Chapter 9 of Diseasing of America, in which Stanton analyzes the meaning of America's larger attitudes towards addiction. He notes that — while constantly harping on treatment of loss of control of alcohol, drugs, and other habits — Americans nonetheless display more of these problems than virtually any other society. Stanton takes on some related incongruities, like America's stratospheric murder rate and poor birthing outcomes, as well as Halloween candy scares, rampant childhood obesity, and the role of TV viewing in societal problems. He traces all of these to self-fulfilling anxieties that characterize the American way of life. He ends this chapter with eight reasons why Americans are enmeshed in loss-of-control experiences — the diseasing of America.

THE PARADOX of the American addiction treatment industry is the tremendous growth it maintains without demonstrating that it works. In the case of alcoholism, the treatment industry first convinced us that alcoholism is a major problem and now persuades us that the problem is ubiquitous. This problem augmentation—and not any evidence the industry has offered that it can stem alcoholism or treat it effectively—serves as the justification for the entire industry. The alcoholism industry thus presents a model of growth for any other industry that would carve out a niche in the mental health marketplace. The drug abuse industry is another case of the success of futility. We have spent successive fortunes on campaigns against drug use—yet inner-city addiction and drug degradation achieved their major gains in urban ghettos only after we targeted drug abuse as a major social problem.

The addiction treatment industry is an expression of larger trends in American society. The principal trend has been our failure to stanch every social problem associated with the underclass that has evolved in the United States. Rather than address the fundamental social issues underlying ghetto deterioration, addiction policies speak to primarily middle-class anxieties. Problems rooted in ghetto life, in addition to substance abuse, include violence, childhood obesity, and the poor health of the fetus and newborn in America relative to every other industrialized nation in the world. And although these problems are worst in the ghetto, middle-class America also suffers from a version of each problem more severe than those found in other economically advanced countries.

Moreover, the addiction industry expresses the sense of loss of control we have developed as a society, an anxiety brought on by our utter incapacity to alter the trends over which we are so distraught. We have simply proved incapable of identifying correctly the sources of our most dire problems, and our tendency instead is to respond to our anxieties. Our fears themselves have now absorbed our attention to the point where they endanger our individual mental health and our health as a society. Our fears for our children, among other fears, affect us so much that we can no longer carry on a community life in the United States. Yet the failure of community leads to greater alienation, health problems, and the kind of violent and addictive relationships we examined in the previous chapter. Americans as a group now share some of the traits said to characterize mental illness, such as a terror at something nameless that we cannot shake.

Is the United States Worse Off Than It Used to Be, or Than the Rest of the World?

In order to get a handle on our social problems, we need to evaluate how bad these problems are, compared with America in the past and compared with the rest of the world. When our terror becomes unmanageable, we need to examine its realistic basis; perhaps the problem about which we are concerned has actually improved over time or isn't as bad as it is in other places. I believe that we badly overstate some of our problems, especially alcoholism and drug abuse, as well as such newfound problems as PMS and postpartum depression.

From the other side, I think we suffer more than we realize from a lack of sense of community and from our failure as a society to attack social problems. I believe that we are creating problems for ourselves—many related to addiction—and that more and more Americans feel themselves in the throes of one or several such compulsions. As we have seen, deciding one is addicted is a complicated process, entailing that one see oneself as being out of control of one's habits. And Americans do seem to feel that they are more out of control of their lives than they have felt in the past. This loss of control—despite all claims about the discovery of new biological causes of menstrual discomfort and genetic sources of alcoholism, depression, anxiety, and other conditions—is principally a social and psychological phenomenon.

Problems that we may overstate—and that have a large subjective element to them—are drug addiction and alcoholism. The signs are complicated, however. Americans' drinking has decreased in recent years, and it comes nowhere near the high per-capita levels of colonial and postcolonial America or of many European countries (like Belgium) that nonetheless do not consider alcoholism a serious problem. Americans use less cocaine and narcotics per capita today than they did at the turn of this century (when Coca-Cola contained a substantial dosage of cocaine, and when narcotics could be bought everywhere at drugstores and from street medicine salesmen). As we approach 1990, middle-class Americans use less cocaine than they did in the early 1980s, and kids are smoking less marijuana than they did in the 1970s. Drug experimentation in the United States is fairly common, although compulsive drug use is rare among high school and especially college students and is far from common in the average American community.

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