Biological approaches to understanding addiction mainly look at the neurochemical and molecular processes that produce the euphoria or “high” from a drug. This helps to explain the positive reinforcing effects of drugs but often ask us to make a leap of faith when explaining the processes that go between the initial “high” experienced by a drug taker and the biological surrender of the addict to the drug, which means they will go into withdrawal in the absence of the drug. Dr D. Nutt gives a pharmacological account of the brain processes involved in addiction. He point out that psychotropic drugs are neuroactive and therefore alter brain transmitter function. This would lead us to believe that drug addicts have a different chemical make-up of the brain, which is acquired through the prolonged us of a drug (Nutt, 1996: 31). The better a drug is at producing this affect on the brain the higher its addictive potential. This means that a pharmacological way to prevent or cure addiction involves blocking the receptors in the brain that transmit the brain chemicals (eg. Dopamine, Endorphins, and Glutamate) that cause the drug “high” (Nutt, 1996: 31). The BBC2 programme ‘Constant Craving’ also use this rationale but in more simple terms saying that drugs affect the ‘reward centres’ of the brain that secreted dopamine to produce a “high” feeling in the case of cocaine. Dr. Nutt mentions the use of the antagonists (they block the release of brain chemicals) such as Naltrexone that prevent the addict from getting a “high” off a drug and so the motivation to take it is gone. However this only takes away the physical affects of the drug and forces people to go into “Cold turkey” as there is no easy fix to stop the discomfort of this procedure of making the body work in the absence of the addictive drug. Nutt sees this as a solution for people who are highly motivated, such as doctors and pharmacists who will loose their jobs if the are addicts (Nutt, 1996: 31). In contrast the television programme unsurprisingly takes a more sensationalist stance that Naltrexone and other antagonists for nicotine (Zyban), cocaine and heroin could be used as vaccines against drug addiction. This view sees drugs and antagonists in an analogy of antibodies and pathogens; the body is being attacked by foreign invaders. This view is more of a quick-fix solution to a far more complicated problem, things such as conditioned habit may make people continue to take the drug, although probably less frequently. It also assumes that addiction is mainly a biological disorder and that people are addicted due to their dependence on the “high” from brain chemicals released by the drug that is being abused. Here the definition of addiction would be: a physical bodily dependence to a drug in relation to the brains neuroactive pathways.
One of the main problems with this view, that drugs are foreign attackers of the body, is that drugs are using existing neurochemical pathways in the brain that usually reward things like food intake and sex with dopamine, as it is advantageous to Natural selection and therefore reward this behaviour. Also there already exists in the brain an opioid system that is involved with appetite, pain and stress (Nutt, 1996: 33). The body is fooled by psychotropic drugs into giving the taker a “high”. So to some degree if a persons neural pathways were dysfunctional, due to a genetic polymorphism, addiction could result from an attempt to rectify the chemical imbalance. This may be a reason for some types of alcoholism. Serotonin could be at the root of why type II alcoholics (early-onset, history of violent crime) drink. This could be due to a genetic polymorphism in their gene for the enzyme tryptophan hydroxylase. This means that they have a low brain turnover of serotonin and that whereas in most people high serotonin level produce anxiety in these people it produces a craving for alcohol (Nutt, 1996:3). This produces good evidence for the biological argument about addiction, but it does not explain why the person with the polymorphism craves alcohol specifically and it also assumes that there are different types of alcoholics, which can partially be accounted for by their genetic make-up.
Genetic factors governing how an individual metabolises a drug may contribute evidence to determine if a person can be genetically predisposed to addiction. Dr Perkinson believes that this is the cause for addictions if there is a history of addiction in the family.
“There is no major psychiatric disease that does not have genetic links. We are
are all genetically predisposed to certain physical and mental illnesses. We are
more likely to acquire the same diseases as the members of our family have had.”
