shakespeare, for example, used the word with gravity in The Life of King Henry the Fifth, written around 1599. 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.[4]
 
     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.[5] It is not until King Henry proves invincible in battle and magnanimous in victory that his earlier addiction is forgotten, in the final act. Henry's youthful addiction is never 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 speculate about the possible effects of the king's addiction on England's military strength.

     The weight of the word "addiction" when used in a positive sense can be illustrated by the King James Version of the Christian Bible, originally published in 1611. This was the standard Bible for English-speaking Protestants until the mid-20th century. The word "addicted" appears in 1 Corinthians, a letter from St. Paul to the early Christian community at Corinth. 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.[6]

     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 20th century translations[7] of these biblical verses make the same point, they do not use the word "addicted" which by the late 19th 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 definition 1a of the Oxford English Dictionary, it has become prudent to avoid it.

     Use of alcohol and psychoactive drugs was well known throughout Western history, and the fact that some users became severely addicted was well understood. But drug addiction was not a matter of sustained concern to either physicians or moralists before the 19th century.[8] For example, opium use in England was not usually discussed in a medical and moral context until the mid-19th 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.[9] 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".[10] 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 [11] summarized the imminent construction of the medical/moral/drug perspective on opium later in the 19th 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.[12]

The Medicalization, Moralization, and Pharmacologization of Addiction

     In the 19th and early 20th centuries, modern scientific medicine subdued mass murderers that had long plagued the human race, including small pox, cholera, typhoid, and rheumatic fever.[13] This same period also witnessed an extended moral panic over increases in excessive drinking of distilled spirits and, later, excessive use of opium, morphine, chloral hydrate, cocaine, heroin, and other drugs. These habits affronted the bourgeoning modern ideals of independence, masculinity, and self-sufficiency [14] In this historical context, the word "addiction" was gradually medicalized, moralized, and restricted to alcohol and drugs[15].

     Historians do not find it surprising that the definition of addiction was medicalized and moralized at about the same time. Although the physical medicine and Christian moralism of the 19th century were rooted in opposing metaphysics, they had similar views of human nature.[16] Often the same people were members of medical associations, temperance societies, and anti-drug movements and held both medical and moral views of addiction.[17] 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 went viral, and became one of the major mass movements of the 19th century was born.

     The powerful temperance movement in North America and Europe proclaimed that liquor, characterized as "ardent spirits", "hard liquor", or "demon rum",[18] was breaking down civilized society. Notwithstanding the hyperbole, the temperance movement's perception of a mass problem was well founded. Although most Europeans and Americans drank prudently even when they drank a lot, a growing minority, particularly visible in the working class, was adopting the drunken, socially abhorrent lifestyles that the temperance movement decried.[19] The movement first spoke of excessive drinkers as "inebriates", "drunkards", "sots", and the like, but the word "addicts" gradually came into use as well.[20] The temperance movement began appropriating the word "addiction" as the name of a moral failure at about the same time that the medical profession began appropriating it as the name of a disease.

     Although the way that the doctors and moralists increasingly used the word "addiction" did not directly contradict the traditional meaning 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.

     By the end of the 19th 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.[21] 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 often 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 19th century[28] and the electronic media of the 20th. 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] methyl amphetamine at the beginning of the 21st century [32], and still more recently with oxycodone in prescription medications like OxyContin® [32.1].
The first medical/moral/drug definition in the OED appeared half a century after the traditional definition, in the 1933 Supplement. A modernized version of the 1933 definition appears as definition 1b in the 2010 edition of the OED, where the traditional meaning of addiction appears as definition 1a. Here is the 1933 definition:
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 encompassed addiction to drugs (including alcohol[34]), but to no other habits or pursuits. Moreover, the new definition situated drug addiction in both medical and moral domains. Close examination of the 1933 definition, along with the text citations and cross-references linked to it in the OED reveals the depth of the medicalization and moralization that it expressed. 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 “dedicated” or “devoted”  appeared in the new definition, 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]

     Although medical/moral/drug definition of addiction descended from the traditional meaning of addiction logically, it had a new, sinister cast. Moreover, unlike the traditional definition, the medical/moral/drug definition included a causal theory. Addiction had become a pathologically compulsive use of a drug caused by its prior use. The new definition of addiction provided the core for an increasingly influential medical/moral/drug perspective on addiction, which, by the late 19th 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 shifted repeatedly during the late 19th and the 20th centuries, although the preponderant tilt was eventually 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 funding agencies, and of those scientific addiction researchers who are accorded the greatest public visibility.[37] It has coalesced into something that historians began calling 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 scientific drug addiction research in the world.[39] Its current form expresses a strong affinity with the thinking of 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 for NIDA-inspired and supported professional research published leading researchers.[45.1]
It is important to distinguish between the Official View, which is often expressed in the language of neuroscience, and the neuroscientists who actually do the 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 multiple 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 and conveyed implicitly.

     The first foundational element is that addiction is fundamentally a problem of drug or alcohol consumption. Even where habits other than drug use 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 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 – or of a residual of past use of a drug that has been engraved in their brain, rather than actively adapting to their world.

     Third, a major portion of people's vulnerability to the addictive transformation 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 and final cure for this disease than there would be for diabetes, asthma, or Alzheimer's disease.[47]

     Fifth, although people cannot be completely cured of the disease of addiction, their disease can be successfully managed through professional treatment and/or membership in self-help groups.[48] If addicted people refuse treatment or self-help group membership, they are expected to further damage themselves and society because there is no possibility that they can recover on their own.[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 a profound faith in Science and Medicine: The view of the Official View as objective science is assumed to guarantee that it is correct and certain.[50] It is said that generous funding of scientific 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 do not associate it with moralism or with 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]

     Although the Official View is proclaimed in tones 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 are stated explicitly or implicitly within its twenty-first century expressions [53.1], some earlier variations have been discredited within the current Official View.

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 his or her will power. This idea may seem to be a relic of the 19th 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-appeared during the panics over crack cocaine in the 1980s and methamphetamine around the turn of the 21st century. Both drugs were said for a time to be instantly and universally addicting in the mass media. These assertions were not actively refuted in public presentations of the Official View.

     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 who uses drugs is at risk that they will cause addiction.[55]

     The weak form of the 2nd 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 normal ability to adapt to their world intelligently and morally.
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 lack of the moral fiber 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 19th 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 view has a central role in the twelve-step doctrine, which is intertwined with the Official View.[57]

     In the most current version of the Official View, the moral content is – paradoxically –  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 primary 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 addiction 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, unclear 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 19th century, and later including opium, morphine, chloral hydrate, cocaine, heroin, marijuana, amphetamine, barbiturates, meprobamate (Miltown®), nicotine, industrial solvents and glue, benzodiazepines (Valium®), crack (i.e., cocaine again), crystal meth (i.e., amphetamine again), and oxycodone, with the prescription medication OxyContin® as its vehicle. There are growing signs that heroin use is on the upswing (again) and may be the Next Big Thing within the Official View. [65.1]

     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" became popular; psychoanalytic theories flourished in that same 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 painkillers or endorphins and by crippling the brain's ability to produce its natural supply of endorphins. In the Official View of the 1980s and 1990s, heroin and other "addictive drugs", especially cocaine and amphetamines, 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.[68] In the most current Official View, “drugs of addiction,” including heroin, are said to cause addiction by increasing the perceptual and reward salience of cues that have been associated with past drug use and simultaneously weakening the cognitive capacity of the brain to distinguish between beneficial responses and drug taking responses [68.1]
Thus, while the six foundational views of addiction within the Official View have remained constant, many variations on them have come and gone.[69] It is safe to predict that new variations will continue to proliferate as the older ones collapse under 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 my book, 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 human addictions. This contradicts the 1st foundational element.
The Official View of addiction grew out of the 19th 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, wealth, 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.

     Recent research has drawn public attention to the fact that in some experimental situations rats act as if Oreo Cookies are more addicting than cocaine [71.1]. Whereas I have no wish to demonize one of my favorite childhood snacks, it is quite likely that serious addiction to junk foods and food in general [71.2] is a much greater problem in many parts of the world, including the United States and Canada, than is addiction to cocaine. The world-wide epidemic of obesity, diabetes, and eating disorders may well be one testimonial to the fact that drug addictions are far from the most important corner of the doleful tapestry of human addictions.

     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 people who know themselves to be severely addicted 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 or other neurological sources of pleasure that their brains lack after they become addicted according to many current versions of the Official View? Very 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 these drugs, and do not become addicted. This contradicts the strong form of the 2nd 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 have been published showing that people of every social class can use "addictive drugs", including crack cocaine and methamphetamine, for very long periods without becoming addicted.[75]

     The evidence that "addictive drugs" can be used safely was not only officially ignored until recently, it was also actively suppressed. The Guardian newspaper on June 13, 2009 reported the overt political suppression 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. This was the largest study of cocaine use ever conducted, with data reported from 22 sites in 19 different countries (I was principle investigator at one of the sites). Its existence and suppression are still 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 most people who are addicted to drugs, as well as other habits and pursuits, are far from out of control. They can explain why they are drawn to a drug addicted lifestyle – despite its enormous dangers and pain – in great detail. They can recount the functions that their addictions serve for them, and explain why socially acceptable life styles are unappealing as well as difficult to achieve.[77] Research on severely addicted people shows that they can control their impulses to use drugs where there is even a small reward for doing so [77.01]

     I am not claiming 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[77.1]. 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 before a judge.

