You Are Not An "Addict"

And you don't have an "addiction"

Clockwise from top left: various drugs and paraphernalia; Andrew Mellon; Harry Anslinger; William Shakespeare; handwritten caption from a photo of Reid Hunt; people with no housing, in California; a person with no housing, in West Virginia; lines of a powder drug. See photo credits below.

The following is an excerpt from p. 16-23 of the Introduction, “What is Drugism?” from my new book, Drugism (2022):

Although this may elicit objection, a careful study of the history of drug use reveals that the modern concept of drug addiction had little, if any, objective reality until the concept itself was introduced and disseminated. Like countless other lies that become truths via repetition, “drug addiction” sprung into existence from the minds of the powerful rather than from pharmacological reality.[i] In simpler terms, it is a socially created phenomenon. This is not to say that drug addiction does not exist. It does exist. However, it is caused not by pharmacology but by the thoughts, words, and actions of people.[ii]

All of these words (addict, addicted, addicting, addiction) come from the Latin addictus, which referred originally to “a citizen of ancient Rome who, being unable to repay his debts, was deprived of freedom by the courts and delivered into slavery under his creditor.”[iii]

This may resonate with modern readers who, owing unfathomable amounts of money to loan agencies, consign themselves to jobs they despise solely to get out of debt. However, people paying off debts such as college loans are not referred to as addicts. Instead, the term is applied to people who obsessively use drugs or other things/activities. The term addictus had nothing to do with drugs, and the term addict, on the surface, has nothing to do with debt. So how did a term that traces to Roman financial law become so intimately associated with drug use?

“Drug addiction” is a socially created phenomenon.

The history is simultaneously fascinating and disturbing. The roots of addictus and all the words which descend from it are ad- (“to,” a common prefix) and dīcere (“speak,” also the root of diction), so a literal translation of its original meaning would be “to speak.” In context, this referred to the process of declaring servitude, primarily as means to pay off debt, although it also applied to prisoners of war. An addictus, then, was someone who had spoken or declared their indebted servitude. At the core of this practice was the idea that a person could be effectively owned by someone (or something) else. It is this idea which allowed the word to eventually acquire new meanings.

The addictus of ancient Rome became, with time, the addict of feudal England.[iv] At this point however the word still held, more or less, its original meaning. A serf who worked, indebted, for someone else was addicted to them. Although the context had changed (from ancient Rome to feudal and then colonial England), the basic meaning of the word (someone who is in debt and thus deprived of their freedom and forced to work) remained.

Gradually, the term addict developed a new meaning. The process it described (that of being owned or indebted) was applied to things and behaviors other than debt servitude. People spoke of individuals who were addicted to particular activities, personal characteristics, and, eventually, substances.[v] By the sixteenth century, addiction meant, according to Merriam-Webster, “a strong inclination to do, use, or indulge in something repeatedly.”

Addict comes from the Latin addictus, which, in Ancient Rome, referred to people who were deeply in debt and required to work to pay off their debt.

One of the first people to apply the term addict to drug use was William Shakespeare, in the late sixteenth century. In his King Henry IV, Part 2, Shakespeare’s character Sir John Falstaff announces,

If I had a thousand sons, the first humane principle I would teach them should be, to forswear thin potations and to addict themselves to sack.[vi]

If this sounds like gibberish, allow me to translate. “Forswear thin potations,” means “avoid weak alcoholic drinks.” “Sack” refers to a type of wine that was popular in Shakespeare’s time. His character Falstaff therefore advises his future offspring to avoid cheap alcohol and drink plenty of wine.

While there was an element of humor to Shakespeare’s use of the term addict, the way it is used today is not funny at all. One may notice that addict was used as a verb by Shakespeare, and indeed, the noun form of addict had not yet developed. That is, the notion that someone addicted to something is a distinct type of person, an addict, had not yet taken form. And it would not for a few hundred years.

The addictus of ancient Rome became, with time, the addict of feudal England.

According to Merriam-Webster, the first time that the word addict was used to describe someone with a drug habit was in 1899. That is precisely the era in which modern concepts of drug use were starting to develop and simultaneously function as ideological fuel for the then-emerging paradigm of prohibition. It is no coincidence that the use of the word addict, in noun form, to refer to someone who habitually uses drugs began in this period.

