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Substance use, substance abuse, misuse and addiction. Both legal and illegal substances are conceived by way of numerous explanatory models, labels, concepts and terms, and thus addiction and bordering concepts are hotly debated.
A podcast about international social work. Made by SocNet98, an European network of 18 universities that graduates students in social work. In this podcast you can listen to a broad specter of topics that is all connected to social work in an international perspective.
Welcome to This Social Pod, a podcast brought to you by Cygnet 98,
a network of universities sharing the common interest for social work in an international perspective.
Hi and welcome to this episode of The Social Pod.
In this episode,
we'll have a dialog between myself to the salad and Associate Professor in Mental Health Care at the University of Southeastern Norway,
and Yip Oder, Associate professor in mental health care, also at the University of Southeastern Norway.
And this dialog will evolve around the concept of addiction.
A highly debated concept. And why is that?
Helen Keen starts her book chapter off by asking Why do some people continue to drink heavily when alcohol is causing major problems in their lives?
Go sun wire, illicit drugs, users prepared to risk imprisonment in order to access their drugs.
Addiction. But also.
Substance use. Substance abuse. Substance misuse, drug use, misuse, abuse.
Why all these names? Yep. I guess that's a very difficult question to answer.
But one perspective that is offered in literature is that we can see so many different
so-called models or explanatory models of addiction in the in the in the research literature.
And so so when we when we when we study addiction or substance use or misuse of whatever you might call it, it could be a it could be a good,
good starting point, I suppose, to look at the model or the models plural that you are binding to in your research or in your frontline practice.
So I guess if we were to ask to answer that question.
The answer would depend on the model explanatory model of addiction.
When I meet students or discuss the topic addiction, drugs, substances, alcohol, it's at least to me, easy to be quite unconscious of the terms.
Uh. Addiction is one thing kind of.
But considering there are several models, you'd you'd argue that we have to be conscious when approaching the subject.
Well, I like the term conceptual awareness, but I.
And it's and it really it it it requires a it requires that both researchers and front lines are
quite theoretically advanced to actually go into the debates about about addiction and drug use,
substance use, misuse, etc. So so to to make life a little bit easier,
some researchers have have actually spent quite a lot of time trying to synthesize or or collect the various models that
are being used in both research policy and mental health practice and addiction treatment treatment practice as well.
And in fact, a number of scholars have have done so, including Keen.
That you mentioned before. But we've we've also seen other publications by, for example, Western Zimmermann being presented.
And I guess and I guess the debate around addiction and has a lot of sort of relations to other concepts in the field of of in the drug field.
But it, but it very much echoes some of the debates around mental health problems from the mental health field.
So. So if we were to look at literature on the the various explanatory models of addiction substance use,
you could argue that that that it it it resembles bordering fields like the mental health field.
And if we look at the chapter that I referred to and you referred to by Queen, she sketches out three models, I think.
And in your opinion, what's the biggest difference between these models?
Well, Keane argues that at that in literature, three types of models are dominance of objects can be very easily identified.
And she categorizes each of these as the as sort of a not diagnostic model, referring to the DSM four or five.
And she outlines what she calls the hijacked brain model and then a loss of control model that very much is a more social,
social model for good behavior in society.
And would that have a lot to do with morality morals?
Because a lot of the addiction field, um, at least in a common sense, would evolve around somehow judging other people's behaviors.
Some types of drug use or alcohol use is not okay.
It's not the way it's supposed to be used and thereby is judged as out of control or immoral in some sort.
Well, if you look at the drug field. Perhaps more more than any other field out there.
Or at least to the same extent as the mental health field, with the basic concepts used in this field such as the addiction concept.
Can be seen as as either moral or cultural or political concepts that in various ways distinguish between the the right and wrong,
the good and the bad, the the the inappropriate, the the deviant, the non deviant, and so on.
So I guess if we look at the use of these concepts, say, for example, the the loss of control model that Kean talks about,
it's very it's very obvious that sort of the the exact opposite of the the individual who has lost control over behavior,
substance use, etc., is very much contradicted by the idea of the the responsible,
the the the the citizen in control of his or her life in every in every every way, including substance use.
So so I guess the range of sort of normative ideas do do indeed inform these kinds of concepts.
And as she. Also touches upon.
Some substances are illegal, some substances are medicines if they're prescribed by a doctor.
They get painkillers. You have alcohol which is sold in a grocery store or at the Veon monopoly.
