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The Democracy of Addicts, if not of Addiction

Updated: Aug 30, 2023

Recently I read a brief article by George E. Vaillant called “The Natural History of Narcotic Drug Addiction” in the 1970 volume of Seminars in Psychiatry. It was based on follow-up studies of patients admitted to the federal narcotic hospital in Lexington, Kentucky, between 1936 and 1952. I was curious about how or whether it anticipated Vaillant’s conclusions in his influential 1983 book, The Natural History of Alcoholism, which was based on longitudinal data about Harvard students, working-class men, and detox patients starting just before World War II. Before getting far, though, I was struck by the second paragraph:

A Nation of In-Patients


There seem to be many different kinds of narcotics addicts and in each decade patterns of addiction change. At first glance this makes delineation of the natural history impossible. There are adolescent and middle-aged addicts; there are “criminal” and “medical” addicts; there are heroin and Demerol addicts; there are white Anglo-Saxon Protestant addicts from small towns and black immigrant addicts from urban ghettos; there are male addicts and female addicts; there are high school dropout addicts with inadequate personalities and an allergy to employment and physician addicts who self-prescribe and remain employed throughout their addiction. However, one of the conclusions of this review will be that both the addiction pattern and underlying personalities of these disparate groups are more similar than dissimilar.

Vaillant’s reference to an “underlying personality” among opiate addicts jumps out, because it is a phenomenon he concludes is absent among alcoholics in his later book. But leaving that observation aside, what captured my attention was the rhetorical shape of the long third sentence. It reminded me of a passage written a generation earlier, by Richard R. Peabody in his 1931 book The Common Sense of Drinking:

It takes all types


When we investigate any particular group, we find the most strikingly contrasted persons succumbing to excessive drinking. The rich and the poor, the highly intellectual and the ignorant, the frail and the robust, the shy and the apparently bold, the worried and the seemingly carefree, all furnish their quota of inebriates. We find that this unhappy group includes people of accomplishment as well as those who achieve nothing, the religious and the unbeliever, those with an interest in life and those without one, those who love and are loved, and those who are alone in the world.

Both of these prominent figures in the history of addiction studies drew a series of opposites to illustrate the breadth of social locations that users and boozers hail from. These soup-to-nuts sketches of the social order have been a consistent feature of addiction and recovery discourse over the years. For me, they are signs of the way that the addiction concept has remained bound at a deep level with efforts to define and reform social relations. They are moments when the effort to describe addiction invokes not just a society but a demos, the populace of a democracy.

Vaillant and Peabody’s versions of this rhetorical figure were not in the service of precisely the same point but, if we are willing to temporarily overlook the large distances of time, topic, and technique, their purposes were similar enough. While Vaillant emphasized social categories, and Peabody focused on psychological characteristics, both were tracing out a society-wide swath of users in order to then drill down into the particular profile that addicts shared. So while they were not arguing that addiction is distributed randomly in society, they still conveyed with these figures the notion that its distribution is broad enough to defy social stereotype. One could even call the figure a vehicle for psychology’s claiming turf from sociology, insofar as the social categories simply describe all of society, whereas it takes specialized psychological tools to excavate the causes of addiction.

Two more concise phrases have played similar but less nuanced roles, one in the middle of the twentieth century and another in the past three decades. Since the early A.A. writings (and long before them, in fact) alcoholism, like the God of the King James New Testament, was deemed “no respecter of persons” (i.e. not someone who discriminated by social status). This phrase is all over the Alcoholism Movement. It is the launching pad for Marty Mann’s own version of the aforementioned rhetorical figure, in her 1950 Primer on Alcoholism: “it is no respecter of persons. All manner of people fall victim to alcoholism: rich and poor, educated and illiterate, godly and ungodly, young and old, men and women, ‘good’ people and ‘bad,’ charming people and those without attraction, and everything in between. …. It is human beings who are affected, not groups, classes or types.” “No respecter of persons” was one of those stock allusions that competent but bland writers of the era drew on frequently, the equivalent of high diction in the language of middlebrow expertise. It was needlessly coy in its flaunting of obsolete usage that nevertheless everyone knew the meaning of. It had a late nineteenth century feel to it, and sure enough it appeared in that era’s temperance writings.

Google tells me that the phrase “equal opportunity” surpassed “no respecter of persons” (in printed frequency among its scanned books) in 1904. But this second phrase is still very popular, and it seems a more recent addition to the alcoholism/addiction lexicon, as in the formula popular since the 1980s, “addiction is an equal opportunity destroyer.” Like “no respecter,” “equal opportunity” has seen wide usage among experts and lay spokespeople devoted to promoting the disease concept and reducing stigma. For this reason, anti-disease-concept scholars including Stanton Peele and Gene Heyman have targeted it as a marker for a specific kind of misinformation emanating from both advocates and researchers.

The language of equality across difference


I don’t want to mount a defense of “equal opportunity” addiction language. But I think it is worth noting the context in which it became a go-to term in the second half of the twentieth century. This phrase did not originate as a casual rhetorical reach by lazy writers, but as a specific allusion to the Equal Opportunity Employment provisions of the 1964 Civil Rights Act and its follow-up laws regarding age and disability (which qualified certain kinds of addicts as a protected class). One of the earliest uses I’ve found of “equal opportunity addiction” is in the title of a women’s studies thesis in the late 1970s. In this context it is an ironic usage, not meant to claim universal susceptibility, but a prior history of discrimination. Consider the poster above, released in 2010 by the Illinois Alcoholism & Drug Dependence Association and entitled “Addiction: An Equal Opportunity Disease for Women and Girls.” It argues not for a universal affliction but for gender-specific causes, challenges, and treatment data. The term “equal opportunity” in the title refers to equality of understanding and treatment access, and against identical experience and random distribution.

One of my wider interests is in the relationship between the rise of recovery culture and the progress of liberalism in the twentieth century. The liberalism of the long New Deal era sought to bring classical liberalism’s ideal of equal opportunity (not outcome) closer to reality via certain state interventions like the above-cited laws. I argue elsewhere that recovery culture came into existence imagining an ideal liberal demos – albeit one largely walled off from the full population and its concerns beyond addiction – in which alcoholism had brought everyone to the same state of “equality,” and hard experience had revealed a set of ethical habits for social and political life within it. (A version of Peabody, Mann, and Vaillant’s “opposite types” figure appears in chapter two of A.A.’s Big Book, and the forewords to the second, third, and fourth editions each focus on elaborating this claim of maximum social reach.) I don’t mean to argue that the addiction concept or recovery culture are liberal in a partisan or even theoretical way, but that liberalism and recovery share certain origins, ideals, and historical trajectories. This is evidenced in the strong overlaps on both the right and the left between hostility to liberalism and hostility to recovery culture.

The phrase “equal opportunity” marks an epoch in the history of the wider society’s liberalism. When awareness groups and recovery speakers use this term in regard to addiction, I believe that often they are not so much making an empirical claim about addiction, as they are adapting this once-powerful language of liberal justice to the imaginary democracy of sufferers. Because this distinction is rarely explicit, the phrase probably does mislead more than it illuminates. But I think both experts and laypeople will continue to use it and new, related terms, and their meanings will continue to evolve along with the wider society’s social and political values. As Vaillant concluded in 1970, again contra the strong “equal opportunity” thesis: “Perhaps no mental illness is more a product of its social setting than addiction to narcotics. … Thus, in part the natural history of drug addiction is like that of a society; it must be rewritten every few years.”

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