The identity of the “drug addict” was constructed in this era as a way to otherize select populations. It was a time of great change, with massive immigration and industrialization occurring simultaneously.[vii] The identity of the drug addict, at its core, owes to the values and politics of those institutions that were the first to promote it: evangelical religious groups, the medical profession, and governments. 

The drugs which, if used repeatedly, qualified people as addicts in this period were drugs which, in one way or another, posed financial threats to the US upper class. Opium for example, was the unfortunate victim of a long and complex process of political negotiation between China and the western imperial powers, particularly Britain and the US. China had already banned it (not because of its pharmacology but because of the effect it had on China’s silver holdings[1]), and expected their trade partners to do the same. The US business elite dearly wanted to sell its goods to China’s vast population, and, if opium had to be restricted for that to happen, then so be it.

As a result, opium and its derivatives grew increasingly restricted in the US and in the same period, the decidedly negative identity of the opium addict was born. It did not matter that until then, people generally did not hurt themselves, go broke, or die using opioids (the now stereotypical characteristics of opioid users: in pain, impoverished due to drug use, and at risk of death from overdose). Because the drug, once the most popular in the country, now represented a financial threat to the US elite (it posed an obstacle to trade with China), opium and the people who used it were deemed unacceptable.

The first time that the word addict was used to describe someone with a drug habit was in 1899—precisely the era in which modern drug prohibition was developed.

Cannabis also became an unacceptable drug only when it posed a threat to the US elite. A popular material for countless generations, it was used for everything from clothing to paper to medicine, and more. Cannabis was effectively prohibited only after it emerged as an alternative to petroleum and, therefore a threat to the financial interests of the US elite. This occurred in the nineteen thirties, when machines were developed which allowed hemp to be processed for industrial use. The Marihuana Tax Act of 1937 was backed by the du Pont family, themselves financially dependent on petroleum, and it assigned authority over the matter to Treasury Secretary Andrew Mellon, who, not coincidentally, managed the du Ponts’ money.

It was in this same period that addiction entered the official medical lexicon. Just three years earlier, in 1934, drug addiction was included in the American Psychiatric Association’s Standard Classified Nomenclature of Diseases (a precursor to today’s Diagnostic and Statistical Manual of Mental Disorders) as a mental illness for the first time.[viii]

The fundamental idea upon which the notion of drug addiction (and all subsequent derivations of it, like “drug abuse” and “substance use disorder”) rests is the idea that molecules are more powerful than we are. Drugs which are “addictive,” or so the story goes, comprise of molecules which have some physical property that makes them irresistible to us.[ix] This molecular irresistibility—supposedly—is enough to overcome the willpower of individuals. This is absurd.

The fundamental idea upon which the notion of drug addiction rests is the idea that molecules are more powerful than we are.

Or, alternatively, if addiction is not attributed to the drug itself, it is blamed on some flaw of the user.[x] In this way, entire populations can be politically managed by their drug use. According to this line of thought, only people who were inherently flawed to begin with became addicted to drugs. Healthy, “normal” people from the dominant social class were assumed to be exempt from these flaws and therefore faced few, if any, legal consequences for their drug use. Journalist Johann Hari details the depth to which politicians such as Harry Anslinger went to cover the tracks of various prominent figures who used illegal drugs in his bestselling book, Chasing the Scream: The First and Last Days of the War on Drugs.[xi]

Racialized concepts of drug use were developed and perpetuated by the same groups: religious organizations, medical professionals, and politicians.[xii] And likewise, every racial stereotype about drug use has been, at its core, an effort by the elite to maintain financial dominance. It is no accident that people who compulsively use certain drugs (i.e. addicts) have so often been described as “slaves” to the drugs.[xiii] The identity of the drug addict was conceived, in a sense, as a social placeholder for the spot vacated by the abolition of plantation slavery.

Such concepts of drug addiction which framed people as pharmacological victims were pushed not only by the American Psychiatric Association but also by people like Anslinger, the director of the Federal Bureau of Narcotics, who made a career out of demonizing drug users (but who himself used morphine in his later years).[xiv] It was also embraced by the medical profession, particularly physicians in need of an explanation for why patients could now use some drugs but not others—the “others” were addictive!

