Is addiction a growing social disease, or just the ultimate excuse for screwing up? Dolan Cummings investigates
The addiction myth
The American cigarette manu-facturer Liggett made world news in March, by becoming the first tobacco corporation to admit that 'smoking is addictive'. This concession follows a campaign, led by the non-inhaling President Clinton, to have tobacco reclassified as a 'drug of addiction' and to clamp down on advertising (see M Fitzpatrick, 'Warning: Anti-smoking crusades can damage your life', LM, October 1996).
On the same day that Liggett relented, a report published by Alcohol Concern warned that one in 20 people in the UK are addicted to alcohol, and called on the government to develop a national alcohol strategy to crack the problem. Alcohol Concern director Eric Appleby insisted that the current 'light-hearted approach' to alcohol abuse would have to change.
Almost every day, it seems, we are confronted with further evidence suggesting that addiction of various sorts is a major and growing problem. But what exactly is addiction?
Everybody knows that heroin is an addictive drug, and that drug addiction is a terrible thing. But is heroin addiction the same thing as cigarette addiction? Is it a physical disease? What about gambling addiction? A psychological disorder? Is there such a thing as an addictive personality? Can anybody become addicted to anything?
Just look at the proliferation of addictions. Is shopping addiction a joke or a disease? What about chocolate addiction? Sex addiction?! A bit of thought reveals that it is all less simple than it first appears. There does seem to be one common factor though: whenever something is labelled addictive, there follow calls for tighter controls on what people can do, see or buy. If tobacco and alcohol are addictive then there must be stricter regulation of cigarette sales, drinks licensing and the advertising of both. The assumption is that addicts cannot control their own behaviour, so controls must be enforced by the authorities for their own good.
Looked at in this light, the increasing propensity to describe problems in terms of addiction indicates a diminished view of individual responsibility. Rather than simply condemning drunks and junkies for their behaviour, there is a tendency to blame the drugs themselves. In this spirit, Marks and Spencer recently offered free treatment to addicts who shoplift to feed their habits. Paul Burns of the Scottish Law Society has called for addicts to be formally relieved of legal responsibility and treated as children until they are weaned off the drugs (Scotland on Sunday, 13 October 1996). More recently, Sheriff Richard Davidson from Dundee suggested to a social work conference that the children of addicts should be put up for adoption, as they could not be expected to be responsible parents. The idea that drugs in themselves can in some way 'take people over', however, is not without problems.
You have to want to
For a start, why is it that so many people are able to take 'addictive' drugs without becoming dependent? And it is not only alcohol: a recent report published by the Scottish Office suggested that there are a significant number of casual heroin users. It could be argued that, rather than addiction being a medical problem that takes over people's lives like a disease, people actually only become addicted to something if their lives are already out of control for some other reason. Even those who develop a physical dependence on drugs like heroin are often able to shake off the withdrawal symptoms with relative ease. Significantly, those who work with 'addicts' realise that recovery from addiction has very little to do with medicine and a lot to do with attitude.
David Bryce is the founder of Calton Athletic, the Glasgow-based drug recovery group that assisted in the making of Trainspotting. He is clear about the nature of the problem: 'It's very simple. An addict either wants to give up, or he wants to go on using. And you have got to recognise that if he doesn't want to give up, you're very limited in what you can do. If an addict does want to give up, it can be done. But nothing can be done without the individual's co-operation. I believe that in my heart and soul.'
Nonetheless, the view that addiction is a medical problem requiring an externally imposed clinical solution is increasingly widespread. An article published in the Lancet last year called for drug addiction to be recognised as a chronic relapsing disorder, in the same league as diabetes or asthma. There is even a growing tendency to explain addiction to particular substances, or even addiction in general, in terms of genetic predispositions. Last year the Medical Research Council granted over £1m to a team at Cambridge University that is researching this area.
The genetic explanation has found an audience among those who wish to explain non-biological supposed 'addictions' which it is hard to explain away as straightforward medical problems. The traditional emphasis on pharmacological dependence could not account for non-chemical addictions such as compulsive gambling. A gene controlling behaviour would explain everything.
If there was a genetic explanation for addiction, it would also help to explain away the pattern of recovery and relapse followed by so many addicts, which makes a mockery of the idea of simple physical dependence. Kicking the habit is relatively easy; everybody in the field knows that it is staying off drugs that addicts find difficult. A gene, or other biological predilection to addictive behaviour, would also explain this problem. But just how convincing is the biological case?
Researchers at Cambridge have identified a part of the brain that they think might control habitual behaviour. It is possible that addicts have peculiarities in this area. Dr Richard Hammersley of Glasgow University's Behavioural Science Group says that the studies are fine as far as they go, but that they can be misinterpreted. He insists that it is 'semantic nonsense' to say that ad-diction is biological, because addiction is not one simple problem that can be looked at in its own terms. 'I'm quite happy with the idea that anything I think or do is caused in the brain', he says, 'but there's a risk of drawing simplistic conclusions'.
