Darin Weinberg's On the Embodiment of Addiction (2002)

On the Embodiment of Addiction

Body & Society 2002 8: 1
DOI: 10.1177/1357034X02008004001

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>> Version of Record - Dec 1, 2002 What is This?
Darin Weinberg, who received his Ph.D at UCLA, is at outstanding scholar with lots of insights into the lives of addicts.  He draws upon ethnomethodology and phenomenology to create an innovative interpretive approach to the embodiment of addiction.

On the Embodiment of Addiction DARIN WEINBERG
Addiction provides a remarkably fruitful empirical site for studying the relation- ship between body and society. However, students of the body/society nexus have yet to fully appreciate the wealth of insights that addiction research might provide. While there have been occasional nods toward addiction in the literature on the body (McCarron, 1999), focused and sustained theoretical attention is not yet evident. The distinctive potential of addiction research for contributing to our theoretical grasp of the body/society nexus lies in the following fact. While the ostensible symptoms of addiction overwhelmingly consist in social or cultural transgressions, its underlying nature is generally located in one or another sort of bodily pathology, deficit or vulnerability. In view of this fact, addiction research can provide opportunities to explore empirically how our bodies are variously configured as causal forces under different social conditions. This kind of research could do much to counter the oft heard criticism that social research on the body has attended too exclusively to representations of the body and too little to the body as a materially incarnate social force (cf. Turner, 2000). Addiction research is not entirely unique on this score. There are, after all, other ‘disorders’ about which the same point might be made. Nonetheless, because it is apparently so pervasive and so closely linked to a variety of core sociological topics (e.g. age, class, consumption, crime, race), addiction should hold a particularly serious interest for scholars concerned to explore the historically and culturally specific social realities of the body.
This article seeks to promote a more rigorous sociological regard for the embodiment of addiction by providing a critical survey of extant theorizing, and proposing a more sociologically incisive theoretical alternative to existing research paradigms. After a very brief summary of the history of addiction
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theorizing, I critically compare three major contemporary approaches to the study of addiction: neurology, learning theory and symbolic interaction. I show that neurological theories and learning theories have failed to account for the role of culturally transmitted meanings in the addiction process. While symbolic interactionist theories have been centrally concerned with the meaning of addiction, they have failed to theorize how issues of meaning might figure in the addict’s inevitable subjective estrangement from his or her drug-related activities. This stems from their failure to appreciate the reality of non-symbolic meaning, or meaningful experience that manifests pre-reflectively, at the level of our immediate bodily encounter with reality. The article concludes by suggesting that sociological students of addiction adopt a more thoroughly praxiological orien- tation to meaningful experience, so as to overcome the analytic limitations inherent in the antinomy between biological reductionism and disembodied cognitivism.
A Brief History of Addiction Theorizing
In its earliest usage the concept addiction was held to refer indiscriminately to a person’s enslavement by someone or something. Well into the 19th century, the idea of addictive enslavement was used widely to describe many different sorts of human fixation (cf. Rothman, 1990). But as Temperance movements grew, the concept addiction was refined and its scope of reference delimited. Many of the early theorists sought to locate the source of addiction in the object of addiction itself (Levine, 1978). By these lights, certain substances, like alcohol or morphine, were inherently capable of enslaving us. Hence the root nature of addiction was to be found through inspection of their distinctive properties. As time passed, cases of people who used alcohol and drugs without becoming enslaved accumu- lated. This, combined with a variety of complex changes within the fields of alcohol and illicit drug control (Weinberg, 1998), eventually moved addiction theorizing away from addictive substances themselves and toward the person of the addict. Most authorities eventually ceased to believe the nature of the problem was to be found ‘in the bottle’, as it were, and came to believe it was to be found ‘in the man’.
Early 20th-century theories of addiction focused predominantly on intrinsic personal deficits – like psychopathology, an addictive personality of some sort, or other sorts of deficits that might induce addictive self-medication. Like those that focus exclusively on the fixed properties of putatively addictive substances, theories that focus exclusively on the fixed properties of addictive people have also been subject to a litany of rather damning critiques. Perhaps the least
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damaging critique is that intrinsic-personal-deficit theories are post hoc. They do not predict who will and will not come to exhibit addictive behaviors but simply classify addicts after the fact. More significantly, because the posited personal deficits are not unique to addicts, intrinsic-personal-deficit theories can’t tell us when or why their possessor will lapse into addictive behavior and when or why s/he will not. Nor are intrinsic-personal-deficit theories particularly good at explaining why so many people who eventually come to exhibit the symptoms of addiction manifest no signs of pathology before their addictions actually ensue.