     Some addicted people do sincerely believe at times that they are out of control and cannot comprehend their own behavior, but these beliefs are readily understood 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] On the other hand, 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 3rd 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 heritability of 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 a particular trait, the presence of which makes a person to social exclusion, can increase the probability of addiction in the persons that carry the gene. These kinds of indirect genetic effects could have measurable effects on the heritability of 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 have been 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 epigenetic 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 4th 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], although 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 self-help meeting rooms and the treatment agencies. 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 20th century and into the 21st. This shows the futility of the 5th foundational element and of the Official View as a whole.

     The dedication of the practitioners who have carried out the interventions that grow out of the Official View is unquestioned. However, their interventions, including prevention programs in the schools, twelve-step groups, conventional psychotherapy, cognitive behavioral modification, 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 private 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.
When an analysis of an urgent problem does not solve the problem, pragmatism dictates that it is time to try a different paradigm. Yet, failure to control addiction is simply explained away in the foundational logic of the Official View. Since the Official View deems addiction a chronic disease, addiction cannot fully recover. Addicts who have become "clean and sober" through treatment are never more than a single slip away from potentially catastrophic relapses. As long as addiction was thought to be limited to drugs, it could be supposed that society could escape the rising tide of addiction when drugs were successfully prohibited or when voluntary drug abstinence became universal. But now it has become obvious that successful drug prohibition and universal abstinence are pipe dreams and that people can become addicted to innumerable other 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
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, 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 6th 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, power, and on and on.[87] Extensive historical evidence for this is summarized elsewhere 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 old moralistic social movements than from new scientific discoveries. This contradicts the claim that the Official View is based on dispassionate science and seriously undermines part of the 4th 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 19th 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 19th 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 20th century moralists thought heroin permanently changed people into despicable "drug fiends". Mainstream biomedical researchers of the 21st 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. Has there really been any fundamental change in thinking over this period?

     In the second half of the 20th 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-neuroscientists 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, especially those that occur early in life, produce measurable effects on the brain.

     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 neologized form of a folk myth 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 unassailable mathematic proof – until 2008 – 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 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.

     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 that can be discerned within the families and communities of people who later become addicted.


10. Contrary to the claims of its advocates, the Official View is intrinsically moralistic and punitive, most obviously because it provides justification for some of the violent excesses of the "War on Drugs".

     Most contemporary versions of the Official View envision 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 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 devour 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 reach of this dehumanizing judgment 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, even if 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 performed a valuable service by trying 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 should never be ignored.

     The downfall of the Official View was that its particular medical and moral analysis was narrow, ineffectual, incompatible with basic facts about addiction, internally inconsistent, and  historically unstable. 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 be murdered 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 a 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 Theory 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, Non-Pharmacological View of Addiction

      An alternate view of addiction is coming to the fore. It is 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] I call this alternate view the "Dislocation Theory" of addiction, although other people have discussed very similar ideas without using my name for them. I am convinced that the Dislocation Theory provides a level of explanation for addiction that will prove far more useful than the Official View in the long run.

     Like the Official View, Dislocation Theory is not a product of pure, dispassionate science, but a social construction, with deep roots in western history and philosophy.[113] Beyond this, however, Dislocation Theory differs from the Official View in almost every way, beginning with who supports it. Its 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 and recovering people understand their personal addictive problems in a way that accords with Dislocation Theory and contradicts 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 it, 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 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, along with a few gestures toward the supporting evidence as it is marshaled in my book.[116]
Rather than concentrating on drug and alcohol addictions, Dislocation Theory encompasses the full range of destructive addictions. Although it does explain addictions to drugs and alcohol, it gives them no special stature among addictions, because severe drug and alcohol addictions do not differ from other severe addictions in their psychological dynamics or their potential for harm.[118]
Dislocation Theory does not view addiction as either a medical condition or a moral failure or both. It envisions no pathological transformation of the brain, the will, the unconscious, the character, or any other hidden aspect of a person. Rather, it depicts addiction as a way of living that a person takes up for reasons that are usually visible and readily understood. Because addiction is not a disease, there is no diagnostic criterion that separates mild instances of addiction from severe ones that warrant concern. As a way of adapting to intolerable circumstances, addiction is no more or less moral than any other kind of adaptation.
Also in contrast to the Official View, Dislocation Theory does not focus on single individuals, but on the societal causes of the globalized flood of addiction in the modern era. Of course each addicted individual's story is unique, but Dislocation Theory provides a societal framework within which the struggles of addicted individuals can be more deeply understood.

Fragmentation

Dislocation Theory starts with the historical fact that societies everywhere have become fragmented in the last few centuries (See Fig. 1, top quadrant). The agricultural and industrial revolutions began to overrun and crush European agrarian cultures before 1600. Then colonialization crushed pre-industrial and aboriginal cultures around the globe. Then the technological revolution and all-powerful multinational corporations overran the local industrialized societies that were emerging from the ruins of agrarian, pre-industrial, and aboriginal cultures. Beneath the repeated passes of the steamroller of modernity, nuclear families have been crushed, extended families have been scattered, traditional religions have been lost or transformed into shallow 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, culture, and the financial crisis.[119]
I think that the fragmenting of modern world society is best understood as a result of the enormous growth of the economic philosophy underlying multinational, free market capitalism. Others understand the underlying cause in a different, although overlapping, vision, for example the domination of the modern world by scientific and industrial rather than intuitive modes of thought, and by the thought processes of the right hemisphere of the brain dominating those of the left[119.1].



Figure 1. The Dislocation Theory of Addiction

Dislocation

Figure 1 (right quadrant) shows mass 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, leaving a bleak and empty experience of the world[120]. Dislocation does its destructive work at every stage of the human life-cycle, 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.
The Dislocation Theory view of modern society is more than mere romanticism. Modernity is not more evil than the eras that preceded it but, like every social era, 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 or income inequality. 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 wealth 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].

Addiction

     Just as the prevalence of dislocation tracks social fragmentation, the prevalence of addiction tracks dislocation (see Fig. 1, bottom quadrant). 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 severe addiction can be 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 tragic but exotic junkie mystique,[129] to make their existence seem less miserable than it is.
Thus, far from being a disease, the modern flood of addiction is a way that many individuals adapts to dislocation, and, more generally, a way of adapting to the social fragmentation of modernity, which is the root cause of much 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.

Consequences of Addiction: The Cycle Repeats

     As the left quadrant in Figure 1 shows, there are 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 degrading their families and communities. As well, many addicted people contribute to further expansion of today's out-of-control multinational economy and the dislocation that flows from it[130] in many roles, from thriving street addicts, to wasteful shopaholics, to insatiably greedy CEOs.[131] In these ways, addiction perpetuates itself.

Recovery

     Although this self-perpetuating cycle will be difficult to break on a global level, many individuals do overcome their personal addictions. Adapting to dislocation is not a chronic brain disease, as the Official View maintains. Because addiction is unlikely to be a successful adaptation in the long run, many people eventually find a better way to live, either by reducing their dislocation, by changing to a less harmful addiction, or by adopting a “recovery” oriented lifestyle. The firmly-established evidence of natural recovery[132] that perplexes the Official View fits comfortably with the Dislocation Theory. On the other hand, some people can neither reduce their dislocation nor find better ways to cope with it 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 their addictions. It deepens the understanding of individual struggles by showing that the more fragmented a society is, the more obstacles will emerge to impede dislocated individuals from winning these struggles and the more likely that a person will lapse, or relapse, into addiction.

Heredity

     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".

Pre-Modern and Modern Society

     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 international 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 accelerating the cycle of addiction.
Ultimately, modernity and free-market economics not only destabilize people's personal and social lives in the interests of the economy, they also destabilize 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 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 2008 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 (See 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.

Conclusions and Speculations

     All six foundational elements of the Official View are untenable, its scientific faith is simplistic, and its promise of a pharmacological cure of addiction is expiring -- like any long-repeated promise that has not been kept. Moreover, the War on Drugs that the Official View tacitly supports is being exposed as futile and cruel. Addiction is more accurately, usefully, and compassionately conceptualized by Dislocation Theory. It is time for a paradigm shift.
The original medicalization, moralization, and pharmacologization of addiction in the 19th century was much more than an attempt to solve a pressing social problem by enlisting the methods of medical science and moral exhortation. Medicalization, moralization, and pharmacologization of addiction served the larger function of reassuring an increasingly nervous population that the brave new world of 19th century modernity was secure and that the growing number of addicted people who could not care for themselves were diseased or immoral aliens who had been enslaved by addictive drugs [146.1]. With the growing malaise of addiction conceptually limited to drugs, there remained no possibility of seeing the rising tide of addiction as an understandable way of adapting to an impoverished social milieu. The possibility that successful intervention would have to come more from societal change than from individual treatment or punishment became unthinkable. At the same time, major benefits accrued to the nascent treatment and pharmaceutical industries that devoted themselves to tirelessly inventing profitable cures for the non-existent disease.

