Sociological View on Addiction

In its original usage, addiction meant simply to be given over to someone or something. It was a term used widely to describe passionate investments in various sorts of activities, as can be seen in Shakespeare’s Othello where we read “Each man to what
sport and revel his addiction leads him.” Well into the nineteenth century the concept of addiction was used to describe a diverse assortment of human fixations. But as Temperance movements grew in the mid nineteenth century, the term was increasingly considered as a medical or quasi-medical term of art and its scope was delimited to describing an individual’s seeming enslavement to alcohol or drugs. A multitude of efforts have been made to provide biological explanations for some people’s apparently pathological attachment to alcohol or drug use but each has met with rather serious conceptual obstacles. In response to these difficulties, most medical lexicons have now dispensed with the term addiction in favor of the presumably less conceptually troubling concept dependence. However, the term addiction continues to be found in both clinical and popular discourse regarding alcohol and drug problems and has indeed been extended to new forms of apparently compulsive behavior including over-eating, gambling, compulsive sexual behavior, and others.
In sociology, addiction has been approached from several distinct theoretical vantage points.
Regrettably, the term has often been used interchangeably with other terms including deviant drug use, drug misuse, and drug abuse. Such imprecision results in a confusion of questions concerning the social approval of various sorts of alcohol or drug use with questions concerning whether this use is voluntary. Much of the history of social policy concerning alcohol and psychoactive drugs has been predicated, at least ostensibly, on the claim that these substances possess unusual powers over people and must be regulated to protect citizens from their own personal proclivities to succumb to addictive use. If we are not able to distinguish claims regarding the putative morality of alcohol or drug use from claims regarding people’s ability to control their use, we are poorly equipped to evaluate effectively the history of policies predicated on the notion that people need protection from putatively addictive substances. We are also poorly equipped to evaluate social research which either endorses or rejects this idea. If it is to have any meaning at all, the term addiction cannot be considered as synonymous with terms denoting voluntary substance use.
The earliest sociological research concerned specifically with addiction was conducted by
Alfred Lindesmith under the tutelage of Herbert Blumer at the University of Chicago. Lindesmith noted that, whereas users who acquired heroin on the street were often vulnerable to addictive patterns of use, those who had been administered opiates in hospital settings were not so vulnerable. He explained this by suggesting that, whereas both hospital and street users experience physiological withdrawal symptoms upon cessation of use, only street users are consciously aware of the fact that the source of their distress lies in their heroin deprivation. Lindesmith argued that, by using drugs specifically to alleviate withdrawal, mere drug users were transformed into genuine drug addicts. This theory was attractive to sociologists in the twentieth century because it insisted the symbolic meanings actors found in their drug experiences were essential elements of the addiction process. While Lindesmith’s theory remains the classic canonical benchmark for contemporary sociological theorizing on addiction, it has been subject to several rather serious critiques. Most fundamentally, his theory presumes that physiological withdrawal distress is a necessary prerequisite for the onset of addictive patterns of behavior. In the wake of the so-called crack cocaine “epidemic,” theories of addiction predicated on the experience of physiological withdrawal distress have been undermined. Because they do not involve gross physiological withdrawal symptoms, crack cocaine addiction, along with nicotine addiction and behavioral addictions like those to eating, gambling, and sex, have cast doubt on the generalizability of Lindesmith’s theory and have even put in question its validity with respect to opiates themselves.
During the mid twentieth century, structural functionalists offered a variety of theoretical accounts for apparently addictive behavior that departed in important ways fromLindesmith’s seminal work. Seeking wholly social structural explanations, these theories shared in common a departure from Lindesmith’s presumption of a necessary physiological component to addiction. In his famous essay “Social Structure and Anomie” (1938, American Sociological Review), Robert K. Merton suggested that chronic drunkards and drug addicts might exemplify the retreatist adaptation, one of his five modes of adjustment whereby social actors adopt ostensibly deviant patterns of action. According to Merton, the addict could be understood as an individual who believes in the propriety of both cultural goals and the institutionalized procedures society affords for achieving those goals but who cannot produce the desired results by socially sanctioned means. The result of this failure is a retreat from social life into “defeatism, quietism, and resignation.” This proposition was developed by Richard Cloward and Lloyd Ohlin in their book Delinquency and Opportunity (1960) in what became their fairly influential “Double Failure” hypothesis regarding addictive behavior. In contrast to Merton, Cloward and Ohlin suggested addicts were not opposed to adopting illegitimatemeans of achieving legitimate cultural goals, but rather were incapable of using even these means for securing social rewards.
Hence, addicts were double failures in the sense that they failed to achieve by either legitimate or criminal procedures. Heavy drug use was held to alienate the putative addict from both mainstream and delinquent subcultures, thus further minimizing their opportunities for social success. Some structural functionalists moved beyond explanations
of the distribution of addicts across social structural positions to consider the social psychological processes that motivated addictive patterns of alcohol or drug use. The best-known of these was normative ambivalence theory, according to which dysfunctional substance use will arise when agents are bombarded with competing normative orientations to their use. According to functionalists, apparently addictive behavior patterns were to be regarded as eminently rational, if painful and socially notorious, adaptations to social structural deprivation. The functionalist approach tended to stereotype addicts as necessarily socially disadvantaged and sometimes to confuse the trappings of poverty with the trappings of addiction. But it had the virtue of freeing sociological research from the presumption of a brute biological basis for addiction and of allowing sociologists to entertain the possibility that people might experience alcohol or drug problems simply as a result of the ways they had learned to use these substances to cope with the social structural circumstances of their lives. Structural functionalist approaches were rivaled by approaches to addiction (and deviant substance use more generally) proffered by ethnographers broadly allied with symbolic interactionism.
