What's Wrong with Addiction? (review)

Less concerned with the consequences of drug use or the "essence of addiction," Helen Keane focuses on how addiction is constituted in current discourses. Eschewing a universalist view, she believes that addiction "is tied to modernity, medical rationality, and a particular notion of the unique and autonomous individual" (p. 6). Although addiction has been characterized negatively because it restricts freedom and individual autonomy, Keane argues that discourses of addiction have tended to limit freedom as they have authorized the prohibitive power of the family, the state, and the corporation.

Keane questions the characterization of drugs as foreign (and unhealthy) and suggests that the "moral distinction between substances as good and evil" be replaced by an examination of whether there were "bad or good encounters," whether they were used "constructively or destructively" (p. 35). Many individuals use drugs to "facilitate friendship and interpersonal relations; it is quitting that brings about the loss of friends" (p. 60). The determination of what constitutes harmful consequences is ambiguous. For Keane, the assertion that an addict is someone who has lost her agency is a moralizing view, not an objective observation.

A case in point is smoking, in which she contrasts the immediate rewards of smoking with its long-term consequences. "The practice of smoking," Keane writes, "is reduced to its potentially most undesirable outcomes, namely, various premature, painful, and protracted forms of death. The enhancements of existence that can come with smoking are dismissed as illusory and excluded from the calculation of risk" (pp. 102-3). Studies of working-class British women smokers, however, suggest an alternative view to Keane in which smoking enables them to cope with chaotic working conditions by "making and taking space and time for themselves" (p. 106). Drawing on this and parallel examples, she finds that "smoking can be seen as an efficient method of acting on the 'longing for [an autonomous] moment'" (p. 107).

Keane also explores how the transformation of eating disorders into addictions reinforces claims for moderation as normative. Anorexia is characterized as addictive because of the putative euphoria caused by the release of endorphins in response to starvation. Bulimics have lately been compared to drug addicts because of the alleged high achieved while bingeing. Compulsive eating and obesity have been fit into the addiction discourse because the overeater craves more and more carbohydrates, increasing the production of serotonin. Although eating disorders manifest themselves differently, they share a similar scenario in which "food becomes addictive for the eating disordered because of their mystification of it as a forbidden, magical pleasure, rigidly divided into the good and the bad" (p. 130). Similarly, Keane's discussion of sex and love addiction points to a promiscuous spectrum of clinical signs including fantasy, flirting, and/or rape that serve to extend diagnosis to a wide range of thoughts and behaviors. For instance, love becomes a drug if it manifests as immoderate desire. Yet Keane points to a contradiction between illness and cure: if "what is ultimately wrong with sex addiction is that its victims use people as objects," it is odd that the route to recovery is through "self-realization," a behavior equally "open to the charge of objectification of the other" (pp. 139-40).

The new discourse of addiction insists that recovery is always tentative, requiring eternal vigilance. Any immoderate behavior may lead the former addict down the road to relapse. Recovery has become tethered to reinsertion into the paternal family, both real and imagined, both biological and metaphorical. From this perspective Keane fears that the addiction discourse poses a clear and present danger to the very freedom it purports to defend. Thus, for her, "the question of what addiction is and what is wrong with it are difficult, perhaps impossible to separate" (p. 188).

These are seductive arguments, worthy of serious consideration...