A smaller number of addiction theorists have sought to address the problem more processually (cf. Jellinek, 1960; Lindesmith, 1938; Vaillant, 1983). Alfred Lindesmith (1938), the pioneer of this approach, argued that addiction cannot be explained atemporally, as the product of timeless chemical, anatomical, physio- logical, or psychic variables, but must be seen as an intrinsically social process that certain otherwise normal people undergo. Lindesmith did acknowledge that some substances possess a characteristic chemical disposition to generate physiological withdrawal symptoms after repeated administration. However, though he felt this disposition was a necessary ingredient for addiction, he did not feel it was sufficient. To lend empirical support to his case, Lindesmith pointed to instances of heavy morphine use among hospital patients after surgery. These patients are often administered sufficient doses of morphine to produce physiological with- drawal symptoms but they do not generally become addicted to morphine after they leave the hospital. Lindesmith explained this apparent anomaly by pointing to patients’ ignorance of the source of their withdrawal distress. By and large hospital patients don’t know their nausea, muscle aches, runny noses and other symptoms stem from morphine withdrawal and hence do not infer a need for opiates from these experiences. The symptoms eventually pass with no yearning for further drug use having been produced. Street addicts, on the other hand, use opiates consciously. They generally do possess knowledge of the fact that these drugs can produce physiological withdrawal symptoms and that further use will alleviate those symptoms. Lindesmith argued that, by learning to use drugs specifically to alleviate withdrawal, mere drug users are transformed into genuine drug addicts.
Lindesmith’s work reflected the wisdom of an era wherein it seemed sensible to speak of distinctions between hard drugs (defined by the fact that they produce physiological withdrawal symptoms) and soft drugs (defined by the fact that they do not do so). But the era has now passed when people could speak confidently of a distinction between drugs that produce genuine, or physical, addictions and drugs that might produce only a more nebulous psychological addiction. The single most important catalyst to this era’s passing was the advent of crack. Crack
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cocaine is widely recognized as extremely addictive by clinical professionals and non-professionals alike but, oddly enough, it produces no gross physiological withdrawal symptoms (Gawin, 1991). The same can also be said of nicotine, and all of the so-called behavioral addictions, sex, gambling, eating, etc.
Furthermore, reliance on the distinction between physical and psychological addiction always suffered another serious analytic problem: relapse. Many consider relapse, or the resumption of a dis-preferred pattern of behavior despite one’s desire not to, as the defining mark of addiction. Theories that trade on the distinction between genuine physical addiction and a less severe psychological addiction cannot remain consistent in their explanations of relapse. A return to Lindesmith’s classic theory will illustrate the problem. Lindesmith explained the resumption of drug use after withdrawal symptoms have ceased primarily in terms of the former addict’s subconscious generalization of his or her response to withdrawal distress to other forms of stress (cf. Lindesmith, 1968: 154). This theory is plainly residual in the sense that it pastes a new subconscious mechan- ism on to the original physiological withdrawal-plus-knowledge-of-withdrawal theorem. Furthermore, it is not consistently supported by empirical data on opiate addiction, and affords no explanation of relapse into the use of substances like nicotine or crack, which do not produce gross physiological withdrawal symptoms in the first place. Given the analogous tendency of former crack and nicotine addicts to relapse, we are well advised to look beyond the generalization of withdrawal distress to adequately understand this process.
Three major theoretical approaches have emerged which seek to explain the addict’s propensity to suffer relapse. These include theories which attend to neurological changes that make the one-time addict vulnerable to relapse (cf. Gawin, 1991; WHO, 1981), various learning theories based in the tradition of behavioral psychology (cf. Akers et al., 1968; Childress et al., 1992; Siegal et al., 1988; Wikler, 1973) and sociological theories based primarily in the school of symbolic interaction (cf. Denzin, 1993; Lindesmith, 1968; Ray, 1961; Stephens, 1991). Each of these approaches usefully captures important features of the addiction process. However, each approach also suffers from important limi- tations. In what follows I briefly describe these three approaches, discuss their respective limitations and conclude by suggesting a theoretical alternative by which these limitations may be overcome.
The Neurological Understanding of Addiction
Neurological theories of addiction are based, in large part, on empirical evidence gathered through laboratory experiments using non-human animals. These
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investigations have indicated many common features between the effects of various drugs on people and on non-human animals and hypothesize that the long-term neurological effects of sustained drug use observed in animals are largely analogous to what occurs in human beings. These long-term neurological effects, or ‘neuroadaptations’ (WHO, 1981), are believed to explain the propen- sity of former heavy substance users to relapse. Before speaking to the limitations of this approach it will behove us to briefly consider the argument and to note some of its strengths.
According to neurologists working in this area, psychoactive chemicals produce euphoria in those who use them largely by affecting neural processes in the pleasure/reward circuitry of the brain. By either promoting the release of neurotransmitters, preventing their re-uptake, or mimicking their effects, psychoactive drugs like heroin, cocaine, alcohol and nicotine change the routine functioning of the brain in ways that tend to be profoundly reinforcing to those so affected. That is, once exposed to their pharmacological effects, people and animals endowed with properly functioning reward circuitry will be strongly inclined to use drugs again. Experiments done with laboratory animals have produced compelling evidence that, indeed, once exposed to the biochemical effects of certain drugs, animals will seek them out and self-administer them, sometimes until they die of overdose or of sheer exhaustion.
