The Brief Addiction Science Information Source (BASIS)

Addiction & the Humanities Vol 4. (4) - "When I was a kid, I inhaled. That was the point."

Part of what affects politicians’ ability to lead is their use of personal biases and experiences to enrich leadership style and effectiveness, and create a positive public image. The current debate about the legalization of marijuana relates directly to politicians’ personal experiences with substance use. These personal experiences affect the public’s perception of the politician’s image and potentially influence the public’s perceptions of drug use. This week’s HUMANITIES uses Barack Obama’s honesty about drug use to consider the effect that politicians’ personal experiences might have on politics and the public.

Experimenting with drugs as a youth is an experience that most public figures try to keep quiet. Barack Obama is one of the few politicians who have been honest and forthcoming with information regarding his substance-related ‘skeletons in the closet’: marijuana and cocaine use. In interviews, debates, and a 1995 memoir, Dreams from my Father, Obama is candid about the personal internal struggles that he faced during his youth that led him to drug use. In Dreams from my Father, he says “I blew a few smoke rings, remembering those years. Pot had helped, and booze; maybe a little blow [cocaine] when you could afford it. Not smack [heroin], though - Mickey, my potential initiator, had been just a little too eager for me to go through with that. Said he could do it blindfolded, but he was shaking like a faulty engine when he said it…(Obama, 1995, p. 85)”

Obama’s reasoning for his honesty regarding past drug use is that he feels he owes it to younger voters to be frank about the situation. When questioned about this in the past, he responded “young people who are already in circumstances that are far more difficult than mine need to know that you can make mistakes and still recover”("Obama Admissions on Drug Use Could Signal New Era in Politics," 2007; Romano, 2007, p. A01). Obama maintains this view and told some students at a high school “You know, I made some bad decisions that I've actually written about. You know, got into drinking. I experimented with drugs,” he says. “There was a whole stretch of time that I didn't really apply myself a lot. It wasn't until I got out of high school and went to college that I started realizing, ‘Man, I wasted a lot of time’” (Saul, 2007, p. 1).

Many major news outlets (e.g., Fox, The Washington Post, The Daily News) have described Obama’s honesty as marking a new era in politics. Previously, admissions of substance-use might have been taboo for the public; the new era involves the acceptance of candidates whose life experiences might differ from the majority of voters. Further, according to Romano (2007) and articles on the Fox news website ("Obama Admissions on Drug Use Could Signal New Era in Politics," 2007), middle-aged voters who support Obama may continue to do so because, as baby boomers, they are part of a generation that spent a decade experimenting with drugs. For them, Obama’s current success proves that early substance abuse does not guarantee lifelong failure.

Despite his success, it is important to ask whether Obama’s honesty about his drug use marks a shift in public opinion about political leaders and their personal conduct. If so, the public should give potential adverse implications equal consideration. A shift towards accepting drug use and experimentation in adolescents could persuade observers to reason that addiction and substance use prevention for youth is unnecessary. However, a favorable shift in public opinion towards substance use is not reason to accept all substance use experimentation. Obama is not suggesting that adolescents can experiment with substances without worrying about short term negative consequences. Rather, he describes the circumstances surrounding his personal experimentation, while still admitting his error – turning to substance use as a solution. Far from implying leniency, this shift suggests that prevention programs and treatment for substance use and addiction are still a necessary part of youth education. Some adolescent experiments with substance use will have tragic consequences. It is for those unlucky individuals that prevention programs are continually further developed and improved.

What do you think? Comments can be addressed to Ingrid R. Maurice

References

Obama Admissions on Drug Use Could Signal New Era in Politics [Electronic (2007). Version]. FoxNews.com. Retrieved December 11, 2007.

Obama, B. (1995). Dreams From my Father: A Story of Race and Inheritance: Times Books, a division of Random House.

Romano, L. (2007). Effect of Obama's Candor Remains to Be Seen [Electronic Version]. The Washington Post. Retrieved January 3, 2007 from http://www.washingtonpost.com/wp-dyn/content/article/2007/01/02/AR2007010201359.html.

Saul, M. (2007). Barack Obama tells N.H. kids of his alcohol, drug use during teen years [Electronic Version]. The Daily News. Retrieved November 21, 2007 from http://www.nydailynews.com/news/politics/2007/11/21/2007-11-21_barack_obama_tells_nh_kids_of_his_alcoho.html.

Addiction & the Humanities Vol.4 (3) –The Buzz: Taking a closer look at addiction in pop culture.

Approximately one year ago, HBO launched The Addiction Project  in partnership with the Robert Wood Johnson Foundation, the National Institute of Drug Abuse, and the National Institute of Alcohol Abuse and Alcoholism (Leis, 2007). Mental health advocates lauded the film and education project as “groundbreaking” and hoped it would educate the public about addiction (Leis, 2007) and create a new dialogue about addiction. Fast forward one year and addiction is still in the headlines. Now, the very same organizations that praised The Addiction Project for its honest portrayal of addiction are upset by “Celebrity Rehab with Dr. Drew” on VH1 (Jesella, 2008). This week’s Humanities inquires whether presentations of addiction in the popular culture are potentially harmful.

HBO’s Addiction Project featured a documentary, a book, four independent addiction-themed movies, a website, and a national community grassroots campaign coordinated by Faces and Voices of Recovery, Join Together, and Community Anti-Drug Coalitions of America (CADCA). These three groups brought together elected officials, people in recovery, and community-based organizations to promote awareness and discuss new policies for addiction treatment. Many reviewers praised the series, which was honored by the Academy of Television Arts and Sciences Governors Award in 2007.

Two recent changes in the media have influenced the depiction of addiction: the public’s desire for celebrity gossip and the explosion of reality television shows.  Celebrity gossip has become so popular that following Brittney Spears, who has been to rehabilitation three times in the past year, has become an industry in and of itself. During the past year, millions of Americans have viewed her every move. You can see the importance of celebrity gossip in our daily lives by measuring the rapid growth of the celebrity gossip website TMZ.com. According to Alexa.com, a company that analyses web traffic, TMZ.com is one of the top 200 websites for Internet traffic in the U.S. and one of the top 1,000 websites worldwide. It has become so popular that photographs and footage shot by TMZ staff have found their way into national news broadcasts. 

The other vehicle driving this voyeuristic behavior is reality television. The popularity of reality television began with MTV’s “Real World” series in 1992. The show placed seven strangers together in an apartment for several months and followed their every move (MTV, 2008). Between 1992 and 2008 there has been a multitude of reality TV shows many of which aired on MTV and VH1. A spin-off of the “Real World” on MTV was “The Surreal Life” on VH1 that used celebrity participants. Reality television was recently bolstered by the 14-week writers’ strike (Mitchell & Goldmann, 2008) that left television executives without scripts. To fill open time slots, TV executives opted for a variety of new reality television shows.

Recent media depictions of substance use and unsuccessful attempts at rehabilitation have some addiction experts worried that celebrities (e.g. Lindsay Lohan and Britney Spears) are making a mockery of the rehabilitation experience and the seriousness of addiction (Reuters, 2007). The exposure of rehabilitation by Dr. Drew Pinsky, a practicing physician board-certified in addiction medicine, in the VH1 reality show “Celebrity Rehab with Dr. Drew” (Kotlyar, 2008) has fueled heated discussion. Groups  such as Faces and Voices of Recovery are mobilizing against “Celebrity Rehab,” arguing that the drama that plays out on the show sensationalizes addiction (Faces and Voices of Recovery, 2008) and takes advantage of vulnerable people. Can people suffering from mental disorder give truly informed consent to have their story televised? Concerned groups argue the show’s depiction does not match reality. For example, most people who seek treatment do not have access to the quality of the facilities shown on “Celebrity Rehab” (Faces and Voices of Recovery, 2008). Opponents of the show “believe that when people see this show, they’ll wonder why they should help people with addiction and why people should get insurance coverage for their care” (Calderone, 2008). This might make it difficult to fix inequalities in the reimbursement for addiction treatment compared with other chronic diseases.

“Celebrity Rehab” seems to be the logical marriage of the public’s incessant need for up-to-the-minute gossip on celebrities (e.g. TMZ.com), the popularity of reality television, and celebrity voyeurism. Dr. Pinsky defends his show arguing that the public’s focus is already on celebrities and their battles with addiction.  What he is attempting to do is harness that focus and help the public understand that rehabilitation is not easy and that it takes a lot of hard work (Celizic, 2008). VH1 executives defend the show stating “Celebrity Rehab is as real as it gets… this is about as scared straight as you’re going to get” (Miller, 2008). The show spans the entire 21 days inpatient rehabilitation process. However, the time restrictions of television allow VH1 to show only approximately one percent of everything that occurred during the 21 days filmed (Kotlyar, 2008). Despite the criticism, the show has opened to favorable reviews (Maynard, 2008; Rhodes, 2008).   

Celebrities and their public fight against addiction will continue to be the buzz in pop culture. Society’s desire for contact with celebrities does not seem to be waning.  Reality television shows offer television audiences an opportunity for guilt-free voyeurism.  Are people watching shows like “Celebrity Rehab” to understand the struggles of addiction?  Maybe, but just as many are probably watching because they enjoy seeing other people, especially the rich and famous, suffer. It gives them an opportunity to compare their lives to those they see on television. Their struggle with addiction in the public eye is an opportunity to educate the public at large.  Addiction advocates and treatment specialists need to constructively shape the discussion and ensure that the public is not misled, all the while making sure that those seeking treatment get the care they deserve. 

What do you think?  Does “Celebrity Rehab with Dr. Drew” glamorize substance use and take advantage of the mentally ill or is it a continuation of the dialogue started by the HBO’s Addiction Project, focused on a younger audience?

Comments can be addressed to John H Kleschinsky.

