Journal of Addictive Behaviors,Therapy & RehabilitationISSN: 2324-9005

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
holiganbetperabetimajbettipobetVdcasino

Review Article, J Addict Behav Ther Rehabil Vol: 2 Issue: 2

Addictions and Medicalization of Social Conditions: Context and Paths of Reflexion

Amnon Jacob Suissa*
University of Quebec at Montreal (UQAM), Canada
Corresponding author : Amnon Jacob Suissa, PhD
Professor – Faculty of Sciences Humanities School of Social Work, University of Quebec at Montreal (UQAM), Pavillon Thérèse Casgrain, 455 René Lévesque East 455, boulevard René Lévesque, East Bureau W-4311, H2L 4Y2, Canada
Tel: 514-987-3000; Fax: 514-987-6317
E-mail: [email protected]
Received: November 11, 2012 Accepted: May 10, 2013 Published: May 14, 2013
Citation: Suissa AJ (2013) Addictions and Medicalization of Social Conditions: Context and Paths of Reflexion. J Addict Behav Ther Rehabil 2:2. doi:10.4172/2324-9005.1000105

Abstract

Addictions and Medicalization of Social Conditions: Context and Paths of Reflexion

In the psychosocial management of addictions, different social control modalities coexist. We can think of the penal, therapeutic, medical and “laissez-faire” perspectives. The current redefinition of the addiction concept reveals that no single explanation can validate diverse addiction conditions; a multifactorial approach is necessary to grasp the complexity of this phenomenon: addiction to psychotropic substances, love, the Internet, cosmetic surgery, groups, shopping, work, etc. In dealing with the hurried society and performance at any cost, how can we explain the growing tendency to medicalize social conditions and the explosion of categories? To what extent does contemporary society generate conditions where a person feels less and less capable of keeping up with the social and institutional pace? The author suggests analyzing individual and social control markers and shedding light on the central issue of social ties. Finally, the author illustrates how, for example, the 12-step philosophy contributes directly to the labeling and socializing of pathologies instead of focusing on the hidden strengths of people and their families and social networks.

Keywords: Addiction; Pathology; Social control; Social ties; Medicalization; 12 Steps; Intervention

Keywords

Addiction; Pathology; Social control; Social ties; Medicalization; 12 Steps; Intervention

Introduction

One of the keys understanding addictions is the definition of the concept itself, which must be understood as multifactorial. Far from being neutral, the definition of addiction constitutes fertile ground for multiple interpretations and represents a crucial scientific and social issue. Because it depends on the actor’s status in the power hierarchy and the interests involved in social relations, the choice of definition for the term addiction varies considerably from one historical period to another and from one social and cultural context to the next [1,2].
The addiction controversy is nourished by the lack of consensus surrounding two principal factors: the etiology of addiction, on one hand, and the different forms of treatment and addiction management, on the other hand. This absence of consensus reveals profound oppositions related to a multidimensional and multifactorial concept of the phenomenon of addiction, rather than a one-dimensional conception, as in the disease model.
Certain researchers and clinicians understand addiction problems in moral terms; others, in biomedical, cultural or psychosocial terms. In fact, each social and professional group has its own version of the facts, depending on the discipline to which it belongs and its social position in the hierarchy. Thus, pharmacists understand addiction as a series of reactions to substances and the body’s growing tolerance to a product; physiologists see it as organ and metabolism dysfunctions, psychiatrists as a syndrome defined by the DSM-IV, psychologists as a self-esteem problem or a symptom hiding various difficulties, sociologists as a reaction to the social regulation process and the inherent constraints on social interaction.
In the face of these various possible versions, which tend to demonstrate the multidimensional nature of addiction, the medical model continues to play a predominant role in the determination of a dominant discourse and ideology, associating addictive behavior with a disease—a pathological condition.
The example of the medicalization of social problems fits into this dynamic of social power relations, wherein individuals and groups with divergent interests interact. The work of Horwitz [3,4] on styles of social control and mental health; Lloyd, Stead, and Cohen [5] on the medicalization of youth’s behaviors; Beaulieu [6] on Michel Foucault’s perspective; as well as the classic studies of Conrad and colleagues [7-10] on the medicalization of deviancy and addictions are good illustrations of the constructivist approach to several social problems that are now subject to medicalization.
For the concept of addiction, questions relate to the process: How does one become dependent? The problem: To what extent should one intervene? And the very nature of this problem: How should one act? All of these questions highlight the concept’s complexity [11]. Although a psychological approach generally enables us to understand the relational dynamics associated with personal and individual factors that can generate addiction, we must acknowledge that the social conditions giving rise to such factors allow us to better identify the social determinants that structure the addictions in question. At the heart of the relational dynamics in which the individual, certain psychotropic substances or activities, and particular social conditions interact, the strength or weakness of social ties can be a key factor in understanding the phenomenon. This article does not claim to respond to all of the multiple possible social determinants, but it suggests some avenues for explanation, essentially based on a psychosocial perspective. In this regard, and given the long list of available models and treatments, we have limited ourselves to certain benchmarks that we find to be particularly significant. These social and contextual determinants include the cult of speed, or performance at any price, individualism and hyperindividualism, and the importance of social ties. To enrich our analysis of the relation between medical discourse and social conditions, we will illustrate how the Alcoholics Anonymous (AA) 12-step ideology contributes to increasing labeling and pathologization, not only of symptoms related to the addictions in question but also of individual social existence itself. In conclusion, avenues promoting the development of the power to act by individuals and their social and family networks will be suggested.