(Perkinson, : 27/03/00)
I find this genetic determinism too radical and too general to accept. He assumes that genes carry almost all the information that will programme your life and that you are helpless against the all-powerful force of nature. He suggests that if you have a history of alcoholism ‘you either abstain from drugs and alcohol or you die.’ Dr. Perkinson also suggests that if someone’s parent is an alcoholic they will have a different way of metabolising alcohol that leads to alcoholism. However he does not suggest a source of this such as a genetic polymorphism or a method of inheritance from adult to child unless he is resorting to the Lamarckian mode of inheritance. He also assumes that environmental factors are of little importance when actually a family history of substance abuse may indicate a sustained environmental factor as the cause, such as in American Indians who’s alcoholism can be attributed to generations of prejudice and the stress of loosing their land, families and cultural heritage (Eber, 1995:6).
What all these perspectives fail to answer is how a person makes the step from trying the drug in the first place to taking it regularly enough to accumulate tolerance (if tolerance is acquired by that type of drug). The positive reinforcing affect that a drug has (the “high”) and the negative reinforcing affects (continue taking to stop withdrawal) that it has are not enough to make a person become an addict. If this were true then practices like “chipping” when someone occasionally uses heroin, and casual drinking would not occur without leading to addiction. This is where people look for the cultural and social situations that a person is in to explain addictive behaviour.
Young is totally committed to this view and makes it credible with the example that he chooses. He strongly puts forward the point that drug taking does not take place in a “social vacuum” (Young, 1971: 34-42). By this he means that there are various social forces acting on a drug user, such as social reaction and drug policies that manipulate them into what they are. This is demonstrated in an ethnography on Rastafarians in that their covert use of marijuana and initially defensive attitude was a result of their antagonistic relationship with the police (Barrett, 1969: 16). Young also says that the pattern of use of a drug is culturally defined. This corresponds to latter research into the effects of drugs in different cultures, which shows that alcohol does not produce the same behavioural affects as it does in Western societies that are often stereotyped as the violent, loud “larger lout”. In studies by MacAndrew and Edgerton and other evidence gathered by Heath show that drinking does not inevitably reduce people into this stereotype.
“The Camba of Bolivia studied by Heath show neither aggression nor sexual license during their frequent social binge-drinking bouts. Nor does alcohol addiction occur in spite of frequent binging with their distilled product, which is undiluted 89 percent ethyl alcohol.”
(Coomber, 199: 48)
There are also many other example that disprove there are inherent behavioural symptoms that accompany alcohol in Mexico, Micronesia and Japan; the most general observation was that alcohol increased talkativeness and sociability (Coomber, 1994: 48). Therefore addiction is the product of society and each society has different socially acceptable ways of using drugs and unacceptable ways of using a drug are also socially defined. My criticism of Young’s approach is that he slightly over-emphasises societies role in manufacturing addiction and that he totally discredits biological findings due to the different patterns of drug use in different cultures. I feel that even if the psychotropic affects of a drug are dwarfed by societies ideas about how one behaves when they are drunk or on drugs the biological change is what started off the process and so cannot be under-estimated. If it was not there to begin with a whole drug or drink culture could not have grown around it.
Another way of looking at addiction is typified in the Alcoholics Anonymous association. This view is that alcoholism is a disease created by an innate predisposition that makes a person alcoholic for life with the only cure being abstinence. It makes the assumption that alcoholics have an insatiable “craving” for alcohol that can be initiated by the smallest quantity of alcohol (Coomber, 1994: 39). This is the view of Dr. Perkinson who is mentioned above. It implies that there is some unknown “alcoholic” gene when in fact if alcoholism was genetically predisposed it would probably be the result of a variety of genes and the environmental factors acting upon them. This view has been accepted socially and medically with the American Medical Association formally giving alcoholism the status of disease in 1956 (Perkinson, : 27/03/00). This has benefited alcoholics as alcoholism is now in the majority of cases seen as a disease and therefore relinquishes the sufferer of any moral fault that may previously have been blamed for the alcoholism. However AA have done a lot to mislead people in that their assumptions although portrayed as scientific fact do not have any credible foundation; Coomber puts it as an “elusive biochemical abnormality”. The drinking patterns of alcoholics are the same as non-alcoholics. There is also no evidence to suggest that alcoholism is an irreversible condition (Coomber, 199: 39). Cross cultural comparison has also shown that there are no inflexible set of symptoms that accompany alcoholism and that people do not reach a final state of alcoholism but alter patterns of behaviour and attitudes to drink in a way that is not accurately described by the term disease (Coomber, 1994: 39). To me a more accurate term would be illness in the anthropological sense of the word,
“Illnesses are experiences of disvalued changes in states of being and in
social function.” (Panter-Brick)
This definition emphasises the subjective aspects of alcoholism, and as long as people realise the difference between illness and disease it is a less misleading label.