References
Calderone, T. (2008). Letter to President of VH1.   Retrieved March 09, 2008, from http://www.facesandvoicesofrecovery.org/pdf/01.25.2008_NAATP_celeb_rehab.pdf

Celizic, M. (2008, Jan 08, 2008). Dr. Drew treats celebrities' demons on new show: TODAY contributor helps the famous, and no-as-famous, with addictions.   Retrieved March 09, 2008, from http://www.msnbc.msn.com/id/22555361/

Faces and Voices of Recovery. (2008). Speak out about VH1's "Celebrity Rehab with Dr. Drew". Campaigns: Retrieved March 09, 2008, from http://www.facesandvoicesofrecovery.org/about/campaigns/celebrity_rehab.php

Jesella, K. (2008). Does 'Rehab' host go too far? [Electronic Version]. Chicago Tribune. Retrieved March 09, 2008 from http://www.chicagotribune.com/features/lifestyle/health/chi-0212_health_rehab_rfeb12,1,7277025.story.

Kotlyar, A. (2008). Celebrity Rehab with Dr. Drew. VH1.com   Retrieved March 09, 2008, from http://www.vh1.com/shows/dyn/celebrity_rehab_with_dr_drew/series.jhtml

Leis, R. (2007). HBO's Groundbreaking 14-Part Series, The ADDICTION Project, Kicks Off March 15. Announcement   Retrieved March, 09, 2007, from http://www.jointogether.org/news/yourturn/announcements/2007/hbo-the-addiction-project.html

Maynard, J. (2008, January 10, 2008). VH1's 'Celebrity Rehab' Could Become a Habit.   Retrieved March 09, 2008, from http://www.washingtonpost.com/wp-dyn/content/article/2008/01/09/AR2008010903434.html

Miller, M. (2008). VH1 puts reality into rehab. Los Angeles Times   Retrieved March 09, 2008, from http://www.latimes.com/entertainment/la-et-rehab9jan09,1,6990632.story

Mitchell, G., & Goldmann, S. (2008). Writers Guild Members Overwhelmingly Ratify New Contract. News Release   Retrieved March 14, 2008, from http://www.wga.org/subpage_newsevents.aspx?id=2780

MTV. (2008). The Real World New York. Real World   Retrieved March 14, 2008, from http://www.mtv.com/ontv/dyn/realworld-season1/series.jhtml

Reuters. (2007, July 26, 2007). Experts: Lohan, Spears making mockery of rehab. Health   Retrieved March 09, 2008, from http://www.cnn.com/2007/HEALTH/07/25/celebrities.rehab.reut/index.html

Rhodes, J. (2008). Shocking Celebrity Rehab Moments Revealed. TV Guide   Retrieved March 09, 2008, from http://seattlepi.nwsource.com/tvguide/349330_tvgif30.html

Addiction & The Humanities Vol. 4(2) - Live Fast, Die Young? Maybe Not.

Media reports and speculation associate celebrity status with early death. Supporting this relationship, qualitative research has concluded that celebrities are more likely to suffer from stress, substance use, and depression, which are risk factors for early death (Patalano, 2000; Raeburn, 1999). This week’s BASIS explores quantitative research about this topic. In “Elvis to Eminem,” Mark Bellis and his colleagues hypothesized that “popstars” would have a higher mortality rate than individuals from matching demographics (e.g., age, sex, and race) in the general population (Bellis et al., 2007).

Bellis et al. focused on European and North American music stars within six genres: rock, punk, rap, R&B (rhythm and blues), electronica, and new age. The researchers calculated celebrities’ total years of life since becoming famous and compared the result to the UK and US general populations’ expected rates of survival. They standardized the general population survival rates for age, sex, and for North American analyses, ethnicity. Bellis et al. found a significant difference between US and UK music stars’ survival rate after 25 years of fame. For European music stars, the relative survival probability increases until the difference between it and the general population’s survival rate is not significant. As shown in Figure 1, for North American “popstars,” the relative survival rate continues to deviate from that of their European counterparts and from that of their matched populations.

Figure 1: Comparative survival curves for North American and European pop stars and demographically matched general populations (Bellis et al., 2007).

The study of the 1,064 music stars also found that an overdose or a chronic drug or alcohol problem caused more than a quarter of music star deaths; however, the crude mortality (i.e., death rate for the entire population including all sexes, ages, and causes) of European music stars was only half of that for North American stars.

The findings of Bellis et al were limited by their operational definition of stardom (i.e., choice of an international poll from the year 2000 that determined the All-Time 1000 Albums). Another limitation was their definition of date of fame, which was not based on any epidemiological standards, but on the artists’ earliest date of chart success, which resulted in slightly more conservative results. A third limitation was their failure to use official cause of death records in their research, rather than a range of non-traditional sources (i.e., cross- referenced over 430 websites, books, etc.). Lastly, the use of US and UK life tables as substitutes for North American and European measures also limited the study.

Bellis et al propose greater collaboration between the health and music industries to help assure that pop star influence leads to better health among fans and rising stars that look to them as leaders. However, it may be more interesting to propose that the music industry provide newest music stars with preventative tools, treatment, and resources to prevent unhealthy lifestyles. Moreover, the same research conclusions and suggestion could be applied to other non-music celebrities. The nature of stress that celebrities face in combination with the easily accessible substances suggest that a certain amount of preparation for this change in lifestyle is necessary to successfully navigate the celebrity world and avoid widely publicized addiction or premature death.

What do you think? Comments can be addressed to Ingrid Maurice.

References

Bellis, M. A., Hennell, T., Lushey, C., Hughes, K., Tocque, K., & Ashtan, J. R. (2007). Elvis to Eminem: quantifying the price of fame through early mortality of European and North American rock and pop stars. Journal of Epidemiology & Community Health, 61(10), 896-901.

Patalano, F. (2000). Psychological stressors and the short life spans of legendary jazz musicians. Perceptual & Motor Skills, 90(2), 435-436.

Raeburn, S. (1999). Psychological issues and treatment strategies in popular musicians. A review, part 1. Medical Problems of Performing Artists, 4(1), 171-179.

Addiction & the Humanities Vol. 4(1) - Frank "Superfly" Lucas: American Gangster

In the last Humanities, we discussed the role of Khun Sa, "The Golden Triangle King", in international drug trafficking. Based out of Myanmar (formerly Burma) Khun Sa had enormous success in growing and trafficking opium. Continuing with the theme of drug trafficking, this week's HUMANITIES reviews the newly released Denzel Washington movie, American Gangster. The movie is similar to other Hollywood movies depicting gangsters and drug dealers (e.g., The Godfather I, II, and III, Scarface, Goodfellas, Hustle and Flow), but American Gangster's storyline is inspired by a real drug dealer: Frank "Superfly" Lucas.

The title American Gangster is the first clue to the movie's importance in American Culture. The movie explains the dry, meticulous business of successful drug trafficking in America, giving it an almost legitimate feel. Further, and more importantly, the movie also provides its viewers with an inside view to the world of successful drug dealers, giving considerable insight into what that world says about drugs and addiction in the United States.

In a move that focuses attention on the US's national drug market, the movie contains only 3 international links: Lucas's wife is of Puerto Rican descent, (although Puerto Rico is a US Territory its culture is distinct from US Culture), the Vietnam War serves as a historical backdrop, and Lucas's product supplier farms his opium in Asia. Although these international links are important, they do not detract from the fact that cutting, shipping, distribution and, most importantly, profit all happen within the US and to benefit US citizens. Even members of the US military participated in the illegal activities. Having been contracted by Lucas, some military personnel turned a blind eye to, and guided the illegal cargo across international lines. This imagery conveys the message to the American public that the leaders of successful drug trafficking operations (people similar to Khun Sa,) are not always based outside of the country. Furthermore, those in the US are often more successful due to the demand for high quality opioid in the West and the reduced price at which people like Frank Lucas could and did purchase purer drugs from the East.

Picture:
(left) Frank Lucas and his wife Julie Lucas
(right) Actors Denzel Washington & Lynmari Nadal as Frank and Eva Lucas.

Further substantiating the significance of the American drug dealer, with minimal glamorization, the movie American Gangster shows the cycle that perpetuates within successful American drug trafficking. This cycle is the same supply and demands cycle that influences international drug trafficking, as well as a lifestyle that rejects the use of addictive substances. However, the cycle has the added elements of familial hierarchy and business. In the movie, Frank Lucas "inherits" his drug business after the death of his former employer, for whom he was the driver. He subsequently expands it by using the services of his closest relatives: his brothers. Furthermore, Frank Lucas's character never uses any of the products that he sells. He doesn't drink excessively, smoke or gamble excessively or engage with any other addictive activities. In fact, various scenes in the movie (e.g., a party at his home in which he is infuriated by a "high"guest) show his disdain for those that use drugs and lack the self-control required to stay away from them. Frank's only addictive behavior pattern, and the reason for his steady success, is his penchant for working constantly.

American Gangster's geographical setting, Harlem, provides the viewing public with a familiar locale within which to place and understand one aspect of American drug trafficking. Because of its rich history -- the Harlem Renaissance, significant cultural diversity before the Great Depression, the 1968 riot following Martin Luther King's assassination, and David N. Dinkins 1989 election as mayor -- Harlem is familiar to most movie-goers. Even for movie-goers that will not recognize Harlem, the presentation of a poorer neighborhood with unsafe apartment complexes filled with illegal drugs is a well-known image with which viewers can easily identify. Movies, television, books, and news outlets repeatedly present these images as a common setting for drug abuse.