The Cult of Speed as a Social Determinant Leading to Addictions

One of the central concepts in understanding addictions is the principle of time. We postulate that time does not have the same meaning for people who have developed addictions as for the case workers and institutions they deal with. Consequently, it is important to investigate time as a social and contextual factor in tracking the personal and social trajectories of people with addictions. Moreover, insofar as it generally takes several years to develop an addiction, it is crucial to relativize the time allotted to the intervention process and thus to avoid focusing on a predetermined deadline. In this context, treatment centers come to mind that claim to “solve” the problem of addictions in 28 days or less, thereby often confusing the goal of a certain level of abstinence with the act of freeing oneself from addictions and improving important aspects of one’s lifestyle [12-14]. In this respect, one author who has analyzed the cult of speed and how it creates conditions propitious for the development of addictions is Carl Honoré, in his book In Praise of Slowness [15]. Reminding us of the fable of the hare and the tortoise, Honoré notes that the social, institutional and individual tempo is increasingly transforming our living conditions so that they make addictions more probable [16]. In other words, there is a price to pay when the cult of speed takes over our hurried society in which obsessive love of speed itself turns into an addiction—a sort of idolatry.
Resorting to liposuction as an alternative to the time it would take to follow a diet and exercise, eating fast food instead of “slow food,” or opting for an even higher-speed Internet connection than was available yesterday all constitute what writer Robert Musil called acuity in matters of detail but indifference toward the whole [17]. This increased acuity of detail means the person has a feeling of winning in the immediate, instantaneous world of the present; overall, though, there is a loss because the perverse effects of this race to cope with the required social norm often ends in a decline in, or even a total breakdown of, psychological and social balance. As evidence of these conditions, consider the skyrocketing rate of medicalization of various symptoms of malaise [5,10,17-20]. Most recently and according to a congressional testimony by the American Society of Intervention Pain Physicians 80 percent of the world’s painkillers are consumed in the U.S. and prescription drug abuse leads to 14,800 deaths a year, which is more than what heroin and cocaine total combined [21]. Have we lost the art of taking the time to do things—or even doing nothing at all? And how can we reconcile a society that promotes excess with the continuous requirement for self-control [22]?
In describing these issues, Honoré [15] does not scruple to use the word “turbo-capitalism” to refer to the rate at which human social and health care costs multiply in the process of adaptation to family and social changes: insomnia, depression, weakened social ties, increased medicalization, etc. Although it is the Japanese who have a word for death from overwork, karoshi, the Western world is facing increasingly worrisome mental health conditions. In the United States, the abuse of drugs in the workplace, for example, has risen by 70% since 1998, and the correlation between performance speed and the obesity rate is very real. Close to one-third of Americans and one-fifth of Britons are obese [15]. The availability of a plethora of options 24 hours a day, 7 days a week, has increasingly become the social norm. Whether it is access to food, sports centers or online services, citizens can obtain almost anything at any hour of the day or night. This frenetic pace of life can have perverse effects on personal, familial and social dynamics.
After the Slow Food movement, we now have the Slow Media movement [23], which aims to warn people not to fall into the trap of multitasking as a social norm related to addiction on technology. Inspired by American professor Jennifer Rauch, this movement considers itself to be neither anti-modernity nor anti-technology; rather, it insists above all on a healthy lifestyle regarding technology use to avoid its pernicious side effects. In Rauch’s view, emotional and cognitive adaptation to the stupefying speed of life means that not only are we living faster, we are developing a need to go faster than ever. Today, the hurried society, combined with the proliferation of technology, is producing a context that is unfavorable to attention and concentration, particularly in young people. As the generation that was born into this ultra-technological environment, many young people in our modern society are bombarded by constant sensory stimulation, mainly through computers, games and so-called “smart” electronic devices. How can young people’s brains be expected to pay undivided attention to any one thing, when there are so many stimulants conspiring to distract them? When parents are shown that the school outcomes for children who have concentration problems or hyperactivity improve by 30% to 85% when those children take Ritalin, it is easy to understand their recourse to this drug. Is it not normal for them to want their children to be able to keep up with the institutional and social tempo? And are the children not paying the price for this frantic society, in which current social trends pressure them to perform at record speed?
In this social context of the hurried society, the recourse to psychostimulants for young people fits right in, as an adaptive strategy to deal with the constraints of the environment. Thus, the medicalization of children and adolescents constitutes an important issue for the future of society insofar as psychotropic drugs, usually psychostimulants, have become a very popular means of treating children with attention, mood, behavior and performance problems [24]. In this regard, a study reveals that the prescription of drugs to treat insomnia in children aged 10 to 19 has climbed by more than 85%; in some cases, these medications are needed to counteract the side effects of Ritalin [25]. Some psychiatrists and researchers question the abusive prescription of psychotropic drugs for young people, pointing out that these practices go well beyond our current knowledge and suggesting that we are treating children as guinea pigs [5,26]. In 2013, the forthcoming DSM-V is expected to play an important role by adding psychiatric risk categories that primarily target young people [27,28].
In light of these realities, we can say that, although stress related to performance can be positive in small doses, over-stress can lead directly to depression and professional and psychological exhaustion [15]. Thus, postmodern society is in the process of creating more and more addictive behaviors, which are generally responded to with legal or medical modes of social control [29]. How can we reconcile a healthy, balanced lifestyle with a social culture that stresses that doing several things at once is modern, efficient and satisfying [30]? Where Freud referred to civilization and its discontents, Ehrenberg [31] analyzes the uneasy society, showing that the weight of economic requirements and social constraints, dictated by the credo of performance at any price, actually destroys the autonomy that people need to consolidate their personal and social equilibrium.