     Today's Official View continues to serve the same function. It narrows addiction, first, by focusing attention on the need for individual treatment or correction rather than societal reorganization, while ignoring the obvious psychological devastation caused by the social fragmentation of the modern world. Second, the Official View narrows addiction by focusing on the addictive problems of drug and alcohol users,[147] while distracting attention from the full range of addiction in contemporary culture. Modern society's highly complex addictive problems have been thus largely confined by the Official View to a relatively small group of addicted individuals (seen as morally irresponsible patients with a brain disease), drug traffickers (seen as morally depraved drug merchants and gang members), third-world farmers (seen as ignorant peasants whose lack of compliance means that their crops may be freely destroyed), and small time growers and laboratories in developed countries (seen as members of motorcycle gangs and organized crime families).

     Grossly oversimplifying a complex social phenomenon has kept the spotlight always turned away from a global world economy that mass-produces dislocation and, consequently, addiction. The global economy also mass-produces a vast, glittering array of products for addicted people to purchase and propagates media images that make all this seem right and proper. The modern status quo is shielded by the Official View from the critical analysis that the current global flood of addiction would otherwise provoke. It is further entrenched in the official mind because our public officials and institutions are influenced and rewarded by immensely powerful corporate and geopolitical interests that feed on the status quo.[148] It is entrenched in the corporate mind because it is good for business.

     The Official View is appealing to private individuals because it spares us all the anguish of facing excruciating social and psychological realities. For example, it spares relatives of addicted children from having to examine their own family contributions to the problem too closely. It spares those who delight in libertarian freedoms that defy tradition from having to enquire about the costs of these liberties for society as a whole.
However, the Official View is untenable and will lose its hypnotic power, sooner or later. Paradigms do shift and ideas like the Dislocation Theory stand at the ready for when the Official View does. Only then can the difficult issues that the Official View obscures be fully confronted.
Although Dislocation Theory finds little overt support in the current medical and biological literature on addiction, it is fully compatible with current clinical practice and biological science. The concept that addiction is an adaptation to dislocation is partly based on extensive published clinical observations from decades of practice. Many modern practitioners use ideas that are part of the Dislocation Theory in their clinical practice with addicted people. Dislocation theory is grounded in the evolutionary concept of adaptation.[149] It could also be grounded in modern neuroscience although virtually all neuroscience research on addiction now goes to scientists committed to the Official View. There are many directions that research on Dislocation Theory could take. It could be based on recent advances in analysing cortical hemisphericity, as conceptualized by Iain McGilchrist[149.1]. Lucy Brown has proposed that the neurological basis of addiction be an extension of the normal neurological roots of attachment, romantic love, and sex.[150] Whatever their roots, there is every reason to suppose that the adaptive patterns that comprise addiction have homologues in other species and that they have determinable neurological and genetic bases.

     Current clinical treatment and harm reduction may be understood more fruitfully within a paradigm for understanding addiction that is founded on Dislocation Theory. For example, as the Official View has opened up to methadone maintenance, it has construed it as a pharmaceutical treatment for heroin addiction.[151] However, the claim that administering an opiate should constitute treatment for addiction to another opiate has seemed obscure to careful thinkers since the end of the 19th century.

     Dislocation Theory does not envision heroin addicted people as sick or immoral, but rather as struggling to adapt to difficult circumstances in ways that are not always socially acceptable. The essence of harm reduction practice is not dispensing methadone, needles, condoms, or crack pipes. These tasks can be accomplished by specialized vending machines. The essence of Harm Reduction is establishing ongoing, respectful relationships between addicted people and caring service providers which increase the likelihood of an addicted person finding a more socially acceptable and productive way of living[152]. The harm reduction movement may be expected to play a much fuller and more vital role when understood in terms of Dislocation Theory.
While recognizing the importance of treatment and harm reduction, Dislocation Theory of course puts the greatest emphasis on dislocation as a root cause of addiction and on fundamental social change as the most important means of bringing addiction under control. However, I think its implications are wider still. The Dislocation Theory of addiction is one of the windows through which we can view the widespread psychological malaise and the underlying structural problems of a tottering civilization. Viewed in this way, addiction is not only a scourge for modern humanity, but also a crucially important teacher. Unfortunately, its lessons have been obscured by the stultifying presence of the Official View.

Endnotes
 
 [1] The Latin form of the word “addiction” was used both in a legal and a psychological sense. In Roman law, for example, a servus addictus was a person legally given over as a bond slave to his creditor. However, the verb addicere could also be used outside of the judicial context to describe strong devotion, which could be either destructive or admirable. The admirable sense of the word is illustrated in the phrases, senatus, cui me semper addixi, "the senate to which I am always devoted (or addicted)", and agros omnes addixit deae, "he devoted (addicted) the fields entirely to the goddess" (Lewis, C.T. and Short, C. A Latin Dictionary: Founded on Andrews' Edition of Freund's Latin Dictionary. (Oxford: Oxford University Press, 1879).
[2] The Oxford English Dictionary is the authoritative dictionary of the English language. An enormous work, it required over half a century to assemble and publish. The original edition came out in separate "fascicules" that were published at different times in the late 19th century. The wording of the traditional definition of addiction is the same in all editions including the online edition launched in 2000 that was current until late in 2010.
 [3] Michel, J.-B. et al. (2011, January 14). Quantitative analysis of culture using millions of digitized books. Science, 331(6014), 176-182.
 
