Language: Abandoning “Addiction”

Editor’s Note: Today’s post comes from Brooks Hudson, a PhD student in history at Southern Illinois University. Brooks is joining Points as a contributing editor for the 2018-2019 year, so look for more posts from him to come. Enjoy!

Historians change their language for all sorts of reasons, specifically when it dehumanizes other people. The humanities have abandoned pejorative and race-based terms, whether it’s “negro,” “colored,” or “oriental.” We understand these terms are powerful and demean others. Similarly, individuals with disabilities no longer face the indignity of having their medical condition be synonymous with who they are as people. Within the last century, we discarded “mentally retarded,” “lunatic,” “imbecile” and “feeble-minded.” Now, we use first-person language, for example, “a person with a mental or physical disability.” Within my lifetime, it’s gone from acceptable to unacceptable to use homophobic language to paint the LGBTQ community as “deviant” or prone to “unnatural desires.” Only in the last five years have mental health professionals acknowledged this mistake and declared that transgender individuals do not suffer from mental illness (“gender identity disorder”). This revision is from the updated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Progress has stalled when it comes to another health issue, however: “drug addiction.” Interestingly, another revision in the DSM-5 was taking out “addiction”—partially because of its “uncertain definition”—and replacing it with substance use disorder. Adoption of this change is underway, but not too many historians are breaking down barricades to enter the debate.

There are a thousand reason to reject “addiction.” It is imprecise. It is laden with value judgements. It is embedded in a history of religious rhetoric. It cannot be separated from largely fact-free government propaganda campaigns, not to mention the newspapers archives that are filled with word, usually within graphic and hysterical accounts that have little basis in reality.

Few have adequately addressed this issue. Fewer have proposed ways to resolve it. Arguably, the closest attempt might be Bruce Alexander’s Globalization of Addiction. In it, he dedicates an entire chapter to disentangling the various meanings of the word, marking distinct usage by subscript—admittedly, a distracting strategy, though one that reduces misinterpretation.

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Ibogaine Treatment: A Psychedelic Approach to Addiction

aaaibogaineToday’s post was contributed by Aeden Smith-Ahearn, who once was a heroin addict for almost 7 years. After trying many different traditional methods to get off drugs, he decided to take a chance on Ibogaine treatment for his addiction. Now, 5 years later, Aeden is the treatment coordinator for a major Ibogaine clinic and he has helped hundreds of individuals find a new life through Ibogaine treatment.

When a highly recognized US medical doctor—the one prescribing opiates to patients on a daily basis—walks through the door of an Ibogaine clinic in Mexico to get treatment for his prescription pill addiction, the massive nature of America’s opioid dependence becomes clear—it affects everyone.

It’s not just doctors but lawyers, teachers, students, parents, CEOs, and the list goes on. Everyone, no matter what walk of life, is a target for opiate addiction. It is physically binding, psychologically confining, and, in almost every instance, impossible to break on your own. Continue reading →

Big Nicotine, Part II: Addiction and the “Cult of Pharmacology”

Last month, the U.S. Food and Drug Administration announced its intention to lower the nicotine content of cigarettes to, ideally, “minimally or nonaddictive” levels. Public health advocates celebrated the decision; on the other hand, Big Tobacco investors began dumping shares at the prospect of supplying an ever-more-elastic demand.

Cigarette critics and capitalists alike belong to what Richard DeGrandpre calls the “cult of pharmacology,” a system of belief that dominates American drug discourse. Rooted in modernist faith in understanding the world through scientific approach, by the early twentieth century many considered drug experience to be a straightforward process of brain and body chemistry, without regard for concepts we might recognize today as set and setting. Historically contingent forces divide drugs into “angel” and “demon” categories, but their effects are similarly reduced to biological mechanism: “‘soul’ was reinterpreted as ‘mind,’ and ‘spirit’ was reinterpreted as ‘biochemistry.’”