Social Control and the Importance of Social Ties: A Brief Reminder

Deviants never exist except in opposition to those they threaten and those who have enough power to control against such threats [32].
The concept of social control, which was the focus of American sociologist Edward Alsworth Ross in the early twentieth century, has long been associated with the normative aspects of social life and its regulation [33]. The term had been employed earlier by Herbert Spencer, in The Principles of Sociology, but without achieving any conceptual understanding [34]. Apart from the linguistic divergences between the European and American versions of the term “social control,” American sociology is still impregnated by the work of Ross, who is definitely considered to be the first researcher to popularize the concept.
It was not until more than 50 years later that sociologist Talcott Parsons first associated the concept of social control with deviance [35,36]. It was by describing illness as passive deviance and promoting the concept of integration rather than anomie that this sociologist made his major contribution to the theory of social control. Applied to the field of addictions, the process of labeling, which is also known as the interactionist model in the sociology of deviance, has modulated the phenomenon of control and social reactions to the status of deviant/dependent. In the field of addictions, such as alcoholism, drug addiction and gambling addiction, we are witnessing a social problematization of use, which veers between the moral model (deviance) and the medical model (illness) as tools for social control. We might even speak of a reversal, since it is no longer only the addiction-creating substance or activity that must be controlled, but also—in fact, primarily—the persons associated with it. In terms of social control, we are seeing a kind of assimilation of addictions with other social behaviors, mainly deviant ones. This kind of assimilation undeniably allows two outcomes: the formation of an “anti-drug” political consensus and the designation of “guilty parties” who must be controlled to protect the social order.
Although most human behaviors entail certain personal and social risks, and there are various possible social control modes, the tendency in our society is to favor the application of criminal law or the process of medicalization as control tools to manage or contain the consequences of behaviors considered to be dangerous or undesirable for public social order. Among the factors that influence the various social reactions to these conditions, the nature of social ties appears to play a predominant role in the choice of control measures. In fact, recourse to penal control is generally justified as an attempt to reduce citizens distance and disengagement in their social relations. For example, a socially distant alcoholic will be more vulnerable to a penal response than a better-integrated person, who is likely to be less subject to this kind of control. One might wonder whether penal control in the field of addictions actually reveals the failure of attempts to maintain social regulation systems.
The populations affected by medicalization as a mode of social control are not generally seen as morally deviant but rather as victims of a disease over which they do not, or no longer, have any mastery. When the reasons for their so-called deviant activities appear incomprehensible, senseless or unintelligible, the control intervention will be therapeutic or medical. Although some cases combine medical and penal responses simultaneously, social distance and social ties still play a central role in the choice of the type of response. As an illustration, populations that the system considers to be too socially distant (e.g., prostitutes, homeless people) are treated as either criminals or patients, depending on the offence committed, the actor’s personality, and the presence or absence of social ties. From this perspective, the fewer social ties you have, the more likely it is that the process of labeling and punishment will apply to you.
If one takes social status into consideration, the therapeutic style appears to be a more viable alternative for higher social classes than for lower classes. The life paths of members of underprivileged social classes with weak social ties are more likely to be visible in the public social space, and thus to be subject to social, legal and medical reactions. In Quebec, for example, a higher proportion of underprivileged youths with attention deficits being treated with Ritalin are taken in charge by youth protection services, whereas more prosperous families may prefer to apply more private means to handle the same kinds of conditions [24].
Although we are all vulnerable, it remains the case that individual paths are intimately related to the strength of social ties and networks. Socioeconomic status, the frequency and intensity of moments of vulnerability, and the strength or weakness of social ties constitute important factors in understanding who is vulnerable, temporarily or transactionally or structurally or even permanently. From this perspective, poor people who are already subject to significant social control measures will experience more constraints in finding solutions to their vulnerable condition and will therefore be more subject to public social control measures. Conversely, citizens who experience the same constraints but come from more affluent social strata and have a certain social network may follow different, more private, paths in managing their vulnerabilities.
In his article “Souffrir sans disparaître” [Suffering without disappearing], the social psychiatrist Jean Furtos [37] shows clearly how psychological and psychosocial problems, for example, actually prevent the ordinary application of social ties by causing the affected person to suffer from self-exclusion. The work of Sylvie Fainzang on the exercise of medical power in the physician-patient relationship also provides valuable benchmarks in grasping the individualizing dynamics of the process of medicalization [38]. There is no doubt that strong social ties help all citizens to get through the sometimes difficult transitions in the life cycle, unlike people who have no social network on which they can rely when facing the constraints inherent in social life.

