Sociology of Addiction

The Sociology of Addiction examines the complex interplay between societal factors and individual behaviors related to substance use and addiction. This field recognizes addiction as a widespread global issue, with millions affected by alcohol and drug abuse, leading to significant health crises and societal costs. Key to this analysis is understanding that addiction is not merely a personal failing but a chronic condition influenced by both biological predispositions and environmental contexts, such as socioeconomic status, peer influences, and parenting styles.

Research indicates that addiction often begins in adolescence, with social and psychological maladjustments contributing to a higher risk of substance use. The stigma surrounding addiction complicates treatment efforts, as individuals may be viewed through negative stereotypes rather than as individuals with a health condition. Treatment approaches are varied, combining behavioral therapies with pharmacological interventions, highlighting that effective recovery typically requires ongoing support and understanding.

Preventive measures are crucial, especially among youth, as early substance use can lead to long-term consequences in academic and personal development. By addressing the biological and environmental components of addiction, society can implement targeted interventions to reduce the prevalence of addiction and support those affected in achieving recovery.

Published in: 2024

By: McMahon, Maureen | Howson, Alexandra

Subject Terms

Sociology of Addiction

Abstract

According to the World Health Organization (WHO), addiction is a worldwide problem. Indeed, more than 15.3 million people confront drug abuse issues internationally, and the abuse of alcohol results in 3 million deaths every year (World Health Organization, 2022). A British Social Trends report (2002) notes that drinking, smoking, and drug addictions are rising in the United Kingdom, especially among young people, with more than 50 percent of teenage boys consuming these substances regularly by the age of fifteen. In the United States, the incidence of addiction is so high that there are insufficient trained professionals to assist those affected by drug abuse, precipitating a crisis in treatment. "Fewer than one-fourth of the persons in need of alcohol and drug abuse services in the United States actually receive treatment" (p. 60, as cited in American Psychiatric Association, 2008). In 2021, fewer than 1.1 percent of the 40.7 million people ages 12 and older in the United States with a substance abuse or alcohol disorder received some sort of rehabilitation. Yet, according to WHO, such rehabilitation is cost-effective, saving seven dollars in "health and social costs" for every one dollar invested in drug treatment programs. The establishment and endorsement of addiction prevention and treatment programs are somewhat compromised by debates and controversies over cause.

Overview

Defining Addiction. Addiction is "a chronic relapsing illness with onset typically occurring in the early teenage years, followed by cycles of drug use and abstinence" (Elkashef, Biswas, Acri and Vocci, 2007). The source of addiction is complex and entails interactions between biological factors (specifically genes) and environmental factors. Some research suggests that some people are born with a higher tendency to become addicted. According to this argument, addiction is a biological disease, much like diabetes or hypertension, and acquiring the tendency (or predisposition) to addiction is as much out of a person's control as the predisposition to some other diseases.

Alternately, the environment in which people develop (including how they are parented, their socioeconomic status of origin, peer group influences, traumatic or stressful experiences, and their levels of education) produces protective or risk-enhancement effects. While many laypeople may view addictive behavior as a choice, there is a growing consensus that both biology and environment are factors in addiction.

Nonetheless, even with explanations about brain chemistry and genetic predisposition, certain stereotypes of addiction prevail: the beggar on skid row or the drunk driver. Those images are powerful, and scientific jargon does not erase them from the cover of newspapers or the lead story on the six o'clock news. Concomitantly, Alan I. Leshner notes the difficulty in addressing such stereotypes:

One major barrier [to treatment] is the tremendous stigma attached to

being a drug user or, worse, an addict. The most beneficent public

view of drug addicts is as victims of their societal situation.

However, the more common view is that drug addicts are weak or bad

people, unwilling to lead moral lives and to control their behavior

and gratifications … We need to face the fact that even if the

condition initially comes about because of a voluntary behavior

(drug use), an addict's brain is different from a nonaddict's brain

… Recall that as recently as the beginning of this century we

were still putting individuals with schizophrenia in prison like

asylums, whereas now we know they require medical treatments (par.

4).

Amphetamine-type stimulants are the second most widely abused drugs worldwide, after cannabis. According to the WHO Report on the Global Tobacco Epidemic, more than 1.3 billion people worldwide smoked tobacco as of 2022, and tobacco kills nearly eight million people each year. In many instances, people who become addicted first use substances voluntarily. As Linda S. Cook (2001) noted, most teenagers have used some substance by the time they turn eighteen. One study on the lifetime prevalence of drug use among a cohort of people in the United Kingdom (which tracked use over twenty years) found that drug use, in general, rose from 9 percent at the age of fifteen to 58 percent by age twenty-three.