[4] Shakespeare, W. (ca. 1599). The Life of King Henry the Fifth. In The Complete Plays of William Shakespeare. New York, NY: Chatham River Press, 1984, pp. 429-457, Act I: Scene I.
[5] Shakespeare, W. (ca. 1599). The Life of King Henry the Fifth. In The Complete Plays of William Shakespeare. New York, NY: Chatham River Press, 1984, pp. 429-457,Act I: Scene II; Act II: Scene IV.
[6] I Corinthians 16:15-16, Authorized (King James) Version of The Bible (1611, italics in original).
[7] I Corinthians 16:15-16, New Living Translation of The Bible (1996); I Corinthians 16:15-16, New American Bible (2002).
[8] Hickman, T.A. (2007). The secret leprosy of modern days: Narcotic addiction and the cultural crisis in the United States, 1870-1920. Amherst, MA: Univesity of Massachusetts Press. It is sometimes argued that the idea of addiction was a new social construction or even a "fetish" that grew out of the economic tensions of the 19th century (See Levine, H.G. (1978). The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America. Journal of Studies on Alcohol 39, 143-174; Reith, G. (2004). Consumption and its Discontents: Addiction, Identity and the Problems of Freedom. British Journal of Sociology, 55, 283-300.) However, some instances of the use of the word "addiction" in accordance with traditional usage to describe destructive lifestyles centered on alcohol can be found much earlier than the 19th century (Warner, J. (1994). Resolv'd to Drink No More': Addiction as a Pre-Industrial Construct. Journal of Studies on Alcohol, 55, 685-691. It is the narrowing of the word to describe only compulsive use of alcohol and drugs, in a medical and/or moral framework, that was new in the 19th century.
[9] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane.
[10] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, pp. xxiv-xxvii, chaps. 3, 4.
[11] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, pp. 51-54.
[12] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, pp. xxvii.
[13] Paradoxically, the last two centuries, in which the term "addiction" became muddled, saw the emergence of clear, accepted understandings of many diseases that had had confused meanings for millennia: smallpox, tuberculosis, cholera, appendicitis, and so on. Along with clear definitions of these problems came accepted causal theories and effective means of control. P. Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982). See also Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, chaps. 10-13.
[14] Hickman, T.A. (2007). The secret leprosy of modern days: Narcotic addiction and the cultural crisis in the United States, 1870-1920. Amherst, MA: Univesity of Massachusetts Press.
[15] Hickman, T.A. (2007). The secret leprosy of modern days: Narcotic addiction and the cultural crisis in the United States, 1870-1920. Amherst, MA: Univesity of Massachusetts Press. (pp. 7-10); Reinarman, C. (2005). Addiction as accomplishment: The discursive construction of disease. Addiction Research and Theory, 13, 307-320.
[16] As historian Nancy Campbell puts it, "The disease concept of addiction goes back to a cultural emphasis on abstinence and temperance that emerged as early as the 1780s." Campbell, N.D. (2007). Discovering addiction: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press, 2007, p. 13; see also Hickman, T.A. (2007). The secret leprosy of modern days: Narcotic addiction and the cultural crisis in the United States, 1870-1920. Amherst, MA: Univesity of Massachusetts Press, p. 41.
[17] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, pp. 154-155; White, W.L. (1998). Slaying the Dragon: The history of alcoholism treatment and recovery in America. Bloomington, IL: Chestnut Health Systems. (pp. 21-78)
[18] "Spirits" were distilled alcohol, in the form of whisky, gin, brandy, etc. At first, the temperance movement regarded wine and beer as acceptable alternatives to spirits, but this changed over the decades.
[19] For documentation of the growth of alcohol and opium consumption in Europe and America in the 18th and 19th centuries, see Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 129-131). For a description of the degraded existence of some 19th century alcoholics, see Charles Dickens, writing as a reporter under the pseudonym Boz, in his article The Drunkard's Death. (See C. Dickens, "The Drunkard's Death," in The Dent Uniform Edition of Dickens' Journalism: Sketches by Boz and Other Early Papers, 1833 - 1835, ed. M. Slater (London, UK: J.M. Dent, 1994)). Jessica Warner has described the alcohol consumption of the British Gin Craze, which began in the 18th century. (See Jessica Warner, Craze: Gin and Debauchery in an Age of Reason (New York: Four Walls Eight Windows, 2002)). Some of today’s descriptions of alcoholics are strikingly similar to the descriptions of Dickens and Warner from an earlier age. (See, for example, L. Crozier and P. Lane, Addicted: Notes from the Belly of the Beast (Vancouver, BC: Greystone Books, 2001)).
[20] Aaron, P. and Musto, D. (1981). Temperance and Prohibition in America: A Historical Overview," in M.H. Moore and D.R. Gerstein (Eds.), Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington, DC: National Academy Press, pp. 125-181 (see especially pp. 138-139); Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, p. 160.
[21] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, p. 154.
[27] Aaron, P. and Musto, D. (1981). Temperance and Prohibition in America: A Historical Overview," in M.H. Moore and D.R. Gerstein (Eds.), Alcohol and Public Policy: Beyond the Shadow of Prohibition. Washington, DC: National Academy Press, pp. 125-181.
[28] G. Silver and M. Aldrich, The Dope Chronicles: 1850 - 1950 (New York: Harper & Row, 1979); E. Murphy, The Black Candle (Toronto, ON: Coles, 1973, original work published 1922).
[29] E. Murphy, The Black Candle (Toronto, ON: Coles, 1973, original work published 1922); C. Carstairs, Jailed for Possession: Illegal Drug Use, Regulation, and Power in Canada, 1920 - 1961 (Toronto, ON: University of Toronto Press, 2006), chaps. 1-2.
[30] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 4; C. Carstairs, Jailed for Possession: Illegal Drug Use, Regulation, and Power in Canada, 1920 - 1961 (Toronto, ON: University of Toronto Press, 2006), chap. 3.
[31] C. Reinarman and H.G. Levine, Crack in America: Demon Drugs and Social Justice (Berkeley, CA: University of California Press, 1997), chap. 1.
[32] J. Armstrong, "Crystal Meth is Sweeping BC: Police, Youth Workers and Health Authorities are Alarmed and Afraid: Toxic Drug Causes Lasting Damage to Brain," Globe and Mail, January 10, 2004, pp. A1, A7; G. Smith, "Swinging at the Shadows: The Curse of Crystal Meth," Globe and Mail, December 4, 2004, pp. A1, A7, A8; T. Hawthorn, "Nothing Funny About Crystal Meth: Drug is Becoming a Scourge in Victoria," Globe and Mail, May 4, 2005, pp. S1, S3; D. Sheff, Beautiful Boy: A Father's Journey Through his Son's Addiction (Boston, MA: Mariner Books, 2009).
[32.1] Blackwell, T. (2011, 12 November). The selling of oxycontin. Retrieved 14 Nov. 2011 from http://news.nationalpost.com/2011/11/12/the-selling-of-oxycontin/
[33] Italics and uppercase in original. This 1933 definition is reworded in the 2010 3rd edition of the OED, but its essential features remain in place.
[34]Alcohol was a drug according to definition 1.b. of "drug" in the OED.
[35] The term "drug-addiction" in this moralistic sense does not appear in the 1884 fascicule or in the main text of the 1928 edition. A form of it does appear in the 1933 Supplement.
[36] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, chap. 13; White, W.L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Bloomington, IL: Chestnut Health Systems. (pp. 21-114).
[37] In discussing addiction research in the 20th century United States, Nancy Campbell wrote, "Although neurophysiology and pharmacology dominated twentieth-century addiction research, vestiges of psychoanalysis stuck in scientific [discourse] as well as popular constructions of the the concept of addiction or drug dependence…Such accounts shaded into older moralistic constructs of alcoholism and addiction as "diseases of the will"…" (Campbell, N.D., 2007, Discovering addiction: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press, p. 28).
[38] Campbell, N.D. (2007). Discovering addiction: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press, p. 19).
