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Introduction: A Brief History of the Concept of Addiction
From antiquity into the nineteenth and twentieth centuries, the term addiction meant abandonment to a bad habit so that habitues totally ignored other life considerations. Addiction was not specifically associated with narcotics or with drugs at all (Peele, 1985; Sonnedecker, 1958). Around the turn of the twentieth century, addiction was appropriated by medical authorities as a property of narcotics (Berridge and Edwards, 1987; Isbell, 1958). The behavioral and psychological markers of addiction were codified as pathologic withdrawal and craving in a deterministic model that replicated the alcoholism-as-disease notion of drug-induced loss of control (Levine, 1978; see Peele, 1990).
For most of this century, the idea that addiction is a physiological process set off by heroin consumption dominated popular and pharmacological thinking (Musto, 1987; Peele, 1985). However, even the earliest efforts at systematic research with addicts did not find that heroin use conformed to this simple, billiard-ball causation (Light & Torrance, 1929; see Peele, 1990). While the public, media, and medical authorities assumed that addiction was a well-defined physiological construct, pharmacologists were compelled instead to construct descriptions of drug use in behavioral, phenomenologic, and existential terms. Thus the World Health Organization (WHO) Expert Committee on Addiction-Producing Drugs separated addiction into "physical dependence" and "psychic dependence" in the 1960s, claiming that psychic dependence is "the most powerful of all factors involved in chronic intoxication with psychotropic drugs...even in the case of most intense craving and perpetuation of compulsive abuse" (Eddy, Halbach, Isbell, & Seevers, 1965, p. 723). In a primary pharmacology reference text, Jaffe (1980) defined addiction as "a behavioral pattern of drug use, characterized by overwhelming involvement with the use of a drug [compulsive use], the securing of its supply, and a high tendency to relapse after withdrawal" (p. 536).
By the mid-1980s, cocaine had supplanted heroin as the drug said to be most dangerous and quickly addictive (for historical overviews of cocaine's public image, see Harrison, 1994; Jones, 1992). Cocaine came to be seen as the major public health menace in this country (before AIDS), and the imagery previously associated with heroin was usurped by cocaine:
Cocaine-driven humans will relegate all other drives and pleasures to a minor role in their lives.... If we were to design deliberately a chemical that would lock people into perpetual usage, it would probably resemble ... cocaine.... (Cohen, 1984, pp. 151-153)
Cocaine (and later crack) addiction became the major focus of government funding for research and treatment on illicit drug use. Since cocaine had not been classified as a drug capable of producing physical dependence, the experiential effects that compel continued drug use once more rose to the fore of theorizing about addiction:
[That] cocaine produces no gross physiological withdrawal symptoms...demonstrate[s] that subjective experiences or symptoms other than physiological discomfort are crucial in addiction to cocaine and to other substances of abuse.... [I]nvestigators are now exploring how psychological symptoms in drug withdrawal, particularly unpleasant mood states and craving for drug euphoria, maintain chronic drug addiction. (Gawin, 1991, p. 1580)
But this recognition of the centrality of lived experience in cocaine addiction did not halt speculation that "cocaine causes a neurophysiological addiction" or slow the search for an understanding of addiction based exclusively on "unraveling the neurophysiological mysteries of human experiences of pleasure and pain" (Gawin, 1991, pp. 1580, 1585; see also Wise, 1988). This view recombines the psychic and physical dependence categories into a single biological construct.
After a period of convoluted reasoning about cocaine's addiction-like properties stretching over the decade from the mid-1980s to the mid-1990s (cf. Peele, 1985), the elaborate distinctions drawn over the previous quarter-century between physical dependence and addiction were lost. Today, the director of the National Institute of Mental Health (Hyman, 1996, p. 611) may simply identify cocaine (and amphetamines, which mimic the effects of cocaine) as addictive in the same sense and as a result of the same changes in "molecular mechanisms" following chronic drug ingestion as heroin: "Repeated doses of addictive drugs — opiates, cocaine, and amphetamine — cause drug dependence and, afterward, withdrawal."
Our modern pharmacological era strives to understand addiction as foremost a biologic response of the organism. Even when researchers and clinicians claim to recognize the multideterminacy of cocaine and other drug addiction (as Gawin above does), they treat the environmental and experiential components in the equation as unmeasurable and unscientific and strive to reduce addiction to a drug's chemical structure and pharmacological effects. This article argues instead that addiction cannot be defined strictly in terms of the addicted organism and a chemical substance, and that drug problems — in this case, compulsive drug use — can never be isolated from cultural and other contextual factors and from the situation of the actor (DeGrandpre & White, 1996; Sidman, 1956; Zinberg, 1984). We review animal laboratory and human epidemiologic studies to show that environmental factors ultimately determine drug use, including the very addictiveness of a drug's appeal and the urge to continue compulsively consuming the substance (Peele, 1985). Such alternative attachments and rewards are powerful enough — or can be made so — to overcome the allure of any pharmacological substance (Reinarman et al., 1994).
If addiction is not identified with any chemical or biological process, moreover, then it can occur with a wide range of involvements in addition to drug use, such as love and gambling (Peele & Brodsky, 1975). Each type of addictive involvement, moreover, does not require a separate theory of addiction. The addictive process with different activities and in different individuals shares a variety of common elements and influences, even though the exact pathways to addiction will most certainly vary from person to person, time to time, and place to place (see Bry, 1996).
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