The Nature of Addiction and Its Implications Stanton Peele Presented at 25th Annual Epidemiology Symposium of the Kettil Bruun Society May 31-June 4, Montreal

The Stanton Peele Addiction Web Site A Brief History of Addiction Pre-mid-19 th century – addicted to whatever Turn of the twentieth century – opiates Mid-century America – heroin 1980s – cocaine 1990s – marijuana 1980s-90s – addicted to whatever

The Stanton Peele Addiction Web Site Pharmacologists and Addiction 1960s –Psychic and Physical Dependence –Alcohol / heroin addictive 1980s –Cocaine is addictive –Compulsive use 1990s –Marijuana is addictive –Brain receptors

The Stanton Peele Addiction Web Site Addiction is not: Reducible to pharmacology/biology Limited to any one drug Separable into physical/psychic dependence Limited to drugs Reducible to neurochemical mechanisms

The Stanton Peele Addiction Web Site ARG Surveys MenWomen Dependence819*58* Problems * Significant at p <.05

The Stanton Peele Addiction Web Site WHO/NIH Cross-Cultural Applicability of Alcohol Dependence: Contrary to expectation, physical dependence criteria vary as much as psych. dependence (Schmidt & Room, 1999)

The Stanton Peele Addiction Web Site What Addiction is: Observed behavior / subjective experience Not all-or-none Occurs with any involving/destructive exper. Person addicted to a gestalt experience –psychic and physical –pharmacological and learned Essential experiential benefits

The Stanton Peele Addiction Web Site Vietnam Robins, Helzer, et al. (1980) –Is addiction to heroin more or less permanent without prolonged treatment? Of those addicted in Vietnam: –Half used again in U.S. –One in 8 (12%) readdicted

The Stanton Peele Addiction Web Site Fundamentally Affected by: Cultural –Social Situational –Developmental –Ritualistic Cognitive –Beliefs –Social learning Values

The Stanton Peele Addiction Web Site Revisionists Nominalists Rationalists Libertarians

The Stanton Peele Addiction Web Site Contrarian Positions There is not addiction Addiction as intentional behavior Except, "in extreme cases"

The Stanton Peele Addiction Web Site Addiction is Important As a template As a practical/clinical tool As an experiential reality