[39] Budney, A.J., Higgins, S.T., Mercer, D.E., Carpenter, G. A Community Reinforcement Approach: Treating Cocaine Addiction. Therapy Manuals for Drug Abuse, Manual 2. Retrieved 2 April 2010 from http://www.drugabuse.gov/TXManuals/cra/CRA2.html
[40] B.K. Alexander, G.A. Dawes, G.F. van de Wijngaart, H.C. Ossebaard, and M.D. Maraun, "The 'Temperance Mentality': A Comparison of University Students in Seven Countries," Journal of Drug Issues 28 (1997): 265-282; C. Russell, J.B. Davies, and S.C. Hunter, "Predictors of Addiction Treatment Providers' Beliefs in the Disease and Choice Models of Addiction," Journal of Substance Abuse Treatment (2010, in press, especially discussion section).
[41] The book is Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale. The national publicity campaign, the film series, the website, and the series of town hall meetings are described in http://www.addictionaction.org/about/about-the-project.html (accessed June 28, 2010). .
[42] These experts are listed by Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, pp. 239-241.
[43] These include Susan Cheever, Katherine Ketcham, and David Sheff. See Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, pp. 238-239.
[44] The Robert Woods Johnson foundation is funded by the fortune accumulated by the Johnson and Johnson Corporation, a vast consortium that comprises the eighth largest pharmaceutical company in the world along with its other holdings in the biomedical field.
[45] For example, National Institute of Drug Abuse, Drugs, Brains, and Behavior: The Science of Drug Addiction (Washington, DC: National Institute of Drug Abuse, 2007, NIH Pub. No. 07-5605).
[45.1] Robinson, T.E. & Berridge, K.C. (2008) The incentive sensitization theory of addiction: some current issues. Philosophical Transactions of the Royal Society B, 363, 3137-3146; Koob, G.F. (2009). Neurological substrates for the dark side of compulsivity in addiction. Neuropharmacology, 56, 18–31; Sinha, R. & Shaham, Y. & Heilig, M. (2011) Translational and reverse translational research on the role of stress in drug craving and relapse. Psychopharmacology, 218, 69–82; Marhe, R., Luijten, M., & Franken, H.A. (2014, January 10). The clinical relevance of neurocognitive measures in addiction. Frontiers in Psychiatry, 4 (Article 185), 1-7.
[46] Campbell, N.D. (2007). Discovering addiction: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press, p. 203.
[47] Leshner, A.I. (1997). Addiction is a brain disease and it matters. Science, 278 (5335), 45-47; Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale; D. Sheff, Beautiful Boy: A Father's Journey Through his Son's Addiction (Boston, MA: Mariner Books, 2009), pp. 320-321.
[48] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale; D. Sheff, Beautiful Boy: A Father's Journey Through his Son's Addiction (Boston, MA: Mariner Books, 2009), pp. 320-321; N. Sheff, Tweak: Growing Up on Amphetamines (New York, NY: Athenum Books for Young Readers, 2009).
[49] See G.M. Heyman, Addiction: A Disorder of Choice (Cambridge, MA: Harvard University Press, 2009), pp. 65-67 for quotes and references to American authorities stating this position.
[50] This assumption is repeated throughout Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale.
[51] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, pp. 17, 139, 148; N. Campbell, "Toward a Critical Neuroscience of Addiction," BioSocieties 5 (2010): 89-104.
[52] H. Pearson, "Science and the war on drugs: A hard habit to break", Nature 430 (2004, 22 July): 394-395.
[53] Campbell, N.D. (2007). Discovering addiction: The science and politics of substance abuse research. Ann Arbor, MI: University of Michigan Press, chap. 1).
[53.1] Koob, G.F. (2009). Neurological substrates for the dark side of compulsivity in addiction. Neuropharmacology, 56, 18–31. Robinson, T.E. & Berridge, K.C. (2008) The incentive sensitization theory of addiction: some current issues. Philosophical Transactions of the Royal Society B, 363, 3137-3146.
[54] See, for example, F. Kasanetz, V. Deroche-Gamonet, N. Berson, E. Balado, M. Lafourcade, O. Manzoni, P.V. Piazza, :Transition to Addiction is Associated with a Persistent Impairment in Synaptic Plasticity," Science 328 (2010): 1709-1712; S.H. Ahmed, "Validation Crisis in Animal Models of Drug Addiction: Beyond Non-disordered Drug Use toward Drug Addiction," Neuroscience and Biobehavioral Reviews, in press.
[55] Hoffman and S. Froemke, Addiction: Why Can't They Just Stop? (New York: Rodale, 2007), pp. 40-43.
[56] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, pp. 332-340.
[57] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 225.
[58] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale. This idea is repeated on many pages throughout the book.
[59] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 209.
[60] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 56.
[61] G.M. Heyman, Addiction: A Disorder of Choice (Cambridge, MA: Harvard University Press, 2009).
[62] G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Toronto, ON: Knopf Canada, 2008; J. Bradshaw, Reclaiming Virtue: How We Can Develop the Moral Intelligence to do the Right Thing at the Right Time for the Right Reason (London, UK: Piatkus, 2009); B. Denizet-Lewis, America Anonymous: Eight Addicts in Search of a Life. (New York: Simon & Schuster, 2009).
[63] A. Leshner, "NIDA Probes the Elusive Link Between Child Abuse and Later Drug Abuse," NIDA Notes 13, no. 2 (1998).
[64] Sex Addiction Treatment Guide. Dr. Drew Talks Sex Addiction on Oprah. Accessed June 15, 2010 at http://sexaddictiontreatmentguide.com/sex-addiction-treatment/dr-drew-talks-sex-addiction-on-oprah/; J. Bradshaw, Reclaiming Virtue: How We Can Develop the Moral Intelligence to do the Right Thing at the Right Time for the Right Reason (London, UK: Piatkus, 2009). John Bradshaw is a major media personality and self-help writer in the United States.
[65] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, pp. 70-73, 90-92.
[65.1] Slater, J. (2014, February 5). America’s rising heroin addiction. The Globe and Mail, p. A3. Retrieved February 11 2014 from  http://www.theglobeandmail.com/news/world/americas-rising-heroin-addiction/article16723525/
[66] White, W.L. (1998). Slaying the dragon: The history of addiction treatment and recovery in America. Bloomington, IL: Chestnut Health Systems (pp. 96-100); Campbell, N.D. (2007). Discovering Addiction: The Science and Politics of Substance Abuse Research. Ann Arbor, MI: University of Michigan Press, chap. 1).
[67] Campbell, N.D. (2007). Discovering Addiction: The Science and Politics of Substance Abuse Research. Ann Arbor, MI: University of Michigan Press, chap. 7).
[68] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 56; Courtwright, D.T. (2010). The NIDA brain disease paradigm: History, resistance, and spinoffs. Biosocieties, 5, 137-147.
[68.1] Goldstein,R.Z. & Volkow, N.D. (2002). Drug Addiction and Its Underlying Neurobiological Basis: Neuroimaging Evidence for the Involvement of the Frontal Cortex. American Journal of Psychiatry, 159, 1642-1652; Robinson, T.E. & Berridge, K.C. (2008) The incentive sensitization theory of addiction: some current issues. Philosophical Transactions of the Royal Society B, 363, 3137-3146; Koob, G.F. (2009). Neurological substrates for the dark side of compulsivity in addiction. Neuropharmacology, 56, 18–31.
[69] Campbell, N.D. (2007). Discovering Addiction: The Science and Politics of Substance Abuse Research. Ann Arbor, MI: University of Michigan Press.
[70] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition. For a more extensive tour of the critical literature, see the references cited in chap. 8.
[71] J. Orford, Excessive Appetites: A Psychological View of Addictions, 2nd ed., (Chichester, UK: Wiley, 2001); G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Toronto, ON: Knopf Canada, 2008); Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 34-36, chaps. 9, 10; J. Bradshaw, Reclaiming Virtue: How We Can Develop the Moral Intelligence to do the Right Thing at the Right Time for the Right Reason (London, UK: Piatkus, 2009); B. Denizet-Lewis, "America Anonymous: Eight Addicts in Search of a Life. (New York: Simon & Schuster, 2009). Polk, S. “For the love of money.” The New York Times Sunday Review, 2014, January 18. Retrieved January 19 2014 from www.nytimes.com/2014/01/19/opinion/sunday/for-the-love-of-money.html?ref=opinion.
 
