Introduction to Volume 1: The Many Faces of Addiction

Angela Browne-Miller, PhD, DSW, MPH

Th is is Faces of Addiction, Th en and Now, volume of Th e Praeger International

Collection on Addictions. Here we bring together a collective understanding of
addiction as we know it today. Studying this worldwide epidemic of addiction in all
its forms, we see a troubling tide sweeping the planet and hope to turn it back. W e
begin part of this volume, Perspectives, with the public health perspective on
addiction as set forth by Elaine R. Feeney, PhD, RN, of the Foundation for Addictions
Nursing in Baltimore, Maryland, United States, in chapter , Addiction as a Public
Health Issue. Feeney carefully establishes this public health perspective on
addiction, one which we cannot deny and cannot a ord to ignore. After all, your
health is my health, and vice versa. Population and public health and individual
health are inextricably linked. While perhaps dauntingly intricate to measure, and
seemingly subtle, almost invisible, this linkage is profound. Feeney urges that we
press for a strong public health approach to addiction: By conceptualizing the
substance abuse/dependence problem in this country as a public health issue, we
might be able to identify possible solutions from the public health perspective as
well. Clearly the individual focus has failed, and we cannot a ord to continue to
allocate resources to initiatives that are unsuccessful. It is my belief that where the
problem can be viewed in a population context, the solutions can also be found. W
e then turn to chapter , Cross-Cultural Issues in Substance Addiction Research
Including Black Americans and Latinos, contributed by Julia F. Hastings, PhD, MSW,
from the School of Social Welfare, University of

xviii Introduction to Volume 1

California Berkeley, in Berkeley, California, United States. Hastings points out that
social science researchers are under great pressure to address racial and cultural
diversity; however, culturally informed research is not easily accomplished.
Addressing outcomes according to race or ethnicity does not ensure cultural
understanding of addiction. It remains to be seen whether social science research,
and research on addiction, will fully recognize and de ne the di erences between
race and culture. Hastings notes that, while it is often said that African Americans,
Caribbean Blacks, and Latinos su er more adverse health conditions from
substance addictions than the White population, we must ask what this statement
is actually telling us. Hastings comments, Th ough identifying many health
conditions and their racial di erences is important, many other factors associated
with substance addiction can impinge on higher substance addiction problems. True,
other factors include poverty status, education, unemployment, families in crisis,
psychiatric problems, little or no insurance coverage, and public program assistance
limitations. Yet the one factor that many researchers and government documents
focus on is race and ethnicity. Identifying with a group is important to all people. A
group de nes who we are and how we envision our place in the world. Above all,
we all belong to many groups. In working to analyze and treat addiction, we cannot
a ord to overlook the limitations of a focus on race and ethnicity to the exclusion of
an e ective operationalization of culture itselfits norms, beliefs, and distributions
of power and roles. Next, we look at Race, Ethnicity, and Early U.S. Drug Policy in
chapter , by Sean R. Hogan, PhD, MSW, of the Department of Social Work,
California State University Fullerton, in Fullerton, California, United States.
Perceptions and de nitions of addictions have evolved over time, with dramatic
shifts in theories and in biases occurring in the twentieth century (and even now in
the early twenty- rst century). Hogan provides important examples, one being that
opium use was once associated with Chinese immigrants and that this prejudice
was actually associated with the rst antidrug legislation in the late s. Long
after, Hogan writes, a signi cant shift in public perception and, consequently, the
strategies designed to address substance use occurred when American society
began to distinguish recreational, or nonmedical, drug use from that of drug use
initiated and prescribed by physicians. Here we see that public perception and
public policy regarding substance use can be fueled by prejudice and bias, a
tendency which may still to this day be having lasting e ects on the formation of
drug policy. Th is report (albeit perhaps inadvertently) brings to the table additional
issues and questions: once recreational use is set apart from prescribed use, we are
forced to decide whether any recreational use is acceptable, and, if so, what use by
whom, and in what amount? Boundaries between categories of use are particularly
di cult to establish and maintain. We are also compelled