A phenomenon like addiction is far too multi-faceted to be explained in straightforward neurological terms. Most importantly, addiction is not a problem that can be isolated in the biology or brain of any individual. It is always part of a socially recognisable lifestyle.
Of course if addiction is about lifestyle, that raises the question of how somebody gets into that lifestyle. We are all familiar with the suggestion that people progress from soft drugs like cannabis to heroin addiction. The latest version of this relates to the club scene. A BBC television programme shown earlier this year warned that regular ecstasy users suffer from increasingly unpleasant come downs, and are soon tempted to take downers to ease the process. After a few months the hapless raver is a helpless addict (Frontline Scotland, 14 January). This disturbing if dubious account is supported by Calton Athletic, who insist that all long term ecstasy users develop problems with other drugs. Of course, recovery groups do not hear from many healthy drug users.
In reality the idea of recreational drug use leading to addiction seems to come from reading history backwards. You take a group of heroin addicts, find that they have all smoked dope in the past, and announce 'conclusively' that there is a direct line leading from one to the other - conveniently ignoring the countless thousands who have used recreational drugs without ever thinking about touching the 'hard stuff'. Nobody becomes an addict overnight, and all addicts have their own stories about how they reached their 'personal hell', usually taking a lot of drugs on the way.
I talked to John-Paul, a recovering addict who is sceptical about the slippery slope argument. 'Myself, I used to smoke a lot of hash, and yeah, I felt like I wanted to try something stronger, to get a better buzz. But not everyone does that. There comes a time when you realise that drugs have taken over your life, and it does kind of sneak up on you, but I suppose that's because the people that become addicts are out of control anyway. You just don't get heavily into drugs unless you've got some other problem.'
The point is that addiction is a logical progression only if drugs become the most important thing in somebody's life. Most people are able to take a step back and decide that it would be better to keep their drug use within limits. If we look at addicts as human beings with the same potential capacities as the rest of us, we have to recognise that they are making a choice of sorts.
Opium fiend and existentialist Jean Cocteau described addiction as 'something that is neither life nor death'. Addiction is a decision to live life in abeyance, to postpone the present. The addict voluntarily suspends his or her will, and surrenders to a simple rhythm of need and gratification. This decision can be more or less deliberate, resulting from a conscious desire to drop out of life, or simply reflecting a perceived lack of alternatives (hardly an alien concept in the 1990s). Either way, rather than doing or thinking anything right now, the addict cooks up another shot. Who needs reasons when you've got heroin?
Addiction, or what most people understand by the term, is a reflection of desperation. It is not something that can be attributed to any drug, and it is not a 'risk' run by everybody who uses drugs. Of course anybody who uses heroin can develop what is called a physical dependence, but this only constitutes an addiction if the user is unable to deal with it. Alcoholism, on the other hand, is an addiction that often occurs without any chemical dependence.
In the past, behaviour has only ever been seriously designated as addictive if it is seen as problematic. That is why the term has traditionally been reserved for the self-destructive behaviour of desperate individuals. The idea of addiction to something worthwhile like sex, or to something as trivial as chocolate, exemplifies a bizarre new situation in which we are not expected to take responsibility for any aspect of our lives. The loss of faith in humanity appears to have reached the point where we are often assumed to be impotent prisoners of our genes or our animal urges. Addiction has become the ultimate excuse, the explanation for every failure and every loss of self-control. And that notion has destructive consequences all of its own for all concerned.
Somebody who binges on Easter eggs simply because they are a glutton can be told to exercise restraint and reasonably be expected to stop acting like a pig. The insecure moron who tries to get off with get every woman he sees can be told to stop behaving like a 16-year old and face up to a mature relationship. But what advice can you possibly give a 'chocolate addict' or a 'sex addict' that could enable them to kick their terrible, all-powerful habits?
The label 'addiction' is used in all sorts of situations today, but it is always associated with a lack of self-control. And this is what accounts for the current popularity of the term. Self discipline is now widely seen as too much to ask of any individual. The idea of addiction then becomes a bit like a modern version of original sin: addicts supposedly cannot escape their terrible desires, and therefore have to be saved from themselves.
Choose life, not drugs, goes the old slogan. Actually some might say the two need not be mutually exclusive, but at least that slogan credits us with the ability to make a decision for ourselves. Nowadays it seems to be automatically assumed that we are at the mercy of our most immediate impulses, and must not be exposed to anything too pleasurable in case we get hooked. Such a cautious world-view, if allowed to go unchallenged, may well drive us all to the horrors of Ovaltine addiction.
Reproduced from LM issue 100, May 1997