[71.1] Hamblin, J. (2013, October 17). How Oreos Act Like Cocaine.  The Atlantic, Retrieved January 24 2014 from http://www.theatlantic.com/health/archive/2013/10/how-oreos-work-like-cocaine/280578/
 
[71.2] Davis, C. (2013). Compulsive Overeating as an Addictive Behavior: Overlap Between Food Addiction and Binge Eating Disorder. Current Obesity Reports, 2, 171-178; Davis, C., Loxton, N.J., Nevitan, R.D., Kaplan, A.S., Carter, J.C., and Kennedy, J.L. (2013). 'Food addiction' and its association with a dopaminergic multilocus genetic profile. Physiology & Behavior, 118, 63-69.
 
[72] N.D. Volkow and R.A. Wise, "How Can Drug Addiction Help us Understand Obesity," Nature Reviews: Neuroscience 8 (2005): 555-560; J. Frascella, M.N. Potenza, L.L. Brown and A.R. Childress, "Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint," Annals of the New York Review of Sciences, Addiction Reviews 2 (2010): 294-315.
[71.1] J. Hamblin, “How Oreos Act Like Cocaine”, The Atlantic, (October 17, 2013). Retrieved January 24 2014 from http://www.theatlantic.com/health/archive/2013/10/how-oreos-work-like-cocaine/280578/
[73] The assumption that an overwhelming involvement is not really an addiction unless it shares brain mechanisms with a known drug addiction is implicit, for example, in J. Frascella, M.N. Potenza, L.L. Brown and A.R. Childress, "Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint," Annals of the New York Review of Sciences, Addiction Reviews 2 (2010): 294-315.
[74] See summary and references in Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 186-189.
[75] Many of these studies are reviewed in Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 8.
[76] B. Goldacre, "Cocaine Study That Got up the Nose of the US," Guardian (UK), June 13, 2009, p. 8. See also The WHO Cocaine Project, Website of the Transnational Institute. Retrieved 20 October 2010 from http://www.tni.org/article/who-cocaine-project.
[77] Burroughs, W. (Under pen name Willam Lee). Junkie: Confessions of an Unredeemed Drug Addict ????; Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 158-160 and associated endnotes; D. Jensen, The End of Civilization, vol. 1 of Endgame, (New York: Seven Stones, 2006), p.153; G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Toronto, ON: Knopf Canada, 2008); N. Sheff, Tweak: Growing up on Methamphetamine, (New York, NY: Athenium Books for Young Readers, p. 150 ff).
[77.01] Hart, C. (2013). High price: A neuroscientist’s voyage of self-discovery that challenges everything you know about drugs and society. New York, NY: HarperCollins; Tierney, J. (2013, September 16). The rational choices of crack addicts. The New York Times, Retrieved 30 Sept 2013 from www.nytimes.com/2013/09/17/science/the-rational-choices-of-crack-addicts.html?pagewanted=all
[77.1] Alexander, B.K. & Shelton, C.P. (in press). A history of psychology in western civilization. Cambridge, UK: Cambridge University Press (chap. 9).
[78] J.B. Davies, The Myth of Addiction: An Application of the Psychological Theory of Attribution to Drug Use (London, UK: Routledge, 1992).
[79] G.E. Vaillant, Adaptation to Life (Boston, MA: Little, Brown, 1977).
[80] For a recent expression of this idea, with comments on some of the older versions, see R.Z. Goldstein, A.D. Craig, A. Bechara, H. Garavan, A.R. Childress, M.P. Paulus, and N.D. Volkow, "The Neurocircuitry of Impaired Insight in Drug Addiction," Trends in Cognitive Sciences, 13 (2009): 372-380.
[81] For a excellent short review of epigenetic evidence against this claim, see G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Toronto, ON: Knopf Canada, 2008), chap. 19 and appendix I. See also H. Kalant, "What Neurobiology Cannot Tell us About Addiction," Addiction 105 (2009).
[82] G.M. Heyman, Addiction: A Disorder of Choice (Cambridge, MA: Harvard University Press, 2009), chap. 4.
[83] G.M. Heyman, Addiction: A Disorder of Choice (Cambridge, MA: Harvard University Press, 2009), pp. 79-80.
[84] R. Granfield and W. Cloud, Coming Clean: Overcoming Addiction Without Treatment (New York: New York University Press, 1999); B.K. Alexander, The Globalization of Addiction: A Study in Poverty of the Spirit (Oxford: Oxford University Press, 2010), pp. 160-161, 290.
[85] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 38-40; D.T. Courtwright, D.T. (2010). The NIDA brain disease paradigm: History, resistance, and spinoffs. Biosocieties, 5, 137-147. Einstein, S. (Ed.) (2012). Substance Use(r) Intervention Failure. Special Double Issue of Substance Use & Misuse, 47, Numbers 13 & 14.
[86] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 6.
[87] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chaps. 6, pp 207-214.
[88] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, pp. 156-157; H.I. Kushner, "Toward a Cultural Biology of Addiction," Biosciences 5 (2010): 8-24.
[89] Leshner, A.I. (1997). Addiction is a brain disease and it matters. Science, 278 (5335), 45-47; Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale).
[90] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 8; S.H. Ahmed, "Validation crisis in animal models of drug addiction: Beyond Non-disordered drug use toward drug addiction," Neuroscience and Biobehavioral Reviews, in press.
[91] See Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale.
[92] H. Kalant, "What Neurobiology Cannot Tell us About Addiction," Addiction 105 (2009): 780-789; L. Sanders, "Trawling the Brain: New Findings Raise Questions About Reliability of fMRI as Gauge of Neural Activity," Science News 176, no. 13 (2009): 16-20.
[93] Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, pp. 153-157; R. Rasmussen, "Maurice Seevers, the Stimulants and the Political Economy of Addiction in American Biomedicine," BioSocieties 5 (2010): 105–123; C.J. Acker, "How Crack Found a Niche in the American Ghetto: The Historical Epidemiology of Drug-Related Harm," BioSocieties 5 (2010): 70-88; P. Pignarre, Comment la Dépression est Devenue une Épidémie (Paris: La Découverte, (2001).; D. Wilson, "Drug Maker Wrote Book Under 2 Doctors' Names, Documents Say," New York Times (30 November, 2010), p. B3; See also N. Campbell, "Toward a Critical Neuroscience of Addiction," BioSocieties 5 (2010): 89-104. Campbell has pointed out that if a specific physiological basis for addiction can be discovered, it will then become a "molecular target" at which pharmaceutical companies can aim highly profitable magic bullets.
[94] T.S. Kuhn, The Structure of Scientific Revolutions, 2nd ed., enlarged (Chicago, IL: University of Chicago Press, 1970); P. Jensen, "L'histoire des sciences n'est pas un long fleuve tranquille," Le Monde diplomatique, June 2010, p. 31.
[95] G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Toronto, ON: Knopf Canada, 2008), chaps. 17, 18.
[96] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 45.
[97] For example, this folk theory is stated in the works of St. Augustine in the 4th century CE. See Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 205-214, 288-294. For the 19th century medical/moral/drug version, which is remarkably similar to the supposed new paradigm of the Official View, see Berridge, V. and Edwards, G. (1987). Opium and the People: Opiate Use in Nineteenth Century England. London, UK: Allan Lane, chap. 13. For an evaluation of the influence of older knowledge on the supposed new paridigm of NIDA scientists, see Campbell, N.D. (2007). Discovering Addiction: The Science and Politics of Substance Abuse Research. Ann Arbor, MI: University of Michigan Press, p. 203.
[98] P. Krugman, "How Did Economists Get it so Wrong?" New York Times, September 2, 2009, p.36.
[99] For example, W. Langeland and C. Hargers, "Child Sexual and Physical Abuse and Alcoholism: A Review," Journal of Studies on Alcohol 59 (1998): 336-348; C.C. Lo and T.C. Cheng, "The Impact of Childhood Maltreatment on Young Adults' Substance Abuse," The American Journal of Drug and Alcohol Abuse 33 (2007): 139-146.
[100] A.V. Horowitz, C.S. Widom, J. McLaughlin, and H.R. White, "The Impact of Childhood Abuse and Neglect on Adult Mental Health: A Prospective Study," Journal of Health and Social Behavior 42 (2001): 184-201; C.S. Widom, N.R. Marmorstein, and H.R. White, "Childhood Victimization and Illicit Drug Use in Middle Adulthood," Psychology of Addictive Behaviors 20 (2006): 394-403; C.E. Sartor, A. Agrawal, V.V. McCutcheon, A.E. Duncan, and M.T. Lynskey, "Disentangling the Complex Association Between Childhood Sexual Abuse and Alcohol-Related Problems: A Review of Methodological Issues and Approaches,"Journal of Studies on Alcohol and Drugs 69 (2008): 718-727.
[101] S.R. Dube, R.F. Anda, V.J. Felitti, V.J. Edwards, and J.B. Croft, "Adverse Childhood Experiences and Personal Alcohol Abuse as an Adult," Addictive Behaviors 27 (2002): 713-725; N. Messina, P. Marinelli-Casey, M. Hillhouse, R. Rawson, J. Hunter, and A. Ang, "Childhood Adverse Events and Methamphetamine Use Among Men and Women," Journal of Psychoactive Drugs SARC Supplement 5 (November 2008): 399-409.
[102] Filmwest Associates, "From Grief to Action" (2002). (Documentary film available from http://www.filmwest.com/Catalogue/itemdetail/2396/)
[103] Courtwright, D.T. (2010). The NIDA brain disease paradigm: History, resistance, and spinoffs. Biosocieties, 5, 137-147.
[104] See the definition of "trafficking" in Canada's Controlled Drugs and Substances Act, p. 3, http://laws.justice.gc.ca/PDF/Statute/C/C-38.8.pdf
[105] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 56.
[106] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, p. 46.
[107] J. Arrizabalaga, "(Re)emerging Diseases: A Global Threat to Public Health, Food Security and Human Development" (paper presented at the Construction of New Realities in Medicine Conference, Social Trends Institute Conference, Barcelona, Spain, April 15-17, 2010).
[108] I am mindful in writing this that some eminent scholars are making efforts to broaden the Official View by analysing the cultural factors that have shaped the Official View as well as the role of structural poverty as a risk factor in addiction. These scholars include C.J. Acker, "How Crack Found a Niche in the American Ghetto: The Historical Epidemiology of Drug-Related Harm," BioSocieties 5 (2010): 70-88; H.I. Kushner, "Toward a Cultural Biology of Addiction," Biosciences 5 (2010): 8-24; Courtwright, D.T. (2010). The NIDA brain disease paradigm: History, resistance, and spinoffs. Biosocieties, 5, 137-147.
[109] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 13.
[110] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 6.
[111] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chaps. 4, 7.
[112] M. Lalonde, "A New Perspective on the Health of Canadians: A Working Document" (Ottawa, ON: Government of Canada, 1974); Mental Health Commission of Canada, "Mental Health and Homelessness" (Ottawa, ON: Government of Canada, 2008). Accessed July 15, 2009 at http://www.mentalhealthcommission.ca/English/Pages/homelessness.aspx.
[113] For the roots of the Dislocation Theory in Plato, see Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 13.
[(114] Alexander, B.K. (2010).The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 158-160; Alexander, B.K. (in press). Replacing the official view of addiction. In Davis, J.E. and Gonzalez, A.M. (Eds.). To Fix or To Heal: Conflicting Directions in Contemporary Medicine and Public Health. New York, NY: NYU Press; See also the discussion section of C. Russell, J.B. Davies, and S.C. Hunter, "Predictors of Addiction Treatment Providers' Beliefs in the Disease and Choice Models of Addiction," Journal of Substance Abuse Treatment (2010, in press)
[115] See British Medical Association Annual Book Competition Winners Website http://www.bma.org.uk/whats_on/offers_and_competitions/2009bookcompetitionwinners.jsp#Mental_health
[116] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chaps. 3-8.
 [118] J. Orford, Excessive Appetites: A Psychological View of Addictions, 2nd ed. (Chichester, UK: Wiley, 2001); Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 34-36, chaps. 9, 10; J. Bradshaw, Reclaiming Virtue: How We Can Develop the Moral Intelligence to do the Right Thing at the Right Time for the Right Reason (London, UK: Piatkus, 2009); B. Denizet-Lewis, America Anonymous: Eight Addicts in Search of a Life. (New York: Simon & Schuster, 2009); G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction (Toronto, ON: Knopf Canada, 2008).
[119] K. Polanyi, The Great Transformation: The Political and Economic Origins of Our Times (Boston, MA: Beacon, 1944); M. Chossudovsky, The Globalization of Poverty: Impact of IMF and World Bank Reforms (London, UK: Zed, 1997); D.-R. Dufour, L'Art de Réduire les Têtes; Sur la nouvelle servitude de l'Homme Libéré à l'Ere du Capitalisme Total (Paris: Édition Nöel, 2003); C.A. Bayley, The Birth of the Modern World (Oxford, UK: Blackwell, 2004); Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 5; McGilchrist, I. (2009). The master and his emissary: The divided brain and the making of the western world. New Haven, Connecticut:Yale University Press.
 