As is evident in the level of self-administration observable among some people, it would seem that the ingestion of some chemicals can also have profoundly reinforcing effects in human beings as well. However, it is one thing to suggest that the effects of some drugs are profoundly reinforcing to most people and are thus sought out, all other things being equal. It is quite another matter to suggest that even after users become painfully aware of the serious negative consequences that using drugs has for them, drug use, nonetheless, continues to produce the same reinforcement. Studies of heavy users of various drugs have repeatedly noted that, after prolonged use, the positive effects of drug use are often eclipsed by the negative (cf. Koob et al., 1989). Some heavy users even report that drug use ceases to give them any rewarding experiences whatsoever and that they simply continue to relapse because they feel they cannot refrain from doing so (cf. Lindesmith, 1968). How do neurologists account for these seemingly anomal- ous findings?
They do so by suggesting that prolonged drug use may induce a compensatory neurological adaptation which, in effect, amounts to the production of a tolerance to the drug in the nervous systems of heavy drug users. While the development of this type of tolerance may or may not induce gross physiological withdrawal symptoms upon removal of the drug, it does produce what neurologists call
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anhedonia, or a marked decrease in the capacity of one so afflicted to experience pleasure after drug use has been discontinued. Studies of abstinent former cocaine users suggest that in the absence of neuro-adaptation, anhedonic symptoms will lift in between two and twelve weeks (Gawin, 1991). However, in the presence of neuro-adaptation the duration of anhedonia is uncertain. During this period the former substance user remains in a comparatively depressed state and thus signifi- cantly more vulnerable than s/he might otherwise be to stimuli that cue him or her to consider the analgesic effects of drug use.
This approach is instructive in a number of important ways. First and foremost, it has important practical payoffs in that it informs our efforts to generate pharmacological therapeutic interventions. Drugs like Naloxone have proven to be life-saving for people in acute stages of opiate overdose and others like Methadone and various anti-depressant medications have improved the quality of life for former heavy drug users who might otherwise have remained without help. In addition, this approach provides theoretical resources for under- standing intrinsically maladaptive human behavior and thus encourages us to recognize the possibility that some behaviors simply cannot be plausibly described as adaptive responses to environmental conditions. Social scientists, in particular, sometimes forget that the human organism itself can and indeed often does interfere with our performing as competent social actors (Leder, 1990; Turner, 2000). A sensitivity to neurological processes can provide an important check on our social scientific propensity to regard all human conduct through a rationalizing gaze.
However, this said, the neurological model does suffer from significant theor- etical limitations. Most fundamentally, as I have said, most of the findings that support the model are taken from experiments using non-human animals. These animals are not administered drugs in the same way, at the same rates, or under the same environmental circumstances that characterize human drug use, and thus their behaviors must be interpreted with the utmost caution as analogs to human drug-using practices. Moreover, we must not be lured into believing that the meanings drug effects have for human beings are analogous to the meanings those effects have for non-human animals. There is a great deal of evidence to suggest the meanings drug effects have for people strongly influence whether those effects are experienced as pleasurable or unpleasurable (cf. Becker, 1953, 1967; Mac- Andrew and Edgerton, 1969). These meanings cannot be explained exclusively with respect to biochemical effects in the brain’s pleasure/reward circuitry (Weinberg, 1997). Because they seek to predicate their theories of compulsive drug use on a presumption that certain chemicals invariably produce pleasurable experiences (cf. Gardner, 1992), neurologists systematically occlude the culturally
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transmitted meanings of drugs and drug use from their analyses. If our effort is to understand the dynamics of compulsive drug using practices in people then blindness to the meanings of drug experiences is a very serious theoretical handicap.
Lastly, we must realize that conceptual resources drawn from neurology are not particularly well-suited to research that seeks to elucidate the subjective experiences and/or the social contexts that foster compulsive drug use or those that foster its amelioration. Theoretical approaches to these kinds of analyses, though they must certainly be open to the possibility of neurological influences on human behavior, must not cast human behavior and experience as merely epiphenomenal to neurological processes.
Approaches to Addiction from Learning Theory
Learning theories of addiction begin from the premise that there are two basic types of learning that occur in drug using situations. One, ‘operant conditioning’ or ‘instrumental learning’, occurs when behavior is followed by rewards or punishments. Under circumstances that reward a given behavior, that behavior has been found likely to increase, and under circumstances that punish the behavior the behavior decreases. The second type of learning, ‘classical condition- ing’, involves the conditioned association of reinforcing events with events that routinely occur concomitant to those events. Research concerning operant and classical conditioning has a long and diverse history but was originally inspired by Ivan Pavlov’s famous experiments in conditioned reflexes (Pavlov, 1927).
