Drugs, Consciousness and Self-control: popular and medical conceptions

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Abstract
Psychoactive drugs alter human consciousness, but the meaning and results of the alteration are mediated by cultural and individual expectations. Industrialization has greatly increased the availability of drugs, while bringing new expectations of self-control and concentration. There are recurrent scenarios of entrenchment and ‘disentrenchment’ of drugs, and for alcohol, at least, there is enough cyclicality to speak of ‘long waves of consumption’. Popular ideas of addiction arose with the 19th century temperance movement as an explanation of life failure: the loss of control is double, not only over the drug use, but also over one's life. The emergence of the Adult Children of Alcoholics movement suggests the continuing vitality of a linkage between life failures and drug use. In medical thought, the ‘loss of control’ formulation was applied only to the drug use; while loss of control used to be the ‘pathognomic symptom’ of alcoholism, such cognitive and experiential symptoms have been marginalized in recent diagnostic criteria. Disjunctive criteria of dependence (e.g. 3 out of 9 symptoms) expand the numbers defined as dependent; where much treatment is coercive, they expand the scope of treatment as social control. The retention of an element of consciousness as a necessary element in dependence definitions would impede the link with coercion.
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