At this point in history, it is necessary to drive a careful path between the shoals of those who medicalize, biologize, and generally reify the addiction concept, and those who deny its existence. In this article, Stanton clarifies the problems with both extremes in the debate (although those in the "reification" camp are far more dangerous), while laying out exactly where in reality addiction exists, its causes, and why all this matters for understanding and dealing with the malady.

Addiction Research, 8:599-607, 2000

The Impact of Mistaken Notions of Addiction

Stanton Peele
Fellow, The Lindesmith Center
New York City

The addiction concept varies cross-culturally and historically in significant ways. The reification of the addiction concept by addiction "experts" is actually an important window for understanding the nature of addiction in our society. Both proponents of the concept who incorrectly misidentify it as a Platonic ideal and critics who dismiss it because of its irregular and unreliable nature and appearance miss the boat on addiction. How we think about addiction influences how individuals become addicted, since we learn to be addicted through the expectations we develop about specific involvements.

From historic experience to "science" - The reification of addiction

The United States (and the Western World generally) has suffered in the throes of a cultural delusion - the idea that addiction is a specific biological syndrome. The current administrations of the National Institutes on Drug Abuse (NIDA) and Alcohol Abuse and Alcoholism (NIAAA) are both pursuing this delusion, ad infinitum (cf. Hyman, 1996; Leshner, 1997). Addiction is real, it can occur with any involvement in which people can become immersed, and it is identified by human experience, which means that individual and cultural outlooks are crucial to its appearance.

Based partly on my work (Peele, 1985/1998) indicating that addiction is not a specific invariant biological phenomenon, some sociologists, anthropologists, psychologists, and others involved in substance abuse research have deduced that addiction itself is not real. They make this assertion because people do not invariably become addicted to any given substance (e.g., heroin), even after repeated exposures to it; because people may feel and act addicted with (that is, are addicted to) powerful nonsubstance activities, such as gambling, eating, shopping, and sex; and because even those classifiable as addicts more often than not terminate their addictions, usually without treatment.

But addiction remains a powerful, useful, and evocative concept. People become, act, and feel addicted, and to say otherwise is to argue with incontrovertible phenomena and experience - what is it called when someone enters a worsening spiral of drinking or drug use that leads to self-destruction (as infrequent as this is)? Those who discard the idea of addiction, when confronted with some supposedly physiological indicator of addiction or some sad case of addiction that cannot be gainsaid, then scurry back to notions that sound like addiction but seem more scientifically based but are not - notably the concept of "physical dependence."

The addiction concept is a hoary one that has actually been both meaningfully and correctly applied in common parlance (until the public has been misled by claims posited by the fields of pharmacology and medicine). That is, prior to the modern scientific discovery of addiction, people used the term to indicate that some people, unlike most others involved in any of a number of activities, comport themselves with such abandon and experience such bad consequences that their self-destructive preoccupation is worthy of note - they are addicted (Peele, 1990). For example, Shakespeare - in Twelfth Night - speaks of Olivia as "being addicted to a melancholy." People likewise were noted to be addicted to love, to tobacco, to alcohol, to opiates, to tea and coffee - but not as though this were some trait of the substance or activity.

Previous to nineteenth and twentieth century claims for the addictiveness of first alcohol and then narcotics and then an expanding range of substances (e.g., barbiturates, nicotine, cocaine, marijuana), simple observation and common sense proved that it could not be the substance which was at the heart of compulsive consumption or preoccupation. Why else did most drinkers and consumers of opiates fail to become destructively engaged with these involvements (as well as most coffee/tea imbibers, shoppers, lovers, and gamblers)? A whole new industry of post hoc hypothesis has evolved to explain the range of addictive activity, cantilevering from the belief that heroin addicts are slaves of neurochemical mechanisms to posit farther-reaching and more unsupportable notions that people have brain diseases resulting in addiction to pleasure, or endorphins, or dopamine.

Mistaken notions of dependence

Among alcohol epidemiologist, Robin Room has been an important critic of alcohol dependence notions. In his early work, Problem Drinking Among American Men (Cahalan & Room, 1974), Room organized drinking problems into 13 categories, among which were heavy intake, loss of control (which Room regards as a purely subjective experience of alcoholism), and symptomatic drinking, defined as "short-term physiological consequences of heavy drinking" corresponding to "addictive symptoms" (p. 22). A major point of this work was to dispute disease conceptions (a) that loss of control was central to alcoholism, and (b) that symptoms of alcoholism occur in some regular and coherent sequence or are consistent over time.

Room did not find that physiological symptoms of addiction were any more consistent over time (in fact they were less so) than was loss-of-control for problem drinkers. In addition, ironically, the correlation between symptomatic drinking was highest for, among all other drinking problems, "psychological dependence" (.41), higher than for heavy intake (.34). Finally, where precedence of symptoms could be established, physiological symptoms preceded heavy intake in 68 percent of cases.