In Norway, the monopoly and others are deemed illegal.
But things also change throughout history.
Well, yeah, and they do. And their sort of status, whether or not they be legal or whether they are legal or illegal,
it also depends on national regulation, sort of alcohol politics.
An alcohol regulation differs significantly across the US and the Nordic region and and and even within the Nordic region,
Denmark and Sweden, Norway, for example, and regulations,
clinical regulations on alcohol consumption and and on citizens possibilities to buy
alcohol are regulated quite differently in accordance with sort of more values,
laws, etc. in the specific nation state.
So, so so I guess that's sort of one take on on that debate.
Another take would be that we see so many different substances, for example,
illegal substances being sort of changing their status towards more illegal and towards a more legal status.
For example, the medical use of cannabis in various context contexts is really a good
example of how some some substances and this and its and the substance status,
so to speak, can be tinkered with and does thus change.
And a third example could be. The the drug.
It's really a prescription drug in in many countries.
Ritalin. Ritalin that is commonly used to to treat people and very often adolescents as well as adults with ADHD diagnoses.
That's really being now being used in various contexts, such as in.
As performance enhancers in in business, in elite sports.
And of course, it has a sort of a the potential to be misused, so to speak, in the nighttime economy.
So so I guess that these kinds of drugs do have various uses and abuses, so to speak, and making.
And in this sense, this makes drugs. And arguably most drugs out there a sort of more ambivalent phenomena,
because they they do have they they sort of they are made significant in various ways.
So if we were to discuss them or even read or write about drug use, abuse, misuse or whatever you call it,
being conscious on which kinds of model we apply would be a beginning point.
Would you say? Well, I guess that there are a number of discussions pertaining to this, to this question.
And one is that the very notion of addiction has become a quite a stigmatizing label.
And to become an addict is very much something you become as a consequence of being categorized as an addict.
So no matter what what model is, you are sort of.
Within which you are categorized. But again.
Or perhaps even as a consequence of that in in parts of the research literature and in parts of practice treatment, practice,
we now use the term drug use to, so to speak about speak and write about this issue in a more neutral way, or at least attempt to.
And so rather than stigmatizing. Yeah, yeah.
Because calling someone or labeling someone an addict sounds quite different than someone who uses that or.
Drug or alcohol in a certain way becomes less of a label in my mind.
Yes, but I suppose categorizing some form of drug use, no matter no matter the drug as as addictive or as an addiction,
puts a very clear emphasis on a particular interpretation of the drug use that
might not meet the the intentions or the perspectives of the person using it.
So so you can use, for example, when researchers finish their doctoral thesis,
it's well known that they're quite few doctoral students have a brandy rum or have a beer or glass of wine before they go to bed,
because it's it's stressful to be in a doctoral student, especially in the last part of the year of the education.
And that would be a very utilitarian approach to to to alcohol use, although that that one could label it as addictive behavior.
So so I guess we have to be slightly wary of or at least conscious about the the unintended consequences of of using the addiction term or concept.
And one of the things that suggests, whether you like it or not, is highly debated,
but also something you almost cannot avoid is the use of diagnosis and care and also touches upon that.
And what is an addiction diagnosis? Well, I guess that in a in a very sort of puts in a very plain way.
It's it's a it's a formal diagnosis.
So it's a medical medicalised way of arguing that it's it's wrong, but that the model abides to some sort of medical logic,
implying that the addictive behavior is rooted in in the first and foremost in the biology of the individual using the drugs,
which might not be the case.
But but it's it's a very common way to talk about addiction, especially within the health field and including the mental health field.
Hmm. So so it's really one of the big models for addiction that you touched upon there.
But but but surely not the only one, and quite often is my experience.
A diagnosis isn't necessarily experienced in the same way by the person who uses drugs for some reason or another,
and the consequences, the reasons why people do it,
which most often is, I guess because they have some kind of positive outcome,
it helps out in some way or another is quite different than what you could read in a manual of diagnosis.
Yes, at least at the conceptual level, the diagnostic manuals are based on the age of the exclusion of context of contextual factors.
Yeah. So they don't take into consideration neither the intention.
So perspectives or sort of reasoning behind doing drugs,
nor does it take into consideration sort of social factors that that shape the individual's behavior.
So I guess. It's very it's a very sort of in various ways, restricted model.
