Addiction seems to be a hot-button issue of society as of late, particularly with the influence of the opioid epidemic. Opinions on addiction and therefore addicts range from the utmost sympathy to utter disgust, and it seems to be a frequent social battle on whether or not addicts deserve treatment or an unceremonial death. While people bicker on what current addicts deserve or what their lives should look like, there is arguably not enough attention focused on the trials and tribulations that addicts go through on a daily basis, or perhaps how addiction grasps people in the first place.
Why do some addicts have a story that evokes sympathy, while others are regarded as similar to trash? How does addiction persevere, despite our best and most modern attempts to facilitate recovery and sobriety? Social theory can provide a variety of answers to said questions, but functionalism, and more specifically strain theory, may provide some telling answers.
Functionalism was expanded in the early 1900s by sociologist Emile Durkheim. Essentially, the understanding of functionalism is that everyone has a place within society, and that some people need to hold the more undesirable roles within society to make it work. The nature of functionalism dictates that it is normal for conflict to exist in the way that it does; our society has been set up a way that facilitates functionalism. According to Durkheim, we exist in organic solidarity, meaning that our modern society causes people to rely on each other now more than ever.
He contrasts this with the idea of mechanical solidarity, which was more of a pre-industrial society, in which people were generally more individualized and tended to their own needs. Durkheim's ideas here do make sense - think of how many people we interact with for our needs. We go to the grocer or order take-out for dinner, we visit doctors, we buy our furniture, and so on and so forth, when in pre-industrial society, we would have tended to all of these needs simply within the family unit. Durkheim claims that the more solidarity that exists within a society, the less deviance will occur. Another of Durkheim's points within functionalism is that of the social fact. He describes a social fact as a societal norm or belief that is constructed by the structure of society, and is beyond one individual to change. On the flipside of this is the idea of anomie, or a lack of social facts within a given society. These ideals within functionalism are noteworthy and applicable to society today, and certainly fit in with the understanding of addiction.
A subset of functionalism can provide even more insight to how addiction and addicts function within our society. More specifically, strain theory, proposed by Robert Merton, claims that people resort to deviance as a result of the inability to achieve what society regularly recognizes as success. Traditional success, particularly in the United States, often refers to wealth, independence, strong interpersonal relationships, and plentiful other traditional social facts.
Merton proposes that since people begin with different tools in life to achieve this success, people will either attempt to achieve it in a deviant manner, or will deviate from the idea of the traditional success as a whole. Consider someone born into a neighborhood of poverty, perhaps raised by a single parent, attending a school that doesn't receive much funding, as compared to a child born into wealth, attending a private school, with two supportive parents. Of course these children have different opportunities to reach the traditional success that society mandates. People on the bottom rung of the ladder in society, generally those born into poverty, must take various approaches to become equal to others, and Merton pinpoints five different reactions that the bottom rung people may opt to take to achieve.
Firstly lies the idea of conformity, in which people accept the culture that exists around them, and do their best to legitimately achieve success (Caliwan). Innovation, a second social reaction, occurs when individuals accept the societal structure around them, but try to come up with alternate ways to achieve success (Caliwan). Ritualism occurs when the oppose happens - an individual does not accept the societal norms in which they exist in, but go through the motions of achieving success anyways, as they're unsure what other route to take in life (Caliwan). Sometimes, people decide to reject both the ideals of society and the traditional means of getting to them, and retreatism then takes place (Caliwan).
Lastly is rebellion, which is similar to retreatism, but adds in the variable of individuals attempting to rewrite both societal norms and how to achieve them (Caliwan). Though Durkheim views deviation and crime as normal, functioning parts of society, Merton offers a more in-depth explanation regarding why people resort to these types of activities.
Addiction is certainly considered an act of deviance, especially in the United States. According to Barry, McGinty, Pescosolido, & Goldman, who conducted a study to assess differences in attitudes regarding addiction and other mental health issues, findings reported that:
Respondents held significantly more negative views toward persons with drug addiction. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them. Respondents were more willing to accept discriminatory practices against persons with drug addiction, more skeptical about the effectiveness of treatments, and more likely to oppose policies aimed at helping them.
A scientific study may solidify those facts, but plenty of us have interacted with people who make these types of studies seem nearly irrelevant for confirmation in the first place. There's always that coworker, that aunt or uncle, or the Facebook friend you have who's more like an acquaintance, who has an opinion to chime in on addiction. With the public space of the Internet and social media, people may be feeling more free now than ever to admit to their opinions on such health epidemics.
The fact of the matter is that people do not perceive addicts in a positive light, generally because they believe that addicts have gotten themselves into that situation by behaving deviantly and taking drugs, and therefore do not believe that they deserve help or sympathy (Barry, McGinty, Pescosolido, & Goldman, 2014).