Pavlov noted that repeated pairing of one stimulus which precipitates a known response (what he called the unconditioned stimulus or UCS) with another novel stimulus (the conditioned stimulus or CS) can train a subject to associate the CS with the UCS and indeed respond to the CS in a manner akin to the response known to follow the UCS. Pavlov’s most famous experiment was one involving dogs, wherein by ringing a bell (the CS) in conjunction with feeding (the UCS) he was eventually able to evoke salivation, the known response to food, simply by ringing the bell alone. This experiment has been replicated many times and clearly demonstrates that animals and humans alike can be trained to respond to novel stimuli by associating those stimuli with stimuli already known to provoke a given response.
This insight has been shown to hold in the case of prior heavy drug users insofar as responses akin to those elicited by drug use (or by drug deprivation) can be provoked by exposing former drug users to other kinds of events that routinely accompanied their drug use (or deprivation) (cf. Childress et al., 1992).
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These findings are consistent across drug types, including opiates, cocaine, alcohol and nicotine. Events former drug users associate with drug use can include external or environmental events like the recognition of a former drug using accomplice, former copping areas, the sight, smell, feel, sound or taste of the drugs themselves, or virtually anything at all the drug user could possibly regard as having an affinity with drug use. They can also include various internal states like fatigue, hunger or moods.
This theoretical approach has contributed a great deal to our understanding of addiction insofar as it accounts for how, in the absence of physiological with- drawal symptoms, certain external and internal cues can provoke craving for a drug and thus induce relapse for a long period of time following cessation of physiological withdrawal symptoms. This approach is also consistent with the reports of drug users who tell us that, though they feel capable of resisting drugs under certain circumstances, and indeed give little thought to them under those circumstances, they feel they become powerless to resist their cravings under the kinds of circumstances that had routinely accompanied their former drug using activities (Robins, 1993).
Therapeutic interventions based on this theoretical approach work in two distinct sorts of ways. Either (1) they endeavor to train subjects to associate negative responses like nausea with drug use and/or drug using situations, or (2) they endeavor to extinguish positive associations with drugs through repeated exposure to drug cues in the absence of chemical reinforcements. These inter- ventions have been widely used but where they have been tested they have shown only modest successes (Childress et al., 1992). One important reason for this lack of success is the failure of research subjects to generalize the training they receive in test settings to their lives beyond the test settings. While repeated exposure to drug scenes and drug-related practices in the absence of the drug itself may desen- sitize a subject to drug cues in a controlled test setting, it does not seem to have the same effect once subjects return to the world outside. As for pharmacologi- cal behavior modification techniques like Antibuse, which do continue to exert effects outside the clinical setting, clients generally exhibit little inclination to stick with the regimens.
This disparity between results in clinical or test settings and the real-world lives of heavy substance users portends some of the serious theoretical weaknesses of the social learning approach. For example, though unconditioned and conditioned stimuli may be relatively easy to separate into discrete variables in test settings, it is far more difficult to do so in real-world settings. A drug user may very well find drug use pleasurable only because the situations in which the drug has routinely been used were also found pleasurable. Parties, music and
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friends, to name only a few common cues, can be powerfully reinforcing factors for drug use as well as cues that trigger the desire for a drug’s putatively ‘intrin- sic’ pharmacological effects. If we accept this then it may be advisable, in some cases, to regard the drug taking as the conditioned stimulus and the contextual features of that drug taking as the unconditioned stimuli. Again we are forced to reckon not only with the putatively ‘basic’ psychoactive effects held to derive from the chemical composition of a drug but also the culturally transmitted meanings those drugs come to have for individual drug takers.
Another difficulty attendant on this theoretical approach is its rather rigid distinction between operant and classical conditioning. Symbolic interactionists, as well as phenomenologists of various other schools, have shown us that stimuli often, and perhaps always, acquire their distinctive character as behavioral cues due to the trajectory of practical action under which they are encountered. For example, a cigarette in the hand of a friend may cue a response very different from that cued by a cigarette in the hand of a chef who is making one’s meal. In the first case one’s practical trajectory may entail fostering solidarity with a friend. The character of the cigarette as a cue will then be shaped by that practical trajec- tory. In the second case, one’s practical trajectory might entail seeing to it that s/he is served an untainted meal and the character of the cigarette as cue will be likewise shaped accordingly. The same ostensible object (i.e. the cigarette) may cue two very different responses. In light of this plasticity of a given stimuli’s cueing potential, we may be well advised not to draw so fine a line between operant and classical conditioning. Courses of human behavior and the cues that constitute our behavioral environments are far more interdependent than behav- ioral psychologists have often been prepared to acknowledge.
