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Keywords:

  • Dependence;
  • medicalization;
  • power

Social science loves playing with meanings, labels, social definitions, claims and messages. Those who have enough power to rule have first of all the power to name people, things or phenomena. In the contemporary world, the authority of science is often used to legitimize defining or re-defining social issues as to secure or to derail existing social order. As Foucault put it:

Knowledge linked to power, not only assumes the authority of ‘the truth’ but has the power to make itself true. All knowledge, once applied in the real world, has effects, and in that sense at least, ‘becomes true’. Knowledge, once used to regulate the conduct of others, entails constraint, regulation and the disciplining of practice. Thus, there is no power relation without the correlative constitution of a field of knowledge, nor any knowledge that does not presuppose and constitute at the same time, power relations ([1], p., p. 27).

In fact, the communication of scientific findings is a machinery in which relations of power are constructed, displayed, re-constructed and petrified.

Being generally in agreement with Cunningham & McCambridge's [2] vision that narrowing the scope of alcohol problems to dependence being understood as a chronic, re-occurring disorder has numerous disadvantages; however, I am not convinced by their argument as presented in the paper. First of all, a concept of alcoholism as a chronic and relapsing disorder has not emerged due to recent advances in neurobiology. It has been interwoven intrinsically into the Alcoholics Anonymous (AA) movement as much as in the disease concept of alcoholism, with all its consequences for treatment. Total abstinence from alcohol became a sole goal of alcohol treatment and a deep belief that alcoholics are not able to control their drinking prevailed. As alcoholics were considered helpless in front of their addiction, relapse was regarded as an obvious part of their life and treatment course.

Despite the recent prioritization of the neurobiology of addiction (first of all, within the US-funded research), no one questions the existence of two worlds of alcoholism [3]: a clinical world with its obvious focus on treatment populations, and a wider and perhaps more diversified world of alcoholics outside the treatment. The question of to what extent these two worlds differ from each other, and to what extent they overlap, needs further research. The application of clinical tools in general population surveys has its limitations which need to be carefully recognized to claim that ‘the majority of people who meet criteria for alcohol dependence at some point of their life . . . resolve their alcohol dependence without any formal treatment . . . and do not repeatedly relapse to alcohol dependence’[2]. Some behaviours considered symptoms of alcohol dependence and reported in population surveys are expressions of a macho culture which may include continuous preoccupation with drinking, uncontrolled consumption of alcohol or even drinking in the morning to reduce hangover rather than withdrawal. Those behaviours may often be a manifestation of belonging to a particular culture, especially among younger respondents, rather than symptoms of dependence.

According to Cunningham & McCambridge, ‘conceptualizing alcohol dependence as a chronic relapsing disorder’[2] has numerous detrimental consequences for public health and clinical care as well as for research. As for public health, the narrow, biological definition is very likely to undermine population-based strategies including reducing affordability, availability and promoting brief interventions. In the clinical setting, a biological definition may divert attention and resources from mildly dependent individuals towards severely dependent people whose treatment is much less cost-efficient. In addition, the treatment becomes preoccupied with the biological roots of addiction rather than offering a holistic approach, covering psychological and social determinants of dependence. Finally, ‘the large majority of funding goes to bio-behavioural research’ at the expense of social research.

In my opinion, the new conceptualization of dependence cannot be blamed for all the above ailments of a current ‘alcoholism arena’ in the United States. The opposite is perhaps true, that priority given to the definition of dependence as a chronic and relapsing disorder in professional and scientific debate reflects dominant contemporary ideologies which stress individual roots of social problems. The medicalization and bio-medicalization of alcohol dependence helps to individualize alcohol-related problems and diverts attention from their social, structural determinants. Moreover, it offers medical treatment as a solution which does not challenge market ideologies, on one hand, and economic interests involved on the other hand.

Similarly, priority given by public funding agencies to bio-medical research reflects political demand for bio-medical explanations of social problems rather than a victory of bio-medical research world over that of social research.

References

  1. Top of page
  2. Declaration of interests
  3. References
  • 1
    Foucault M. Discipline and Punishment. London: Tavistock; 1977.
  • 2
    Cunningham J., McCambridge J. Is alcohol dependence best viewed as a chronic relapsing disorder? Addiction 2012; 107: 612.
  • 3
    Room R. Measurement and distribution of drinking patterns and problems in general populations. In: Edwards G., Gross M. M., Leller M., Moser J., Room R., editors. Alcohol-Related Disabilities. Geneva: World Health Organization; 1977, p. 6287.