Month: April 2011

Teaching Drugs and Alcohol through the Filter of Student Life

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In his second week as a Points Guest Blogger, Eoin Cannon reflects on the difficulties of talking intelligently about addiction with a roomful of undergraduates who may still be hungover from the night before.

Last fall, I taught a course called “Stories of Addiction” for my university’s Freshman Seminar program. It was the first opportunity I’d found to teach my scholarly interest in a sustained way. As in approaching any new course, I gave some thought during my preparation to what beliefs, assumptions, and values students would bring to the topic. In departmental courses, I think, you can count on your discipline’s critical tools, and your students’ developing comfort with them, to create analytical distance. Not a space, hopefully, in which personal experience is unwelcome, but one colored by the implicit understanding that our main purpose here is not to do therapy or reproduce conventional wisdom.

But three factors made the issue of distance particularly salient in my seminar. First, it was for freshman only, during their fall semester. They had no experience with college-level critical thinking. Second, the seminar context, combined with my own approach to the topic, put the course outside of any single disciplinary framework and its implied critical distance.

Your Experience Here

It wasn’t “addiction in literature,” it wasn’t “the history of addiction,” it was just “addiction stories,” and the shapes they take, the work they do, in various contexts. I was using the category of narrative to develop an interdisciplinary framework that would not be obvious to students. Third, and most important, alcohol/drugs is a topic freighted with official and unofficial discourses that play key roles in the social identities of college students.

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Addiction is a Brain Disease (But Not Always?)

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Closing out her stint as a Guest Blogger, Helen Keane notes the gap between the way pain management experts and neuroscientists think about addiction.

The currently dominant scientific paradigm of addiction is that of a ‘chronic, relapsing, brain disease’ which develops as a result of persistent consumption of drugs of abuse. Over time, according to this model, drug use produces long-term changes in brain structure and function, and what began as a voluntary behaviour becomes an uncontrollable compulsion. The process is driven by the effect of dopamine on brain reward pathways, and the ability of drugs to ‘hijack’ these pathways which evolved to reinforce behaviours necessary for survival such as eating and sex.

In addiction science journals the brain disease paradigm is celebrated as a major breakthrough which promises a new era of enlightened treatment, prevention and research.

This Explains Everything!

But as David Courtwright outlined in a recent article  it has also been met with ‘indifference’, ‘suspicion’ and ‘resistance’ from a range of  interested parties including politicians, clinicians and (perhaps least surprisingly) social scientists.[i]  From a sociological and historical perspective there are many things questionable about the neuroscientific discourse of addiction, including, to cite Joseph Gabriel’s recent post, the idea that drug effects on the body can be understood as theoretically prior to the social and cultural contexts in which they occur. But the apparently limited impact of the brain disease model on medical understandings of addiction is more surprising.

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Meth and Moral Panics, Part One

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Today, I’m posting the first in a short series on the concept of “moral panic” and its utility for those of us who write and think about the history of drugs and alcohol. I’ve been promising this series to co-managing editor Trysh Travis (and to my students) for some time, so I’m glad to get things underway.

While there’s been no “moral panic” tag here at the Points blog (until today), there’s no shortage of references to it here, either. You can find Trysh Travis dropping the phrase here and here. In keeping with the spirit of Trysh’s posts, I thought I’d use the history of methampetamine (and its place within the moral panic literature) as the focusing point of this series.

Let’s go back, for a moment, to 1990. Early in my graduate career, I was just beginning my long engagement with drugs history when I ran across an article in the February 8, 1990 issue of Rolling Stone magazine. On the cover, right alongside a photo of the old-even-then Paul McCartney, was the lead: “The Ice Age: A New Drug Epidemic Threatens America.” The actual article, written by contributing editor Mike Sager, was scarcely less scary and foreboding than the words on the cover. Effectively, Sager was warning readers in “The Ice Age” that an epidemic of smokable crystal methamphetamine use was on its way from Hawaii to the U.S. mainland, soon to surpass heroin and cocaine as the nation’s major drug problem. I confess to having found Sager’s article compelling reading—the gritty realism of his style as a Rolling Stone contributing editor during these years was and is of the sort you can see in much greater detail in a collection of his work entitled Scary Monsters and Super Freaks: Stories of Sex, Drugs, Rock ‘n’ Roll and Murder. At about the same time, Sager spelled out the central claim in the Chicago Sun-Times: “The Age of Ice is a new era in drug abuse” and ground zero for this new age was Hawaii, “where use of the drug has recently been declared ‘epidemic.’”

Sager wasn’t the only one working the ice beat in late 1989 and early 1990. A substantial volume of news stories and longer article appeared in the local and national press, most echoing the basic tone of Sager’s warning piece. Indeed, Sager and his fellow journalists were hardly the only ones at this party–the story had grown from a big issue in Hawaiian local politics to the national political stage. Less then one month before Sager’s article appeared in Rolling Stone, ice was the subject of a Congressional hearing “Drug Crisis in Hawaii” [Drug crisis in Hawaii : hearing before the Select Committee on Narcotics Abuse and Control, House of Representatives, One Hundred First Congress, second session, January 13, 1990]. Indeed, the phrase “ice age” was borrowed by Sager from the ongoing political conversation–the phrase had been employed multiple times to describe the looming crisis.