Individualism and Hyperindividualism

Individualism—some would even say hyperindividualism— in our postmodern society may help to explain the recourse to medicalization as modes of social control over behaviors or statuses seen as deviant and needing to be normalized. As early as 1980, Stanton Peele warned us against the ideology of competition and performance at any cost, which is generally reflected in a feeling of exclusion conducive to addiction.
It is because of the strength of our culture’s orientation towards individual accomplishment and responsibility that so many people in the culture are trapped by feelings of inadequacy [39].
In his article “Dilemmes de l’individualisme: un contexte sociétaire de l’usage de drogues” (Dilemmas of individualism: A social context for drug use), Van Caloen [40] shows clearly how the use of psychotropic substances, for example, fits directly into the inclusion process for people looking for support to help them deal with social performance requirements. In other words, if one ignores the structural context that gives rise to people’s social conditions (e.g., unemployment in certain regions), the tendency will be to make use of medicalization or prescription drugs as a mode of control to manage the social distance that may be created between the normal performers who have jobs and the non-performers who do not. As side effects, the response to these conditions is generally conveyed by a social point of view that individualizes the problem and often marginalizes the person who has it via medicalization (depression, anxiety, insomnia, etc.). At that point, what often happens is the prescription of drugs, accompanied by a more private and individual social withdrawal. To fill these gaps and overcome the social distance between the public, social, outside world and the private inner world, the individual will take action to try to establish social ties that will contribute to his or her normalization [41].
Lipovetsky [42] characterizes our hyperindividualist, hyperconsuming society, which has lost any sense of ritual, as having a malaise of the soul. Gori and Volgo [43] expand on this point by noting that a failure to be is transformed into a failure to have. Insofar as we are increasingly exposed to a virtual world created by communication devices (Internet, cellular phones, cyberaddictions, etc.), we are witnessing a process of virtual social belonging, to the detriment of real social ties. It is from this absence of real social ties that individualism draws its meaning. In other words, faced with the lack of rituals that could give meaning to deteriorating real-world social ties, the individual will engage in a more private, individual social withdrawal [41].
Among the authors who have considered the contemporary question of individualism, and conducted some very fruitful debates in Europe, Robert Castel [44,45] and Alain Ehrenberg [31,46] are key figures. In his most recent book, The Uneasy Society, the latter carries out a comparative study of the foundations of individualism and its social effects in France and America. According to Ehrenberg, in terms of social categories, the self occupies the space in the United States that the institution has historically held in France. Understood primarily as a category with social origins, the self, for Ehrenberg, is not a philosophical or psychological category. From this comparative perspective, he refers to autonomy as a supreme value in the United States, which is not the case in France. Consequently, the concept of personality in the United States is an institution that serves as a framework for American social sciences, whereas in France societal malaise, for example, is more a collective representation in the Durkheimian sense of the expression. Ehrenberg speaks of “narcissistic pathologies,” accompanied by social ideals and psychic suffering, which are distinguished according to the cultural values and social attributes assigned to them in the two societies.
Basing his argument on the social cohesion problems generated by the weakening of protective systems, on one hand, and the increase in social and economic inequalities, on the other, Ehrenberg speaks of a crisis of equality in France. This constitutes a crisis of equality of opportunities, where it is crucial to promote opportunities to compete, as dictated by turbo-capitalism [15] and thus to become involved in the process of social insertion. By calling for a policy regarding “autonomy-as-a-condition,” Ehrenberg echoes the ideas proposed by Le Bossé, who argues for DPA (Development of the Power to Act) by people and their familial, social and community networks, as a strategy to reappropriate personal and social power [12].