But cults are given to blind faith, so it is worth considering the extent to which substances are to blame for problem use. Continue reading →

Interpreting Donald Trump’s “Oxy Electorate”: On the Interaction of Pain and Politics

On January 20 – inauguration day – the HBO news talk show Real Time with Bill Maher aired its fifteenth season premier. Unsurprisingly, Donald Trump was the topic of the hour. After Maher and his panel of pundits concluded their discussion, the host delivered an editorial monologue analyzing Trump’s electoral victory and offered a provocative comparison:

“Here on inauguration day, in the spirit of new beginnings, liberals have to stop calling Trump voters rubes and simpletons and instead reach out and feel their pain, the pain they insist we didn’t see. And there is ample evidence for that pain. Did you know that of the fourteen states with the highest painkiller prescriptions per person, they all went for Trump? Trump won eighty percent of the states that have the biggest heroin problem… So let’s stop calling Trump voters idiots and fools and call them what they are: fucking drug addicts!” Continue reading →

Anti-Narcotics as Social Critique: Earle Albert Rowell’s Crusade

 

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Earle Albert Rowell

We are introduced to David Dare in Experiences of David Dare in Bible Research, a novel written by Earle Albert Rowell in 1933. Dare, presenting a series of lectures on biblical prophecy to a town of agnostics gradually wins over the Emersons, a local family who become convinced by Dare’s lectures and convert to Christianity. Four years later, Dare and the Emersons reappear as a team of anti-narcotics crusaders, saving a wealthy family, the Marvels, from the perils of addiction in Dope Adventures of David Dare.

Dare’s creator, Earle Albert Rowell had written several short books on religion and drugs through this period. One about the opium habit from 1929 Battling the Worlves of Socitey and another about the new scourge of marijuana in his 1939 book, On The Trail of Marihuana. Described by his publishers as a well traveled anti-narcotics crusader, a member of the White Cross International Anti-Narcotics Society. He and his son Robert, Earle’s opium pipe in hand, had criss-crossed the country educating the public about narcotics and writing about his work. Continue reading →

Another Shot: Will dAd5GNE “End” Cocaine Addiction?

Among Facebook friends familiar with my work, dozens of conversations have started by their linking me to relevant pieces on, for example, the racial disparities of marijuana legalization, the therapeutic application of psychedelics, and, perhaps less pressing but no less appreciated, the varieties of ways our ancestors got high.

As much as I try to stay up on my drug news, sometimes people scoop me. This most recently happened last month when I received an article with a fantastically understated title: “Groundbreaking Treatment could be the End of Cocaine Addiction.” It was certainly enough to make a skeptical drug historian smile (and chuckle at the layered humor of Yahoo Finance covering anything related to the stockbroker’s culturally purported substance-of-choice).

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Leonardo DiCaprio’s Jordan Belfort fulfilling every stereotype

Cocaine addiction is probably here to stay for the foreseeable future, but the new treatment, called a cocaine “vaccine,” offers some promise. It’s certainly groundbreaking at least. Dr. Ronald Crystal, principal investigator for currently-enrolling clinical trials at New York-Presbyterian/Weill Cornel Medical Center, correctly notes that, “While there are drugs like methadone designed to treat heroin, there aren’t any therapeutics available to treat cocaine addiction.” Addiction research scientists understand fairly well how our opioid receptors operate but most are perpetually vexed by cocaine’s complex neurotransmitter influence.

The vaccine, named dAd5GNE, combines parts of a common cold virus with a particle molecularly similar to cocaine, triggering an immune response against both. “Once immune cells are educated to regard cocaine as the enemy,” Crystal explains, “it produces antibodies, from that moment on, against cocaine the moment the drug enters the body.” The idea is to neutralize cocaine particles before they pass the blood-brain barrier, blunting their effects. This is a key distinction among addiction medications like methadone, which partially block opioid receptors once drugs like heroin cross over.