The American Gangster movie formula is not a new one: information about a drug dealer's pre-drug business life, his rise to power and notoriety, and his downfall. However, American Gangster is interesting and worth seeing. Both leads, Denzel Washington and Russell Crowe play their parts well, and the imagery in the movie is evocative. The movie's plot becomes even more interesting when viewers take the time to research the real Frank Lucas. In two New York Magazine interviews, from 2000 and 2007, images and quotes from the real Frank Lucas (Jacobson, 2000; Jacobson, 2007) immediately bring the reader back to specific scenes in the movie. Although the movie is not biographical, the attention to details and facts from Frank Lucas' life is captivating. For example, the left side of the above photo is not of Denzel Washington, but of the real Frank Lucas and his wife; movie-goers will remember that the same fur coat ultimately brings about Lucas' downfall in the movie.

What do you think? Comments can be addressed to Ingrid Maurice.

 

References

Grazer, B. (Producer), & Scott R. (Director). (2007). American Gangster [Motino Picture]. United States: Universal Pictures

Jacobson, M. (2000). The Return of Superfly. Retrieved on December 23, 2007 from http://nymag.com/nymetro/news/people/features/3649/

Jacobson, M. (2007). The Lords of Dopetown. Retrieved on December 23, 2007 from http://nymag.com/guides/money/2007/39948/

Addiction & the Humanities Vol. 3(10) - Supply & Demand: Looking at addiction through drug trafficking

The guiding principle of supply and demand plays a key role in the indirect exchange between drug suppliers and drug users. In addition to local drug traffickers, there are also international drug rings whose successful operations make them essential collaborators in the drug business. One leader of such a drug ring was Khun Sa, whose life and death highlights differences in international government practices related to drug control. In this issue of Addiction and the Humanities, we use Khun Sa as a lens to examine the role of drug trafficking in the supply and demand that feeds drug addiction.

From 1974 to 1994, Khun Sa had unrivalled success and control over the growth and transport of opium, and its derivative, heroin, in the Shan State of Myanmar (formerly Burma) (AlJazeera.net, October 30, 2007; Economist, November 8, 2007). His rise to control came from a combination of confused reasoning and a government whose wish for economic and military aid clouded its judgment on how to deal with drug trafficking. Although never formally educated, Khun Sa received military training from the Chinese Nationalist forces. This experience no doubt proved valuable in commanding a local militia, and running his part of the already present opium business.

After moving his life and business to Myanmar (formerly Burma) (Fuller, November 5, 2007), Khun Sa maintained a love-hate relationship with both the Shan people and the Burmese Government; he argued that providing economic stability for the Shan people motivated him to engage in drug trafficking. In addition, although it publicly condemned him, the Burmese Government tolerated his control of Myanmar’s most economically rewarding export, and his arrangements with local police, soldiers, and generals. In 1996, the government reached a tacit agreement with Khun Sa ensuring that he would avoid extradition, receive government protection, and could retire comfortably; in return he had to surrender his home, weapons, ammunition, soldiers, refineries, and crops to the Burmese Government.

In 1977, Khun Sa offered to sell his entire opium crop to the United States (Johnson, March 1, 1982); this proposal suggested that buying his opium crop was the only way for the US to take it off the market and minimize the amount of opium traveling from Asia to the US. Khun Sa knew that his products, business, and influence stretched internationally, and with the Burmese Government’s help, he was able to avoid the consequences (e.g., indictment, extradition, trials) of international illegal activity. With the majority of demand for illegal drugs originating in the West, more specifically in the United States, foreign government cooperation with drug traffickers poses a threat to international attempts to put a stop to drug business’s power. In Khun Sa’s case, the Burmese Government enabled him in multiple ways. While Khun Sa controlled a personal army, the government accepted the idea of opium as a profitable crop and chose to ignore the evident negative effects on international relations. In fact, Khun Sa’s January 7, 1996 surrender to the Burmese Government placed a significant amount of weaponry and property in their hands.

Myanmar’s exit from the opium (heroin) business (Liu, November 6, 2007) made room for other Eastern countries' re-entry. Afghanistan, for example, has regained its position as the number one producer of heroin in the East; 92% of the world’s heroin is now produced in Afghanistan (Liu, November 6, 2007). The situation in Afghanistan is similar to that in Myanmar: without sufficient government regulations, drug traffickers can impose their power and deceive nations into thinking that their drug transactions function like all other import/export businesses. The difference in philosophy between Eastern and Western government ideas explains why Khun Sa’s proposal to the United States was met with an indictment. In the US, illegal drug activity is punished on both ends of the supply and demand scale; however, similar to the Shan state, currently some Eastern nations have less demand and can focus on their role as suppliers to bring them financial stability.

What do you think? Comments can be addressed to Ingrid Maurice.

References

AlJazeera.net. (October 30, 2007). Golden Triangle drugs kingpin dies.   Retrieved November 26, 2007, from http://english.aljazeera.net/NR/exeres/FA91ECD1-59CA-4963-83EE-34DCB6557F71.htm

Economist, T. (November 8, 2007). Obituaries: Khun Sa (Chang Chi-fu), master of the heroin trade, died on October 26th, aged 73.   Retrieved November 19, 2007, from http://www.economist.com/obituary/displaystory.cfm?story_id=10097596

Fuller, T. (November 5, 2007). Khun Sa, Golden Triangle Drug King, Dies at 73. New York Times, Asia Pacific Section   Retrieved November 19, 2007, from http://www.nytimes.com/2007/11/05/world/asia/05khunsa.html

Johnson, M. (March 1, 1982). The Great Opium War. Time Magazine   Retrieved November 26, 2007, from http://www.time.com/time/magazine/article/0,9171,922799,00.html

Liu, M. (November 6, 2007). Death of the Golden Triangle's most powerful druglord. Newsweek   Retrieved November 19, 2007, from http://www.blog.newsweek.com/blogs/ov/trackback.aspx?PostID=65236

Addiction & the Humanities Vol. 3(9) - Holidays: A Time to Celebrate, a Reason to Drink, or a Time to Celebrate Drinking?

Growing up, many people think of Halloween as a time for costumes and candy. Birthdays provide a reason to have cake and receive presents. Thanksgiving is a chance to see family and watch football.  But research suggests that college students view holidays in a more limited way:  as opportunities to engage in heavy drinking.  This week’s Addiction and the Humanities examines college students’ celebratory drinking habits.

Previous studies of the American general population found that certain holidays (e.g., Christmas, New Year’s Eve) correlate with greater alcohol consumption (Poikolainen, Leppanen, & Vuori, 2002; Weir, 2003).  Considering the large body of research describing college students’ excessive alcohol use, it seems reasonable to ask whether this association extends to additional holidays on college campuses.  However, few studies have scrutinized students’ drinking behavior during holiday festivities. 

When surveyed, college students report “special events” as one of the principal reasons for drinking (Klein, 1992), and “fun and celebration” as the essential motive for playing drinking games (Johnson, Hamilton, & Sheets, 1999).  These studies also found that those who endorsed the “fun and celebration” rationale drank greater quantities of alcohol and viewed drinking as a way to have fun. These attitudes might contribute to binge drinking and other serious abuses of alcohol.

To measure the alcoholiday effect (i.e., holidays and celebrations that center on alcohol) without relying on self-reported consumption, which might bias the results, Glindemann, Wiegand, and Geller (2007) performed three similar studies comparing students’ blood alcohol concentrations (BACs) during holiday celebrations and ordinary weeknights. In the first study, for five consecutive Thursdays, the fourth Thursday being Halloween 2002, research assistants in different sections of downtown Blacksburg, Virginia, executed brief surveys. Using handheld breathalyzers, they measured pedestrians’ BACs, 87.8% of whom were students.  Research assistants followed the same procedures around St. Patrick’s Day in 2003 (Study 2) and 2005 (Study 3), during which 84.5% and 92.7% of pedestrians were students. 

Study 1 revealed a statistically significant main effect for costume; participants wearing costumes had an average BAC of .089, compared to those in everyday clothes who had a mean BAC of .058.  Furthermore, Chi-square comparisons indicated that the number of participants with a BAC of .08 (i.e., threshold of intoxication) or greater was significantly higher for those in costume (i.e., 60.3% vs. 35.7%).  Data from Studies 2 and 3 revealed that BACs were significantly higher for participants reporting a celebration motive (.096) as opposed to those not reporting the motive (.074).  Analyses from all three studies revealed a main effect of holiday: participants’ BACs were significantly higher during celebratory occasions than the non-celebrating occasions.

Figure 1. “Costumes for Kids”("Costumes for Kids" 2006)

Glindemann, Wiegand and Geller’s (2007) findings are similar to the results of a study conducted earlier by Miller, Jasper and Hill (1993).  The 1993 study not only found a significant association between dressing in costume and alcohol consumption, but also revealed that 85% of participants who were involved in Halloween activities, regardless of costume wearing, had used alcohol. 

These studies provide important insight into circumstances that are associated with risky drinking behavior by students on college campuses.  The studies are limited, however, because the participants are from a specific and narrow segment of the population.  Moreover, those who agreed to participate might represent only a segment of the original sample, biasing the results.  Future research should expand upon these studies by examining the effects of different holidays (e.g., July 4th, New Year’s Eve) and the potential moderating effects of geographic locations on celebratory drinking patterns.  Better understanding of the alcoholiday phenomenon could lead to better prevention and intervention programs.

What do you think? Comments should be addressed to Sara Kaplan.

References

Costumes for Kids. (2006).   Retrieved October 30, 2007, from http://cip.plsinfo.org/bulletin/CIPRB0610.htm

Glindemann, K. E., Wiegand, D. M., & Geller, E. S. (2007). Celebratory drinking and intoxication. Environment and Behavior, 39(3), 352-366.

Johnson, T. J., Hamilton, S., & Sheets, V. L. (1999). College students' self-reported reasons for playing drinking games Addictive Behaviors, 24(2), 279-286.