Ehrenberg relies on an interactionist vision, integrating the malaise of society with the affective malaise of individuals on an interactive and indivisible basis. His hypothesis about individual psychic suffering posits a change in the social status of psychic suffering, whereby individual pain constantly exists alongside societal pain. The following quotation illustrates this thought:
Individualism describes a way of making up a society that ascribes the same value to every individual, the same to oneself as to another person, because equality makes all human beings of equivalent value [31].
As for Castel [4], he opposes Ehrenberg’s conception of autonomy-as-a-condition by situating it primarily as a new mode of domination. In this sociologist’s view, the social suffering of individuals is primarily the result of a lack of basic necessities (work, housing, etc.), where the resources available in the environment rarely meet affective and social needs. This gap between needs and real autonomy means that autonomy is decontextualized from its real conditions of existence. Castel prefers to talk of autonomy as being an aspiration or a demand for emancipation.
His remarks support those of Châtel and Roy [47], who see individualism as a structuring element in the management of social relationships. In their work, which aimed to consider the concept of vulnerability as a condition that weakens the individual and his or her social world, these researchers carried out an exhaustive study of the central concept. Vulnerability is also understood as a manifestation of the weakening of social networks and ties, and these authors ask whether it is not more of a process than a condition. Along the same lines as Ehrenberg [31], they see vulnerability as a condition filtered by the concept of autonomy, which comprises three factors: the possibility to act, moral law, and the relationship with others. From this perspective, contemporary individuals are motivated by a utopian apologia for self-realization and liberty. That being so, self-realization cannot ignore the objective conditions of individual resources to make the person useful or, as Foucault would say, a “docile body.” To what extent can economic liberalism be situated outside the self-promotion and individual progress that constitute the basis of its arguments? Are we witnessing again an age of “me,” to the detriment of “we,” and thus one in which relations with other people in the public space have become unimportant?
Although the concept of vulnerability is related to a number of interwoven realities, it is still true that the determination of who is vulnerable and who is less so depends on certain social categories considered to be more at risk in relation to the established order [48]. According to Soulet [49], there is no such thing as vulnerability per se; rather there are human beings who are vulnerable under certain circumstances and conditions. From this interactionist point of view, it is clear that vulnerability is not a matter of chance or of solely individual failure: it fits into a trajectory determined by structural conditions at the social, economic, cultural and political levels. When we pile up destabilizing conditions and inequalities (poverty, weak social ties, more limited horizon in projecting the future), vulnerability produces both unpredictability and uncertainty. In other words, we are not all equal in the face of risks and vulnerability; there is undoubtedly a structural dimension related to individuals’ position in the social and economic structure. As Tinland [50] emphasized, when an individual is no longer producing value for the community, that citizen will be more likely to be medicalized, or even pathologized.
In a special issue of the weekly Courrier International, the content focused on how medicine has lost its way in the twenty-first century [51]. By showing how much the discipline of medicine is at the mercy of money and lobbying, it clearly proved that the pharmaceutical industry, for example, has drifted far from its original noble vocation—investing in research, discovering and manufacturing useful new drugs—so that it now projects itself first and foremost in marketing aimed at selling drugs at any price for the benefit of private shareholders [51].