Many of those who are addicted to drugs go through a cycle of abuse and recovery that is difficult to explain. As Leshner observes:

Many people equate addiction with simply using drugs and therefore

expect that addiction should be cured quickly, and if it is not,

treatment is a failure. In reality, because addiction is a chronic

disorder, the ultimate goal of long-term abstinence often requires

sustained and repeated treatment episodes (p. 10).

This cycle of repeated treatment and relapse is difficult for individuals with addiction, their families, and the general public to understand and can also be viewed as an excuse for an addicted person's behavior. Davies notes that the biological source of addiction may be accepted for the wrong reasons as a means to absolve people who behave badly because the disease is out of their control.

Further Insights

Neurobiology. The biological explanation for addiction is based on research linking addiction to significant changes to brain chemistry caused by repeated substance use. Different kinds of drugs produce particular responses in precise areas of the brain, although the mechanisms underpinning these responses vary, as do the outcomes. For instance, Leshner notes:

Virtually all drugs of abuse have common effects, either directly or

indirectly, on a single pathway deep within the brain …

Activation of this system appears to be a common element in what

keeps drug users taking drugs. Not only does acute drug use modify

brain function in critical ways, but prolonged drug use causes

pervasive changes in brain function that persist long after the

individual stops taking the drug … The addicted brain is

distinctly different from the nonaddicted brain, as manifested by

changes in brain metabolic activity, receptor availability, gene

expression, and responsiveness to environmental cues … That

addiction is tied to changes in brain structure and function is what

makes it, fundamentally, a brain disease (p. 45).

According to Nora Volkow, the long-time director of the National Institute on Drug Abuse (NIDA), the recognition of addiction as a biological disease has not only changed the way of thinking about addiction for the scientific community but also the options for treatment.

When science began to study addictive behavior in the 1930s, people

addicted to drugs were thought to be morally flawed and lacking in

willpower. Those views shaped society's responses to drug abuse,

treating it as a moral failing rather than a health problem, which

led to an emphasis on punitive rather than preventative and

therapeutic actions … addiction is a disease that affects

both brain and behavior. We have identified many of the biological

and environmental factors and are beginning to search for the

genetic variations that contribute to the development and

progression of the disease (Volkow, 2008, n.p.).

Genetics.In addition to biochemical factors and the cycle of addiction outlined above, according to D. Ball, M. Pembrey, and D. Stephens, genetics is also a causal factor linked to addiction. For instance, they note:

Twin and adoption studies show that genetics contributes (along with

environment) to our vulnerability to different types of addiction,

probably via genes that regulate the metabolism of psychoactive drugs

and the brain neurotransmitter systems on which they act (as cited in

Hall, 2006, p. 1530).

To clarify any confusion about genetics, though, Hall makes the distinction that,

…it is not the case that if you have 'the gene' you will become

addicted and if you do not then you will not. Instead, addiction is

most likely to be a polygenic disorder that results from interactions

between the environment and the effects of a large number of genes

… that affect a variety of personal characteristics such as:

drug metabolism, levels of brain neurotransmitters and transporters,

preparedness to use drugs, school performance, susceptibility to

peer influence, and so on (2006, p. 1530).

Biology & Environment. Focusing on the combination of biology and environment, J. Shedler and J. Block conducted a longitudinal study to look at drug use in relation to psychological characteristics. Specifically, they assessed both ego and cognitive development during seven different interviews with each of the 101 participants at ages three, four, five, seven, eleven, fourteen, and eighteen years. Shedler and Block note that at the age eighteen interview:

Of the 101 subjects for whom information about drug use was

available, 68 percent had tried marijuana … 39 percent … reported

using marijuana once a month or more, and 21 percent reported using it

weekly or more than weekly (p. 196).

Based on this data, the researchers created the following three categories of participants, frequent users, abstainers, and experimenters, and they were able to make comparisons based on information they collected over the fifteen-year period of the study.

Throughout most of the study, frequent users displayed characteristics that were unique when compared to subjects in the other two categories. For instance, frequent users were identified as:

Not dependable or responsible
Not productive
Deceitful
Opportunistic
Unpredictable
Unable to delay gratification
Rebellious and non-conforming
Feeling cheated and victimized by life
Having fluctuating moods.