In fairness, it must be noted that a few versions of learning theory (cf. Akers, 1985; Bandura, 1986) are more sensitive to these difficulties than are most others. However, though some of the leading learning theorists do seem at least partially aware of the problems I have raised here, they continue studiously to avoid the use of naturalistic research methods. They thereby seriously impair their ability to investigate or appreciate the various mechanisms by which meanings attach to drugs and drug effects in the natural settings in which drug use actually does become meaningful to people. For this reason they do little to illuminate the role played by meaning when addiction processes take place in real-world settings.
Symbolic Interactionist Approaches
Both neurological theories and learning theories have been found to give inade- quate attention to the culturally transmitted meaning drugs and drug effects have
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for drug users. Symbolic interactionist approaches, on the other hand, focus quite directly on the relevance of meaning. Alfred Lindesmith (1938) was the first to note the theoretical significance of the meaning drug users find in their drug experiences. As I’ve said, he noted that people who are given enough morphine in hospital settings to develop a physiological tolerance rarely become addicted. He attributed this to their ignorance of the source of their withdrawal symptoms and hypothesized that, in addition to suffering withdrawal symptoms, the onset of addiction requires that users cognitively appreciate their withdrawal symptoms for what they are and seek to alleviate them by re-administering the drug (Lindesmith, 1938: 606). Critical to his theory was the meaning drug effects have for drug users.
Lindesmith pioneered the investigation of drug use and drug effects by quali- tative social scientists allied with the symbolic interactionist school. Social scien- tists since Lindesmith have drawn upon ethnographic methods of investigation and/or the theoretical resources of symbolic interaction to describe drug cultures (cf. Finestone, 1957; Johnson, 1980; Preble and Casey, 1969; Rosenbaum, 1981; Rubington, 1968), the social settings of drug activity (cf. Adler, 1992; Bourgois, 1998; Sutter, 1969; Wiseman, 1970), the ritual practices attendant on drug use in natural settings (cf. Becker, 1953; Waldorf et al., 1991; Williams, 1992), and the self-identities of drug users (cf. Denzin, 1993; Lindesmith, 1968; Ray, 1961). These studies are the tip of an enormous iceberg of naturalistic investigations of drug use and drug users that have vastly enriched our understanding of the meanings attendant on drugs and drug experiences for those involved in these worlds. Any theory of the addiction process must draw upon the insights these studies provide if it is to fully account for the place drugs take in the lives of those who use them. However, only a small fraction of these studies actually speak explicitly to the nature of addiction itself. Furthermore, those studies that actually do broach the nature of addiction tend to render the addiction process somewhat counter- intuitively, and/or in ways that do not jibe well with much of the available empiri- cal evidence (Weinberg, 1997). A closer look at some exemplary studies will demonstrate the point.
Lindesmith himself spoke predominantly to the attitudes and behaviors of physiologically tolerant drug users and spent considerably less time addressing the propensity of former heavy heroin users to relapse back into heroin use after the cessation of withdrawal symptoms. However, he once listed the following set of influences to explain the propensity of the former heavy heroin user to relapse:
. . . the changed perceptions of the addict which lead him to respond to virtually all distress as though it were withdrawal distress to be banished by a fix; the neutralization of memories of the miseries of addiction which are relatively remote consequences of taking a shot compared
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to the invariably satisfactory immediate ones; the rationalizations of the abstainer that life without the drug is dull, that he is better off using the drug than not, and that he might as well use it because he is stigmatized anyway; the knowledge or beliefs acquired from direct personal experience of the marvelous potency and versatility of the drug; and finally, the attraction exercised by associations within the drug using subculture, which, with a few exceptions, provides the only social setting in which full and free communication on all matters associated with the habit is possible without risk to the ego. (Lindesmith, 1968: 154–5)
This list no doubt reflects many of the issues that bear on the propensity of many former heroin users to relapse. However, it fails to speak to two essential questions that arise from listening to addicts speak of their problems and from observing them in the conduct of their lives. First, it does not adequately explain how we are to understand relapsers’ reports that, under certain kinds of circum- stances, they feel they are truly overwhelmed, rather than just rationally persuaded, by their craving to use drugs (Weinberg, 1997). And, second, it does not account for the repeated cycle of abstinence and relapse. Why does the chronic relapsers’ propensity to ‘neutraliz[e] memories of the miseries of addiction’ not wane to extinction after repeated calamities involving drug use? We should expect to see all addicts who experience serious drug-related problems ‘mature out’ (Winick, 1962), but unfortunately we don’t. What is it about some people’s drug experiences that fosters powerful visceral cravings even after repeated association of drug use with negative experiences and despite their stated desires to abstain? Either each and every person who reports such experiences is dissembling or mistaken, or our theoretical resources for understanding the cycle of abstinence and relapse must go beyond Lindesmith’s pioneering, and indisputably seminal, theoretical work. Later symbolic interactionists have fared little better than Lindesmith in answering these questions. Ultimately, however, they are not only important theoretical questions but also critical policy and treatment questions because it is precisely those who continue to report powerful craving experiences despite serious substance-related problems who are most exquisitely in need of therapeutic assistance.
