On Addiction: Insights From History, Ethnography, and Critical Theory

Book Title: On Addiction: Insights From History, Ethnography, and Critical Theory

Author: Darin Weinberg

Publication Details: Duke University Press, 2024, 200 pp., $25.95 paperback

This collection of Darin Weinberg’s essays reviews the history of society’s approach to addiction, critiques the current mainstream concepts, and suggests a more holistic approach. The author muses on the many dichotomies presented by those who seek to understand and approach addiction: determinism vs free will, rationality vs emotionalism, mind vs body, culture vs nature, clinical vs social, corrective vs appreciative, and others. In doing so, he does an excellent job of exploring the complexities and nuances inherent in substance use, abuse, and addiction.

While each of the contemporary mainstream models of addiction captures portions of what addiction is, none encapsulate its entirety. The author weaves together the roles of physiology (psychiatry and neurobiology), meaning (psychology and ethnography), and context (sociology and ecology), seeking a new approach to definition that includes both quantitative empirical science and qualitative lived experience. Professor Weinberg rejects the separation of theory and practice, seeking to integrate them into a whole. Similarly, he has little use for various academic disciplines that take a reductionist approach to research that leads to incomplete, fragmented understanding, dismissing them as “independent and autonomous intellectual pursuits bearing only occasional relevance to one another” (p. 19).

In doing so, sociologist Weinberg’s perspective sounds like the comprehensive approach of family doctors, treating the whole patient, not isolated organs or diseases!

The author dives deeply into the positive and negative contributions of four historical approaches to addiction: the contemporary brain disease and liberal voluntarist discourses, and the early modern puritan and civic republican discourses. The two contemporary discourses, while they differ substantially, both claim amoral approaches to addiction; both in their own ways fail to establish the assumption that the essence of addiction is a loss of self-control and fail to make the case for treating addiction. The two early modern discourses were strongly value-based and sought to reform those with addiction, though not always having empathy or faith that “those so enslaved” could (or should!) “be freed from their madness.”

Ethnography observes individual behavior within a group in social situations and seeks to understand how the group members interpret their own behavior. Applied to addiction, “If we are to more fully understand addiction, we must understand that it poses a threat not only to our self-regulation but also to our freedom more generally” (p. 114).

In addition, an ecological understanding of addiction does a better job of explaining effective therapies:

The provision of immersive ecological alternatives to the spaces within which people’s addictions were forged and . . . continue to be rekindled . . . [are] better keyed to the linkage of our habits to the various ecological spaces within which they are acquired and sustained and within which we also evaluate their compatibility with our specific projects of self-discovery and ongoing self-actualization.

(p. 128)

In the closing chapter, Weinberg presents what he considers the missing core in addiction science: posthumanism.

I do not conceptualize addiction as a universal relation between the generic human body and a psychoactive compound. I have deliberately avoided this because most drug users do not become addicted even if they do become physiologically dependent. Instead, following the lead of my research subjects, I conceptualize addictions as nonhuman agents residing in the bodies of those who are addicted.

(p. 143)

He explains that while some postulate that human bodies are various types of situationally created singularities, he theorizes that human bodies are multiplicities that articulate together to varying degrees.

A sense of estrangement or loss of self-control over one’s bodily articulations pertaining to drug use emerges when (1) these articulations are perceived to chronically interfere with others from which one derives a greater sense of felicity or self-esteem and (2) one’s perceived capacity to discontinue these bodily articulations is somehow compromised.

(p. 145)

Addiction as a disease is not biological dysfunction, according to the author, but patterns of bodily articulations with which the individual does not identify that conflict with those articulations with which they do identify.

This collection of essays that were previously published over a quarter century ago flows in a coherent way as though written in one sitting—a masterful feat. The proposal for a posthuman approach to addiction science is intriguing; the essays leading up to this proposition do a remarkable job of laying the groundwork to warrant it serious consideration. Posthumanism is a product of critical theory, reacting against classical humanism. It views the “posthuman” not as a defined individual, but as one who can become different identities and understand the world from heterogeneous perspectives.¹ It subsumes the individual into the group; as family physicians understand, knowing the family (group) context, yet remaining patient-oriented is important. Critical theory, currently popular in academia, tends to be subjective and self-referential, often rejecting empirical methodology.² The physician who endorses evidence-based medicine is rightfully skeptical of this approach. Nevertheless, this book is a fascinating and thought-provoking read; I commend it to your attention.