Detailed notes of all addiction lectures from year 23/34. Contains a variety of subjects including histories/analysis of individual substance use as well as general notes on policy and treatment suggestions.
LECTURE 1: INTRO
Addiction as a multi-disciplinary academic ‘field’: specialist field involving topics including public health
and prevention, sociology, medical anthropology, health psychology, cultural studies, epidemiology.
Multi-disciplinary but not always an interaction between disciplines.
- Searching for literature can include journals from different disciplines, rewarded for
this
IMPORTANT TEXTS
Bancroft, A. (2009) Drugs and Society
Hammersley, R. (2008) Drugs and Crime, Theories and Practises (Crime and Society
series)
McKeganey, N. (2011) Controversies in Drug Policy and Practise
Alexander, B.K. (2008) The globalisation of addiction
What is addiction?
Definition? Definition of dependence? What are you addicted to?
LECTURE 2 – WHAT IS ADDICTION?
HISTORICAL CONCEPTS OF ADDICTION
- West (2006): addiction is a socially defined concept which changes over time
- Latin verb ‘addico’ = ‘given over’ or devoted to something
- Could be positive (e.g., religious devotion, passion about a cause) or negative (e.g.
alcoholism)
-
Addiction 1 – 19th century, more restrictive
use connected with drugs (Alexander and
Schweighofer, 2008). Temperance
movement (anti-alcohol) and anti-opium.
Addiction as illness, drug addiction with
withdrawal symptoms. Links to religion
and sin/’vices.
CHANGES TO DEFINITION:
Physical adaption to drug (e.g., alcoholic
was able to drink more alcohol, needs
larger amounts to have the same effect as
on others), withdrawal symptoms if not
taken (dependence on or tolerance of
substance to avoid cravings and
symptoms). Medical definition of addiction
as ‘disease’ but this was still seen as
morally wrong and stigmatised.
Do you have to take drugs to be addicted?
“Addiction…is best defined by repeated
failure to refrain from drug use despite
prior resolutions to do so” (Heather, 1998 in West, 2006:2) – going against own will.
What about non-drug addictions? If you don’t try to stop does this mean you are not
addicted?
New model: New era of non-pharma addiction such internet, sex and gambling, covers
‘reward-seeking behaviour’ both pharma and non-pharma, compulsion/loss of control over
behaviours, affecting functioning, causing harm (physical, to self, to others, across domains
such as work). (Addiction became shorthand term for ‘loss of control’). These vary from
person to person and addiction to addiction, whole groups of people who are ‘dependant’ on
substances for everyday functioning but are NOT addicted (Alexander, 2008) eg diabetics.
,ADDICTION ANT2086
DR HANNAH FARRIMOND
Further considerations: Intoxication, expansion of the term ‘addiction’, are some substances
more addictive than others? who becomes addicted? media and social perception, matters
of language
Do you have to be intoxicated to be addicted? Robinson and Pritchard (1992) say yes, in
terms of alcohol, heroin etc., but this does not account for all the ‘lifestyle’ addictions such as
smoking.
EXPANSION OF THE TERM ‘ADDICTION’
- Gambling?
- Compulsive eating/binge-eating?
- Compulsive shopping? (Lee and Mysyk 2004: compulsive shopping is better
understood as a response to western consumption and the financial crisis)
- Internet/gaming addiction? Social media?
Is this simply part of the medicalisation of life – where life choices are given medical
definitions and treatment?
Facilitated by societal structure?
Are certain things more addictive than others?
Some substances are highly addictive (e.g. opioids), but the substance is only a relatively
small part of addiction, other considerations include personality, environmental factors and
events.
WHAT BECOMES ADDICTION?
- Idea of ‘susceptibilities’ (West, 2006)
- Personality traits
- Genetic predisposition (evidence of heritability of addictive behaviours such as
alcoholism)
- Are there environments in which most people become addicts? (e.g. if you grew up in
a household of drug users? If more than half your friends smoke weed?)