Marsh Ray (1961) is the symbolic interactionist who has most explicitly addressed the cycle of abstinence and relapse, and his is probably also the most widely cited theoretical statement of how relapse can be understood from a symbolic interactionist vantage point. Richard Stephens (1991: 57–8) cites Ray’s theory as the primary resource in his own symbolic interactionist account of relapse. Dan Waldorf (1970: 229) cites Ray’s theory as the ‘only . . . attempt to learn anything of the processes of relapse after a period of abstention’, though he expresses some reservations as to the theory’s explanatory power. According to Ray’s theory, the cycle of abstinence and relapse should be understood as a
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process during which the former user consciously oscillates between a commit-
ment to his using and non-using self-concepts. Ray concludes his classic essay:
. . . socially disjunctive experiences bring about a questioning of the value of an abstainer identity and promote reflections in which addict and non-addict identities are compared. The abstainer’s realignment of his values with those of the world of addiction results in the redefi- nition of self as an addict and has as a consequence the actions necessary to relapse. (Ray, 1961: 140)
This theory suggests relapse is a process necessarily involving conscious delib- eration and comparisons between one’s using and non-using identities. As one can see, Ray’s is an extremely cognitivist, and indeed, rationalist, construal of the relapse process. The relapser is an individual who rationally evaluates the pros and cons of being an addict versus being an abstainer before deciding to relapse. But does this sound like addiction? If Ray is correct, what sense is there in thinking that addicts require any kind of therapeutic assistance whatsoever? Aside from its somewhat ominous policy implications, this theory suffers on purely scientific grounds. The difficulty is that it provides no place for the visceral components of relapse – the embodied and emotional compulsions a great many people report experiencing and to which they themselves very often assign primary responsibility for their relapses.1 Though we must by no means adopt our informants’ accounts uncritically (Weinberg, 2000), we must contend better than does Ray with the activities and accounts of those whose lives and experi- ences constitute our only sources of data.
Norman Denzin (1993) is the only symbolic interactionist who has sought to explicitly introduce the body and the emotions of the substance user into his account of compulsive drug use. He is thus the only symbolic interactionist who has tried to move beyond the disembodied cognitivism that uniformly marked earlier symbolic interactionist contributions to our theoretical understanding of addiction. In his theory of the ‘alcoholic self’, Denzin suggests that alcoholics suffer from an ‘emotionally divided self’ wherein ‘the self is divided against itself’ (Denzin, 1993: 362). While this appreciation of the role of emotion in the addiction process is indisputably a significant advance over previous efforts, it does not succeed in fully eliminating the cognitivism and rationalism tradition- ally implicit in symbolic interactionist approaches. Cognitivism and rationalism slip back into Denzin’s theory in his insistence that situations which induce the alcoholic to drink are consciously evaluated as such on the basis of a ‘fully grounded interpretive system’ (Denzin, 1993: 67) or ‘lay theory of alcoholism’ (Denzin, 1993: 64–8).
Denzin accepts the traditional distinction between physiological craving and what he calls ‘psychological, symbolic, or phenomenological’ craving,
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characterizing the latter as a compelling need or desire to drink or use in the absence of physiological withdrawal symptoms (Denzin, 1993: 34). This second variety of craving is understood as a learned emotional response rather than an innate biological one and it is quite clear throughout his text that it is the psycho- emotional type of craving which holds primary interest for him. However, there is a feature of Denzin’s theorizing on emotion that makes his position somewhat difficult to apply to the experience of addictive craving as it is commonly reported by addicts themselves. Following John Dewey’s view that ‘emotion as such arises through the inhibition of a tendency to act’ (Denzin, 1984: 423), Denzin insists that experiencing emotion necessarily entails that people consciously evaluate their perceptions or behavior as emotional. He writes:
Pure behavior is not emotion, nor is the simple awareness of that behavior emotion. Behavior becomes emotional only when it is interpreted by the person and brought into self-interactions. The body adjusts itself to the emotional interpretations persons place upon it. (Denzin, 1983: 403–4)
This nominal view of emotion properly insists that we recognize ‘emotion’ as an interpretive category which is, at one level, socially constructed. However, it introduces a cognitive step that is not consistent with the reports of many people who have struggled with addictive craving. According to Denzin’s model, craving, to the extent it is an instance of emotional experience, must involve ‘1) a sense of the feeling in terms of awareness and definition, 2) a sense of the self feeling the feeling; 3) a revealing of the moral or feeling self through this experience’ (Denzin, 1983: 403–4).