Klein, H. (1992). Self-reported reasons for why college students drink. Journal of Alcohol and Drug Education 37, 14-28.

Miller, K. A., Jasper, C. R., & Hill, D. R. (1993). Dressing in costume and the use of alcohol, marijuana, and other drugs by college students. . Adolescence 28(109), 189-198.

Poikolainen, K., Leppanen, K., & Vuori, E. (2002). Alcohol sales and fatal alcohol poisonings:  A time-series analysis Addiction 97, 1037-1040.

Weir, E. (2003). Seasonal drinking:  Let's avoid the "January effect". Canadian Medical Association Journal 169(11), 1186.

Addiction & the Humanities Vol. 3(8) - Examining racial and ethnic substance use differences following exposure to disaster.

Disasters, such as recent hurricanes and floods in North America, earthquakes in Indonesia, the 2004 tsunami in Southeast Asia, and the New York City World Trade Center attack, have killed thousands and exposed thousands more to ongoing trauma.  Survivors probably manage the aftermath of such disasters by utilizing coping methods dependent upon their current situation; specific strategies vary by culture. For example, researchers have found differences in social support and coping among different racial and ethnic groups (Pole et al., 2005; Kim et al., 2007.)  This week, Addictions and the Humanities considers whether people exposed to the World Trade Center attack from different racial, ethnic, and cultural backgrounds experienced different addiction-related health outcomes.

Unfortunately, it is difficult to conduct disaster research for a number of reasons. Disasters vary in many ways: geographic size, mortality rates, elapsed time, and displacement among others. Such differences make studying the effect and generalizability of findings related to disasters and their aftermath challenging.

To study the effect of the World Trade Center attack (WTC attack) on increased cigarette and alcohol use, Wu et al. (2006) drew a stratified random sample of all high school students in New York City and had the students complete a survey about their exposure (direct, family or media) and their cigarette and alcohol use after the WTC attack.  Researchers examined participants’ self-reports that they “started” or “increased” smoking/drinking after the WTC attack.  Analyses revealed that students directly exposed to the attack reported increased alcohol use after the WTC attack, Odds Ratio (OR)  1.8 (95% CI, 1.1-2.8).  Researchers compared African Americans, Asian American and Hispanic American students to their non-Hispanic white counter parts; these minority groups were protected from increased alcohol use after the WTC attack.  The OR for African American students was 0.4 (95% CI, 0.2-0.7), for Asian American students the OR was 0.5 (95% CI, 0.3-0.9), and for Hispanic American students the OR was 0.6 (95% CI, 0.3-0.9) (see Table 1).

There are several limitations to discuss.  The study is not longitudinal; therefore, it is impossible to determine if exposure to the WTC attack precipitated the change in smoking and drinking behavior.  Second, the population studied was high school students in New York City.  Consequently, the results should only be generalized to adolescents involved in disasters where displacement is minimal, as was the case in NY.  Finally, researchers asked only if subjects initiated or increased use of alcohol and cigarettes but not other substances of abuse.  This makes it difficult to determine the degree to which substance use increases after a disaster.

The finding that Asian, Hispanic and African-American students drank alcohol less than non-Hispanic whites is interesting and warrants further study.  This finding contrasts with results from the Youth Risk Behavior Surveillance System, which identified higher alcohol use prevalence rates among Hispanic and non-Hispanic white students compared to African-American students (Eaton et al., 2006).  It is possible that certain cultural values might have lead to protection against alcohol abuse or that certain cultures abuse other substances not measured in response to disasters.  Future studies must use comprehensive measures of substance use, focus more on cultural differences, and follow up with students over a longer period of time.  Researchers also must study whether coping mechanisms manifest differently in various geographical areas and cultures. If more research identifies cultural coping differences, these results should inform public health strategies and interventions.

What do you think?  Comments can be addressed to John Kleschinsky.

References
Eaton, D. K., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Harris, W. A., et al. (2006). Youth risk behavior surveillance--United States, 2005. MMWR Surveillance Summaries, 55(5), 1-108.

Kim, J. H., Knight, B. G., & Longmire, C. V. (2007). The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health. Health Psychology, 26(5), 564-576.

Pole, N., Best, S. R., Metzler, T., & Marmar, C. R. (2005). Why are hispanics at greater risk for PTSD? Cultural Diversity and Ethnic Minority Psychology, 11(2), 144-161.

Wu, P., Duarte, C. S., Mandell, D. J., Fan, B., Liu, X., Fuller, C. J., et al. (2006). Exposure to the World Trade Center attack and the use of cigarettes and alcohol among New York City public high-school students. American Journal of Public Health, 96(5), 804-807.

Addiction & the Humanities Vol. 3(7) - Higher education: Does obtaining an advanced degree help protect against risky behavior?

Many societies regard higher education as a protectorate against addiction.  Such culturally developed beliefs can create biases that preclude opportunities for early detection of problems and consequently early intervention. In this issue of Addiction and the Humanities, we review evidence of substance-related problems among the highly educated.  Although education tends to decrease the likelihood of substance-related addiction (Substance Abuse and Mental Health Services Administration, 2005), the highly educated are not immune to developing substance use problems. 

Researchers surveyed a highly educated workforce (Matano, Wanat, Westrup, Koopman, & Whistsell, 2002) to investigate the prevalence of risky substance use behaviors among a more educated workforce.  Matano et al. (2002) randomly selected 10% (N=857) of employees to receive surveys regarding their substance use behaviors during the previous 12 months.  Of these eligible employees, 504 sent back completed surveys. Respondents were 62.8% female and ranged in age from 21 to 78 (M=43.8).  Eighty one percent of the sample earned a bachelor’s degree or higher and 3% earned a high school diploma or less. 

Table 1 summarizes the survey results.  The results reveal that alcohol and licit drug use was more prevalent than illicit substance use among this sample.  A significant number of employees however, reported illicit drug use during the past year.  Based on responses to the CAGE (Ewing, 1984), 12% qualified for “likely to have lifetime alcohol dependence.” Responses to the AUDIT (Bush, Kivlahan, Mcdonnell, Fihn, & Bradley, 1998) indicated that 5% had a “high likelihood of alcohol abuse.” In addition, 3% claimed that their alcohol consumption caused injury to someone else.  Despite these results only a handful of employees reported receiving any substance abuse treatment over the last year.

Table 1. Past year substance use among employees (N=504)

There are several limitations to this study. For example, the 60% response rate might result in substance use differences between those that completed and those that did not complete the survey. In addition, this survey was conducted in 1999, and it is possible that substance use behaviors among highly educated employees have changed since then.  Finally, substance use might be a more sensitive topic for the highly educated, perhaps biasing the self-report in the direction of underreporting.

Despite constraints that might limit the extent of reported substance use and related problems, this study confirms that substance use and abuse is not an issue reserved only for less educated individuals.  There is a need for employee prevention and intervention programs in work forces populated by the highly educated. Assuming that educated individuals are immune to substance use problems might diminish their chances of getting the help they need.

References

Bush, K., Kivlahan, D. R., Mcdonnell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789-1795.

Ewing, J. A. (1984). Detecting alcoholism: the CAGE questionnaire. Journal of the American Medical Association, 252(14), 1905-1907.

Matano, R. A., Wanat, S. F., Westrup, D., Koopman, C., & Whistsell, S. D. (2002). Prevalence of Alcohol and Drug Use in a Highly Educated Workforce. The Journal of Behavioral Health Services & Research, 29(1), 30-44.

Substance Abuse and Mental Health Services Administration. (2005). Overview of findings from the 2004 National Household Survey on Drug Abuse: Volume 1. Summary of National Findings (No. SMA 05-4061). Rockville, MD.

Addiction & the Humanities Vol. 3(6)- Vodka & Lighter Fluid: Russian Mortality Rates on the Rocks?

Russia is famous for ballet, Romanovs, Dostoevsky, and communism among many other things. Many people think Russian vodka is the best in the world.  However, this particular cultural strength also might be associated with a high rate of alcoholism and alcohol-related deaths. For example, research indicates that nearly half of all deaths among men 25-54 in an average Russian city were related to hazardous drinking behavior (Leon et al., 2007). This week’s Addiction and the Humanities examines a related phenomenon: surrogate alcohol consumption in Russia (McKee et al., 2005).

In Russia, the consumption of surrogate alcohols (i.e., products not sold legally for consumption), such as medicinal compounds, samogon (i.e., home-produced spirits), and aftershave is somewhat common. One study indicated that the prevalence of past year surrogate alcohol consumption in an average Russian city was 7.3% (McKee et al., 2005). Among the most common surrogates are aftershave, lighter fluid, samogon, and medicine. Many surrogates contain a lethal ethanol content, which if watered down produces more for your ruble; but, if ingested undiluted, these substances can be very harmful.  In addition, home-made spirits contain unhealthy levels of toxic alcohols whose effects are not known.

                     

People might consume surrogate alcohol for a variety of reasons. Researchers (McKee et al., 2005) suggest that one reason some Russians might do so is because of regional packaging. In Russia, surrogate alcohol often comes in 250-ml bottles that look similar to bottles used for beverage alcohol. In the West, similar products typically are available only in 30- or 50-ml bottles (McKee et al., 2005).  The surrogate products do not face administrative scrutiny or alcohol taxation rates; however, their large containers suggest that they might be marketed for consumption (McKee et al., 2005).  This hypothesis makes sense; however, it is necessary to test this hypothesis using empirical methods. One way to do this might be to compare packaging and surrogate alcohol consumption in several countries. However, confounding variables, such as cultural and individual differences as well as marketing intentions, could make it very difficult to establish causality.

