Cocaine and the Concept of Addiction: Environmental Factors in Drug Compulsions

Abstract

Addiction is an evocative psychological and medical term whose meaning has changed significantly over time. For most of this century it has been described in terms of an abstinence syndrome (dependence and withdrawal) and associated with heroin use. In the 1980s, however, cocaine replaced heroin as the prototypical drug of abuse. Cocaine had heretofore not been considered to produce “physical dependence.” Nonetheless, for both cocaine and heroin, current models of addiction — models widely propagated by the media —reduce drug use patterns to the properties of drugs and biological characteristics of the user. In creating this model, scientific and clinical debates along with public debates rely on the supposedly typical, inevitably addicting results of repeated cocaine consumption. Yet naturalistic human drug use and drug taking by animals in the laboratory instead reinforce the picture that use of all drugs depends on the user's environment-Indeed, even the most severe examples of compulsive drug use can be reversed when key elements in the setting are modified. Such findings should by now play a fundamental role in both scientific and public conceptions of addiction, but they do not.