Denzin’s model proposes that addictive craving necessarily involves, in addition to one’s imperious desire to use, a reflexive interpretation of this desire as such, a reflexive acknowledgment that one is the particular self who is experi- encing the craving, and some type of moral evaluation of that particular self. This model reintroduces the cognitivism that prevented Ray from grasping the spon- taneous visceral character of craving and forces us to conceive of relapse as always preceded by a reflexive interpretation of oneself and one’s emotions. This inter- pretive work is construed not just as a possible component, but as an analytically necessary component of the relapse process. This theory disregards the profound power of what George Herbert Mead called ‘the affective side of all conscious- ness’ (quoted from Denzin, 1984: 423) which, though it occurs beneath the level of deliberate interpretation, nonetheless steers us in much of our practical life. And like Ray’s theory, it ultimately requires that relapse be viewed as a deliber- ate, quasi-rational, rejection of the recovering alcoholic identity in favor of the resumption of drug use (Denzin, 1993: 286–7). It thereby denies credence to the reports of many who claim to experience relapse not as a decision to resume drug
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use but as a steadfast commitment to a non-addict identity and lifestyle that is
painfully and persistently thwarted by powerful visceral compulsions to use.
A Praxiological Alternative
I have sketched a brief summary of our theoretical options for understanding the nature of addiction that shows how these options force us to choose between the Scylla of biological reductionism and the Charybdis of a disembodied cognitivist rationalism. We have, it seems, been ill-equipped conceptually to transcend this antinomy, always alternating between two theoretical positions both of which fail to elucidate the actions exhibited, and experiences reported, by those apparently struggling with addictions. Must we either ignore the meanings drugs and drug effects have for people or else consider those meanings at the expense of completely rationalizing addictive behavior? I don’t think so. We may instead draw upon advances in social phenomenology to suggest that meaning can be, and indeed usually is, apprehended without any intervening necessity of rational reflection or conscious interpretation.
Following the work of a growing number of phenomenologically informed social scientists (cf. Bourdieu, 1990; Coulter, 1994; Coulter and Parsons, 1990; Ostrow, 1990; Shusterman, 1991; Turner, 2000) we may understand the culturally transmitted meanings inherent in drug use and craving as pre-reflective, non- symbolic, and embodied rather than interpretive, symbolic and disembodied. According to the praxiological view I would advise, we must not regard Mead’s ‘affective side of all consciousness’ as necessarily involving an interpretive step between ‘brute sensations’ and meaningful experience. Instead we must under- stand that social learning occurs not only through symbolically mediated inter- pretive work, but through embodied forms of collaborative practice as well (Bourdieu, 1990; Mead, 1934). By learning through practice to participate in social activities, people come to personally embody culturally transmitted meanings at a pre-reflective, or habitual, level of being (Camic, 1985). Instead of insisting, as symbolic interactionists traditionally have, that a process of symbolic interpre- tation always intervenes between the environmental ‘stimulus’ and the behavioral ‘response’ (Blumer, 1969: 79), we must instead recognize that social life fashions the relationship between stimulus and response always prior to the conscious encounter of the actor with his or her world (Dreyfus, 1991). Recognizing this pre-empts the threat that human beings would be rendered automatons or cultural dopes and also makes unnecessary the counter-intuitive, untenable and unverifiable assumption that in all our affairs we unwittingly experience a brute
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collection of physiological stimuli just prior to rendering those stimuli meaning- ful through symbolically mediated interpretation.
Instead of regarding the apprehension of meaning as in every instance a super- imposition of linguistic or cultural categories on ‘raw feels’ or ‘brute sensations’, the praxiological view suggests we regard it as a faculty of habit that is developed through socialization into social worlds involving objects and activities of various sorts. It is not that social objects like drugs and drug experiences have some sort of intrinsic biological or pharmacological meaning or practical significance, nor is it that we must deliberately interpret intrinsically meaningless arrays of sensory stimuli. Instead, the meaningful world we inhabit is comprised of our actual practical involvements in that world. Applied to addiction, this approach suggests that the meaning of drugs and the emotional effects drugs have on us derive to a significant extent from the ways in which we have come to use those drugs in the various social contexts that make up our lives. But again, because these meanings and emotional effects manifest non-symbolically, pre-reflectively, pre- discursively and unwittingly, it is reasonable to regard their impact on our behavior as, in a very literal sense, uncalculated and involuntary.
Addictive behavior is exhibited when people, or their significant others, come to perceive that their tacit practical reliance on a drug for coping in one area of their lives negatively impacts upon that or other areas. This perception is often not enough to produce a cessation of drug use, though, because the urge to use does not manifest in lived experience as a deliberate decision, let alone a holistic cost–benefit analysis, but as a viscerally felt compulsion informed by the perceived practical demands of the moment. The addictive craving to use drugs is thus experienced as deriving from beyond the self and decidedly not in any way an exercise of self-will. However, the difficulties thus experienced may occur with various degrees of intensity depending upon whether people are competent, or are confident they can become competent, in exercising coping techniques other than drug use, or are relatively free to avoid the settings wherein drugs had become integral to their perceived ability to cope (Marlatt and Gordon, 1985).