MEDIA AND SOCIAL PERCEPTION/CONSTRUCT
- the portrayal of addiction in the media, tv, etc
- social perception, older adults, women, middle-class groups are less likely to be
stereotyped as addicts (Smith and Farrimond, 2019), less likely to receive help
- BUT: more people died of legal opiate overdose (for painkiller) then illegal heroin in
2018
LANGUAGE MATTERS
Moves to make language around addiction less stigmatising, not ‘dirty/clean’ but
‘positive/negative’, person-centred recovery language: ‘person with a substance use disorder
(SUD)’, medical language+ medical casualty of use
Does it matter if we don’t all define addiction in the same way? Not one concept was agreed
on by more than half the sample (clients used the term ‘needs’ vs experts who used
professional definitions such as ‘physical dependence’) (Walters and Gilbert 2000), both
shared the idea of diminished control, addiction is an ‘elusive’ and contested concept,
different terminology may work in different contexts
ADDICTION AS AN ‘INDUSTRY’
Commercial dimension, pharmaceuticals which are misused equals substance abuse, legal
selling of tobacco and alcohol (and legal highs), illegal industry of drug
production/trafficking/sales, addiction ‘industry’ to treat addicts (rehabilitation, therapy,
replacement substances, addiction counsellors) (Keane 2003)
Who benefits from ‘addiction’ as constructed as a medical disorder – commercial industry,
who pays for treatment?
SEMINAR 1 – BROYLES ET AL (2018) AND ALEXANDER AND SCHWEIGHOFER (1988)
,ADDICTION ANT2086
DR HANNAH FARRIMOND
1) Broyles et al (2014) Confronting Inadvertent Stigma & Pejorative Language in Addiction
Scholarship
This paper is written by the Editorial Team for the journal, ‘Substance Abuse.’ What four new
language guidelines do they present for authors?
Use of ‘people-first’ language, use of language that reflects the medical nature of substance
abuse, avoidance of slang and idioms, use of language that promotes recovery.
Why are these changes important? What impacts can the use of inappropriate addiction
language have?
allows the individual to be more in control of own recovery, gives power back to the
individual, avoids negative stigma and adding to damaging stereotypes of addicts.
Why do the advocate authors advocate use of ‘people-first language’ in the field of
addiction?
This puts more emphasis on the role of the addict in managing/recovering from their
addiction, instead of presenting them as helpless or a victim of circumstance. This also gives
them more power and control over their own actions and are supported by doctors, not
simply placed in rehab by other individuals who manage their recovery/treatment.
What are the two reasons given for favouring a medical framing of addiction? In what ways
might the medicalization of substance use be more problematic, than helpful?
1. Emphasises the role of medical-based treatments which are generally evidence-based
and have positive reviews
2. Allows the addict to take the role of a patient, developing a doctor-patient dynamic which
is supportive and can support whole health in a more holistic manner
This may however be problematic as it puts the medical industry ‘in control’ of addiction,
links to big pharma and commercialisation of addiction.
Who do the authors believe should, ultimately, determine the language surrounding
addiction?
The addicts themselves – as this involves them and stops them being seen as ‘outcasts’ or
‘rejects’ from society. The authors believe that addicts themselves are best placed to
understand the language they want to use to describe their addiction to others – however
this could be questioned as do they necessarily have the knowledge or willingness to share
something so personal and/or difficult with strangers? If we speak technically using medical
terms, would they understand this and how it relates to their personal experience? Also, this
is highly subjective, with each addict experiencing different reasons for becoming addicted,
different substances to be addicted to, different symptoms of addiction and so on – so would
getting the addict SOLELY to be the person explaining addiction to others be useful when
discussing this topic?
2) Alexander & Schweighofer (1988) Defining Addiction
How did use of the term ‘addiction’ change during the nineteenth century?
Move from idea of ‘devotion’ or being ‘given over’ in the pursuit or something to a more
technical definition that included reference to specific substances and the behaviours this
results in.
Which three historical developments contributed to a change in how the term ‘addiction’ was
used?