[119.1] McGilchrist, I. (2009). The master and his emissary: The divided brain and the making of the western world. New Haven, Connecticut:Yale University Press., chaps. 7-12)
[120] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 4.
[121]G. Maté, In the Realm of Hungry Ghosts: Close Encounters with Alcoholism (Toronto: Alfred A. Knopf, Canada, 2008), pp. 205-207.
[122] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition. See case studies in chapters 9 and 10 and references in endnote 18, p. 23.
[123] This has been the tragic experience of many tribal groups of Canadian Indians who were given substantial amounts of money in payment for the land and resources that had been the backbone of their formerly healthy cultures and psychosocial integration, as, for example, in the Innu people who were moved from Davis Inlet to Natuashish (Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 131-136). The same principle had been abundantly documented in the anthropological literature half a century earlier (K. Polanyi, The Great Transformation: The Political and Economic Origins of Our Times (Boston, MA: Beacon, 1944), pp. 99, 153-161, 291-293).
[124] Emile Durkheim introduced the idea that the primary cause of suicide in 19th century Europe was the failure of people to achieve or maintain integration with their society. His conclusion was based on minute analysis of suicide statistics, which showed that suicide was less frequent at times and in places that favored psychosocial integration (E. Durkheim, Suicide: A Study in Sociology, trans. J.A. Spaulding and G. Simpson (Glencoe, IL: Free Press, 1951, original work published 1897). This conclusion has been challenged in more recent literature. However, Chandler and his colleagues carried out quantitative studies of suicide among aboriginal children in British Columbia during two time periods, 1987 - 1992 and 1997 - 2000. These studies showed that the relative frequency of suicide is much higher among aboriginal children whose bands are more estranged from their traditional culture than among those whose bands are less estranged. In both studies, bands that had a positive rating on all seven of the "cultural continuity variables" had no suicides at all, whereas bands with a positive score on none of the cultural continuity variables had child suicide rates of 137.5 and 61 per 100,000 population (M.J. Chandler, C.E. Lalonde, B.W. Sokol, and D. Hallet, "Personal Persistence, Identity Development, and Suicide: A Study of Native and Non-Native North American Adolescents," Monographs of the Society for the Study of Child Development 68, no. 2 (2003)).
[125] For a general analysis of the anguish and degradation produced by dislocation, see K. Polanyi, The Great Transformation: The Political and Economic Origins of Our Times, (Boston, MA: Beacon Press, 1944) and P. Bourdieu, "Ce terrible repos qui est celui de la mort social," Le Monde diplomatique, June 2003, p. 5 (original work published 1981). For a historical case study, see B.K. Alexander, "Alcohol Prohibition Among the Tse-Shaht Indians, 1860-1865: A Natural Experiment" Revised version of presentation at 5th International Conference on the History of Drugs and Alcohol: Pathways to Prohibition, Glasgow, June 27 2009. Retrieved 22 November 2010 from http://www.globalizationofaddiction.ca.
[126] N. Klein, The Shock Doctrine: The Rise of Disaster Capitalism (Toronto, ON: Knopf, 2007), chap. 1.
[127] See Figure 1.
[128] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chaps. 6-8.
[129] Burroughs, W. (Using pen name Willam Lee). Junkie: Confessions of an Unredeemed Drug Addict ????; Pryor,W. (2003) The Survival of the Coolest: an Addiction Memoir. Bath, UK: Clear Press.; Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, p. 164-165.
[130] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 5.
[131] Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, chap. 9.
[132] G.M. Heyman, Addiction: A Disorder of Choice (Cambridge, MA: Harvard University Press, 2009), pp. 79-88, chap. 4; R. Granfield and W. Cloud, Coming Clean: Overcoming Addiction Without Treatment (New York: New York University Press, 1999); Alexander, B.K. (2010). The Globalization of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, paperback edition, pp. 160-161, 290; Peele, S. (2014, January 1). Government Says You Can’t Overcome Addiction, Contrary to What Government Research Shows. Reason.com. Downloaded February 1 2014 from http://reason.com/archives/2014/02/01/the-government-wants-you-to-know-you-can
[133] K. Polanyi, The Great Transformation: The Political and Economic Origins of Our Times (Boston, MA: Beacon, 1944), p. 128, italics added.
[134] J. Kapica, "Copyright Litigation is Threatening Innovation," Globe and Mail, December 11, 2003, 11 December p. B13.
[135] B. Fawcett, "Saving Culture From the Market," review of Blockbusters and Trade Wars: Popular Culture in a Globalized World, by P.S. Grant and C. Wood, Globe and Mail, April 3, 2004, p. D5.
[136] H.-J. Chang, "De protectionnisme au libre-échangisme, une conversion opportuniste," Le Monde diplomatique, June 2003, pp. 26-27; A. Mattelart, "Jeter les bases d'une information ethique," Le Monde diplomatique, December 2003, p. 32; E. Illouz, Cold Intimacies: The Making of Emotional Capitalism (Cambridge, UK: Polity, 2007).
[137] D.-R. Dufour, L'Art de Réduire les Têtes; Sur la nouvelle servitude de l'Homme Libéré à l'Ere du Capitalisme Total (Paris: Édition Nöel, 2003); D.-R. Dufour, "Servitude de l'homme libéré: A l'heure du capitalisme total," Le Monde diplomatique, October 2003, p. 3; M. Abley, "Where's the Rage When You Need it?" review of The Defiant Imagination: Why Culture Matters, by M. Wyman, Globe and Mail, April 3, 2004, p. D4; B. Fawcett, "Saving Culture From the Market," review of Blockbusters and Trade Wars: Popular Culture in a Globalized World, by P.S. Grant and C. Wood, Globe and Mail, April 3, 2004, p. D5; D. Ticoll, "Flatism Will Get You Everywhere," review of The World is Flat: A Brief History of the Twenty-First Century, by T.L. Friedman, Globe and Mail, April 30, 2005, p. D14.
[138] Here is a standard definition of social capital: "… a person's or group's concern, caring, regard, respect, or sense of obligation for the well-being of another person or group that may produce a potential benefit, advantage, and preferential treatment for another person or group beyond that which might be expected in an [economic] exchange relationship." (H. Veltmeyer, "Neoliberal Globalisation and the Peasantry: Political Dynamics of Social Choice in Latin America" (paper presented at the 10th International Conference of the Karl Polanyi Institute, Istanbul, Turkey, October 14-16, 2005), p. 2.
[139] E. Illouz, Cold Intimacies: The Making of Emotional Capitalism (Cambridge, UK: Polity, 2007), pp. 62-67; E. Illouz, Saving the Modern Soul: Therapy, Emotions, and the Culture of Self Help (Berkeley, CA: University of California Press, 2008), pp. 175, 180.
[140] J.R. Beniger, The Control Revolution: Technical and Economic Origins of the Information Society (Cambridge, MA: Harvard University Press, 1986); P. Bourdieu, "L'essence du néolibéralisme," Le Monde diplomatique, March 1998, p. 3; M. Dobbin, The Myth of the Good Corporate Citizen: Democracy Under the Rule of Big Business (Toronto, ON: Stoddard, 1998), chap. 3; S. Beaud and M. Pialoux, "Cette casse délibérée des solidarités militante: Des ouvriers sans classe," Le Monde diplomatique, January 2000, pp. 10-11; I. Ramonet, Propagande silencieuse: Masses, télévision, cinéma (Paris: Galilée, 2000); G. MacDonald and B. Little, "The Cash Crash," Globe and Mail, September 29, 2001, pp. F1, F10; R. Blackwell, "Corus Banking on 'Kidfluence'," Globe and Mail, October 3, 2003, pp. B1, B10; W. Immen, "Workplace Privacy Gets Day in Court," Globe and Mail, April 28, 2004, pp. C1, C7; E. Anderssen, "They Know When You Are Sleeping, They Know When You're Awake – And Whether You Like Sushi," Globe and Mail, December 18, 2004, pp. F1, F8; J. Partridge, "Savings Gap Seen as a Threat to Growth in Canada: Companies Said Saving Too Much, Households Too Little," Globe and Mail, August 23, 2005, p. B4; M. Fritz, "Not Enough Babies: Report Fingers New Threat to Economy," Globe and Mail, August 23, 2005, p. B12; T. Wegert, "The Web Cookie is Crumbling – And Marketers Feel the Fallout," Globe and Mail, July 21, 2005, p. B9; Globe and Mail, "How to Retain Workers Without a Big Amnesty," Globe and Mail, March 28, 2006, p. A14.
[141] Dislocation might seem to be an urban phenomenon, but it is not. A good description of small-town dislocation is provided by C. Lackner, "Small is Scary: The Village is Yet Another Tale of Terror in a Little Town. Just What Makes Them so Frightening?" Globe and Mail, July 27, 2004, pp. R1, R5; see also A. Mooers, "Now the News Hits Home: When the Local Pulp Mill Closed, it Was Not Just Another Headline," Maclean's 117, no. 51, December 20, 2004, p. 56.
[142] J. Saunders, "IT Jobs Contracted From Far and Wide: North American Companies are Saving Money by 'Offshoring'," Globe and Mail, October 14, 2003, p. B1; A. Ramirez, "Life With Layoffs: The New Normal," Globe and Mail, October 8, 2004, p. C1; G. Pitts, "Industrial Evolution," Globe and Mail, May 29, 2006, pp. B1, B4.
[143] S. McCarthy, "Pension Crisis Fears Deepen as US Air Seeks to Skip Contributions," Globe and Mail, September 14, 2004, pp. B1, B8; S. McCarthy, "UAL Pension Ploy Could Start a Trend: Obligation Dumping May Save Struggling Companies, But Cost Workers, Taxpayers," Globe and Mail, May 12, 2005, p. B11; S. McCarthy, "GM Braces For Fallout From Delphi," Globe and Mail, October 10, 2005, pp. B1, B4; Globe and Mail, "The Pension Trap," Globe and Mail, September 20, 2004, p. A12; R.D. Atlas and M.W. Walsh, "Pension Officers Putting Billions into Hedge Funds: Question Raised on Risk," New York Times, November 27, 2005, pp. A1, A27; A. Shalai-Esa, "U.S. Auditor Warns of Crisis Unless Pension Issue Resolved, Globe and Mail, May 1, 2006, p. B11.
[144] P. Bouffartigue, "Fracture chez les cols blancs," Le Monde diplomatique, May 2002, pp. 8-9.
[145] F. Lordon, Et la vertue sauvera le monde: Après la débâcle financière, le salut par l'? (Paris: Raisons d'Agir, 2003); F. Lordon, "Comment la finance a tué Moulinex: Un cas d'école," Le Monde diplomatique, March 2004, pp. 1, 22-23; P.J. Davies, J. Hughes, and G. Tett, "So What is it Worth? Financiers and Accountants Wrangle Over Credit Pricing," Financial Times (London, UK), September 13, 2007, p. 13.
[146] Dufour describes the effects of "le capitalisme total": D.-R. Dufour, L'Art de Réduire les Têtes; Sur la nouvelle servitude de l'Homme Libéré à l'Ere du Capitalisme Total (Paris: Édition Nöel, 2003); D.-R. Dufour, "Servitude de l'homme libéré: A l'heure du capitalisme total," Le Monde diplomatique, October 2003, p. 3.
[146.1] Hickman, T.A. (2007). The secret leprosy of modern days: Narcotic addiction and the cultural crisis in the United States, 1870-1920. Amherst, MA: Univesity of Massachusetts Press.
[147] This is true even though the Official View has begun to acknowledge that some addictions, like gambling and overeating, do not involve drugs. Still today, whether or not a habit is considered an addiction within the Official View is determined by the degree to which it can be shown to involve the neurochemical mechanisms that are supposed to cause drug addiction, as if drug addiction were somehow the prototypical addiction. See N.D. Volkow and R.A. Wise, "How Can Drug Addiction Help us Understand Obesity," Nature Reviews: Neuroscience 8 (2005): 555-560; J. Frascella, M.N. Potenza, L.L. Brown and A.R. Childress, "Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint," Annals of the New York Review of Sciences, Addiction Reviews 2 (2010): 294-315
[148] F.W. Engdahl, Gods of Money: Wall Street and the Death of the American Century (Wiesbaden, Germany: edition.engdahl, 2009).
[149] Adaptation, as understood within evolutionary biology, does not always take the form of an individually successful or socially desirable response to the environment. Often adaptation takes the form of a short-term response that maximizes either individual or inclusive fitness under difficult conditions. (B.K. Alexander, The Globalization of Addiction: A Study in Poverty of the Spirit (Oxford: Oxford University Press, 2010), pp. 162-163.
[149.1] A neurological basis for the adaptive function of addiction could be derived from recent research on brain hermispericity, as conceptualized by Iain McGilchrist[149.1]
[150] J. Frascella, M.N. Potenza, L.L. Brown and A.R. Childress, "Shared brain vulnerabilities open the way for nonsubstance addictions: Carving addiction at a new joint," Annals of the New York Review of Sciences, Addiction Reviews 2 (2010): 294-315.
[151] Hoffman, J. and Froemke, S. (2007). Addiction: Why Can't They Just Stop? New York, NY: Rodale, pp. 145-147.
[152] Donald MacPherson of the Canadian Foundation for Drug Policy clarified this for me in an email conversation.