There is scant research related to this topic, despite the need for empirical examination.  For example, it is not clear whether surrogate consumption rates in Russia are higher than those of other countries or if they indicate typical rates found across cultures. Cheaper cost and unregulated alcohol content, along with their colorful containers, might make surrogate alcohol use appealing. Future research should examine the relative contribution of each of these factors to the decision to consume surrogate alcohol. Additional research and increased public health awareness can help uncover the extent of surrogate alcohol use in Russia and the dangers that societal customs might unintentionally support.

What do you think? Comments can be addressed to Erinn Walsh.

References

Drogvan Genuine Russian Vodka. (2007).   Retrieved 28 June, 2007, from http://blueplanetspirits.trustpast.alibaba.com

Leon, D. A., Saburova, L., Tomkins, S., Andreev, E., Kiryanov, N., McKee, M., et al. (2007). Hazardous alcohol drinking and premature mortality in Russia: a population based case-control study. Lancet, 369, 2001-2009.

McKee, M., Suzcs, S., Sarvary, A., Adany, R., Kiryanov, N., Saburova, L., et al. (2005). The Composition of Surrogate Alcohols Consumed in Russia. Alcoholism: Clinical and Experimental Research, 29(10), 1884-1888.

Troynoi. (2007).   Retrieved 28 June, 2007, from http://www.englishrussia.com

Addiction & the Humanities Vol. 3(5) - Celebrity Spokesperson: A perfect match or a "cause célèbre"?

For many years celebrities have worked to bring attention to issues such as, underage alcohol use, drug addiction, and smoking; however, researchers have not systematically examined whether this provides benefits to such causes. Although celebrity sponsorship undoubtedly brings needed attention to addiction-related problems, such attention also could create unwanted complications. Celebrities are, and always will be, under close scrutiny by the public and the media. For this reason, deciding to seek the public support of celebrities for important causes should be done after weighing a number of pros and cons for both the cause and the celebrity.

Celebrities can help important causes in a number of ways. For example, the right celebrity might bring a campaign national exposure overnight. Al Unser Jr., for example, has generated significant amounts of attention for LIVE outside the bottle: The story of alcoholism in America, a national multi-media campaign addressing alcohol dependence in the United States. Since joining the campaign on May 18 more than 100 news articles have been published online discussing Unser Jr., his battle with addiction, and his work with LIVE outside the bottle.

Celebrities can influence public opinion and consequently have the potential to reduce the stigma surrounding addiction. For example, there remains an ongoing social stigma (see BASIS Editorial 2/14/07) associated with addiction because many people still believe that addiction stems from a lack of will power. However, addiction is much more complicated than simply a lack of will power. Celebrities can direct the public toward specific treatment options and educate them about a more accurate understanding of addiction. Two time Indianapolis 500 winner Al Unser Jr. is trying to do this through his connection with LIVE outside the bottle by emphasizing a disease model of addiction.

But, there are also some downsides to celebrity and these could carryover to the causes they seek to support. During recent years, news organizations have focused significant attention on entertainers. News outlets include sources of information found on Internet websites like TMZ or blogs. TV shows that air during primetime like Extra and Inside Edition, as well as gossip magazines People and Star, focus on celebrity news. Unfortunately, this means that many celebrities get caught in the gossip crosshairs, and this potentially can detract from an addiction campaign and create stress for the celebrity.

In this court drawing by court artist Mona Shafer Edwards, Paris Hilton, right, is seen with her parents Rick Hilton and Kathy Richards Hilton, left, at the the Los Angeles Municipal Court Metropolitan branch Friday, May 4, 2007, in Los Angeles. Superior Court Judge Michael T. Sauer sentenced Paris Hilton to 45 days in jail Friday for violating her probation. The judge ruled that she was in violation of the terms of her probation in an alcohol-related reckless driving case. (AP Photo/Bill Robles). Paris Hilton came out in support for the Annual SOBER DAY USA: A Day of Awareness sponsored by The Brent Shapiro Foundation for Drug Awareness on May 1, 2006.

Finally, it is not uncommon for celebrities who support addiction-related causes to consider themselves to be “in recovery.” However, relapse is a very common part of the recovery process. In fact, between 60 and 80 percent of those who have experienced addiction to alcohol, heroin, or smoking relapse during the 12 months following treatment (Hunt, Barnett, and Branch, 1971). For celebrities, transgressions are likely to make international headlines soon after it happens. These headlines can be damaging to the campaign and to the celebrity.

The recent struggles of entertainers, such as Paris Hilton and Lindsay Lohan, and the successes of country music star Keith Urban, star athlete Brett Farve, and racing legend Al Unser Jr., have all made the headlines. This is in part due to the speed with which information travels. From smartphones with cameras, to YouTube and blogging, information travels fast. Some might argue that entertainment news is an invasion of privacy, but it might be capable of something much larger. With the help of technology, every new headline, exhibit, website, and celebrity spokesperson builds on the movement to deconstruct the social stigma surrounding addiction. Celebrities will continue to be the focus of media gossip, with paparazzi lurking in every corner. Choose your celebrity carefully; As Forest Gump says “Life is like a box of chocolates. You never know what you are going to get.”

What do you think? Comments can be addressed to John Kleschinsky.

Addiction & the Humanities Vol. 3(4) - Addiction and Technology– From Sex to Drugs: Considering Evolution and Addiction

With his book The Origin of the Species, Charles Darwin offered two fundamental scientific postulates: the first suggests that all living things on earth are descendents of earlier species (i.e., evolution); and, the second suggests that natural selection is the architect of evolution. Natural selection drives evolution through adaptations to environmental challenges. Organisms that develop beneficial adaptations, increasing the likelihood that they will survive, are more likely to pass on these adaptive genes to their offspring than organisms that fail to develop beneficial adaptations. Consequently, over time, the organisms that fail to adapt and survive contribute fewer genes and become less prominent in a species. Although scientists and others often think about evolution with respect to physical changes among a species, the theory of evolution also can provide a unique perspective about behavioral processes that emerge within a species, such as addiction. In this week’s Addiction and the Humanities, we consider the application of evolutionary theory to addiction by examining evolution and addiction in terms of species, individuals, and science.

I. Evolution of Addiction: The Species

Many phenomena make the existence of addiction possible. Two quirks of evolution deserve special mention. First, the brain’s reward system (See WAGER's 8(30);8(31);8 (33)), which functions to reinforce important behaviors like eating, drinking, sleeping, and engaging in sex, is vulnerable to corruption. Many drugs of abuse mimic naturally occurring neurotransmitters that activate the brain’s reward system (Hall, 2002) – co­opting it for purposes not part of the original design. This ability to mimic natural neurotransmitters, in a mainly effortless but reliable way, can contribute to ongoing drug taking. Panksepp, Knutson, and Burgdorf (2002) assert that this is why we consider psychoactive drugs to “commandeer” normal functions of the reward system. (Hembolt, 1902)

Second, most addiction involves ingesting, in some way, plant related substances. The existence of these substances probably emerged, however, not to promote other species to consume plants, but to prevent predatory species from consuming plants. Nesse (2002) points out that developing mind-altering substances might be a method of defense and way to ensure their safety because plants cannot run away. Ironically, the natural toxins, which deter some predators from consuming these plants, have served as temptations for humans who discovered and find attractive their psychoactive properties. The evolutionary development of the reward system and the evolutionary development of defense toxins in plants were likely independent; however, the interaction of these consequents of evolution creates the opportunity for addiction.

II. Evolution of Addiction: The Individual

Evolutionary adaptations have made addiction possible for humans as a species, and similar processes contribute to the development of addiction within individuals. Consider the syndrome view of addiction (Shaffer et al., 2004). According to this model, people have different sets of risk factors: neurobiological, psychological, and social. The more risks factors, the greater an individual’s chance of developing addiction. However, being at-risk is not sufficient for the development of addiction. An individual also must gain exposure to an object of addiction and interact with that object before addiction can develop. Further, an individual’s interaction with a particular object must stimulate a desirable change in subjective experience (e.g., relief of discomfort, or creation of pleasure). That is, for addiction to develop, people must experience repeated interactions with the object and those interactions must produce a recurring desirable subjective shift. After a repeated history of desirable experience, addiction can emerge.

Most anything can become an object of addiction; however, those things that more reliably and robustly generate desirable subjective shifts are more likely to become objects of addiction. Leaps in technology have yielded new potential objects of addiction, such as synthetic and “designer drugs”, drug combinations, and tools that increase the potency of drug administration (e.g., hypodermic needles). Most recently, people have identified computers, the Internet, and slot machines as potential objects of addiction. Supporting this belief, research suggests that some non-chemical objects of addiction (e.g., money) can activate the same regions of the brain as psychoactive drug objects of addiction that co-opt the reward system (e.g., cocaine) (Breiter, Aharon, Kahneman, Dale, & Shizgal, 2001). Such findings suggest that novel technology creates new opportunities for addiction, as technology often changes more rapidly than evolutionary adaptations.

III. Evolution of Addiction: Science

The observation that many different objects can be involved in addiction, even those that do not artificially co-opt the reward system (e.g., gambling), has contributed to an evolution of theories of addiction. Consistent with Kuhn’s (1970) representation of scientific advance as a shift in paradigms, addiction science has evolved as new research forced its guiding models to adapt. Early conceptions of addiction were morality-based or object-based (i.e., objects, such as drugs, cause addiction). More recently, scientists have considered addiction in a more encompassing way. New research suggests that the objects of addiction are less important to the process of addiction than initially imagined (Shaffer et al., 2004). For example, evidence has shown a shared genetic vulnerability for pathological gambling and alcohol dependence (Slutske et al., 2000). Similarly, twin studies have identified common genetic and environmental risk factors for different objects of addiction (Kendler, Jacobson, Prescott, & Neale, 2003). Earlier conceptualizations of addiction could not account for such evidence; consequently, a new model of addiction that adapts and integrates such new research emerged.