Sadly, drug abuse is not on the decline, either - according to Scot Thomas and the American Addiction Centers, over seven million Americans struggled with substance abuse in 2014 alone. Even more disheartening, only about 10.9% of addicts received proper treatment at a recognized facility in 2013 (Thomas, 2018). Interestingly, almost twice as many people who are unemployed struggle with addiction than those who are fulltime workers, and about half of the population of American prisons and jails suffer from addiction (Thomas, 2014). Even worse, relapse rates for those who do seek treatment fall at about 40-50% (Thomas, 2014). Thomas cites reasons for addiction to be genetic or environmental, but sociologically, it is reasonable that functionalism and strain theory can offer an interesting take on why people get addicted in the first place.
As aforementioned, Durkheim claims that deviance within society is normal. As deviance is needed to keep a society running (who else can you point fingers at and make an example of what not to become?), as are addicts. Addicts do fulfill a number of roles within society, as well. Firstly, addicts are often considered a burden on the healthcare system. As addicts can cost the United States healthcare system over 193 billion dollars annually, it is difficult to argue this point (Thomas, 2014).
They fill the role of patients, keeping doctors, nurses, and hospitals with people to work on. Those facing addiction also often attempt to go to rehab at one point or another, or over and over again. Addiction rehabilitation centers aren't cheap, either - detox alone can cost upwards of $1,500, and in-patient rehab is estimated to cost approximately $12,000-$60,000 for people requiring 60 to 90 day programs (Thomas, 2014). Rehab centers supply jobs to many people, and therefore more money can kick back into the economy - a clear profit can be seen to be made off of addicts. Lastly, addicts have to get their drugs from somewhere.
The SAMHSA National Report from 2017 details that 53% of opioid users get their drugs from a friend or family member, but 35% were also prescribed the drugs legitimately. Addicts who are abusing controlled substances also provide work for the doctors they visit to get prescriptions, the pharmacies that they pick up the drugs from, and the pharmacological companies that produce the drugs. Of course, the traditional idea of an addict sneakily buying dope in an alleyway in some shady city has yet to totally die, and the dealers in this way end up making a profit as well.
The dealers likely got the drugs from another dealer, or directly from a doctor or pharmacological company, and these companies benefit once again. Lastly, policies on the legality of drugs and their possession or sale have a lot of influence in the lives of addicts, as well. Minimum sentencing drug laws of course play a huge role in the incarceration of addicts and dealers, but drugs tend to flow into prisons, as well (Connor & Tewksbury, 2016). Through the incarceration system, however, drug addiction is generally not treated, facilitates the movement of more drugs, and does not rehabilitate drug users (Chandler, Fletcher, & Volkow, 2010). Though addicts may be seen as a waste in society, a lot of money certainly can be made off of them.
There will always be people who disagree with the social facts, but what provokes descent into something like addiction? Here we can apply Merton's strain theory for a thorough and clear explanation. A conformist, according to Merton, wouldn't get caught up in drug usage in the first place. As they accept societal norms and the means to achieve them, they would stick to the notion that drugs are bad. An innovator, on the other hand, may partake in dealing drugs, but likely would not end up using. Innovators accept social facts, which leads them to want to pursue traditional success, but unconventional means could lead to activities like hustling, which would generate income, but the commitment to social facts would probably keep most innovators from becoming addicted.
Ritualists don't seem as likely to partake in drug usage, either - as they accept the means to achieve, they likely hold down legitimate jobs and partake in socially acceptable hobbies. Those most likely to become addicts seem to be the rebels or the retreatists. Rebels, rejecting both norms and means to achieve, almost seem to be a wild card in Merton's theory. They attend to their own ideals of what their lives should look like. However, retreatists appear to be more likely than any other group to become addicts. As retreatists have opted out from both accepting social facts or trying to achieve them, they can be seen as those who don't care.
Retreatists are more apt to live in unconventional ways, and as they've more than likely already been born into poverty, they've already become more at risk to become addicts, anyways (Thomas, 2014).
One fascinating article attempts to pinpoint how addicts actually become fully addicted to drugs. The article notes three distinct steps that take someone from a casual user to an addict, being individual vulnerability, degree or amount of drug exposure, and and loss of control (Piazza & Deroche-Gamonet, 2013). Individual vulnerability may include aspects like genetics, exposure in the household, levels of poverty, or individual impulse controllability.
During the degree of drug exposure, the brain is overactivated and realizes that drugs are a highly rewarding stimuli (Piazza & Deroche-Gamonet, 2013). Even with sporadic use, a learning process occurs within the brain, solidifying that drugs make it feel good. Once drug use becomes more intensified, sustained, [and] escalated, the body becomes used to have the drugs, and the brain becomes used to being stimulated (Piazza & Deroche-Gamonet, 2013). Piazza & Deroche-Gamonet attribute likelihood for addiction to be related to a hyperactive dopaminergic system and impaired prefrontal cortex system, biological factors that help to solidify addiction. Lastly, during the loss of control stage, it is assumed that long-term drug exposure has occurred, and that long-lasting loss of synaptic plasticity in reward areas in the brain has happened as well (Piazza & Deroche-Gamonet, 2013).