The Example of Alcoholics Anonymous: A Space for Socializing and Medicalizing Addictions

The AA-style medicalization of addictive behaviors matches the vocabulary used in the organization’s discourse: allergy; progressive disease of the will, emotions or moods; loss of control; or impulse disorder. Contrary to the harm-reduction approach, wherein people are considered to be able to exert a certain control [52,53], the AA philosophy continues to oppose the idea that people who have developed an addiction may potentially gain control.
From a scientific perspective, insofar as science depends on the validation by questioning of absolute or probable facts, one can say that AA is not based on scientific foundations. By not questioning the etiology—the why—behind alcoholism and other addiction conditions labeled as diseases, it sidelines science. In fact, questioning the multifactorial complexity of addictions is not part of AA’s vision. In this regard, the AA slogan is KISS (Keep It Simple, Stupid), which reminds members that it is stupid to see and question all the complexities of life and that they are, and will remain, powerless if they do not turn to a higher power than themselves: God. Oriented toward action and anchored in group dynamics, AA is structured in such a way that members pore over and ruminate about the different interpretations of such key words as power, control, emotion, sobriety, fear, dry spell, anger, serenity, peace, powerlessness and abstinence.
Although belief in a superior power (God) is not a contraindication as such, AA’s practice conveys the idea that you cannot succeed alone and that only God can help you. In this sense, it is a binary vision, an all-or-nothing world: to drink is to die—it’s a matter of life or death. “Love It or Leave It” is the motto of this black-andwhite worldview: you’re either with us or against us. The reality on the ground demonstrates that individuals suffering from addictions are characterized by an impressive degree of variability, and that abstinence or belief in God as absolute prerequisites may not suit all individuals in their rehabilitation process.
From a clinical point of view, in order to create conditions that are propitious to DPA (development of power to act) a case worker may form a valid social argument based on thoughtful practice and scientific foundations leading to personal and social change. Can we not emphasize the protective factors, competencies and strengths hidden in the addicted person’s lifestyle, thereby favoring a trajectory that focuses on sustainable solutions rather than deficiencies?
Regarding the amount of time invested during the first few months in AA, it has been shown that, when referrals to AA are made effectively, that is, with intensive follow-up (known as intensive referral intervention), the outcome can be different. In a study of 345 patients who had been assigned to either an intensive referral or a standard referral group, the results showed that members in the intensive group succeeded in remaining abstinent for longer [54]. After six months of observations, the results of this study showed that the patients who had been assigned volunteer mentors were more involved in the 12 steps than the ones who had received a standard referral. To prevent members from backsliding and dropping out, the researchers therefore proposed that more time should be invested in intensive referral interventions.
That being said, is addiction not primarily the outcome of a psychological, social and cultural choice? If it is, then the response must also be psychological, social and cultural. The concept of competence disappears in the first of the 12 steps (admitting that one is powerless over the substance); according to AA, what enables one to start the rehabilitation process is hitting bottom, so that one can start to recover. Is there not a paradox when we try to reconcile the self-image conveyed by the Anonymous philosophy with the act of freeing oneself from one’s addiction? In other words, how can we ignore the use of negative self-images—I am powerless over the substance/activity; once an alcoholic, always an alcoholic; I have a disease and I always will, etc.—which condition the way individuals perceive themselves?