While I was credulously absorbing Sager’s tale of drug menace, historian Phillip Jenkins was taking a different and more critical approach to this and other writings on the subject. What happened next? I’ll let Jenkins tell the rest of the story, which shows me to have been pretty gullible, and Jenkins fairly savvy:

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Addiction and Pseudoaddiction

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Guest Blogging at Points for a third day, Helen Keane addresses the need for some refinements in the concept of “drug dependence.”

In my previous post I talked about the need to distinguish pain patients from addicts in the pain clinic. Both may be dependent on opiates, but the addict manifests aberrant drug-seeking behavior and an unhealthy obsession with drugs. However the problem of legitimate pain patients who behave like addicts has lead to a refinement of the addicted/non-addicted binary.

Just Say "Manage It"

“Pseudoaddiction” is a concept developed by pain specialists in the 1990s to describe desperate drug-seeking, produced not by true drug addiction, but by the under-treatment of pain. The behaviour of patients exhibiting pseudoaddiction mimics the out of control conduct of  the addicted: they may increase their dose without approval, complain aggressively, or lie to get more drugs and turn to street drugs or doctor shopping to increase their supply. Pseudoaddiction looks like addiction but it is not addiction.

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Opiate Users: Deserving and Undeserving?

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In her second day as a Guest Blogger, Helen Keane of Australian National University examines how “niceness” and the lack thereof shape our understandings of heavy drug use.

In the previous post I discussed the distinction between dependence and addiction. Here I’d like to raise a few issues about the psychological/behavioural model of addiction developed in pain medicine. I’ve written about this topic with Kelly Hamill in this paper.[i]

In the context of pain treatment, opiates are not dangerous illicit substances but effective and safe analgesics appropriate for long-term use in selected patients.

The At-Risk & Predisposed Individual

Because the prescription of opiate drugs is central to its clinical practice, pain medicine has developed a definition of addiction which does not implicate drugs as the primary agents of addictive disorder.Instead it constructs addiction as a psychological disorder recognisable by the addict’s out of control behaviour, her drug-focused lifestyle and her destructive patterns of drug use. The prevention of addiction in the pain clinic therefore centres on the identification of certain “at risk” and predisposed individuals, including those with a past history of substance abuse.

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Non-Addicted Drug Dependence

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Guest blogging at Points continues this week with a series of pieces by Helen Keane, who teaches gender studies and sociology at the Australian National University in Canberra. Keane is the author of What’s Wrong with Addiction?  (NYUP 2002), and has written widely on the social and cultural aspects of alcohol and illicit drug use, pharmaceutical drugs and addiction. Her current research interests include ADHD and constructions of childhood; intoxication and gender; and theories of medicalization.

Coming Soon: the Fifth Dimension

Much of my work is focused on the concept of addiction and its mix of medical, ethical and social elements. I don’t see this mix as reducible: it seems to me that this collection of biological markers, clinical evaluations, and ethical and cultural judgements is what addiction is. While I think that untangling the strands that make up the idea of addiction is intellectually and politically important, dis-entanglement does not necessarily clarify the true nature of the disorder.  What it does reveal is what is at stake in such classificatory and definitional exercises. In this series of posts I want to look at some different medical definitions of addiction:  in pain medicine, in the draft DSM-V, and in addiction neuroscience.

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Ask Your Doctor!

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So a college student walks into a doctor’s office and they start talking meds.  The student had been deeply troubled in the past, had been acting out, drinking too much, failing classes, etc., but he had seen his life turn around after he started taking Prozac a year or so ago.  It was a miracle, he told the doctor.  But at the same time he was worried:  was the whole new him dependent on the pill?  What if he stopped taking it, or if it stopped working?  Would he lose all the wonderful new attitudes and capabilities he’d developed?  He wasn’t overly frightened, mind you, just mildly nervous.  He didn’t directly ask what to do about it, but the question still hung in the air, waiting for the doctor to advise him.

Office Hours for the Wrong Kinda Doctor

A typical moment from psychiatry’s wonder-drug era, right?  Except the doctor wasn’t an MD.  The doctor was me:  a historian with a PhD, or, as we like to say in my family, WkD—the Wrong kinda Doctor.

Two other recent examples of this kind of situation, which seems to crop up fairly often (details changed to protect privacy, as with the Prozac story above):

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Battle of the Social Movements

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The Milwaukee Journal Sentinel reports today that the University of Wisconsin’s Pain and Policy Studies Group will no longer accept research funding from Purdue Pharma, manufacturers of Oxycontin. The research group has been under pressure since the Journal’s revelations about this funding stream came to light early in April, prompting a concerned citizens’ letter-writing campaign …

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