IV. Concluding Thoughts

Perhaps, while examining the beak length of various bird species, it was not Darwin’s intent to investigate addiction. Nonetheless, Darwinian evolution provides a useful lens for understanding addiction within species, individuals, and science. For example, evolution allows us to consider that although addiction appears to be purely destructive, for some people, under certain circumstances, it might serve some adaptive function. Although it is uncertain whether addiction advances the goal of propagating the species, it can satisfy an individual’s goal to get from one day to the next in a stressful world. If we view evolution as a tool, perhaps it can advance our understanding of where we have come, as a species, as individuals, and as a field. This might help us better prepare for our future.

What do you think? Comments can be addressed to Erinn Walsh.

References

Breiter, H. C., Aharon, I., Kahneman, D., Dale, A., & Shizgal, P. (2001). Functional imaging of neural responses to expectancy and experience of monetary gains and losses. Neuron, 30(2), 619-639.

Hall, W. (2002). Taking Darwin Seriously: More Than Telling Just So Stories. Addiction, 97, 472.

Hembolt, H. F. (1902). Charles Darwin. Retrieved May 9, 2007, from http://www.english.upenn.edu/Projects/knarf/ Gifs/cdarwin.html

Kendler, K. S., Jacobson, K. C., Prescott, C. A., & Neale, M. C. (2003). Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. American Journal of Psychiatry, 160(4), 687-695.

Kuhn, T. S. (1970). The structure of scientific revolutions (Second ed.). Chicago: University of Chicago Press.

Nesse, R. M. (2002). Evolution and Addiction. Addiction, 97, 470-471.

Panksepp, J., Knutson, B., & Burgdorf, J. (2002). The role of brain emotional systems in addictions: a neuro­evolutionary perspective and new 'self-report' animal model. Addiction, 97, 459-469.

Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, T., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple expressions, common etiology. Harvard Review of Psychiatry, 12, 367-374.

Slutske, W. S., Eisen, S., True, W. R., Lyons, M. J., Goldberg, J., & Tsuang, M. (2000). Common genetic vulnerability for pathological gambling and alcohol dependence in men. Archives of General Psychiatry, 57(7), 666-673.

Addiction & the Humanities Vol. 3(3) - Addiction and Technology - Politics: It’s Not Just About Votes Anymore

Anyone can go online and access the stock market – where people purchase stocks, bonds, or other securities in an attempt to gain a financial return. The types of online investments that people can make have expanded. For example, the Hollywood Stock Exchange allows users to invest fake money on the likelihood of certain actors winning an Oscar. The Foresight Exchange allows users to invest real money on questions such as whether the US will invade Iraq before 2009. A share sells for $35, and costs $36 to buy, showing investors are not moving strongly in either direction in light of recent events (The Foresight Exchange Project, 2007). This week’s Addictions and Humanities will discuss the growing diversity of investment opportunities, taking a special look at the dynamics of investment opportunities in political elections.

Allowing investment opportunities in the fields of art, current events, and politics blurs the lines between “investing” and “gambling,” extends opportunities to gamble, and introduces more people to various fields because of their economic lure rather than because of genuine interest. Although many of these websites focus on frivolous topics, others demand closer attention. The Iowa Electronic Markets (IEM), owned by the University of Iowa, is perhaps the best known example of a futures investing website. The IEM has allowed users to invest money online in the expected outcomes of presidential races since 1988. The IEM has evidenced amazingly accurate predictions of election outcomes. The IEM’s predictions of the four presidential elections from 1988-2000 and the actual voting share of these elections differed by 1.37% (Berg, Forsythe, Nelson, & Rietz, 2000; Surowiecki, 2003). One reason the investment numbers are accurate is because investments are made according to people’s predictions of who will win an election, rather than whom they would prefer to win. Because predictions from the IEM and other futures investment sites are so accurate, companies sometimes call them “prediction markets” and use them as “decision support systems”(Berg & Rietz, 2003). However, this unanticipated usefulness of online investing could come at a price. Such political investing might create a fundamental change in the motivation for becoming involved in politics: a change from personal ideals to economics.

The Internet provides ample opportunity for many people to access futures investment sites from any location at any time of day. Interestingly, a surprisingly high rate of investing or gambling on political election outcomes predates the Internet. In 1979, the first study to examine national prevalence rates of gambling and gambling-related problems reported 9.1% of Americans had wagered money on presidential elections during their lifetime (Kallick, Suits, Dielman, & Hybels, 1979). The current estimate is not known, but the opportunity to wager on political races is much more available than ever before because of online investing sites. This could mean that more people in the last 28 years are following politics because of the chance of economic gain.

Such Internet-based activity could normalize “betting” and “investing” in politics. Whether or not this normalization directly will influence the electoral process is unclear. Arizona’s 2006 Proposition 200 suggested entering all people in a lottery to win $1 million dollars (in unclaimed state lottery money) in return for their vote in state and national elections. Lawmakers intended the bill to increase voter turnout, which was 2.8% lower than the national average of 60.9% in 2004. However, voters ultimately rejected this bill because of concerns about a similar change in motivation that online investing in politics might create. That is, those people who are motivated to vote by the lottery, rather than by their political ideals, might not have taken enough time to learn or care enough about the issues before voting. (Arizona Secretary of State, 2006).

Voting is presented as an American tradition, privilege, and right. It is unclear whether “investing” in politics can raise longstanding low voter turnout rates. Also, unclear is whether increases in wagering on politics, online or otherwise, violate the fundamental principles behind voting. Steve Twist, Chairman of the Board of Directors for the Arizona Chamber of Commerce wrote on the voting ballot that adding gambling to voting “belittle[s] it by turning it into a game” (Arizona Secretary of State, 2006). Arizona voters – individuals whose vote represented genuine interest in the issue – agreed. Proposition 200 did not pass.

What do you think? Comments can be addressed to Leslie Bosworth.

References

Arizona Secretary of the State (2006). 2006 Ballot Propositions and Judicial Performance Review. Retrieved March 28, 2007, from http://www.azsos.gov/election/2006/Info/PubPamphlet/english/Prop200.htm

Berg, J., Forsythe, R., Nelson, F., & Rietz, T. (2000). Results from a dozen years of election futures markets research. Iowa City: University of Iowa, College of Business Administration.

Berg, J., & Rietz, T. (2003). Prediction markets as decision support systems. Information Systems Frontiers, 5(1), 79­
93.

Kallick, M., Suits, D., Dielman, T., & Hybels, J. (1979). A survey of American gambling attitudes and behavior (Research report series, Survey Research Center, Institute for Social Research). Ann Arbor, MI: University of Michigan Press.

Surowiecki, J. (March 24, 2003). Decisions, Decisions. The New Yorker.

The Foresight Exchange Project. (2007). The Foresight Exchange Prediction Market. Retrieved March 28, 2007, 2007, from http://www.ideosphere.com/

Addiction & the Humanities Vol. 3(2) - If Leonardo smokes, so do I: The effect of smoking in movies on smoking in adolescents

Social cognitive theory (Bandura, 1986) posits that interactions between various risk factors in the environment (including, individual factors, peer factors, parental involvement, and media influences) and in cognitions (including, beliefs, norms, and expectations) lead to favorable or unfavorable attitudes towards a behavior of interest (e.g., smoking), which then lead to an increased likelihood of participating in the behavior. According to this framework, exposure to smoking in movies should influence mediating attitudes towards initiating smoking among adolescent never-smokers (Sargent et al., 2002). There is a wide range of research about this topic, and this week’s issue of Addiction and the Humanities will review and discuss the available evidence. We will present studies that assessed the prevalence of smoking in movies, studies that examined the impact of smoking in movies on smoking by adolescents, and studies that explored potential measures to prevent adolescent exposure to smoking in movies.

Researchers have studied the extant to which movies contain scenes showing people who are smoking. One study found that the “smoking prevalence” among movies decreased during the period from 1950 to 1990, but increased rapidly after that period (Charlesworth & Glantz, 2005). Consistent with this finding, a study by Dalton et al. reported that, of movies shown from 1988 through 1997, 87% contained scenes of tobacco use (Dalton et al., 2002). A later study looking at movies released from 1996 through 2004 reported a marked decrease to 57% (Worth, Dal Cin, & Sargent, 2006). One study used the interesting approach of comparing the smoking prevalence among movie characters with the actual smoking prevalence among adults in the United States (Worth et al., 2006). The overall rates were remarkably similar. However, although the pattern of average movie-prevalence was a good approximation for actual smoking, the large variability across movies did not support the finding that the two rates are linked.

At a more direct level, researchers have found a moderate to strong association between seeing smoking in the movies and having positive attitudes toward smoking (Charlesworth & Glantz, 2005; Sargent et al., 2002). Adolescents whose favorite movie star smokes expressed lower levels of commitment not to smoke (Distefan, Gilpin, Sargent, & Pierce, 1999; Tickle, Sargent, Dalton, Beach, & Heatherton, 2001). Other studies went further and found a relation to actual behavior. In a nation-wide representative survey, the more movies with smoking adolescents had watched, the more likely they were to have tried smoking (Sargent et al., 2005). In a prospective cohort study, adolescents were more likely to have changed from never-smoking at baseline to smoking at follow-up when they were in the highest quartile of exposure to movie smoking (i.e., when they had watched the highest number of smoking occurrences in movies) (Dalton et al., 2003).

Persuaded to the position that a relationship exists, some scientists have argued that movies containing smoking generally should be rated ‘R’ (Charlesworth & Glantz, 2005). Others suggest pressuring the movie industry to reduce smoking in movies (Sargent, 2005). Some observers have encouraged parents to restrict or monitor children’s and adolescents’ movie watching, because this has been shown to have a protective influence on the risks for smoking (Dalton et al., 2006; Sargent et al., 2004).

