Addiction, drug addiction, alcoholism, dependency … a matter of perception
“Addict,” “drug addict,” “junkie,” “stoned”; these words have one thing in common, and that is the reaction they provoke: hatred, misunderstanding, fear, or disgust. One of the most common words to define dependency is “drug addiction” (Toxicomanie). The term “addiction” (toxicomanie in French) refers to a toxic mania, an approach that refers to the medical field. The term was first adopted in 1905. Before its introduction, the different types of addictions were broken down by substance, thus referring to different “manias” such as alcohol addiction (alchoolmania), opium addiction (opiomania), and morphine addiction (morphinomania). Toxicon is Greek for poison and mania is Greek for madness.
Over a hundred years later, research and social perceptions evolved. Today, we lean closer to a global vision of the person, and therefore of addiction. However, the battle is not won. This is not only a lexical issue, it is also a psychosocial issue, since the definition of a term influences the understanding of a concept, and therefore on its perception.
Negative attitudes such as prejudice, lack of empathy, or misunderstanding shown by health care professionals towards people who use substances or suffer from addiction have been shown to have a direct impact on their recovery process. These attitudes may result in people with substance use-related experiences being perceived as responsible for their problems, manipulative, violent, or lacking motivation, to name a few examples. This phenomenon highlights the importance of educating and informing in order to break down prejudices to avoid stigmatization, which leads to shame among people with addictions and discourages them from seeking help.
Scientific progress and advances in the psychosocial field have led to rethinking the word “drug addiction” (toxicomanie) to target a more inclusive and non-pejorative term. The concept of addiction has the potential to include more than just the consumption of psychoactive substances. The term allows us to focus on behaviour rather than on the person directly, and suggests a situation rather than a personality trait. The revision of the term “toxicomanie” was prompted by the discovery of various addictions outside psychoactive substances such as cyber addiction (dependence to the Internet and new technologies), gambling addiction, emotional dependence, work, or food dependence, etc. The term “toxicomanie” is now more widely used to refer to the global conception of this phenomenon. Stanton Peele argues that addiction is not only physiological, genetic, or hormonal, as portrayed by the medical system. It would also be psychosocial and consider the individual, their environment, social and cultural context, and relationship to the subject of addiction. This perspective enables the phenomenon to be considered as a whole and not just limited to one aspect, namely the use of the psychoactive substance. Thus, biological, and psychological factors, but also social situation, life events or network of relatives may also contribute to the problem. The definition of the term “toxicomane” is therefore broader and demonstrates a situation that is potentially transitory.
Increasingly, we are moving towards a process of de-pathologizing addiction, i.e. looking beyond the disease and having a more holistic vision. Stanton Peele defines addiction as “a way of life, a way of dealing with the world and oneself, a lifestyle.” Such a vision removes the perspective in which the individual is solely to blame and is in constant loss of control while emphasizing a movement of adaptation. The following chart highlights the difference between the various concepts of addiction.
|Medical Model||Psychosocial Model|
|Addiction is innate||Addiction is a way of adapting to oneself and the world|
|The only solutions are medical treatment and support groups such as Alcoholics Anonymous||The solution requires becoming aware of the problem and taking the necessary actions to get out of it (e.g. changing one’s habits)|
|A person is either dependent or is not (dichotomy)||A person is likely to develop an addiction. Substance use does not necessarily imply dependence and is part of a continuum.|
|Addiction is a disease that manifests itself first||Addiction can be fuelled by various risk factors in a person’s life|
|The addiction is continuous, and a person can relapse whenever.||Addiction can keep progressing, be reduced, or can be stopped|
|A person must believe in a force greater than themselves to get better||Opportunity for improvement depends on the development of personal empowerment.|
Reading these models makes it easier to understand the evolution of addiction. The psychosocial model considers external factors that may influence the development of an addiction. For example, a person may drink alcohol to reduce stress levels or to relieve feelings of discomfort related to the loss of a loved one, in the same way that a person might use cocaine to increase productivity at work. Dependence is not only the result of the substance’s components, but also of its effect (reduced anxiety, relief, increased productivity, etc.) as well as the context in which it is used.
Lastly, are the medical and psychosocial models incompatible? The two visions can contribute to each other. The concept of “toxicomanie” has evolved over the years and nowadays, it is more extensively studied as a global reality and considers the situation of people with addictions. Has the evolution of the concept reached its peak? Absolutely not. This is only the beginning towards an even greater openness. This development only goes to show the importance of pursuing education related to addiction and the use of psychoactive substances, in the hopes that better understanding will lead to greater acceptance.
1 Van Boeckel, L.C., Brouwers, E.P., Van Weeghel, J., & Garretsen, H.F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence, 131 (1–2), 23–25.
2 Suissa, Amnon Jacob. (2010) From the concept of addictus to the depathologization process: the psychosocial wealth of the concept of dependency according to Stanton Peele Les nouvelles tendances de l’intervention en dépendance, volume 8, issue 2, 75–108. https://doi.org/10.7202/044472ar