When compared with subjects who had experimented with marijuana, the subjects in the frequent user group were identified as having adverse characteristics at the age eighteen interviews. Furthermore, "the frequent users appear to be relatively maladjusted as children. As early as age 7, the picture that emerges is of a child unable to form good relationships, who is insecure, and who shows numerous signs of distress" (p. 200). As children, these subjects exhibited similar characteristics as when they were eighteen.

In addition to assessing the child participants in the study, Shedler and Block also assessed the participants' mothers and observed that "compared with the mothers of experimenters, both the mothers of frequent users and the mothers of abstainers were perceived to be cold, critical, pressuring, and unresponsive to their children’s' needs" (p. 205). Such research suggests that how a person is treated by his or her primary caregiver when he or she is a child will most likely affect the way he or she behaves in later life, although it is not certain how that behavior will manifest. What is clear from this research, however, is that "the relative social and psychological maladjustment of the frequent users predates adolescence, and predates initiation of drug use" (p. 200). It is probable that drug use leading to addiction is most likely the symptom of a greater issue.

Viewpoints

Blame & Biology. One of the problems with addiction is that many people do not understand it and place blame on those who are addicted. Attribution theory explains the rules that people use to infer the causes of behavior. While people tend to attribute their own behaviors to their social circumstances (or environment), they attribute other people's behaviors (especially socially problematic behaviors) to personality or biology.

John Monterosso, Edward B. Royzman, and Barry Schwartz tested attribution theory in a study to determine if people would be more willing to accept negative behavior if it were the result of physiology (biological make-up) rather than experience (environmental factors). Almost two hundred subjects participated, with an almost even split between university undergraduates (n=96) and middle-class White adults in a suburban area (n=100). The participants were presented with several written scenarios that depicted characters intentionally behaving in negative ways. Each scenario randomly offered one of two explanations for the character's behavior, and participants were asked to determine whether they thought the behavior was voluntary. For instance, in one scenario, a man killed a store clerk in an argument. The explanation given for this behavior was that either he had an exceptionally high quantity of a particular neurotransmitter or had a history of being severely abused as a child. The researchers were not surprised by their findings:

Observers judged actors as less responsible for misdeeds explained

physiologically than for those explained experientially …

Physiological explanations resulted in … less judged volition,

greater sympathy, greater blame mitigation, more positive treatment,

and a greater expressed likelihood by the participants that they

would also behave in the undesirable way if the antecedent were true

of them (Monterosso, Royzman & Schwartz, 2005, p. 150).

Specifically, one of the participants explained, "I don't think it can be willpower or character if it is a brain thing" (Monterosso, Royzman & Schwartz, 2005, p. 153). In other words, the characters in the scenarios were considered less responsible for their actions—even when they murdered someone—when a physiological basis rather than an environmental basis was cited as the reason for their actions. In addition, subjects in the study felt sympathy for the characters based on the circumstance of biology.

Treating Addiction. There are three main approaches to treating addiction: behavioral (cognitive behavioral therapy or motivational enhancement), pharmacologic, and immunologic therapies, such as vaccines, especially for stimulant use disorders and nicotine addiction.

Research in the field of genetics suggests that there are biological underpinnings to drug abuse disorders and, concomitantly, biological markers that can be identified (for instance, through brain imaging techniques) and used to plan more precise treatment regimes. However, the routine use of genomic medicine is limited until future research further develops a proper methodology. In the meantime, there is no magic treatment for substance addiction, and while many people find success with twelve-step programs, in-patient programs, outpatient programs, or a combination of any of these, no program offers individuals suffering from addiction or their families a guarantee of sobriety.

Indeed, treatment for addiction is as complex as the causes of addiction and typically includes a mix of pharmacologic (e.g. nonaddictive stimulant substitution, such as nicotine replacement products) and behavioral/psychological therapy, such as motivational enhancement and cognitive behavior therapy, which focuses on "patterns of thinking that are maladaptive and the beliefs that underlie such thinking" (NAMI, n.d.).