Introduction to Volume 1 xix

to note that legal recreational use is perhaps immune to the moral imperative. And
here we have it, the slippery matter of moral imperativewhat forms this
imperative always being the elephant in the room, the presence we hardly see. In
chapter , Martha Romero Mendoza, PhD, of the National Institute of Psychiatry, in
Mexico D.F., Mexico, contributes her insights into Gender Inequalities and Inequities
among Women with Substance Abuse Problems. Romero Mendoza explains that
health inequalities are avoidable and unnecessary. Yet, with the majority of
addiction research being based on male experience, and based on a gendered
society, we are in need of balancing perceptions and understandings of gender di
erences and similarities. We must be cautious as to the e ects of our research
paradigms and consequent ndings, for, in Romero Mendozas words, social
inequality and the bias that arises from it at the moment of the research are
perpetuated through social hierarchy preservation, that is, power relationships.
Here we have the added dimension of genderthe very necessary dimension of
addiction research and treatment. F ollowing this brief look at matters of diversity,
we step back in chapter to look at Ethical Th eory and Addiction, by Ann N.
Dapice, PhD, of T. K. Wolf Inc., a Native Americanfocused addiction treatment
program in Tulsa, Oklahoma, United States. Dapice emphasizes that the higher
levels of moral reasoning must be developed in both addiction treatment
professionals and persons who are addicted once into their recoveries. (I emphasize
here that Dapice includes professionals.). Dapice also notes that moral development
is hijacked by addictive substances and behaviors, something we must pay closer
attention to in our work. Connecting a few dots here, we might add that if moral
development is impaired by addictive substance use, then how responsible is the
user from a moral standpoint? Can sound moral judgments be made by an impaired
moral function? Chapter , Th e Religious and Th eological Roots of Alcoholics
Anonymous, by Rev. Linda Mercadante, PhD, of the Methodist Th eological School
in Delaware, Ohio, United States, delves deeply into the theological roots of the
Alcoholics Anonymous (AA) -Step Recovery Program. Mercadante unearths, via a
colorful historical and analytical review, a key dichotomy in the disease versus sin
or moral failing views of addiction to alcohol. Mercadante places the -Step AA
approach in the historical context of the Christian evangelistic Oxford Group, which
hit its peak in the s and s; AA founder Bill Wilson was once a member.
Th ese roots continue to inform the -Step method of addiction recovery,
including the focus on sin and conversion in recovery from addiction. Clearly,
recognizing what informs any approach to addiction, seeing the evolution of any
philosophy of addiction and its recovery, is essential as we move forward in working
to respond to addiction.

xx Introduction to Volume 1

C asting another light on this matter of addiction, part of this volume concludes
through chapter with a report by Jemel P. Aguilar, PhD, MSW, from the School of
Social Work, University of Texas at Austin, in Austin, Texas, United States, titled
Adolescent Drug Sellers and Distributors. Aguilar urges us to be aware that, in his
words, with the growing numbers of youth entering into the juvenile justice system
because of drug-related crimes, it is important that researchers and practitioners
have a better understanding of the dynamics of youth drug selling and distribution
so that more e ective interventions can be developed to prevent youth from
becoming active drug sellers and distributors and/or stem youth involvement once
they enter into this economy. Only this awareness can open our eyes to truly
understanding what is going on, and our arms to helping to do something about it. P
art , Dimensions, begins with a look at Historical Aspects of Alcohol Use in India:
Role of Culture and Gender, chapter , contributed by Meera Vaswani, PhD, Atul
Ambekar, MD, and Ramandeep Pattanayak, MD, all from the National Drug
Dependence Treatment Centre, Department of Psychiatry, All India Institute of
Medical Sciences, in New Delhi, Delhi, India. Th is chapter looks at the historical and
cultural context of alcohol use in India, reaching as far back as b.c. and
building through the eras into present-day alcohol use issues. Th e authors of this
chapter note that alcohol use among women remains understudied in Indian
literature; cultural attitudes toward womens alcohol use may be preventing them
from reporting alcohol use and abuse. Again, the importance of gender-sensitive
addiction research is highlighted. W e then, in chapter , turn to Alcohol and Drug
Abuse in Malaysia, contributed by See Ching Mey, PhD, MEd, from the School of
Educational Studies, Universiti Sains Malaysia in Pulau Pinang, Malaysia, and Cecilia
A. Essau, PhD, MA, HBA, of the School of Human and Life Sciences, Roehampton
University, Whitelands College, in London, England. Mey and Essau report that the
data they have reviewed indicate that Malaysia is the th largest consumer of
alcohol in the world. Marketing approaches hard sell alcohol to Malaysians via
several means not allowed in many Western nations, including particularly heavy
forms of ethnic targeting loaded with health claims, such as the Guinness
Stout campaign including the slogan Guinness Stout is good for you. Additionally,
Malaysia has identi ed drug use and tra cking as a security problem, one which
is increasing, with an overwhelming majority of all drug addicts in Malaysia being in
the - to -year-old age group. N ext, in chapter , we look at Alcohol Use
and Binge Drinking in Cyprus, by Xenia Anastassiou-Hadjicharalambous, PhD, of
the Department of Psychology, University of Nicosia, in Nicosia, Cyprus, and Cecilia
A. Essau, PhD, MA, HBA, and George Georgiou, PhD, both at the School of Human
and Life Sciences, Roehampton University, London. Archaeological evidence

