The globalisation of addiction
[ bookreviews ]
Bruce Alexander is best known - though deserves to be much better known - for the 'Rat Park' experiments he conducted in 1981. As an addiction psychologist, much of the data with which he worked was drawn from laboratory trials with rats and monkeys: the 'addictiveness' of drugs such as opiates and cocaine was established by observing how frequently caged animals would push levers to obtain doses. But Alexander's observations of addicts at the clinic where he worked in Vancouver suggested powerfully to him that the root cause of addiction was not so much the pharmacology of these particular drugs as the environmental stressors with which his addicts were trying to cope.
To test his hunch he designed Rat Park, an alternative laboratory environment constructed around the need of the subjects rather than the experimenters. A colony of rats, who are naturally gregarious, were allowed to roam together in a large vivarium enriched with wheels, balls and other playthings, on a deep bed of aromatic cedar shavings and with plenty of space for breeding and private interactions. Pleasant woodland vistas were even painted on the surrounding walls. In this situation, the rats' responses to drugs such as opiates were transformed. They no longer showed interest in pressing levers for rewards of morphine: even if forcibly addicted, they would suffer withdrawals rather than maintaining their dependence. Even a sugar solution could not tempt them to the morphine water (though they would choose this if naloxone was added to block the opiate effects). It seemed that the standard experiments were measuring not the addictiveness of opiates but the cruelty of the stresses inflicted on lab rats caged in solitary confinement, shaved, catheterised and with probes inserted into their median forebrain bundles.
Yet despite (or perhaps because of) their radical implications for the data that underpin addiction psychology, the Rat Park experiments attracted little attention. Alexander's paper was rejected by major journals including Science and Nature, and eventually published only in the respectable but minor Pharmacology, Biochemistry and Behavior. Although the experiments have subsequently been replicated and extended, they still inform the science of addiction only at its margins. The Globalisation of Addiction is Alexander's attempt to draw out their full implications for our understanding of addiction, and to chart a course towards forms of treatment that can transform their findings into practice.
His analysis begins with a radical reconception of addiction itself. Throughout the 20th century, as the science and treatment of addiction have developed into vast academic and professional industries, its underlying nature has stubbornly refused to coalesce into any sort of consensus. Is it a physiological condition marked by metabolic responses such as tolerance and withdrawal, a condition produced simply by exposure to 'addictive' drugs? Or is it a psychological affliction, the product of an 'addictive personality' - or, alternatively, a moral weakness, a failure of willpower and abrogation of social responsibilities? And how do these clinical views of addiction relate to the ever-expanding meanings of the term in the wider culture?
For Alexander, all these seemingly disparate accounts are united by their focus on the individual addict; but even a cursory historical and cultural survey reveals that the incidence of addiction is essentially a social phenomenon. Many historical and indigenous cultures have lacked even the concept of addiction - but many of these same cultures, once their traditional structures have been disrupted by conquest or colonisation, have been destroyed by it. All across the Americas, the Pacific and Australia, hundreds of 'demoralised' cultures have descended into vicious spirals of addiction, usually to alcohol, in many tragic cases wiping themselves out entirely. The root causes of addiction, then, must run deeper than any individual pathology: they must be sought in a larger story of cultural malaise and 'poverty of the spirit' that forces individuals, often en masse, into desperate and dysfunctional coping strategies.
Once addiction is recognised as a consequence of broader social currents, it becomes clear that the problem is far more widespread than the professional focus on drugs allows. Uncontrolled and chaotic appetites are extensively diagnosed across our culture not merely for illicit drugs, alcohol and nicotine but for other substances (food), other consumer activities (shopping, gambling), and other sources of emotional support such as romantic love. 'Addictive' is a slogan of enticement used to sell online gaming, exercise programmes and women's magazines. Even successful and high-functioning individuals can often be accurately described as addicted to money, power or status. Throughout the 20th century, these extensions of the concept of addiction were typically marginalised on the grounds that, unlike illicit drugs, these were mainstream activities that generated dysfunctional behaviour only in a minority of subjects. But alcohol has always been both mainstream and addictive, and it is increasingly clear that illicit drugs are used widely without necessarily generating addiction. Any attempt to get to the root of the problem must recognise that addiction is rampant not merely among a subculture of problem drug users but across society at large.