But but on the other hand, of course, it's it's quite it's diagnosis and including the diagnosis and diagnoses
pertaining to addiction are or at least can be helpful tools for practitioners.
But if we were to have a sort of open up the scope a little bit,
you could argue that given that that there are so many different definitions and explanatory
models of addiction and in which or that that that in turn holds some sort of truth,
it's it's tempting to argue that neither of them sort of signal the whole truth.
So. So if you sum up that documentation, you could at least get the impression that we're not quite sure yet what addiction actually is,
although we have so many different and and very good models.
I think I've said the similar thing before, but can it be several things you think?
Yes. And I, as I mentioned before,
to come come back to the discussion around addiction and the concept of addiction or the concept of drugs being slightly ambivalent.
Yeah, sort of. They have a multitude of meanings.
They have a various significance in various contexts.
And. It's a it's a very good way, I think, to to conceptualize what is at stake when we talk about addiction and drugs, for that matter.
Yeah, And grasping real life through research, at least in my mind, has proven quite difficult or a big challenge.
You could kind of put the spotlight on something, understand something, but the big picture is harder to capture.
Yeah, I agree. But. But at least in research, as compared to a sort of treatment, treatment,
practice and research and researchers are somewhat privileged because we we get to spend more time
actually choosing sort of our conceptual take on what might be at stake in a given situation.
And this might be sort of juxtaposed by. Or in situations where practitioners need to make decisions very quickly and within
with very scarce resources and within a very limited timeframe and so on and so on.
So, so, so practitioners rarely.
Have the have very good opportunities or possibilities to actually tinker with their own
interpretations of what is at stake for the individual in the particular situation.
Although its the the explanatory models used by practitioners tend to guide or shape the choice of treatment intervention.
So this in research, I think we have better possibilities to actually refine.
Our use of of of addiction much more than than than practitioners do on a daily basis.
Yeah. And with briefly touched upon what could be considered a second field, the mental health field.
I've long struggled to see why these fields have been separated in the way they have, at least for people who use services at the mental health field.
Substance use fields or the drug field have been silos, parallel silos.
And to some extent, I would argue they are, or at least.
One field. Maybe the mental health field takes some assumptions for granted and the two fields are merged without being aware of the.
Concepts, the traditions, the history of the field.
Do you have any comment on that? Well, it's I think my comment would be that that it's an intriguing thought.
And I guess the discussion.
Um, pertaining to what you're saying would depend on whether or not you focus on how things are organized,
how treatment practices are organized, how service provision is organized, how how policy relates to different set of.
The types of interventions or subgroups. So in sort of in recent years, we've seen, at least in and in Western cultures plural,
that that that drug policy and mental health policy sort of abide to or rely on very different models when it comes to addiction and mental health,
although the models might be similar in various ways, but at the same time they do have.
They tend to signal a generic trait that and I think the French philosopher co argued that the notion of biopolitics that that
politics would be based on sort of biological medical categories with a view to to to govern various groups more efficiently,
is is a good way of viewing what is at stake. And so so if if from a sort of public or a governance perspective that you would like to govern, say,
the ill behaved those who have been think think in in in devious ways or who who act irresponsibly in terms of drinking too much alcohol,
smoking too many cigarets of doing, doing crack or whatever.
Really, it's these policies are based on on various categorizations, medical categorizations,
very often of of the target group that sort of shapes the, the and the preferred interventions at the political level.
And I think these kinds of ideas have have very much shaped the the organization
of of of of services in globally but also in the in the Nordic region and.
In ways that that might, in fact, differ a little bit across nations.
So, so so I think in response to the so some of the practical problems arising from that issue, from that kind of situation.
We've we've we've seen in recent days attempts to sort of bridge the drug field and the in the mental health field at the level of policy,
at the level of organization,
at the level of service provision and and a number of of sort of evaluations that were conducted throughout the nineties and early 2000 in the US.
And we've seen similar kinds of projects being conducted in the Nordic region over the last 15 years,
and that's very potent analysis being published in 2004 that argue that that was this,
this bridging approach was a very inefficient way of, of of organizing service provision and providing individuals with care.
And in response to that. We've seen attempts to to move or reorganize and then put sort of include the addiction
services and addiction treatment services in the mental health field more systematically,
although that this might not be without its problems. And by no means finished.
There's lots to do still. Absolutely. Yeah, I think that will be the closest thing to a conclusion.
Thank you. Yep. My pleasure.