Introduction to Volume 1 xxi

suggests that the grapevine has been cultivated and wine has been made in Cyprus
for at least , years. Th e authors of this chapter report that their ongoing study
indicates that today, about one-third of young adults in Cyprus binge drink on a
regular basis, with a wide range of social and personal problems attending this
behavior. Directions for future research are suggested. From here, Anna
Bokszczanin, PhD, from the University of Opole (Uniwersytet Opolski), in Opole,
Poland, and Cecilia A. Essau, PhD, MA, HBA, and Jean OCallaghan, PhD, from the
School of Human and Life Sciences at Roehampton University, London, share with
us Alcohol Use and Abuse in Poland as chapter . In recent decades, alcohol
use and abuse have increased in Poland, parallel to the privatization of the market
there, after years of markedly low alcohol consumption. Directions for treatment
and prevention are reviewed and hope is o ered. Questions come into focus
troubling questions. Can we say that the privatization of the market is largely
responsible for what has happened in Poland? If yes, is this e ect consistent across
cultures around the world? If not, what other factors were present and are relevant?
For example, do speci c characteristics of the regulation of alcohol advertising and
distribution make a di erence? Chapter , Alcohol Consumption and Binge
Drinking in the United Kingdom, is contributed by Cecilia A. Essau, PhD, MA, HBA,
Changiz Mohiyeddini, MD, PhD, and Diane Bray, PhD, of the School of Human and
Life Sciences at Roehampton University, London. As in many societies, alcohol use is
found to be an acceptable part of social interaction in the United Kingdom. Of great
concern is the high cost of prevalent binge drinking in the United Kingdom. Th e
authors of this chapter note that there is a need to balance policies that promote
public health with those that promote economic interests. Is this a tension that
cannot be worked through to support both sides of this dilemma? Alcohol Use and
Abuse in Germany, by Changiz Mohiyeddini, MD, PhD, Cecilia A. Essau, PhD, MA,
HBA, and Regina Pauli, BSc, PhD, all of the School of Human and Life Sciences at
Roehampton University, London, is chapter . Here we read more about modern-
day alcohol use in developed countries, seeing the great cost of this use and abuse,
and at the same time the great investment the alcoholic beverage industry has in
the consumption of alcohol. For example, in Germany, where the legal age for
alcohol consumption is (typical of many European and other nations, and unlike
the United States general legal age of ), television advertising aimed at young
people utilizes bright colors, youthful music, and high action to attract young people
and new consumers of alcohol. Th is is taking place even though alcohol advertising
targeting young people in the European Union (EU) is controlled by means of rules
suggested in the European Council Recommendation that was adopted on June ,
, by the EU Health Ministry.

xxii Introduction to Volume 1

We conclude part with chapter , From British India to the Taliban: Lessons
from the History of the Heroin Market, by Kathryn Meyer, PhD, from Wright State
Universitys Department of History in Dayton, Ohio, United States. Meyer reports
that the plan of Pino Arlacchi (who became head of the United Nations International
Drug Control Program in ) was to eradicate narcotics worldwide. Arlacchi
traveled to Afghanistan as part of a global plan to replace drug crops with
alternative industries, yet poppy production continued in Taliban-controlled areas.
Meyer weaves the story of a complex political and economic scenario surrounding
heroin. Never is the problem of addiction free of politics and economics. P art ,
Aspects, includes a collection of chapters sampling aspects of addiction and some
of its many faces, beginning with chapter , Youth Tobacco Use: Its Health E
ects, Trends in Smoking Rates, and Reasons Why Kids Use Tobacco, by Clete Snell,
PhD, at the School of Juvenile Justice and Psychology, Prairie View A&M University in
College Station, Texas, United States. Snell reports that the life stage of adolescents
is a strong predictor of cigarette and tobacco use, with the transition between
elementary and high school being the period of greatest risk for the onset of youth
tobacco use. What may drive youth tobacco use is the young persons risk-taking
behavior, desire for stress reduction, desire to look older, longing to relieve
boredom, and peer pressure. Next we hear from Va Nee L. Van Vleck, PhD, of the
Department of Economics in the College of Social Sciences at California State
University Fresno, in Fresno, California, United States, and Th omas K. Green eld,
PhD, at the Alcohol Research Group, in Emeryville California, United States, who
report on their study in chapter , Brewing Trouble: Some Employment
Implications of Regular Malt Liquor Beer Consumption. Van Vleck and Green eld
examine the association between regular use of malt liquor and poor employment
conditions, including unemployment. Van Vleck and Green eld also note that
patterns of alcohol dependence are similar to those of chronic diseases, the latter of
which they remind us are value-neutral. Th e so-called blame for the physical
illness is far less than the blame for the addiction, although addiction can also be a
physical illness and surely is a physicalwhere physical includes the brain and
other parts of the bodyillness. We then hear, in chapter , from David T.
Courtwright, PhD, from the University of North Florida, in Jacksonville, Florida,
United States, in his chapter titled Th e Roads to H: Th e Emergence of the
American Heroin Complex, . Here Courtwright reviews the history of
heroin in the United States as a model of the impact of novel psychoactive drugs. A
new drug promises a range of therapeutic usages and then is debated per these
claims. Eventually, the drug slips out of control and into the hands of the general

