Module 4 Addiction - Google Docs PDF

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Lecture notes for module 4: addiction...

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Conceptualizing addictions and drug (mis)use ● Drug: “any substance that causes a biochemical reaction in the body…” ● Drug misuse: using a drug for a purpose other than what it was intended ● Therapeutic: takes a drug for a specific purpose (reducing fever, controlling diabetes) ● Recreational: takes a drug for no other purpose than achieving some pleasure ● Drug abuse: subjective and objective elements need to be considered here ○ Textbook was written before marijuana was legalized in Canada so the definition is different ○ This is an example o the subjectivity built into the ways that societies decide what is a problem and what is not. This harkens back to earlier discussions aout how societies decide/construct what is and what is not a social problem ○ Another example: drinking alcohol -- there are some religious groups who consume communion wine, some people often drink socially to celebrate -- society is often okay with these instances ● Drug use, misuse, and abuse Drug abuse ●

Addiction

“Excessive or inappropriate drug use resulting in social, psychological, and/or physiological impairments. It stems from a chronic physical and psychological compulsion to continue taking a drug in order to avoid unpleasant withdrawal symptoms” (p. 81) ○

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“A dependency on substances that is uncontrollable, repetitious, and possibly harmful” (p. 77)

Other forms of addiction ■ Gambling disorder ■ Etc ■ Other socially disapproved behaviors -- we now (i.e. socially construction) classify these as addictions -- excessive eating, shopping, hoarding, sex, and internet use ■ Socially constructed processes -- through diagnosis processes society comes to recognize and label what is “normal” and “pathological” experiences ■ Contributes to processes of medicalization: the treating of a person’s condition as an illness we move our understanding outside of the realm of morality and even of the role of the individual What is the role of the state in constructing addiction? ■ Ex: 1964 US surgeon general report: we see how the response in Canada was informed by responses elsewhere. In other words, the response to social problems does not occur in a silo. It was monumental because of how it disrupted the existing culture of smoking. At this time, smoking was very common and fashionable, tobacco companies were huge ● Attempt to reduce the impact of tobacco use on negative health outcomes including cancer and other serious diseases

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Compliance: the act of conforming to the expertise of professionals What is the role of diagnosis in determining addiction? ■ Medicalization: the process through which behaviors are reconcieved as instances of illness and are deemed no longer sinful since they’re outside personal control ● A socially constructed process ● Link to public safety concerns ● Attempt to regulate behaviors among social groups (ex: youth) ■ The DSM 5 symptoms of addiction: ● Tolerance: larger doses of a drug are needed over time to produce the same physical or psychological effect that was originally achieved by a smaller dose ● Desire to cut down ● Withdrawal: variety of physical and/or psychological symptoms that habitual drug users experience when they discontinue drug use ● Difficulty controlling use ● Negative consequences ● Putting off or neglecting activities ● Spending significant time or emotional energy

Trends and patterns ● Legal tobacco use and alcohol use are the most widely used addictive substances in Canada ● Substance abuse most prevalent among young people ● Many people flow in and out of addictions over the course of their lives ● Comorbidity: people with a mental illness are twice as likely to have a substance use problem compared to the general population. At least 20% of people with a mental illness have a co-occurring substance use problem. For people with schizophrenia, the number may be as high as 50% ● Stats Canada 2015 ○ Majority of impaired drivers are male (i.e. 80% of those charged are male), but the proportion who are female is rising (20% of those charged) ○ Those playing team sports reported being more likely to drink and drive ○ Saskatchewan had the highest rate of police-reported impaired driving among the provinces ■ Ontario had the lowest impaired driving rates in the country ○ Geographical variation can be explained by a number of factors including… ■ Availability and access to public transit ■ Distance required to travel ■ Number of drug enforcing officers in the area ■ Culture Stigmatization and exclusion ● Stigma (Erving Goffman): an attribute that is deeply discrediting”

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Types: ○ Discredited: visible attribute ○ Discreditable: invisible/less apparent (ex: mental health, ex-convict, addiction) Stigma is also a socially constructed process. Who might face stigma is tied to also one’s own social position (ex: one’s class position may shape if/how they experience social exclusion or stigma)

Theorizing addictions and drug (mis)use Biomedical view ● ● ● ●

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Health is the absence of illness The human body is a machine that sometimes requires repair Promotes the use of therapeutic intervention (i.e. drugs, surgery) to “cure” disease and injury Based in western scientific principles

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Health and disease are the products of the interaction between body, mind, and environment Ex: addiction is more likely rooted in childhood trauma than in genetic personality traits People are more likely to become problem gamblers if a parent or relative is a gambling addict

How do we learn to become “drug users”? ○ Howard becker (1963) “becoming a marijuana user” ■ An individual will be able to use marijuana for pleasure only when [they] (1) learn to smoke it in a way that will produce real effects; (2) learn to recognize the effects and connect them with drug use; and (3) learn to enjoy the sensations [they] perceive” (p. 235) ● Becoming a drug user and/or developing an addiction is a learning process

Addictions as form of deviance ●

Biopsychosocial view

Deviance: actions that violence social norms, and that may or may not be against the law ○ Howard becker: not the act itself rather people’s reaction to the act that makes it deviant ■ Influence of moral entrepreneurs

Addictions tied to immorality ●

Need to consider more context with which people are located and how this shapes their behavior and the subsequent interpretation of such ○ Moral panic (p. 77) ○ Role of moral entrepreneurs

