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Education: Higher Education

America’s Mind-Altering History

Class 2. Addiction—An American Way of Life


The second class examines the evolving concept of addiction in America. If psychoactive drugs have been a part of American life for more than three centuries, so too have chemical dependencies, known by many names: inebriety, intemperance, dipsomania, narcomania, alcoholism, morphinism, and cocainism. Many 19th-century physicians saw “inebriety” as a global disease category to describe dependency to a variety of substances. Although dependence on psychoactive drugs takes many forms, today we also tend to apply a global term, “addiction,” to an individual drug user’s loss of control over his or her habit. This is particularly true when the behavior proves destructive to both the user and those closest to him or her. Contemporary challenges to the disease concept of addiction have come from many corners, but particularly from within the disciplines of psychology and sociology. In part, this is the result of the term “addiction” being applied to habitual behaviors of all stripes, when those behaviors come to dominate one’s life and to impair their ability to function normally in society.

Consider sex addiction, Internet addiction, shopping addiction, and addiction to work. Has the wide application of the term rendered it meaningless? What are the consequences of calling a self-destructive behavior a “disease” rather than a vice or moral failing? Do the challenges posed to the disease concept of addiction today differ from those posed one hundred years ago? If so, how? The materials for this class explore these questions and introduce students to the ways in which an addict’s status and identity depend not only upon the drug that he or she chooses, but also upon the individual’s demographic characteristics (gender, ethnicity, class), as well as Americans’ evolving cultural, economic, and religious values.

Class Resources
  • Courtwright, David. “The Transformation of the Opiate Addict.” In Dark Paradise: A History of Opiate Addiction in America. Cambridge, MA: Harvard University Press, 2001, pp. 110-44.
  • Kleiman, Mark A.R., Jonathan Caulkins, and Angela Hawken. “Why is ‘Drug’ the Name of a Problem?” In Drugs and Drug Policy: What Everyone Needs to Know. New York and Oxford: Oxford University Press, 2011, pp. 1-14.
  • Levine, Harry Gene. “The Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America.” Journal of Studies on Alcohol 39 (1978): 143-74.
  • Peele, Stanton. “Why Addiction is Not a Disease and Why We should care that It Not be Treated as Such.” Diseasing of America: Addiction Treatment Out of Control. Boston: Houghton Mifflin Company, 1989, pp. 1-29.
  • Rasmussen, Nicolas. “Maurice Seevers, the stimulants and the political economy of addiction in American biomedicine.” BioSocieties 5 (2010): 105-23.
  • Tracy, Sarah W. “Medicalizing Alcoholism 100 Years Ago.” Harvard Review of Psychiatry 15 (March/April 2007): 86-91.
  • White, William. “The Lessons of Language: Historical Perspectives on the Rhetoric of Addiction.” In Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800-2000, edited by Sarah W. Tracy and Caroline Jean Acker. Amherst, MA: University of Massachusetts Press, 2004, pp. 33-60.

Discussion Questions
  1. How do gender and class—i.e., socioeconomic status—affect the definitions of inebriety proposed by Thomas Crothers and Benjamin Rush? How does the definition of addiction today also reflect certain gender and class biases? Think about popular images of addicts and alcoholics portrayed in movies such as “Leaving Las Vegas” or “Requiem for a Dream.”
  2. Iatrogenic addiction is addiction caused through the use of drugs prescribed by physicians. Courtwright addresses the changing face of opiate addiction in the 19th and 20th centuries. Does the recent controversy over Oxycontin (oxycodone) prescription and abuse offer a comparable example to opiate addiction in the late 19th century? Why or why not?
  3. How do the demographics of using and addicted populations influence legal, penal, and treatment options for addicts? Consider both the case of the opiate addict and the more contemporary example of the difference between the penalties for crack and powder cocaine use. Why do you think this treatment has or has not changed over time?
  4. What is the strongest argument for considering addiction to psychoactive substances a disease? What is the strongest argument not to consider such addictions as a disease? How and at what point do you think addiction becomes a disease?
  5. How would you make the argument that addiction is a particularly American disease? Consider the nation’s consumer culture, changing gender roles, the fast pace of American life, the focus on individual achievement, the power of the American medical profession, the role of drugs in everyday life, and other salient characteristics of American society.
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