However, according to Wayne Hall, Lucy Carter, and Katherine Morley, neuroscience research offers hope that a cure and possibly even a vaccine for addiction may eventually be developed. Such research:

… may lead to more effective ways of helping drug-dependent

people to withdraw from their drug of dependence and it may increase

their chances of remaining abstinent (Koob, 2000). We may also have

immunological prostheses for relapse prevention — 'drug

vaccines' — that help former addicts remain abstinent by

preventing their drug of choice from acting on receptors in their

brains during the period when they are most vulnerable to relapse

(Fox, 1997; Hall, 2002) (Hall, Carter & Morley, 2003, p. 867).

Progress has been made in these efforts in the twenty-first century with the introduction of medications like naltrexone, marketed under the brand name Vivitrol. Vivitrol was approved by the Federal Drug Administration (FDA) in 2006 for the treatment of alcohol use disorders and works by reducing the craving for alcohol. In 2010, the FDA approved the drug for use in those with opioid dependency. An injection of naltrexone blocks opioid receptors making the pleasurable effects of the opioids impossible to feel. Since this medication works on neurotransmitters and receptors in the brain, it is hopeful it is a step towards more vaccine-like treatments.

Preventing Addiction. Addiction has a very good chance of ruining a young person's life. In a study looking at criminal behavior and adolescents, F. A. Esbensen, D. Huizinga, and S. Menard identified that "chemical dependence played a greater role in the number and types of crimes committed than criminal behavior did in the development of addiction" (as cited in Cook, 2001, p. 151). What is even more alarming is that substance use among this population is pervasive. Cook notes statistics gathered by the National Household Survey on Drug Abuse from 1995 to show how prevalent substance abuse is within this population.

By the age of fourteen, over one-third of the student population has tried an illegal drug. The numbers rise to 46 percent by the age of sixteen and 52 percent by the age of eighteen. The figures for alcohol use are higher: 55 percent of fourteen-year-olds, 71 percent of sixteen-year-olds, and 81 percent of eighteen-year-olds. For those children who do become dependent upon drugs or alcohol, however, the consequences are devastating. All aspects of the child's life are affected. Academic performance typically drops as absenteeism increases. Hawkins, Catalano, and Miller (1992) allude to an increased school dropout rate among adolescent drug users. The cessation of education places limits on the child's future employment and earning potential, making it more difficult to support oneself and making poverty more likely (Cook, 2001, p. 152).

According to the 2021 National Survey on Drug Use and Health, 5.9 million adolescents between the ages of twelve and twenty were current alcohol users, and 2.7 million adolescents aged twelve to seventeen were current users of illicit drugs. The link between substance abuse and criminal behavior should make it clear that a population so impressionable needs intervention before abuse or dependence is an issue, as recognized by campaigns such as the National Youth Anti-Drug Media Campaign. Researchers know that just because children inherit a predisposition to addiction does not mean that they will become addicted. Nor can anyone be sure that being neglected as a child leads to life-avoidance patterns such as substance abuse. However, what is known is that links have been made between biological and environmental factors. With that knowledge, society as a whole—doctors, psychologists, educators, and neighbors—can focus resources on those youth who are predisposed to dependency before the disease takes over their lives.

Terms & Concepts

Abstinence: Restraint from a behavior or activity.

Abuse: Using something in a harmful (often habitual) way.

Addiction: Being physiologically or psychologically dependent on a drug or habitual behavior.

Chronic: An illness or condition (often medical) that lasts over a long period of time and which can cause changes in the body.

Compulsion: The inability to resist a desire to do something.

Disease: A disorder that is pathological in nature.

Predisposition: Susceptibility to an illness or disease based on genetic factors.

Relapse: A return to undesirable behavior that was once stopped.

Volition: The ability to make choices, whether positive or negative.

Essay by Maureen McMahon, MS; Reviewed by Alexandra Howson; Edited by Alexandra Howson

Maureen McMahon received her bachelor's degree from the State University of New York at Plattsburgh where she studied English. Her master's degree in curriculum development and instructional technology was earned from the University of Albany. Ms. McMahon has worked in higher education administration for eight years and taught composition and developmental writing for the past six. She resides in Plattsburgh, New York with her husband and two children.

Alexandra Howson, PhD, taught sociology for over a decade at several universities in the United Kingdom. She has published books and peer- reviewed articles on the sociology of the body, gender, and health and is now an independent researcher, writer, and editor based in the Seattle area.

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Sociology of Addiction

On this Page

Subject Terms

Sociology of Addiction

Abstract

Overview

Further Insights

Viewpoints

Terms & Concepts

Bibliography

Suggested Reading