Toward an Alternative Paradigm to the Medicalization of Addictions

In the age of evidence-based and the epidemiological approach to the management of social problems, how can we ignore the facts that confirm that thousands of people succeed in breaking the cycle of suffering, addiction and medicalization without being labeled for life [2]? Why are other societies and cultures, faced with similar constraints, less likely to medicalize their young people? Why are cultural and familial factors not included in the diagnostic and treatment process, as conveyed by the DSM-IV, even though they are determining factors? Why do we never highlight the results related to the spontaneous remission (natural recovery) of people who reveal hitherto hidden strengths and skills when they need to?
If mental health can be defined as a set of interactions among social, cultural and psychological factors, or a dynamic and temporary state aiming at equilibrium, where are we going in this drive toward overmedicalization that dictates the path to follow on an epidemiological, even deterministic, basis? This chemical ideology confuses cause with effect, while psychiatry tends to ignore the subjective or symptomatic aspects underlying suffering; the psyche is set aside in favor of neurobiological or even biopolitical elements [55]. Thus, the use of DSM-IV instruments is not neutral; the inclusion of subjects’ experiential knowledge and self-management skills could enhance the dynamic and the understanding of subject-drug relations.
The work of Lourdes and Poirel [55] on autonomous medication management, for example, clearly shows that recourse to drugs is not the only possibility in mental health. Working with the underlying reasons and the meaning and function the subject attributes to the drug within his or her family and lifestyle allows that individual to make a free and enlightened choice and thus to create conditions more favorable to DPA [13]. In our era of hyperindividualism and hyperconsumption, reflected in a gradual decline in ritual, Lipovetsky [42] does not hesitate to speak of diseases of the soul. In his view, hyperconsumerism destabilizes both cultures and individuals, creating a consumerist spiral and disrupting people’s psychological life. Could we not invest more in the strengths of family and social networks rather than accepting this verdict? Is it possible to suffer without disappearing [37]?

Conclusion and Outlook: Bringing the Medical and the Social Closer Together

Certain people may develop addictions for reasons related to their environment—unemployment, poverty, weak social ties— while others abuse substances or activities as strategies to confront conditions of alienation, mental health and identity problems. That being the case, the reality on the ground, along with research, teaches us that certain people experiencing these conditions may decide to abandon their addictions and choose another road. This choice relies on solidly grounded resilience and self-esteem. In other words, although we are all candidates to develop addictive behaviors, it only happens when the addiction fills an emotional, psychological, affective or social vacuum and turns the individual away from the multiple sources of pleasure he or she might find in the environment, without “crutches.” Conversely, when people succeed in developing numerous centers of interest and pleasure, the incidence of addictions is low to nonexistent. As Alexander [57-59] and Reith underlines in their analysis, addiction cannot be just medicalized we have to look at the etiology and the social causes, it is mainly a social problem.
In as much as most addiction problems result from individual reactions to social and structural problems (poverty, poor social ties, disaffiliation), can we adopt an argument (knowledge, know-how, interpersonal skills and speaking skills) that would gradually adopt a psychosocial approach, rather than acting as an extension of the medical model? Can we take the time to explore alternatives to the medical model with people and their networks by adapting to their individual characteristics and coaching them accordingly? Can we take the social world into consideration when we work with people, their families and their networks in the context of addiction? What’s about the issue of freedom and personal will [60]?
To these questions, Maté a canadian physician at the Portland Clinic in Vancouver’s Downtown Eastside, treats the hardest of hardcore substance abusers. The facility houses North America’s first supervised injection site, focusing on harm reduction rather than the nebulous aim of “fighting” addiction. In short, Maté concrete interventions illustrate the importance of social ties as a main contributor to recovery. In this perspective, Bruce Alexander’s scientific research work in the same Vancouver’s Downtown Eastside area can enhance our understanding of the addiction phenomenon [57,58]. This researcher underlines what he calls the globalisation of addiction and gives the example of the city of Vancouver as being one of the most beautiful cities in the world but it is also a« terminal city » where social dislocation, poverty and hyperindividualism makes it the most addicted city of Canada.
The medical model is not incompatible with a psychosocial perspective. Including subjects’ social world when one treats a case may bring both sides—medical and social—to bear. Recognizing the medical aspects of the social and the social aspects of the medical would represent a major step forward. In this regard, a number of physicians, psychiatrists and therapists working the area of health and addictions, such as Pirlot, Plante, Weil and Breggin [26,61-63], have proven that bridges between the medical and social worlds are definitely available and that people and their family and social networks can be placed at the center of case workers’ concerns and interventions. If detoxification cures are necessary to rehabilitation from the medical perspective, that should not cause any problems with the rehabilitation process, which emphasizes the competencies of people and their networks—that is, the development of their power to act. How are we to reconcile the labeling of thousands of people as dependents, sick for life, even though they often succeed in reducing, abstaining or even controlling their addictions? Can we not adhere to a multifactorial vision of the complex phenomenon of addictions [64]?

References

































































Track Your Manuscript

Recommended Journals