 

Eco-Crisis, Spirituality, and Addiction

Eco-Crisis, Spirituality, and Addiction

Bruce K. Alexander

Professor Emeritus, Simon Fraser University,

Vancouver, BC, Canada

Workshop presented at "Healing Our World and Ourselves" Conference

Vero Beach, Florida, February 21, 2014

(I have received expert guidance on this project from several friends and colleagues who are recovering from addictions and also actively involved in environmental and social justice issues. Most of them are members of AA and/or other 12-step groups and are therefore anonymous. They do not necessarily all agree with all of the ideas stated here.)

In the twenty-first century, the miracles of modern technology and science are bringing forth a world civilization that encompasses virtually all peoples, cultures, and religions of the planet. This is a wondrous new stage in human progress, but it has brought deadly problems in its train. Right at the head of the deadly train, the new civilization appears to be well on the way to destroying the sustainability of the Earth’s intricate and fragile ecosystems. The ultimate nightmare is before us: Destruction of life itself may turn out to be a side effect of modern, globalized civilization. (McKibben, 2010; Kolbert, 2013).

Read more: Eco-Crisis, Spirituality, and Addiction

 

A Train Trip through Methland

PDF 

2 February 2011                                                                                                                                               

Nick Reding’s book, Methland, is a fascinating, new study of addiction. It focuses on the town of Olewein, Iowa, which has been stricken by methamphetamine addiction in the past few decades. Methamphetamine is an infamous stimulant drug with many aliases. It is also known as “meth” “crank” “crystal,” and, most ominously, “ice.”

Beyond Olewein, the book tells the story of a huge area of the rural United States, which Reding christens “Methland”. As Nick Reding defines it, “Methland,” is the rural center of the US -- the 28 landlocked American states. Obviously, Methland has more familiar names too, such as “Middle America,” but Reding renames it Methland because at the end of the 20th century it became notorious for its rampant meth use, meth addiction, and amateur meth manufacturing or “cooking”. Reding was determined to figure out why.

Read more: A Train Trip through Methland

 

A Change of Venue for Addiction: From Medicine to Social Science

 

(Revised 26 December 2010)

Bruce K. Alexander, Professor Emeritus, Psychology Department, Simon Fraser University

Abstract

Global society has failed to control a devastating flood of addiction[1] to drug use and innumerable other habits. A century of scientific research has not produced a durable consensus on what addiction is, what causes it, and how it can be remedied. Physicians, addiction counselors, social workers, and psychologists only succeed with a minority of addicted clients. Police and soldiers find themselves drafted into a cruel and futile "war on drugs". Hi-tech neuroscience, education, harm reduction, and spirituality cannot control today's flood of addiction either.

The only real hope of controlling the flood of addiction comes from the social sciences, which are uniquely suited to replace society's worn-out formulas with a more productive paradigm. Although many social scientists have analysed the cause of addiction in specific historical circumstances,[2] this short article will focus on more general analyses by Karl Polanyi and a few more recent scholars. This overview shows that society's cardinal error in confronting addiction has been ignoring what Polanyi called "dislocation".[3]

Read more: A Change of Venue for Addiction: From Medicine to Social Science

 

Addiction: The View from Rat Park

If you were a cute little white rat…

Figure 1 - White Rats

…you certainly wouldn’t want to live in a psychology laboratory.

Read more: Addiction: The View from Rat Park

 

Recovery from Addiction: The Role of Spirituality and the Planet Earth

Bruce Alexander

Presented (In shortened form) to A Community Aware, 

Longhouse Church

Vancouver, September 10 2013

Late in the 19th century, a young Harvard scholar named William James, dreamed that brain science could cure the psychological pain and suffering that he saw all around him, including his own (Richardson, 2007). More broadly, he envisioned brain science as the basis of a new, scientific approach to the entire field of psychology (James, 1890/1950). William James was not alone in these dreams, but was one of a scattered fraternity of brilliant European and American researchers who pursued similar visons (Boring, 1950; E. Taylor, 2011). 

William James was much more than a physiological psychologist, however. He was also a member of a brilliantly intellectual, but conflicted family; an encompassing, classical scholar who read the great philosophers in Latin, German, and French; a modern, pragmatic philosopher; and a man of deep personal friendships and universal compassion. His whole family was fervently opposed to slavery and two of his brothers risked their lives to fight it in the American Civil War (Richardson, 2007).

Read more: Recovery from Addiction: The Role of Spirituality and the Planet Earth

 

Thinking More Deeply about Harm Reduction: An Open Letter to Margaret Wente

This is an updated form of a letter I sent to Margaret Wente in response to her attacks on Vancouver's harm reduction program. Her first four columns on this topic appeared in the Globe and Mail in July 2008. I originally wrote her on 10 October 2008 and re-sent the letter on 15 October. She acknowledged receipt, but did not respond to my critique. She then published another attack on harm reduction in November, 2008. This open letter, published in the Canadian Centre for Policy Alternatives for February 2009, addresses all five of her columns.

Read more: Thinking More Deeply about Harm Reduction: An Open Letter to Margaret Wente

 
New Revision of
"The Rise and Fall
of the Official View
of Addiction"
Read Here
Newest Workshop by
Bruce Alexander:
Vero Beach Florida,
21 February 2014
(Healing Our Word and Ourselves Conference). "Eco-Crisis, Spirituality, and Addiction"
Read Now
Bruce Alexander addressing
The Royal Society of Arts
in London: 
"Addiction:
What To Do
When Everything Else Fails"
Hear Podcast Now

"Connection" by the DockSreet Band, a song inspired by "The Globalization of Addiction"

New Podcast: Steve Paikin Interviews Bruce Alexander on TVOntario