Responding to addictions and drug (mis)use ● Le dain commission (1973) ○ Investigation by the government of Canada into if/how the governments and courts should be involved in the prohibition and regulation of drugs used for non-medical purposes

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Final report (1973) pushed for the decriminalization of drugs ● Importance -- here we see the response to drugs as an ongoing (controversial) conversation that often is slow to translate into action

Tobacco use ○ Tobacco act (1997, Canada) ■ Sought to control national health problems related to tobacco use ● Ex: restrictions surrounding access to produces (i.e. youth), requirements around product labels and warnings, restrictions on the promotion of products ■ Amended in 2018 to the tobacco and vaping products act ■ The act prohibits cigarette manufacturers from advertising their products on radio or television or in magazines or newspapers; they are also prohibited from sponsoring sports and art events Responding to alcohol and drug use ○ Federal criminal law: BAC for fully licensed drivers in 0.08. Driving with BAC over 0.08 is a criminal offence ■ Provinces and territories can enact additional laws and sanctions ● Ex: ontario divers under 21 or any novice driver cannot hav eany presence of alcohol within their blood while driving; (warn range: 0.05-0.08) ○ Bill C-46 (federal, June 2018): drug impaired driving ■ Illegal to be at over the alcohol limit within 2 hours of drivin ● Addresses the “bolus drinking defence” ○ Argument that suggests that alcohol consumed just before driving was not fully absorbed and so the driver was not over the limit ■ Three new drug-impared driving offences ● THC between 2ng and 5ng ● THC over 5ng ● THC (2.5ng) and alcohol (BAC 0.5) ■ Zero tolerance for other impaired drugs ■ Authorizing mandatory alcohol screening to make it easier to detect whether a driver is impaired ○ Section 253: prior to these changes, drivers could argue that alcohol that they drank just before driving was not fully absorbed and so they were not over the limit when driving ○ THC and alcohol penalties: mandatory min. Penalties of $1000 fine for a first time offence, 30 days imprisonment for a second offence and 120 days imprisonment for a third offence ○ 254(2) under the old law police officers must have reasonable suspicion that a driver has alcohol in their body before doing any roadside testing. When part 2 of the legislation came into force, police officers who have an approved screening device on hand are able to test a breath sample of any drivers they lawfully stop even without reasonable suspicion that the driver has alcohol in their body. This would be done after the person has been lawfully stopped pursuant to existing authority (common law or

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provincial highway traffic act). A driver who refused to provide a breath sample could be subject to a criminal offence. ■ Controversial: if you are pulled over they can now ask you to perform a roadside breath test -- concern that this will impact some groups to a greater extent than others ○ Work of MADD involves: ■ victim/survivor services -- comprehensive program of support and resources of individuals who have lost a loved one or suffered a serious injury as a result of an impiared driving crash ■ Youth services -- specialized programming for elementary, middle and high school students to educate them about the dangers of mixing alcohol and/or drug use with driving ■ Public awareness and education -- campaigns to reach out to the public about the dangers of impaired driving and how they can help improve safety on our roads, waterways, and trails ■ Public policy -- promotion of legislative best practices in impaired driving countermeasures, at both the federal and provincial levels to address the impaired driving problem in Canada ■ Technology -- partnering with international traffic safety organizations, automotive manufacturers and technology companies to explore technological solutions to stop impaired driving Responding to opioids ○ Moral panic: a public expression of feeling and attitude typically based on false or exaggerated perceptions that some cultural behavior or group of people (often a minority group) is dangerously deviant and poses a menace to society ○ Canadian drug strategy (1987) ■ Emergence of 4 pillar responses ● Prevention ● Treatment ● Harm reduction: “social policy interventions that focus on eliminating or reducing the harmful consequences of apparently eprsistent social problems” ○ Often seen as opposing abstinence-only rograms ● Enforcement ■ Most of federal funding went to enforcement ○ National anti-drug strategy (2007) ■ Removal of harm reduction as a strategy and continued push for enforcement ■ Fear based education program directed at youth ○ Canadian drug and substances strategy (2016) ■ Canadian criminal code and the youth justice act support the enforcement of the CDSS ■ CDSS lead by the minister of health ○ Good samaritan overdose acct (2017) ■ Federal piece of legislation

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Drug addiction is an illness that requires care and compassion like any other health condition ● “During an overdose, a call to 911 can often be the difference between life and death. We hope that this new law, and the legal protection it offers will help encourage those who experience or witness an overdose to make that important call, and save a life” Honorable Jane Philpott, Minister of Health ■ Encourages people who are at the scene of an overdose who may be in possession of drugs to call 911 for help ○ Services included in harm reduction ■ Needle distribution/exchange programs ■ Substitution therapies (ex: methadone clinics) ■ Naloxone programs (ex: Narcan) ■ Supervised consumption facilities ■ Outreach and education services ○ What is harm reduction? ■ Includes policies, programs, and practices that aim to keep people safe and minimize death, disease, and injury from high risk behavior especially psychoactive substance use. Harm reduction recognizes that the high risk behavior may continue despite the risks ■ Is not about getting people to stop using drugs ○ Safe injection sites according to Zaric… ■ Support drug addiction ■ Increase spread of illness and disease ■ Increase public safety Practice of social control ○ The origins and implementation of laws and policies directed at addictions and drug use are not equal but often tied to axes of difference (ex: class, gender, race)...