Introduction to Volume 1 xxiii

population. And then, predictably, government must intervene to control the drug.
Th is is the way heroin emerged into modern times, as a product of Bayer
Pharmaceutical Company in the late s. In the decades that followed, a signi
cant underground and underworld interest in heroin developed. By the s, the
U.S. federal government had outlawed the manufacture of heroin, listing it as the
rst o cial Schedule I drug, meaning that it was totally prohibited, except for
research purposes. Having escaped the realm of healing for that of self-
indulgence, heroin has made its way through time and into the veins of far too
many, leading the way for other novel drugs. A consequent, or perhaps parallel,
history emerges in the history of the treatment drug for heroin addiction:
methadone. Herbert D. Kleber, MD, of the Department of Psychiatry and the
Division on Substance Abuse, Columbia University, in New York, New York, United
States, reviews Methadone: Th e Drug, the Treatment, the Controversy in chapter
. Weaving the history and politics of methadone, we see that some things work
perfectly but not at all well. Here methadone maintenance as the antidote to heroin
addiction is both lauded and revealed for its shortcomings and attending
controversies. And of course, here the administration of one drug is done to curb
response to another. Is one addiction purposefully replacing another? N ext we
consider another addictive drug, methamphetamine, as no sampling of work on
addiction can overlook this drug in our times. Chapter considers this drug in
Prevalence of Use and Manufacture of Methamphetamine in the United States: Is
the Sky Falling, or Is It Not Really a Problem? by Herbert C. Covey, PhD, of the
Adams County Social Services Department and the College of Continuing Education,
University of Colorado at Boulder, Boulder, Colorado, United States. Covey reminds
us that unlike other illicit drugs, meth does not have to be imported into the country
and can actually be homemade. We have all heard of the meth lab, and this is
where it all happens. Mary F. Holley, MD, of the national organization Mothers
against Methamphetamine in Arab, Alabama, and the Alabama State Attorney
Generals Methamphetamine Task Force, Alabama, United States, adds to this
discussion of methamphetamine (also known as "crystal meth" and "ice") use, o
ering chapter , Interaction between Methamphetamine Use and HIV Infection.
Holley points out that methamphetamine use is associated with higher rates of
sexually transmitted diseases (STDs), speci cally the most deadly STD, HIV. Where
we go from here, once we see what meth can do and is doing to many cultures of
the world, is perhaps the question of the hour. Th e fascinating and illuminating
chapters following this introduction open Th e Praeger International Collection on
Addictions and compose volume , Faces of Addiction, Th en and Now. Th ese
chapters o er a striking and disturbing cross section of addiction today and set the
stage for the volumes that follow.

xxiv Introduction to Volume 1

O f great concern is the degree to which human addictiona condition, an a

iction, a maladyis a read on the state of the species. Th ere is hope, however. We
are responding as a species, around the globe, on all levels, in all professions, from
all religions, world views, from all philosophical standpoints, from all walks of life.
We have called ourselves to action and have heard the call. We know that no single
theory, policy, philosophy, or religious approach alone can solve this problem, let
alone de ne it. To this end, the International Substance Abuse and Addiction
Coalition (ISAAC) authored its October Red Sea Declaration, which ISAAC has
been generous enough to share within this publication. We include this declaration
here, in full recognition that there are other statements by numerous other
organizations that at some future point we may also have the opportunity to share.