Alexander's search for the drivers behind the modern explosion in addiction leads him to consider the parallel spread of free market societies. Along with their obvious economic benefits, free markets also bring a widespread increase in what he terms cultural 'dislocation'. What were once elaborately reciprocated cultural transactions are reduced to simple commercial exchanges, and 'the competitive marketplace becomes the matrix of human existence'. Social fabrics are loosened as economic winners and losers polarise into their respective ghettoes, and traditional networks of trust are replaced by often brutal demarcations between neighbourhoods and social classes. It is our now endemic culture of competitive, zero-sum individualism that has, in the phrase of Alexander's title, globalised addiction over the last 50 years.
It is, he acknowledges, too simplistic to blame capitalism itself: the fundamental problem, dislocation, can equally be generated by feudalism , communism or any other political system. Nevertheless, a consumer society systemically erodes the sovereign remedy against addiction which, following Erik Erikson, Alexander terms 'psychosocial integration'. This has long been recognised as a necessity for social functioning: even Charles Darwin, whose theory is typically used to support competitive free market ideology, insisted that generating 'social and moral qualities' was a crucial factor in human evolutionary success. Psychosocial integration eliminates the hyperfocused pursuit of individual gratification that manifests as addictive behaviour, and balances individual autonomy with social belonging. Dislocation, though its effects are concentrated among the poor and socially excluded, has pervasive effects on society as a whole, which is why levels of happiness and welbeing stubbornly refuse to rise in proportion with purchasing power. The greatest modern triumph over drug addiction, in China during Mao's Great Leap Forward from 1949-1955, took place against a background of material poverty but intense social cooperation in rebuilding a shattered society.
This analysis has helped Alexander to understand the successes and failures of treatment progammes in his professional world in Vancouver, where alcoholism and violence remain an intractable problem among many native Canadian Indians. Dislocation, rather than poverty, is their ultimate cause: communities resettled on unfamiliar land can be subsidised to the point where a 4x4 sits in every drive and a satellite dish on every roof, but still manifest higher levels of addiction than those which are allowed to remain in their homelands and follow their traditional subsistence strategies. In the arresting motto adopted by British Columbia's successful aboriginal community projects, 'Culture is Treatment'.
Once addiction is reconceived as a symptom of the dislocation embedded in modern cultures, the practical measures required to manage it become vast in scope. Treatment of addicts needs to become more holistic, and interwoven into a far wider spectrum of social programmes. Education and treatment need to lose their narrow focus on illicit drugs and alcohol, and to encompass addiction in all its forms. Although the prohibition of drugs is a major contributor to social dislocation, legalisation is far from a panacea: the majority of addictions, after all, are to legally available products. (The greatest benefit of legalisation, perhaps, would be to allow communities to determine their own drug policies, thereby providing a crucial lever for increasing psychosocial integration.) Faith-based treatments, whether Christian or more broadly spiritual, have an important role to play: St. Augustine's Confessions remains a powerful template for the addiction recovery narrative, and membership of faith groups can provide an effective antidote to dislocation. Political activism, both global and local, is a tool of social empowerment that can benefit addicts and addiction professionals alike.
All these strategies are eminently sensible, but remain hard to patch into the treatment of addiction as currently constituted. We may accept Alexander's persuasive case that drug addiction, properly understood, is a scapegoat for broader social dysfunction, but it is by no means obvious how to respond effectively. Like it or not, treatment remains focused on individuals, for whom his analysis holds limited explanatory power. Alexander does not deny the existence of personal tendencies to addiction, which may include genetics and neurochemistry, but maintains that they are often marginal factors and poor predictors of individual risk: overall, interventions are more effective at the social level than the personal. But these underlying causes are far easier to identify than to address. Our societies are profoundly structured around the need for individual autonomy; and personal freedom must, on some levels, always include the freedom to become addicted.
The Globalisation of Addiction is a considerable work, highly ambitious in its scope, impressive in its multidisciplinary scholarship, clear in its structure and generous in its references. It is both its strength and its weakness that it integrates addiction so convincingly into broader issues of social and political reform. Like Rat Park, it offers a fundamental critique of the 20th century view of addiction, but also demonstrates how dominant are the processes and structures that drive it.