Archie Brodsky reviews the enduring importance of The Meaning of Addiction in the International Journal of Drug Policy.

This is a prepublication version of a review that appeared at International Journal of Drug Policy, 12, 273-77, 2001 (with permission of Archie Brodsky)

Review Essay

Archie Brodsky
Department of Psychiatry,
Harvard Medical School, and
Heller Graduate School,
Brandeis University

When Stanton Peele's The Meaning of Addiction was first published in 1985, it was reviewed in The New England Journal of Medicine by Margaret Bean-Bayog, then a prominent addiction specialist on the faculty of Harvard Medical School. The language of the review was not what readers of the staid Journal would expect to read: "[T]his book worried me. Dr. Peele is widely read outside the scientific community. The distortions are subtle, the writing is slick, and to a person unfamiliar with the literature, the arguments are very seductive" (Bean-Bayog, 1986, p. 189). "[I]f a book pretends to scientific neutrality when it is actually a polemic. . ., what then?" Dr. Bean-Bayog asked, adding, "Is there any court of appeal from slur and innuendo?" (p. 190)

What prompted this odd outburst, directed toward a book published for professionals in which the author proposed a comprehensive framework for understanding addictive experience? The answer lies in the cultural background of the dispute. Disagreement about the nature and treatment of addiction exists worldwide. However only in America has the controversy taken on a ferocity comparable to political upheavals that occur when a nation experiences a threat to its psyche. The "culture war" over addiction was at its height in the mid-1980s. Those who deviated from the disease model, with its insistence on abstinence as the only treatment goal and the 12 steps of Alcoholics Anonymous as the only way to get there, were viewed as heretics (much as alleged communists had been viewed 30 years earlier).

Never shy of controversy, Peele stepped in with a reasoned challenge to received wisdom. The original subtitle, "Compulsive Experience and Its Interpretation" (simplified in the 1998 Jossey-Bass reprint to "An Unconventional View") nicely summarized what the book is about. Addiction is an experience, Peele asserts, not an invariant biochemical reaction. In his first chapter he sets forth evidence that conventional notions of addiction do not adequately explain the highly variegated reality they purport to address, including striking cultural differences in susceptibility to addiction to drugs and other experiences, nonaddictive use of the substances considered most addictive (e.g., controlled narcotic users, hospital patients given morphine), surprisingly common examples of natural remission (e.g. Vietnam veterans), and large fluctuations in individuals' usage patterns across the life span, even among heavy users.

To recognize that addiction is akin to other complex human experiences is to bring to bear an individual's whole cultural background and social and psychological universe to understand the individual's reaction to a substance, sensation, or other compelling involvement. According to Peele, the experience of craving or of withdrawal, as well as of tolerance for a drug "engages a person's expectations, values, and self-concept, as well as the person's sense of alternative opportunities for gratification" (p. 2). This is the radical insight (developed both theoretically and empirically) that he has contributed to the field—namely, that the observed physical and emotional manifestations of addiction (its defining attributes) are fundamentally influenced by psychological, environmental, and existential variables.

Thus the word "interpretation" in the book's subtitle refers, in its narrower sense, to the way people interpret potentially seductive experiences (i.e., experiences on which some people, at some times and places, get "hooked") in the light of both their immediate circumstances and life histories. "Interpretation" has a broader application as well, which gives the chapter on "Theories of Addiction" an importance beyond its demonstration of the inadequacy of theories that pass as scientific, including both genetic and exposure (biological or conditioning) theories. Ideas do not exist on a sterile field: forged in cultural history, they reflect and shape individual experience. What we think has a lot to do with how we feel and act. Specifically, explaining and theorizing about addiction are not just scholarly pastimes. Rather, interpretations of addiction—collective as well as individual—are part of the causal nexus that surrounds the behavior. Researchers, clinicians, the legal system, the media, and the schools all contribute to causing or preventing addiction, to making it worse or alleviating it, by what they believe and say about it.

It is Peele's conviction that the United States, as much as any country in the world, has adopted a set of beliefs that make becoming and remaining addicted a self-fulfilling prophecy. As a result, millions of people have come to think they have a "chronic, relapsing disease" rather than a learned and culturally and situationally reinforced behavior that they can outgrow. In this way, Peele has taken the beleaguered term "addiction"—a word so argued over and picked apart that many have discarded it—and shown that it can have relevant and useful meaning. But the "meaning" of his title is a complex one, encompassing both the meanings individuals and cultures assign to their compulsive behaviors and the meanings we, as scientific observers, can find in those behaviors.

Peele's background as a social psychologist informs his vision, as he made clear as far back as Love and Addiction (Peele and Brodsky, 1975). The interdisciplinary perspective of social psychology enables him to see how individual, institutional, and scientific conceptions of addiction are culturally conditioned. His ease in moving back and forth among the different sectors of society where the meaning of addiction is created, maintained, and changed—among them the addicted person, the family, the neighborhood, the church, the workplace, the clinic, the hospital, the laboratory, the courtroom, the newsroom, and the board room—risks leaving behind those whose expertise is limited to a particular discipline. This gift of making large connections and synthesizing disparate forms of evidence is increasingly rare in our specialized academic world.