One major limitation of this research is that the causal attributions about movies and smoking might not be correct. It remains unclear whether viewing movie smoking causes adolescents to start smoking, or whether adolescents who become interested in smoking self-select to watch movies with smoking depictions. Although compelling evidence is available, conclusive evidence to infer causal links would require randomized controlled trials, but this methodology has ethical limitations that make it inappropriate to investigate this topic. Another limitation is that all studies so far have been conducted with adolescents from the United States. Movies, however, are popular across cultures and countries. Therefore, the impact of movies on adolescents outside the United States also needs to be examined.

Image from the motion picture Titanic. Twentieth Century Fox (c) 2005 by Paramount Pictures and Twentieth Century  Fox. All Rights Reserved.

In recent years, the culture of smoking in movies seems to be changing, and smoking movie characters or smoking movie stars are not as socially accepted anymore. For example, the release of the biggest blockbuster movie of all times, Titanic, in 1997 was followed by an outcry among scientists (Chapman & Davis, 1998) and journalists (Gladwell, 1998), because the leading male character Jack Dawson, Leonardo DiCaprio, is depicted smoking throughout the movie (see image above). In defending the movie, the executive producer of Titanic argued that people simply smoked in that time, and that the movie did not try to glamorize smoking (Chapman & Davis, 1998).
Research so far provides empirical evidence that smoking in movies can be a risk factor for some adolescents. However, the full extent of the association between smoking in movies and smoking in adolescents still requires more investigation.

What do you think? Click Here and let us know! Comments can be addressed to Anja Schumann.

References

Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.

Chapman, S., & Davis, R. M. (1998). Play it again. Tobacco Control, 7, 304-309.

Charlesworth, A., & Glantz, S. A. (2005). Smoking in the movies increases adolescent smoking: a review. Pediatrics, 116, 1516-1528.

Dalton, M. A., Adachi-Mejia, A. M., Longacre, M. R., Titus-Ernstoff, L. T., Gibson, J. J., Martin, S. K., Sargent, J. D., & Beach, M. L. (2006). Parental rules and monitoring of children's movie viewing associated with children's risk for smoking and drinking. Pediatrics, 118, 1932-1942.

Dalton, M. A., Sargent, J. D., Beach, M. L., Titus-Ernstoff, L., Gibson, J. J., Ahrens, M. B., Tickle, J. J., & Heatherton,
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Sargent, J. D., Beach, M. L., Adachi-Mejia, A. M., Gibson, J. J., Titus-Ernstoff, L. T., Carusi, C. P., Swain, S. D., Heatherton, T. F., & Dalton, M. A. (2005). Exposure to movie smoking: its relation to smoking initiation among US adolescents. Pediatrics, 116, 1183-1191.

Sargent, J. D., Beach, M. L., Dalton, M. A., Ernstoff, L. T., Gibson, J. J., Tickle, J. J., & Heatherton, T. F. (2004). Effect of parental R-rated movie restriction on adolescent smoking initiation: a prospective study. Pediatrics, 114, 149-156.

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Worth, K. A., Dal Cin, S., & Sargent, J. D. (2006). Prevalence of smoking among major movie characters: 1996-2004. Tobacco Control, 15, 442-446.

Addiction & the Humanities Vol. 3(1) - The Ticket to Addiction: Fyodor Dostoevsky

Fyodor Dostoevsky was one of the great writers of the 19th century. His image on a Russian lottery ticket (NPR, 2005) is ironic considering his life-long gambling addiction. Dostoevsky lived a tumultuous life, undergoing many personal tragedies. He often pawned his wedding rings and wife’s valuables to purchase a ticket home from gambling binges only to be swayed by what he described as a “fever” until he reached the table (Hughes, 2005). He would then write his wife again when he gambled away the proceeds (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003; The Existential Primer, 2007). Despite his success in writing, Fyodor persistently gambled his family into debt and frequently appealed to friends and relatives for money (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003; The Existential Primer, 2007). Although he was desperately ashamed of his actions, he continued to spend his loans at the roulette wheel instead of on bills (Freeborn, 2003). These difficulties probably impacted numerous aspects of his life, from his writing to his addiction. This week’s Addiction & the Humanities will consider the life of Fyodor Mikhailevich Dostoevsky using the syndrome model of addiction (Shaffer et al., 2004). This strategy will illustrate how several factors might have influenced the distinct expression of his addiction: pathological gambling.

Figure 1. Fyodor Dostoevsky’s image (St. Petersburg Times, 2005) appeared on a Russian lottery ticket called Chestnaya Igra which means “honest play” (Chestnaya Igra, 2005).


The syndrome model views addiction as “a cluster of symptoms and signs related to an abnormal underlying condition; not all symptoms or signs are present in every expression of the syndrome, and some manifestations of the syndrome have unique signs and symptoms” (Shaffer et al., 2004, p. 367). In addition, “evidence of multiple and interacting biopsychosocial antecedents, manifestations, and consequents—within and among behavioral and substance-related patterns of excess—reflects an underlying addiction syndrome” (Shaffer et al., 2004, p. 367). Dostoevsky’s life events illustrate experiential (e.g. poverty), psychological (e.g. anxiety), and biological (e.g. epilepsy) components of the addiction syndrome model. These vulnerabilities might have contributed to the development and maintenance of gambling addiction.

Social/Experiential Cluster

Many social aspects of Dostoevsky’s life might have increased the likelihood of addiction. Fyodor Mikhailevich Dostoevsky was born in Moscow, the second of seven children, in 1821 to a stern father Mikhail and nurturing mother Maria (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003). Gocsik (2003) suggests that Mikhail’s authoritarian parenting style promoted in his children two things common to many people with addiction: shame and guilt. Gambling, specifically, might have become Fyodor’s object of addiction due to his father’s obsession with status and wealth (Gocsik, 2003). The emphasis on wealth might have caused Fyodor to see a particular advantage to gambling, which is the only addiction that offers the chance to earn money, as well as lose it. Further, pathological gamblers often report that they feel important when they gamble.

Dr. Dostoevsky valued status above all and Fyodor and brother Mikhail despised their father, who treated his serfs with cruelty, insisting his family follow suit. Unfortunately for Dostoevsky, his kind and pious mother died before he was 18, prompting his father to send Fyodor to St. Petersburg to attend the Academy for Engineers; this event separated the two brothers (Freeborn, 2003). Not long after starting private school his father died; many say that his serfs murdered him and left him in the road (Kjetsaa, 1987). After graduating in 1843, Fyodor took a military desk job and returned to the poverty he had known during his early childhood. The financial flip-flop Fyodor experienced might have made him well aware of his financial shortcomings - drawing him to an easy way out of this situation through gambling. By 1843, with his translation of Balzac, he was recognized in literary circles. Soon after this he displayed his own literary talent by publishing Poor Folk, The Double, and The Landlady (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003). Around this time, he began to lose his wages to billiards, dominoes, and later roulette, causing him to borrow money often and gamble it away again (Gocsik, 2003). Consequently, despite his literary success publishing novels like Crime and Punishment (1866), The Idiot (1868), and The Brothers Karamazov (1879-80), Dostoevsky did not attain financial stability (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003; The Existential Primer, 2007).

Dostoevsky became involved in controversial political meetings that led to his eventual arrest and conviction for alleged crimes against the tsar in 1849 (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003). Fyodor was issued the death penalty but instead served in Siberian exile from 1850-1854 (Amoia, 1993). During his exile he was cut off from communication with his brother and alienated by the other prisoners who hated him for his educated social class and literary success (Freeborn, 2003). His troubles persisted upon his release and, to work out of his debt, in 1866 Dostoevsky wrote The Gambler (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003). This book drew upon his personal experience. Though the book was a success, it failed to alleviate his financial stress and added fuel to his gambling addiction (Kjetsaa, 1987).

Psychological Cluster

Fyodor faced numerous psychological challenges in his life. For example, he suffered many deaths in his family during his life. The death of so many family members took a significant psychological toll. In particular, he was profoundly influenced by the death of his father. Sigmund Freud’s study of the Dostoevsky notes that the writer’s extreme guilt was a product of his own desire for his father’s death (Freeborn, 2003, pp. 18-19). The conflict he likely faced upon his father’s death might have increased his tendency to act out by gambling, perhaps making him feel important or perhaps serving as an anodyne to his painful feelings.

Observers thought that Fyodor’s father had an anxiety disorder, his sister was a psychopath, and these problems might have made the author more prone to develop his own psychopathology (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003) – placing him at greater risk for the development of addiction generally, and gambling in particular (Amoia, 1993; Freeborn, 2003; Gocsik, 2003; Goodwin, 2003). In addition, Dostoevsky’s impulsive personality also might have made him particularly vulnerable to adopting faulty belief-systems that often propagate and sustain addictive behavior. “Dostoevsky’s lack of self-control made him a typical ‘system player’. If one could only discover a ‘tendency’ in the roulette wheel—if, for example ten times in a row, the wheel ended its wild dance by landing on red, then all one had to do was to bet on black” (Kjetsaa, 1987, p. 155). His introduction to roulette in Germany and bout of beginners luck caused him to believe he could master the game (Kjetsaa, 1987, p. 155). An impulsive person exposed to a casino environment within which they experience an early win presents a particular threat; it stimulates belief in the illogical. Fyodor lost so much by death, prison, and exile that his own family history of addiction as well as his personality type might have promoted gambling as a coping mechanism to help him manage all of the losses.

