Addiction as accomplishment: The discursive construction of disease

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Abstract
The ubiquity of the disease concept of addiction obscures the fact that it did not emerge from the accretion of scientific discoveries. Addiction-as-disease has been continuously redefined, mostly in the direction of conceptual elasticity, such that it now yields an embarrassment of riches: a growing range of allegedly addictive phenomena which do not involve drugs. This article begins with questions that have been raised about whether “addiction” is a discrete disease entity with a distinct etiology. It then summarizes the historical and cultural conditions under which addiction-as-disease was constructed, the specific actors and institutions who promulgated it, and the discursive procedures through which it is reproduced and internalized by those said to be afflicted. Understanding how the dominance of additiction discourse was accomplished in these ways does not imply that the lived experience of what is called addiction is therefore any less acute or compelling. But it does invite attention to the contradictory uses of disease discourse: a humane warrant for necessary health services and legitimation of repressive drug policies.