Note the underlying themes of ownership and finance. The meaning of addiction, though it took centuries, shifted from the legal ownership of people by people to the chemical ownership of people by drugs. However, in both cases, the primary concern was and is financial: serfs in debt to masters; consumers spending money on foreign commodities. The issue, at the core, is money. It was never about pharmacology.

The identity of the drug addict was conceived as a placeholder for the spot vacated by the abolition of plantation slavery.

If one can understand this, then all of the apparent contradictions in modern drug policy disappear. It always was, and always will be, about money first and foremost.

No way! You may insist, I know someone addicted to drugs. They are physically hooked! There has to be something else going on here, some chemical component.

Many, for example, argue that the hallmarks of drug addiction are the development of tolerance and withdrawal symptoms. However, tolerance plus withdrawal does not addiction make. Consider the following scenario. A patient is depressed and goes to see a doctor. The doctor prescribes an antidepressant to be used daily. When, after two or three weeks, the patient sees little improvement, the doctor ups the dose. After another two or three weeks, feeling worse instead of better, the patient stops the drug altogether. For a few days afterward, they feel groggy and dazed.

The person in this scenario has repeatedly used a drug and developed a tolerance (their dose was increased) as well as withdrawal symptoms (grogginess after stopping the drug). Do they qualify as a drug addict? Most people would not say so. This scenario and others like it are actually quite common.[xv] You may not hear about them because they do not conveniently fit popular notions of medical care or drug use. Alternatively, you may have experienced something like this yourself. But the thirty second ad for the antidepressant is not going to tell us about withdrawal effects. And the typical doctor will not label their patient an addict for taking antidepressants.

The issue, at the core, is money. It was never about pharmacology.

Some other definitions of addiction therefore do not include tolerance or withdrawal but instead frame addiction as the continued use of a substance despite knowledge that there will be negative repercussions.[xvi] But consider, for a moment, just how many things people do with the knowledge that something bad may happen as a result.

How many of us have ever stayed up late to watch a movie and then been tired or grumpy the next day, even though we already knew that such consequences might follow? How many of us have ever been in a car accident, and then continued to drive or ride in cars afterward, knowing full well that another accident is possible? How many of us continue each day to carry on with our lives even though we know that, inevitably, painful experiences and even death will occur?

The issue with defining addiction as the continued use of something despite negative repercussions is that the definition is so universally applicable that it is not meaningful. It does not really express what drug addiction is, primarily because drug addiction is not a thing so much as a way of thinking about drug use. It is, at best, a semi-functional explanation for something which is in reality too complex to reduce to a single phrase or definition.

As psychopharmacologist Richard DeGrandpre explains in The Cult of Pharmacology, a growing body of research indicates that tolerance, withdrawal, and even craving do not, in fact, inevitably lead to compulsive, problematic drug use. DeGrandpre also notes that there is a deep, collective fear of the process of drug withdrawal in US society.[xvii] Coming off of a habit, even if only temporarily—whether fentanyl or sugar—is thought to be among the most miserably unbearable experiences imaginable.[xviii] The reality is a bit more nuanced.  

Drug addiction is not a thing, but rather a way of thinking about drug use.

In a fascinating twist of conventional wisdom, when opiate users are led to believe they are receiving opiates but in fact are not, they typically do not experience withdrawal symptoms. Conversely, when they have been led to believe they are not receiving opiates but in fact they are, they do experience withdrawal symptoms.[xix] This has been demonstrated clinically. It has also been shown to occur in real-world, illicit contexts. Such evidence suggests that withdrawal symptoms are largely psychological in nature, even when associated with drugs which are thought to be physically habit-forming.

DeGrandpre and others have described addiction as a self-fulfilling prophecy.[xx] By its very repetition it gains a type of reality. Ultimately, it is a concept that was first used by figures of authority for the purpose of social manipulation. It has since been embraced by people who use drugs in need of an explanation for our behavior. People use drugs for many reasons, but enslavement to a molecule is not one of them.