Crystal concedes that the process may not reliably pan out for humans. Years ago, his team observed vaccinated rats appearing less hyperactive after cocaine use than non-vaccinated rats, and the isolated antibody absorbing cocaine particles in a test tube, but scaling up is not necessarily linear. “We need to find out if the vaccine will cause enough anti-cocaine antibodies to be produced so that it works in humans, too.”

Crystal’s cautious optimism is not reflected in articles like the one my friend shared (though author Melody Hahm is considerably more measured in the main text). Once Crystal began experimenting on primates after mice, an article from The Fix invited readers to “[i]magine that cocaine addiction could be eradicated, poof, with a simple vaccine. [Crystal] now thinks his team has actually figured out a very clever trick to make that dream a reality.” A recent article in the New York Post calls the treatment a potential “saving grace” for addicts.

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Methadone did little to alleviate the structural inequalities that contributed to drug addiction, as elaborated in this 1966 pamphlet

Poof! The drug historian continues smiling. In the early 1960s, scientists Vincent Dole and Marie Nyswander began using the synthetic opioid methadone to treat heroin addiction. Soon, journalists began proclaiming the drug as the “magic bullet” solution to the nation’s growing heroin problem. (But not without reason; the uniquely favorable conditions of early methadone trials, which featured rigorous screening processes for applicants and included staggered patient cohorts in cumulative retention data, produced impressive results: anywhere from 71 to 94 percent of users ceased criminal activity, found steady employment, and/or enrolled in college.) But heroin addiction was most prevalent in poor, high-stress urban neighborhoods characterized by racial discrimination in housing and employment. Methadone didn’t alter the scene much in places short on opportunity and long on reasons to use and sell dope. For decades, critics have credited the drug with simply perpetuating social conditions that give rise to drug use in the first place.

dAd5GNE may face similar charges. It doesn’t eliminate craving for cocaine, it just reduces the drug’s effect. Research suggests cocaine must occupy at least 47 percent of a dopamine transporter to produce a characteristic high and Crystal’s vaccinated primates never reached levels above 20 percent. But committed human addicts may accidentally overdose trying to bridge the gap, assuming they stick with the vaccination booster regiment at all, while polydrug users have an easier workaround. In any case, neither the setting or consequences of cocaine use on a social or individual level will probably change much. And, like its opioid-blocking counterparts, the cocaine vaccine gets us no closer to answering questions about addiction’s natured and (or?) nurtured etiology.

However, the vaccine has one major advantage over most opioid maintenance therapies: it has virtually no addictive potential. Twelve-step adherents and other abstemious interests liken methadone maintenance to substituting one drug – read: addiction – for another. Opioid replacement drugs can induce a mild euphoria, create physical tolerance, and even be fatal at certain dosage thresholds, which, at least theoretically, are non-issues for vaccine boosters administered weeks apart.

However, this treatment is not for everyone who does cocaine. The vast majority of users enjoy it as a fun or utilitarian stimulant without adverse outcomes. Many have no desire to stop. But even for problem users hoping to quit, the cocaine vaccine may go the way of methadone, Antabuse, and nicotine patches: magic bullets for some, stopgaps for others, nothing for most. (Assuming, of course, that trials confirm dAd5GNE is viable for human use.) But for anyone who earnestly desires to break patterns of destructive behavior, here’s hoping for more poofs in the future than the past.

Announcing the latest episode of Poinstcast!

The latest episode of Poinstcast is now available on Soundcloud for your listening pleasure! On this episode, Alex and I introduce a new segment, the Paper Chase, where we unpack the cultural meaning of even silly-sounding news from a not-so-bygone era. We end with a discussion of the “lovable drunk” television trope, particularly on The Bachelor and other reality (“reality”) shows featuring heavy alcohol use. Join us for a meandering conversation about dogs on marijuana, a purported heroin Queenpin in 1940s Chicago, and whether Barney Gumble and Karen Walker are held to a gendered double standard.

As always, feel free to reach out via email at pointscast@gmail.com, post on or message our Facebook page, or find us on Twitter. (#YouVapeBro?)