Luigi Zoja puts forward a very different view of addiction based on depth psychology. In this he looks at addiction as an attempt for someone in the modern world to perform an initiation rite. The initiation is into a drug using group or drug culture. Zoja makes the assumption that due to initiations or rites of passage existing before the formation of the Western consumer state, initiation into adulthood is a necessary feature of human society; he equates its universal importance to be like the incest taboo (Zoja, no date: 1-8). Zoja feels that drug users fail in this ultimate goal because they do not properly follow the stages of initiation. Drug users exclude initiatory death, which is to reject ones former identity so that one can move smoothly into another adult identity without any “baggage” and withdraw from consumer behaviour (Zoja, no date: 6). Zoja sees the problem of addiction arising because users stay in the drug-induced world and do not move onto a third stage of initiation that would mean moving out of the drug scene in a reborn state,
“a certain state of grace mere biological birth cannot provide.”
(Zoja, no date, 8)
I find it difficult to accept this hypothesis for drug addiction although I find it very interesting and it would provide a convenient answer to why people do embrace addiction in the first place; to fulfil some unconscious need for ritual and initiation through group acceptance and belonging.
These brief summaries of some of the perspectives given on addiction are very diverse and in many places difficult to reconcile. Although I feel a lot of progress has been made in the last three decades to increase the awareness of addiction I feel that organisations like Alcoholics Anonymous have gone too far in making the addict seem totally helpless to the drug they are addicted to. The biological evidence gives good reasons for the positive and negative reinforcing affects of drugs but they only tell you why someone would take the drug in the first place (the “high”), and how a drug problem escalates due to the affects of tolerance and withdrawal. They exclude the reasons why someone while being aware of the dangers associated with drugs and the possibility of addiction would continue to take the drugs once the initial curiosity has worn off. For the answer to these questions we have to go to the social and cultural side of the argument that puts forward the notion that drug addiction is the result of a dysfunctional personal life or in the case of Zoja the product of a society that does not include the essential element of initiation so that people look for their own esoteric rituals in a dysfunctional way that opens the door to addiction. These arguments seem to totally blame society for an addicts outside position. I think to fully understand the nature of addiction one has to synthesise the biomedical actions of the drug, the cultural setting that the addiction is taking place in and the individual’s perceptions of society (which may or may not be pathological). This approach does not dangerously generalise and accepts that there could be many personal as well as societal and biological reasons for addiction, which gives the topic a holistic approach.
BIBLIOGRAPHY
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Altman, J Biological, Social and Clinical basis of Drug Addiction (1996) Volume. 125 Psychopharmacology.
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Barrett, L. E The Rastafarians: A Study of Messianic Culturalism in Jamaica (1969) Institute of Caribbean Studies.
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BBC2 Constant Craving 30/03/00.
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Coomber, R Drugs and Drug Use in Society (1994) Greenwich University Press.
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Eber, C Women and Alcohol in a Highland Maya Town (1995) University of Texas.
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Hsu, F (ed.) Psychological Anthropology (1972) Schenkman Publishing Co. Ltd.
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Nutt, D Addiction: Brain Mechanisms and their Treatment Implications (1996) The Lancet.
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Perkinson, R Drugs (27/03/00) Internet Site.
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Young, J The Drugtakers: the Social Meaning of Drug Use (1971) Granada Publishing Ltd.
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Zoja, L Drug Addiction and Initiation: The Modern Search for Ritual (no date given) Sigo Press.