Biological Cluster

Dostoevsky’s family history of addiction, mental illness and epilepsy represents the third cluster of influence on his vulnerability to gambling addiction (Gocsik, 2003). Fyodor inherited—either genetically or psychosocially or both—epilepsy and a predisposition to addiction and mental illness. Dr. Dostoevsky was an epileptic and a heavy drinker, one uncle and two brothers also were alcoholics, and his sister was a psychopath (Hughes, 2005). Alcohol withdrawal stimulated some of Fyodor’s more violent epileptic seizures (Hughes, 2005), although many seizures occurred without such chemical antecedent. Hughes (2005) even suggests a relationship between Dostoevsky’s gambling and his epilepsy. Hughes suggests that epilepsy can be associated with the symptoms of obsessive-compulsive disorder (OCD). Pathological gambling might have seemed an obsessive-compulsive disorder; however, gambling disorders often associate with depression and anxiety. Pathological gambling can occur suddenly without other obsessive-compulsive behaviors or family history of OCD (Hughes, 2005). Dostoevsky’s behavior might be consistent with this explanation.

In 1868, Fyodor lost an infant daughter, Sonya, from a prolonged seizure thought to have been caused by inherited epilepsy. This loss filled Dostoevsky with guilt and shame. His heavy gambling continued. At the roulette table, he lost all of his earnings and delved further and further into debt. Although epilepsy might not have a direct biological connection with addiction, the stress of this disruptive illness might have had a negative impact on Dostoevsky’s daily life. In turn, these events might have exacerbated other problems, thereby increasing the likelihood that gambling provided respite. Such a relief, or desirable shift in subjective state, can increase the likelihood of addiction.

In the End

After a long battle with pathological gambling, Dostoevsky quit in 1871; he never discussed how he was able to do so (Hughes, 2005, p. 533). Dostoevsky’s 3-year-old son, Alyosha, died in 1878 (Kjetsaa, 1987(The Existential Primer, 2007). However, Dostoevsky might have developed new ways to cope with this kind of stress. In 1881, the great writer died of a lung hemorrhage likely caused by smoking, which he began in prison.

Conclusion

Although there are many commonalities among the psychosocial and biological antecedents of addiction, the relationship is too complicated and considerable research still remains to demonstrate the variety of causal links. In the case of Fyodor Dostoevsky, the syndrome model of addiction provides some insight into how his unique constellation of biopsychosocial vulnerabilities might have influenced the development of a gambling addiction instead of another type of addictive disorder. Since Freud (1928), many psychologically-minded observers have depicted the psychobiography of Dostoevsky. He was a literary giant and a tragic figure.

What do you think? Comments can be addressed to Erinn Walsh.

References

Amoia, A. (1993). Feodor Dostoevsky. New York: The Continuum Publishing Company.
Chestnaya Igra. (2005). The Dostoevsky ticket. Retrieved January 9, 2007, from
http://www.theglobalgame.com/gleanrus.html

Freeborn, R. (2003). Dostoevsky. London: Haus Publishing.

Freud, S. (1928). Dostoevsky and parricide. (J. Strachey, Trans.). In J. Strachey (Ed.), Standard edition of the complete psychological works of Sigmund Freud (1961 ed., Vol. XXI, pp. 175-196). London: Hogarth.

Gocsik, K. (2003). The Brothers Karamazov. Retrieved January 5, 2007, from
http://www.dartmouth.edu/~karamazo/bio_all.html

Goodwin, E. (2003). Fyodor Dostoevsky. Retrieved January 5, 2007, from
http://www.littlebluelight.com/lblphp/intro.php?ikey=7

Hughes, J. R. (2005). The idiosyncratic aspects of the epilepsy of Fyodor Dostoevsky. Epilepsy & Behavior, 7, 531­
538.

Kjetsaa, G. (1987). Fyodor Dostoyevsky: A Writer's Life (S. Hustvedt & D. McDuff, Trans.). New York: Elisabeth Sifton Books: Viking.

NPR. (2005). Dostoevsky Kin Sues over Image on Russian Lottery Tickets. All Things Considered Retrieved January 5, 2007, from http://www.npr.org/templates/story/story.php?storyId=4521792

Shaffer, H. J., LaPlante, D. A., LaBrie, R. A., Kidman, R. C., Donato, A., & Stanton, M. V. (2004). Toward a syndrome model of addiction: Multiple manifestations, common etiology. Harvard Review of Psychiatry, 12(6), 367-374.
St. Petersburg Times. (2005). Betting Image Spurs Suit. Retrieved January 9, 2007, from nocasinoerie.org/images/dostoy.jpg

The Existential Primer. (2007). Fyodor Dostoevsky. Retrieved January 5, 2007, from http://www.tameri.com/csw/exist/dostoevsky.shtml

Addictions and the Humanities, Volume 2(10) - Addiction and Stigma: The Social Perception of Disease

Social stigma refers to negative attitudes and beliefs that motivate any group to fear, reject, avoid, and discriminate against another group of people. In one of the few studies to examine empirically the social perception of addictive disease, Shaffer (1987) found a clear distinction between the perception of biological and behavioral disorders. This issue of Addiction and the Humanities examines the results of Shaffer’s study in conjunction with a recent review of the literature on stigma and marginalization in relationship to psychoactive substance use (Room, 2005). This discussion examines factors that contribute to the ongoing moralization of alcohol and drug problems, which, in turn, contributes to the stigmatization and marginalization of people with addiction.

Shaffer recruited 96 individuals (44.8% male; 55.2% female) within a variety of community settings (e.g., schools, work places, and waiting areas). Participants responded to a prerecorded audio tape of 80 words or phrases and judged each using a Likert-type scale (i.e., definitely yes, probably yes, uncertain, probably no, and definitely no) in response to whether or not the word or phrase represented a disease. Shaffer then factor analyzed the data to obtain clusters of words that represented a homogeneous subset of variables (i.e., a group of items that had similar patterns of Likert scale scores).

Shaffer’s results showed that individuals subjectively distinguished disease items that had a clear biological aspect to them (e.g., muscular dystrophy, cirrhosis of the liver, multiple sclerosis) compared to those disease items that reflected behavior patterns (e.g., cocaine abuse, heroin abuse, alcoholism). Table 1 summarizes the clusters or groups of items that factor analysis identified. Clearly participants did not perceive addiction-related behaviors (e.g., alcoholism, heroin dependence, or chemical dependence) as the same kind of disease as biologically based diseases (e.g., cirrhosis, tuberculosis, asthma, etc.).

Jungian-based therapy introduced ideas about the influence of the unconscious on both Pollock’s emotional troubles as well as his art. Jackson had trouble expressing his troubles verbally and often showed his work to aid the analysis (Frank, 1983, p. 30). This process revealed how art served a primary mode of communication for Pollock. The impact of Jungian-based therapy encouraged free association: this process ultimately resulted in Pollock’s drip or splatter method in the late forties for which Jackson became famous (Fineberg, 1995).

Table 1. Disease Clusters (adapted from Shaffer, 1987)

Room (2005) conducted a literature review to examine societal views about alcohol and drug problems and considered how these views affect individuals who are addicted to psychoactive substances. Consistent with Shaffer (1987), Room found ongoing social disapproval or stigma related to addiction. This circumstance was associated with de-prioritization of addiction within the healthcare system. Room identified three related elements of addiction that might influence the degree of social disapproval and moralization associated with behavioral addictions: unpredictability; losing control; and cultural context. First, intoxication is associated with unpredictability (e.g., abandoning the norm, or sobriety; and losing inhibitions); this might cause anxiety for those who come into contact with an intoxicated person. Second, Room suggests that society views those who lose personal control to a substance, which he describes as being characterized by society as a “disease of the will,” as blameworthy. Third, the cultural context within which the substance use occurs will influence the extent of social stigma (e.g., a Muslim drinking alcohol or a pregnant woman drinking in the U.S.) and the mechanisms within a society that lead to stigma and marginalization.

Room also identified three main processes of social control that might be a source of ongoing stigmatization and marginalization. First, interactions with friends and family members serve as a powerful social control, which can provoke isolation of a person with addiction. Second, some decisions by social agents and agencies, which tend to focus their attention on the most severe or problematic individuals (e.g., methadone clinics or needle exchanges), might inadvertently lead to more marginalization if their efforts fail to effectively reintegrate people with addiction into society. Finally, some policy decisions at the local and national level might increase stigmatization and marginalization. For example, a federal U.S. law that requires a family to be evicted from public housing if any member of the family is associated with drug dealing or, on a local level, the Rockefeller drug laws in N.Y. that require extended prison terms for the possession or sale of relatively small amounts of drugs.

As both Shaffer and Room have shown, the social perception of drug and alcohol problems distinguish addiction from other deviant behavior patterns; these public perceptions sustain the negative view that addiction results from personal choice and immoral values. These views often seep into various aspects of life. For example, consider how the media portrays addiction, how matters of addiction are taught in school, how families discuss people with addiction, and how the legal and medical systems deal with people suffering with addiction.

However, although some observers might argue that moralization and marginalization are effective ways of curbing addiction, theses approaches have not worked optimally. Despite attempts to portray addiction as a disease, Shaffer has shown that the public still views addiction as something different from biologically based diseases, despite their willingness to call it a disease. To help people with addiction, it is crucial to effect change within the same channels that perpetuate stigmatization of addiction (e.g., media, legal system, medical system). Both researchers and clinicians should make energetic efforts to lessen the degree of moralization placed upon substance misuse and addiction. Therefore, future efforts will need to focus on improving methods of treatment and community reintegration. Further, these efforts will have to shift the social perception of addiction from a one dimensional “disease of the will” or a “disease of the body” to a multidimensional illness with all of the attendant biopsychosocial factors that typically accompany the presence of sickness.

What do you think?  Comments can be addressed to Juan Molina.

References

Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 24, 143-155.

Shaffer, H. J. (1987). The Epistemology of "Addictive Disease": The Lincoln-Douglas Debate. Journal of Substance Abuse Trea