When the brain's reward pathways are disrupted, it may become more difficult for an individual to feel pleasure from completing tasks that they used to enjoy, or from setting goals. Substances have corrupted these pathways, and influenced how individuals may react. The authors state that drugs are now not only wanted and needed but pathologically mourned when absent, an emotional statement that rings true within addiction (Piazza & Deroche-Gamonet, 2013).
Although this is only one theory as to how addiction solidifies itself within a person, it is interesting to see how this theory alone fits into Merton's ideas of strain theory. Consider the idea of an innovator, who has decided to achieve traditional success by making their money hustling drugs. Along the way, the hustler ends up doing a little partying, and sampling some of their product. After sampling enough times, an innovator may lose sight of the success that they were striving for when their reward pathways are interrupted, and may instead find more pleasure using than working for something better, as they once were. A rebel may also turn to drugs, as they are not held in high opinion by the general public, and drug usage is not a social fact that Americans hold high and proud. As rebels reject traditional social facts, they may try drugs as a way to defy the society in which they exist in.
Once again, the corruption of the reward pathways in the brain may take a rebel from actively working to change the reality in which they live, to trying to find the next high as quickly as possible. Lastly, a retreatist may dabble with drug usage simply because they have opted out of societal norms, and, like the rebel, want to partake in an activity that is known to exist outside of the realm of normalcy. As the retreatist is not actively working towards the traditional goal of success in the first place, they may get stuck using drugs instead - as they didn't have the goal of wealth or social mobility in the first place, what harm is it to them to use drugs? Again, although this is only the examination of one article, it is clear to see how Merton's theory is easily applicable to the science of how addiction actually occurs.
Social roles may also play a part in why addicts remain addicted, as well. A research study done by Tingle, Cruwys, & Frings analyzes the power of labelling within addiction.
According to the article, once someone identifies themselves as an addict, they are more likely to use and to actually become or to remain as such (Tingle, Cruwys, & Frings, 2015). On the other hand, when people committed to labelling themselves as recovered or sober, they ended up more likely to remain as such in that regard (Tingle, Cruwys, & Frings, 2015). The article reinforces the idea that certain social roles can be powerful for an individual, and that once an individual feels concrete within their own defining role, they are more apt to stay there. Focusing treatment on identifying one's self as recovered or sober may actually help people to become.
Though functionalism and strain theory are certainly useful at understanding what may cause people to become addicts and what may be keeping them remaining as such, it does not offer many solutions on how to help. Durkheim, in believing that deviance is normal, would therefore not inherently see an issue with addiction. Addicts are, after all, filling a social role that generates a lot of money for others. Merton, though explaining in detail how people may compensate from their bottom rung realities to try and achieve the American Dream, does not offer guidance on how to change those most likely for addiction, such as the rebels or retreatists.
Getting clean isn't easy in the first place, but functionalism and strain theory do not offer much advice to avoid becoming an addict, nor in the sobriety aspect, either. Social roles are functional within functionalism by its very definition, and if social roles are aiding the economy and other people are benefitting, why seek out to change the suffering of some others? Though the insights of the discipline are very telling and some aspects may be able to be used in treatment, there simply isn't enough emphasis on changing the deviance in the first place. As Durkheim deems it necessary, there of course is not a lot of emphasis on preventing or changing societal phenomenons that stem from said issues, like addiction.
Functionalism and strain theory provide a great amount of insight as to how addiction may be purposeful within society, and how certain people may be vulnerable in the first place. Merton's analysis on the five types of deviance lend a lot of knowledge to the field of addiction, and provide background on why people may turn to drugs in the first place. Durkheim's ideas of social facts, social roles, and solidarity also play a major part in defining the cause and the benefit of addiction.
Scientific studies may aid in confirming this information yet again as well, but unfortunately, these social theories do not provide adequate enough advice to prevent or to treat addiction, other than upheaving the structure of our entire society as we are aware of it, which is generally unlikely to occur. If these theories did offer any insight on how to change users, anyways, it would require massive changes in policy, law, and the understanding of addicts as we know it, as well.
While modern medicine keeps moving along to try to treat addicts, there will always be an argument that they don't deserve it in the first place. Maybe this is due to personal opinion, or perhaps it's due to the knowledge that the economy and certain people are benefiting off of addicts in one way or another. Either way, it is unfortunate that the argument keeps coming back to whether or not addicts deserve treatment, or how they got addicted in the first place, that keeps us from focusing on how to better the lives of addicts and how to treat people in a holistic, beneficial way at all.
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