Race, inequality and the medicalization of drug addiction: an analysis of documentary films

Abstract

The increased medicalization of traits and behaviors signifies a society eager for more humane approaches to social problems such as drug addiction. Yet, scholars have only begun to understand how medicalization processes might perpetuate inequality. One type of disparity could be symbolic if media campaigns represent people differently. For example, to what extent does the neuroscience approach define all addicts as patients suffering a brain disease? Our paper begins to address this question by analyzing documentary films between 1991 and 2008. We found evidence of symbolic inequality by race in both the representation of addicts and explanations of their addictions. White addicts were portrayed as patients suffering disease and in need of treatment despite their heavy criminal involvement. Overall, minorities were under-represented in medicalized narratives. When depicted, minority addicts were discussed with criminal narratives, highlighting personal choice, deviance and state control. We end by linking our work to debates on the medicalization of drug addiction.

• Documentary film
• drug addiction
• inequality
• medicalization
• race

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes

¹From NIDA Director Reports, February 2008 http://www.drugabuse.gov/DirReports/DirRep208/DirectorReport14.html (last accessed 11 January 2010).

²Phelan’s (2005) paper is a possible exception even though it addresses stigma, not racial inequality. Her study of people’s perceptions of the mentally ill found that genetic and other biological explanations do not necessarily alter the stigma and prejudice of the mentally ill. Her subjects excused the mentally ill for responsibility of their conditions, but kept their distance due to beliefs that mental illness was constitutional and permanent, i.e. genetic determinism.

³Our proposition that racial minorities might suffer consequences from not being medicalized in the same way as whites may seem to run counter to genetic determinism and what Phelan (2005), Lynch et al. (2008) and others claim happens to stigma as conditions are medicalized. Drug addiction may be an important exception to this given the history of illicit drug control in America. To wit, drug control policy has been especially punitive over time, exacting a much heavier toll on minorities. Criminal stigma is more problematic than medical stigma and produces heavier consequences. Thus, the current campaign to medicalize addiction could reduce the stigma faced by minority addicts as it seeks to eliminate criminal stigma and replace war on drugs policies and with more humane responses.

⁴Bridges & Steen (1998) found something similar in court decisions based on probation officers’ in written narratives of juvenile offenders.

⁵A racial breakdown by type of drug abuse is not available in the NSDUH.

⁶In addition, we consulted with our library staff about the value and scope of several documentary databases. In their opinion, the FFH database was among the most comprehensive to date.

⁷The term “dependence” has been used in the past to indicate addiction. We included it in our search criteria since the FHS database included it as a keyword on the topic of drugs and we reasoned that it might yield relevant films on addiction, especially those from the earlier years in the documentary database.

⁸One way to assess the representativeness of our sample is to compare the films we located at the FHS website with those listed on a different database. Our librarians helped us do this with a documentary search on Worldcat. A search there yielded about 200 documentaries on drug addiction between our study years. Half of our FHS films turned up on this list. We compared the matched FHS films with those from the FHS database that were unmatched in the Worldcat search. Our comparison of the FHS and Worldcat databases yielded consistent support for our sample criteria and selection of films to include in our analysis. It also produced no discernible differences between the two groups in any of the drug addiction narratives over time or in the racial representations noted in any of our patterns below.

⁹The brain disease paradigm that appeared in the late 1990s, and which dominates discourse today, is actually the second “disease” narrative in the field of addiction. The first is the 12-step, self-help disease paradigm that does not directly discuss a biomedical explanation for drug or alcohol addiction. It is a more folk-based disease concept that disallows addicts to ever use drugs again. It was coined at a time when medical explanations of addiction were not popular and it has grown in popularity without making claims to a specific bio-medical addiction processes. While beyond the scope of this paper, an important question to ask is to what extent do these two disease paradigms contradict, compete with, or substantiate each other?

¹⁰Some of these films covered other opiate drugs (licit and illicit) as well, but primarily addressed heroin.

¹¹Included here are all other medical or biological-based explanations of drug use and addiction, often with endorsement of the 12-step disease model of addiction.

¹²In each of these films, initial drug use was explained sociologically while addiction was explained with neuroscience or other biological models.

¹³This category features explanations that combined aspects of all disciplines: medical/biological, sociological, psychological, morality and legal.

¹⁴Two of these three films drew on psychological or moral explanations to explain initial drug use, but not addiction.

¹⁵These films could not be classified into one of the six patterns because they (1) did not match the criteria for that pattern or, more commonly, (2) they fit more than one of the six patterns.