Probably the best and most thorough articulation of this situation is The Myth of Addiction by psychologist John Booth Davies. Originally published in 1992 after decades of research, Davies’ masterpiece was mostly ignored. It is no wonder why: the message it contained threatened the financial security of the massive industry which exists around the treatment of drug use. To acknowledge Davies’ findings would mean to challenge the hegemony of the current medical and political elite.

Davies wrote,

People who use drugs do so for their own reasons, on purpose, because they like it, and because they find no adequate reason for not doing so; rather than because they fall prey to some addictive illness which removes their capacity for voluntary behavior.[xxi]

The idea of drug addiction, Davies insisted, “alienates people from their own behavior and intention.”[xxii] It denies people agency over their own actions.

The concept of drug addiction “alienates people from their own behavior and intention.”

However, due to the inherent power relations of the medical establishment, such a view has actually become, in some sense, advantageous both for people who habitually use drugs and for figures of authority.[xxiii] By assigning agency to the drug rather than the self, addiction becomes an inviting idea for people in need of an explanation for various issues in their lives, in our lives. “It’s not me—it’s the drugs.” The effect is a release from responsibility, both for those of us who compulsively use drugs and for the various figures of authority around us. Through addiction, we are exempted from responsibility. It is a dangerously seductive idea.

From the moment such a notion is embraced as a functional explanation, it is perpetuated. “The very act of explaining drug use in certain habitual ways,” Davies wrote, tends to “maintain and develop a drug problem in those terms.”[xxiv] It becomes a part of a “script,” as Davies noted.[xxv] By now, it is a script familiar to all of us.

The various theories of drug addiction are not backed by science but by stereotypes.[xxvi] They are semi-functional but ultimately incorrect explanations of the mechanisms which underly compulsive drug use. Davies insisted that drug addiction is not a pharmacological phenomenon but rather a “preferred style of explanation” for a complex set of behaviors, the causes and consequences of which cannot be accurately expressed in a single theory.[xxvii]

The various theories of drug addiction are not backed by science but by stereotypes.

In simpler terms, the various theories of addiction do not adequately explain compulsive drug use. As Davies suggested,

…‘addiction’ is not so much a thing that happens to people, as a functional set of cognitions surrounding the activity of taking drugs; a way of thinking made necessary only by the sanctions with which we surround the act of using substances to change our state of consciousness.[xxviii]

Furthermore, he noted,

The more we treat drug problems as if they were the domain of  inadequate, sick or helpless people, the more people will present themselves within that framework, and the more we will produce and encounter drug users who fit that description.[xxix]

Although Davies has unfortunately passed away, his work and the underlying truth it points to are still here. Then what are we to make of it all?

For starters, we can stop using the terms addict, addicted, addicting, and addiction. The more we use these terms, the harder it will be to truly address the issues associated with drug use.

Some of us have already stopped using these words. However, the idea they represent—that of the drug user as helpless victim—has remained, cloaked in new language. For example, in 1994 the American Psychiatric Association replaced addiction with dependence in the fourth edition of their Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV. In 2013, this was again replaced by substance use disorder in the fifth edition of the text, the DSM-V.[xxx]

All of these terms have something in common with addiction: they deny people who use drugs their self-respect, integrity, and responsibility. In so doing, they contribute to rather than resolve the issues commonly associated with drug use. Although it may seem arduous, to whatever extent we hope to redress this, we must place people, not drugs, back at the center of the equation.

We must place people, not drugs, back at the center of the equation.

[Click here to see an evidence-backed 5-step plan for drug policy.]

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Footnotes

[1] The colonial opium trade notoriously depleted China’s silver holdings. However, this was not because opium drove people to destitution; it was because the European merchants who sold the opium, themselves hungry for silver, only accepted silver as payment, despite the existence of other bullion, coins, etc. which could suffice for such transactions. Financial greed, not pharmacology, is the driving factor here.

[2] Most often associated with use of needles, some have speculated whether viruses can also spread via smoking (See Dowd, “Canada study…”).

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Endnotes

[i] Szasz, 54, 56.

[ii] Hart, ibid., 12.

[iii] Kamieński, Shooting Up, xix.