As part of a more general critical turn against structural functionalism in the second half of the twentieth century, many of these sociologists distanced themselves from what David Matza, in his book Becoming Deviant (1969) dubbed the “correctional” perspective found in structural functionalist theories of addiction and deviant substance use, and moved towards what he called an “appreciative” analytic stance towards such putatively deviant behavior. Noting that modern societies were a good deal more pluralistic and conflicted than structural functionalists had generally allowed, these researchers advocated an agnostic moral regard for putatively dysfunctional or deviant behavior and an effort to empathize with putatively deviant individuals and subcultures.
No longer was it assumed that behavior reviled in mainstream culture was necessarily viewed negatively by those who themselves engaged in the behavior. Nor was it any longer assumed that the social mechanisms according to which these behaviors were produced and sustained need reflect a functional breakdown of either the individual or his or her society. Indeed, many of these studies highlighted the existence of subcultural prestige hierarchies, wherein the use and sale of illicit substances was valued as a mark of adventurousness and other subculturally valued characteristics. Substance use was depicted as a source of meaning in the lives of users. Hence studies focused on such matters as drug slang or argot, the settings of drug-related activity, the norms and practices characteristic of drug and alcohol using subcultures, and the careers through which drug users passed as they moved from initiates to seasoned veterans of drug- or alcohol-using social worlds. The concept of career has also been used by researchers to emphasize the important influence exercised by labeling on putatively addictive behavior patterns.
More recently, the topic of addiction has been taken up by leaders in rational choice theory who have properly recognized it as an apparent counterexample to the axiomatic proposition that social action is necessarily rational action. Some of these theorists have sought to reconcile empirical instances of addictive patterns of behavior with core propositions of rational choice theory. Others have concluded that addiction is essentially irrational and more thoroughly rooted in neurological dysfunction than micro-economic decisionmaking mechanisms. While these efforts have produced some interesting technical refinements of rational choice theory itself, they have done less to shed new sociological light on why some people seemto experience rather severe levels of difficulty refraining from the use of alcohol or drugs, even after repeated negative experiences with them. Another more recent line of theoretical work on addiction hails from attribution theory. Attribution theorists turn their attention away from why certain people fall into apparently addictive behavior patterns and instead consider social and psychological explanations for why people attribute behavior to addictions. Attribution theory properly highlights the fact that objective characteristics of social behavior and efforts to explain that behavior are intimately linked to one another. In addition to research that considers why certain activities are so addictive for certain people, fruitful insights can come from the study of why the concept of addiction is itself so compelling for certain people acting in certain social contexts.
To date, sociologists have illuminated various important dimensions of problematic substance use but have recurrently found it almost impossible to validate the concept of addiction without recourse to biological accounts of physiological dysfunction. Those who have taken the idea of involuntary substance use seriously have overwhelmingly incorporated reference to biological mechanisms as indispensable elements of their own sociological theories. In contrast, the vast majority of those who have not drawn from biology have found it difficult to account for the apparently involuntary aspects of addiction. In his book The Alcoholic Society (1993), Norman Denzin develops a theory of “the alcoholic self” which takes important theoretical strides towards a more thoroughly sociological explanation by incorporating his more general approach to the sociology of emotions into his theory of addiction.
While an undeniably important contribution, Denzin’s research on the emotionality of addiction exhibits consequential ambiguities that make it difficult to square fully with the claim that addictive patterns of behavior are genuinely involuntary. In a series of essays including “The Embodiment of Addiction” (2002, Body and Society), Darin Weinberg has drawn upon the growing literature on the sociology of embodiment to reconcile the phenomenology of addiction as involuntary affliction with the longstanding sociological claim that people might acquire problematic patterns of substance use simply by virtue of the ways they have learned to use these substances to cope with the social structural circumstances of their lives. He argues that the sociology of embodiment allows us to appreciate more fully that not all meaningful, or socially structured, behavior is behavior that we deliberately choose or with which we self-identify. This work suggests a fruitful interface between the sociology of embodiment, the sociology of moral inclusion, and sociological work on the boundaries of human agency.
Rather predictably, most contemporary sociological research on drugs and alcohol focuses on questions pertaining to the various social problems that arise from either substance use itself or the social policies in place to control substance use. No doubt these questions will, and should, continue to occupy the attentions of social scientists, whether or not they require use of a concept of addiction. But the sociology of addiction as such also holds promise as a valuable empirical test case for social theories concerned with the relationship between much more general sociological themes, including nature/culture, structure/ agency, rationality, emotion, embodiment, and social exclusion. This type of research will certainly require a vigilant enforcement of the conceptual distinction highlighted earlier – that between addiction per se and voluntary activity that is merely deviant.