Opium ban from China, which was supported by the USA, temperance (alcohol restriction),
changing attitudes towards alcohol abuse in the UK
What are some of the problems with a restrictive definition of addiction, according to
Alexander & Schweighofer?
Addiction may not necessarily be harmful, no difference in treatments of a wide range of
addictions (all seen as similar), some addictions don’t have withdrawal symptoms, “the
similarity between severe addictions to drugs and other activities may be partly obscured by
everyday experience” (page 4)
Do you think addictions can ever be positive?
Probably not – not in balance with lifestyle factors, whether this is a substance or
behavioural addiction the principle is still the same.
, ADDICTION ANT2086
DR HANNAH FARRIMOND
LECTURE 3: MODELS OF ADDICTION 1: PHARMACOLOGY, PSYHCOLOGY AND
NEUROBIOLOGY
WHAT HAVE GENETIC, NEUROBIOLOGICAL AND COGNITIVE/PSYCH MODELS GOT IN
COMMON?
- Primarily medical models of addiction as pathological (i.e. not normal)
- Foreground individual level of explanation; social factors are de-emphasised
- Emphasise lack of control/habitual aspects of addiction (West, 2006)
- Neurobiology in particular has led to a biomedicalization of addiction (conceptualised in
medical terms, using biotechnologies and pharmaceuticals as solutions)
GENETIC MODELS OF ADDICTION
- Models explain why certain individuals get addiction get addiction or why addictions cluster in
families
- ‘folk’ or ‘lay’ knowledge that alcoholism runs in families; but is this due to genes or
socialisation into alcohol use and abuse?
- Complexity in genetic models
- Multiple potential sites of influence: genetic predisposition to poor impulse control/ easily
hijacked receptors; to particular ‘harm’ (eg lung cancer, cirrhosis), genetic changes at
neurological level once addicted; interactive gene effects
- Developmental effect: peak at adolescence (what your family does determines what you do at
this time point) and less over the lifespan (Kendler et al 2008)
GENETIC MODELS: CRITICISMS
- Similar behaviour in families may also be due to a shared environment, values and availability
of one substance over another
- Why do some twins/siblings not become addicted given their shared genetics?
- Little is known about the mechanisms of gene expression/gene interactions throughout
lifespan
- Best thought of as a ‘predisposition’ or ‘vulnerability’ rather than the inevitable
NEUROBIOLOGICAL MODELS OF ADDICTION
‘That addiction is tied to changes in brain structure and function is what makes it,
fundamentally, a brain disease. A metaphorical switch in the brain seems to be thrown as
a result of prolonged drug use’
Leshner (1997)
ADDICTION AS A BRAIN DISEASE
- Part of a wider ‘molecular revolution’
- Main idea: key neuro-biological processes identified which appear to underlie all addictions
- Receptors to naturally occurring ‘reward’ neurotransmitter pathways (dopamine,
noradrenaline) appear to be ‘hijacked’ by artificial/repeated behaviour, so the receptors
themselves are altered (eg will turn into a nicotine/opiate receptor)
- This causes measurable alterations in brain structure, primarily that the brain, now over-
stimulated, requires the artificial stimulation to produce pleasure and ‘normal’ activities no
longer provide it (Leshner and Koob 1999)
- Brain sites for impulse/inhibition control are also impaired (inhibition dysregulation theory)
- Current disease models place less emphasis on ‘withdrawal’ (physiological syndrome
associated with not using substance), more on how substance/addictive behaviour is
biologically compulsive (known as ‘disrupted volition’) and comes to overtake lifestyle and
cause harm
- Some anti-addiction medications eg Naltrexone as an anti-craving drug
- Very dominant explanation politically
ADVANTAGES OF NEUROBIOLOGICAL MODEL
- Compatible with genetic models, as drugs are thought to activate certain genetic variabilities
(gene expression) (Kuhar, 2010)
- Good explanation of the chronically relapsing nature of drug addiction
- Potential to remove stigma of ‘being addicted’, translating it into ‘having a medical/brain
disorder’
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