So what is the wider relevance of these remarks for empirical social research? I would like to conclude the article by answering this question with respect to my own research with homeless addicts. Most social scientists are, for good reason, critical of research that makes too much of the relationship between homeless- ness and drug addiction (cf. Snow and Anderson, 1993). It is feared that such research will encourage victim blaming, and that it distracts us from the much
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more important social-structural causes of homelessness. I share these fears. But, in place of polemics against ‘naturalizing’, or ‘pathologizing’, homelessness, I am convinced it is a good deal more useful to de-naturalize addiction – that is, to enlighten people as to the deeply sociological dimensions of addiction and recovery among homeless people.
As I mentioned earlier, behaviorist talk of ‘secondary reinforcers’ now domi- nates scientific theorizing regarding the social environmental sources of addictive behavior. According to the behaviorist’s logic, arbitrary elements of the drug user’s social environment may come to be cognitively associated with the experi- ence of intoxication and thus cue cravings for drugs which, by virtue of their invariably pleasurable biochemical effects in the brain, are understood as ‘primary reinforcers’. This view completely misses the fact that the pleasurability of these biochemical effects is not a foregone neurological conclusion but is itself socially, culturally and personally variable in the extreme. This view also encourages images of the homeless addict as innately impulsive, hedonistic, short-sighted, undisciplined, self-centered and incapable of deferring gratification. It is natural- ized neurological and psychological theories like these that genuinely blame victims.
In my view, if we are to adequately understand and cope with the relationship between addiction and homelessness, we must strive to free ourselves from these kinds of images. In opposition to such views, I would insist that people do literally use drugs in ways that are always personally meaningful to them. And this meaningful use of drugs is always embedded in, and at least to some extent, practically responsive to, socially structured contexts of action. This is particu- larly obvious in the case of homeless drug users. Who can doubt that homeless- ness provides myriad incentives for drug use? But in opposition to some rational choice theorists, who would have us believe that the fact of drug use is logically inseparable from a calculated resolution to use, we must insist that not all meaningful, or even all sociogenic, behavior is behavior that we deliberately choose or with which we self-identify. Even when it is recognized as drenched in social structure, culture and meaning, there remains a depth to the human psyche of which we as selves, subjects or egos are at best only dimly aware, and at best only partially able to control (Chodorow, 1999). My research suggests the extreme material and emotional hardships of homelessness quite seriously inten- sify the tendencies we all sometimes have to find the other, the ‘not-us’ and ‘not- me’, in our own personal actions and experiences. Though we might sometimes wish to relish such mysteries, we might sometimes also find them profoundly disturbing and yearn for therapeutic assistance to secure for ourselves a more intelligible and integrated social being. In this sense, the work of fostering
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recovery from addiction may be seen as a simultaneously collective and personal project of self (i.e. social being) actualization – one among many types of struggle for redemption from the jointly psychic and social spaces of otherness with which we cannot or do not want to identify. We should not, then, simply ignore or attack the linkage of homelessness with addiction, so much as try to formulate more just, more therapeutic and more theoretically defensible understandings of that linkage.
I would like to thank members of the Body Research Group at the University of Cambridge for their comments and discussion of an earlier version of this article. Writing of the article was supported by a grant from the Lindesmith Center of the Open Society Institute.
1. The following fieldnote excerpt from my own research with homeless drug users will serve to illustrate what is a ubiquitous tendency in the narrative accounts sufferers give of their own drug problems:
I’ve promised myself I wouldn’t use a thousand times and really meant it. And then I use. I mean it’s like there are two sides of me. The rational reasonable person who knows he’s gonna die if he keeps on living the way he is and the insane one who just doesn’t care. My reasonable side of me can be as sure as it wants to be but when those drugs appear in front of me the insane one takes over and all those reasons I had not to use are just gone. They just disappear. And I use. It’s like my mind just goes dead and my addiction takes over. I hate myself right after- wards and I’m completely confused by the fact that I just used. I didn’t want to but I did. It’s all well and good to say you need to make a commitment but for some of us that’s not enough. We need something more than that and it doesn’t help for people to be all smug about how we need to make a commitment and it’s all that simple.
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Darin Weinberg teaches sociology in the Faculty of Social and Political Sciences, University of Cambridge and is a Fellow of King’s College, Cambridge. His research attends to the use of medical concepts like addiction and mental disorder in various historical and contemporary contexts. He is particularly interested in how these concepts figure in state-sponsored campaigns of social welfare and social control, and what their uses reveal about how people distinguish the social and natural forces that govern human behavior. He has recently edited a collection of readings for Blackwell entitled Quali- tative Research Methods (2002).
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