The Meaning of Addiction - 1. The Concept of Addiction - Defining Traits of Addiction

Written by Stanton Peele

Observations of the defining traits of addiction have been made not only with the broader family of sedative-analgesic drugs and alcohol but also with stimulants. Goldstein et al. (1969) have noted craving and withdrawal among habitual coffee drinkers that are not qualitatively different from the craving and withdrawal observed in cases of narcotics use. This discovery serves to remind us that at the turn of the century, prominent British pharmacologists could say of the excessive coffee drinker, "the sufferer is tremulous and loses his self-command.... As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery" (quoted in Lewis 1969: 10). Schachter (1978), meanwhile, has forcefully presented the case that cigarettes are addicting in the typical pharmacological sense and that their continued use by the addict is maintained by the avoidance of withdrawal (cf. Krasnegor 1979).

Nicotine and caffeine are stimulants that are consumed indirectly through their presence in cigarettes and coffee. Surprisingly, pharmacologists have classified stimulants that users self-administer directly—such as amphetamines and cocaine—as nonaddictive because, according to their research, these drugs do not produce withdrawal (Eddy et al. 1965). Why milder stimulant use like that manifested by coffee and cigarette habitués should be more potent than cocaine and amphetamine habits is mystifying. In fact, as cocaine has become a popular recreational drug in the United States, severe withdrawal is now regularly noted among individuals calling a hot line for counseling about the drug (Washton 1983). In order to preserve traditional categories of thought, those commenting on observations of compulsive cocaine use claim it produces "psychological dependence whose effects are not all that different from addiction" because cocaine "is the most psychologically tenacious drug available" ("Cocaine: Middle Class High" 1981: 57, 61).

In response to the observation of an increasing number of involvements that can lead to addiction-like behavior, two conflicting trends have appeared in addiction theorizing. One, found mainly in popular writing (Oates 1971; Slater 1980) but also in serious theorizing (Peele and Brodsky 1975), has been to return to the pre-twentieth-century usage of the term "addiction" and to apply this term to all types of compulsive, self-destructive activities. The other refuses to certify as addictive any involvement other than with narcotics or drugs thought to be more or less similar to narcotics. One unsatisfactory attempt at a synthesis of these positions has been to relate all addictive behavior to changes in the organism's neurological functioning. Thus biological mechanisms have been hypothesized to account for self-destructive running (Morgan 1979), overeating (Weisz and Thompson 1983), and love relationships (Liebowitz 1983; Tennov 1979). This wishful thinking is associated with a continuing failure to make sense of the experiential, environmental, and social factors that are integrally related to addictive phenomena.

Nonbiological Factors in Addiction

A concept that aims to describe the full reality of addiction must incorporate nonbiological factors as essential ingredients in addiction—up to and including the appearance of craving, withdrawal, and tolerance effects. Following is a summary of these factors in addiction.

Cultural

Different cultures regard, use, and react to substances in different ways, which in turn influence the likelihood of addiction. Thus, opium was never proscribed or considered a dangerous substance in India, where it was grown and used indigenously, but it quickly became a major social problem in China when it was brought there by the British (Blum et al. 1969). The external introduction of a substance into a culture that does not have established social mechanisms for regulating its use is common in the history of drug abuse. The appearance of widespread abuse of and addiction to a substance may also take place after indigenous customs regarding its use are overwhelmed by a dominant foreign power. Thus the Hopi and Zuni Indians drank alcohol in a ritualistic and regulated manner prior to the coming of the Spanish, but in a destructive and generally addictive manner thereafter (Bales 1946). Sometimes a drug takes root as an addictive substance in one culture but not in other cultures that are exposed to it at the same time. Heroin was transported to the United States through European countries no more familiar with opiate use than was the United States (Solomon 1977). Yet heroin addiction, while considered a vicious social menace here, was regarded as a purely American disease in those European countries where the raw opium was processed (Epstein 1977).

It is crucial to recognize that—as in the case of nineteenth-and twentieth-century opiate use—addictive patterns of drug use do not depend solely, or even largely, on the amount of the substance in use at a given time and place. Per capita alcohol consumption was several times its current level in the United States during the colonial period, yet both problem drinking and alcoholism were at far lower levels than they are today (Lender and Martin 1982; Zinberg and Fraser 1979). Indeed, colonial Americans did not comprehend alcoholism as an uncontrollable disease or addiction (Levine 1978). Because alcohol is so commonly used throughout the world, it offers the best illustration of how the effects of a substance are interpreted in widely divergent ways that influence its addictive potential. As a prime example, the belief that drunkenness excuses aggressive, escapist, and other antisocial behavior is much more pronounced in some cultures than in others (Falk 1983; MacAndrew and Edgerton 1969). Such beliefs translate into cultural visions of alcohol and its effects that are strongly associated with the appearance of alcoholism. That is, the displays of antisocial aggression and loss of control that define alcoholism among American Indians and Eskimos and in Scandinavia, Eastern Europe, and the United States are notably absent in the drinking of Greeks and Italians, and American Jews, Chinese, and Japanese (Barnett 1955; Blum and Blum 1969; Glassner and Berg 1980; Vaillant 1983).

Social

Drug use is closely tied to the social and peer groups a person belongs to. Jessor and Jessor (1977) and Kandel (1978), among others, have identified the power of peer pressure on the initiation and continuation of drug use among adolescents. Styles of drinking, from moderate to excessive, are strongly influenced by the immediate social group (Cahalan and Room 1974; Clark 1982). Zinberg (1984) has been the main proponent of the view that the way a person uses heroin is likewise a function of group membership—controlled use is supported by knowing controlled users (and also by simultaneously belonging to groups where heroin is not used). At the same time that groups affect patterns of usage, they affect the way drug use is experienced. Drug effects give rise to internal states that the individual seeks to label cognitively, often by noting the reactions of others (Schachter and Singer 1962).