[iv] Brecher, Licit & Illicit…, 64.

[v] Brecher, 64; Szasz, 6.

[vi] From Act IV, Scene III, of King Henry IV, Part 2 by William Shakespeare.

[vii] See Acker, throughout.

[viii] Szasz, 7.

[ix] Hari, Chasing the Scream, 155.

[x] Acker, Chapter 5.

[xi] Hari, 26.

[xii] Acker, throughout and Hart, ibid., throughout.

[xiii] DeGrandpre, 105; Kamieński, xix.

[xiv] Hari, 155, 298.

[xv] This observation is drawn from firsthand experience leading community discussions about drugs.

[xvi] “Addiction and Substance…”

[xvii] On tolerance and withdrawal as factors in compulsive use, see DeGrandpre, 234; on the collective fear of withdrawal, see 215.

[xviii] This is a common theme that can be found throughout the work of Acker, Davies, DeGrandpre, Hari, Hart, etc.

[xix] DeGrandpre, 122; Hari, 170.

[xx] DeGrandpre, 92-93, 99.

[xxi] Davies, xi.

[xxii] Davies, 163.

[xxiii] Davies, 139.

[xxiv] Davies, 15.

[xxv] Davies, 139.

[xxvi] Davies, 26.

[xxvii] Davies, 164.

[xxviii] Davies, 170.

[xxix] Davies, 23.

[xxx] DeGrandpre, 94; Hart, ’21, 11; “DSM History.”

[xxxi] Hart, ibid., 235.

[xxxii] Ibid., 227.

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Sources

Acker, Caroline Jean. Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control. The Johns Hopkins University Press, Baltimore, MD. 2002.

“Addiction and Substance Use Disorders.” American Psychiatric Association. https://psychiatry.org/patients-families/addiction-substance-use-disorders

Brecher, Edward, and the Editors of Consumer Reports. Licit & Illicit Drugs: The Consumers Union Report on Narcotics, Stimulants, Depressants, Inhalants, Hallucinogens, and Marijuana—including Caffeine, Nicotine, and Alcohol. Little, Brown and Company, Boston, MA. 1972.

Davies, John Booth. The Myth of Addiction. Routledge, New York, NY. 2006 [originally published in 1992].

DeGrandpre, Richard. The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture. Duke University Press, Durham, NC. 2006.

“DSM History.” American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm

Hari, Johann. Chasing the Scream: The First and Last Days of the War on Drugs. Bloomsbury Publishing Plc, New York, NY. 2015.

Hart, Carl. Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear. Penguin Press, New York, NY. 2021.

Kamieński, Łucasz. Shooting Up: A Short History of Drugs and War. Oxford University Press, New York, NY. 2016.

Szasz, Thomas. Ceremonial Chemistry: The ritual persecution of drugs, addicts, and pushers. Learning Publications, Inc., Holmes Beach, FL. 1985.

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Photo credits

Photo of various drugs and paraphernalia from The Meadows Outpatient Center: https://meadowsoutpatient.com/treatment/drug-addiction/

Photo of Andrew Mellon from Inequality.org: https://inequality.org/great-divide/mellon/

Photo of Harry Anslinger from Points: https://pointshistory.com/2016/09/27/reconsidering-anslinger-race-the-gateway-theory-and-the-origins-of-marijuana-prohibition-part-i/

Portrait of William Shakespeare from the Royal Shakespeare Company: https://cdn2.rsc.org.uk/sitefinity/images/people/the_flower_portrait_of_william_shakespeare_rsc_theatre_collection_6154.tmb-gal-1340.jpg?sfvrsn=ab8c2321_1

Handwritten caption on photo of Reid Hunt from Wikidata: https://www.wikidata.org/wiki/Q63111430

People without housing in California from the Public Policy Institute of California: https://www.ppic.org/blog/2020-census-counting-californias-homeless-population/

People without housing in West Virginia from WV Public Broadcasting, via Matthew Woitunski: https://www.wvpublic.org/wvpb-news/2022-02-01/w-va-counts-its-homeless-population

Lines of powdered drug from The Guardian: https://www.theguardian.com/society/2011/feb/24/british-drug-use-falling

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