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This chapter analyzes the issue of addiction. It argues that after the Revolution the treatment of substance abuse began to be seen by the government outside the previously held medical paradigm. In accordance with the government's new standards of morality, which were drawn along the Islamic religious precepts, and in accordance with new ideological rhetoric, stringent antidrug campaigns were launched; elements of these campaigns included the fining of addicts, imprisonment, physical punishment, and even the death penalty for serious offenses. Substance-abuse specialists from the medical community—no longer benefiting from government support—were marginalized and treatment centers were closed. Despite these measures (and in tandem with the Iran–Iraq War, political repression, and a deteriorating economy), the drug problem continued to grow, with the number of addicts increasing rapidly. In the early 1990s, as the more pragmatic Rafsanjani came to power, the government began to take a less doctrinaire approach to substance abuse. The chapter explores the history of this shift in policy, beginning with the early days of treatment policy in the Qajar and Pahlavi periods through the early postrevolutionary governments in Iran, and finally to the current crystallization of the harm-reduction treatment model exemplified by community-sponsored methadone and bupenorphine-addition drug-treatment programs.

Consideration of the importance of Pavlovian conditioning involving interoceptive stimuli to health-related issues dates back to Pavlov. Despite this long history and its likely importance, the preponderance of empirical and theoretical effort in the drug abuse field has been on exteroceptive conditioning with the drug conceptualized as the unconditioned stimulus. This chapter reviews what research has been done on Pavlovian conditioning involving the interoceptive effects of abused drugs as stimuli (i.e., conditioned stimuli or occasion setters). That research indicates that conditioning not only alters behavior evoked or modulated by drug stimuli, but that it alters the drug state in a manner that likely contributes to addiction. For instance, nicotine and diazepam acquire conditioned reinforcing value by virtue of being repeatedly paired with an appetitive event. Throughout the chapter we highlight translational links between preclinical research on interoceptive drug stimuli and drug addiction, as well as identify gaps in the scientific literature.

Although experts influence public opinion regarding drug addictiveness, no previous research surveys the opinions of different groups of experts in order to compare their ratings of addictiveness. This chapter reports on a survey of addiction researchers, clinicians specializing in addiction, and generalist psychotherapists. Respondents rated the addiction, tolerance and withdrawal potential of 12 drugs. They gave LSD, 3-4 methylenedioxymethamphetamine (MDMA), and cannabis the lowest ratings of addictiveness, and crack cocaine, nicotine, and heroin the highest. Addiction treatment specialists gave the highest average addictiveness ratings, followed by non-specialist clinicians and then by researchers. Respondents who had more formal education and had written more published articles gave lower ratings; those with more clinical contact gave higher ratings. Findings are explained in terms of the information each professional group routinely encounters, and judgment and decision theory.

Chronic use of stimulants and/or opiates has been associated with a wide range of cognitive deficits, involving domains of attention, inhibitory control, planning, decision making, learning, and memory. Although both stimulant and opiate users show marked impairment in various aspects of cognitive function, the impairment profile is distinctly different according to the substance of abuse. This chapter provides an in-depth overview of the neuropsychology of stimulant and opiate dependence as informed by findings of recent neuropsychological and neuroimaging studies.

This chapter traces the history of drug courts and discusses the sociology of knowledge literature. Drug courts, created partly in response to the overcrowding of jails and prisons resulting from punitive drug policies, are intended to address drug addiction that is believed to be the impetus for crime while retaining the coercion traditionally associated with the criminal justice system. Drug courts come in two main models: pre-plea and post-plea. In pre-plea drug courts, also called “deferred prosecution,” the defendant enters mandated drug treatment before pleading guilty to a charge. In the post-plea model, the defendant pleads guilty to the offense before accessing drug treatment. This chapter considers the National Association of Drug Court Professionals' campaign called All Rise to advocate for increased funding for drug courts. It also cites evidence that challenges drug courts' claims as an alternative to incarceration and goes on to chronicle the emergence of coerced treatment with the threat of incarceration as an approach to drug use.

This chapter examines how drug court advocates move from an emphasis on drug addiction as a “genuine neurobiological disease of the brain” to the conclusion that “force is the best medicine” when arguing for the important role that coercion can, and should, play in curing addiction. It considers drug court advocates's reliance on the prevailing medical and social sciences to explain addiction and to argue for coerced treatment over incarceration. It also discusses the role of sanctions and incentives in drug court practice, the importance of judges in the success of drug courts, and drug court advocates' arguments for “enlightened coercion.” Finally, it explores the consequences of the broad goals of drug courts arising from a model that combines rehabilitation and punishment.

This chapter compares the epidemiological and neuroscientific data on different addictions and addiction-like syndromes, from drug addiction to binge-eating disorders, gambling, and videogame addiction. It considers the various neurological and behavioral differences that can seem to differentiate these different behavioral syndromes, and it argues that these differences are not essential to the underlying behavioral condition that unifies various “addictive” behaviors. Based on these data, it is argued that there is a hazard inherent in any rewarding operant behavior, no matter how apparently benign: that we may become genuinely “addicted” to any behavior that provides operant reward. With this in mind, addiction is rightly seen as a possibility for any human being, not a product of the particular pharmacological or technological properties of any one particular substance or behavior.

This chapter critically considers the assumptions underlying policy proposals for sex-working drug users and drug-using sex workers in New Labour's prostitution strategy. It argues that by conflating sex work with other social problems, particularly drug addiction (see, for example, Cusick and Berney, 2005; Melrose, 2006a), the strategy conveniently sidesteps the wider structural problems associated with involvement in street sex work, such as poverty, social exclusion, and homelessness. The chapter explains that what the strategy offers are punitive responses that provide ‘individualized solutions to de-contextualized social problems’ (Phoenix, 2003), rather that structural solutions to socially contextualized social problems (Buchanan, 2004; Cusick and Berney, 2005; Melrose, 2006a).

The young men in this study came of age years after crack consumption peaked in American inner cities. Chapter 3 shows that their lives were nevertheless significantly impacted by their parents’ drug consumption. Focusing on four African American men whose criminal behavior was closely connected to their parents’ drug addiction, the chapter shows that these young men suffered from a reverse “maturity gap.” They were forced to make independent decisions when they were neither physically nor cognitively ready to take care of themselves or to foresee the consequences of their behavioral choices.

This chapter examines how medicalized theories of addiction became the basis for the broad support for drug courts and for advocates' argument in support of enlightened coercion. It begins with a historical overview of medical interpretations of deviance that have come to dominate society's understanding of what causes people to break norms and how to “fix” this rulebreaking. It then considers the cultural proliferation of the concepts of health and illness and their expanding social reach in relation to the simultaneous intensification of medicalization, reconfigured as biomedicalization. It also discusses the historical and contemporary work on the medicalization of addiction and concludes by suggesting that drug courts are directly contributing to the medicalization of addiction by drawing on medicalized interpretations of drug addiction to advocate for enhanced criminal justice.

Many laboratories, working worldwide on both animal models and human subjects, have produced significant insights into the neurobiological mechanisms that underlie drug addiction. Addictive drugs produce pathologic activation of brain reward circuits, resulting in long-term alterations in brain circuitry involved in decision-making and control of behavior. The result is a loss of control over drug seeking and engagement in compulsive drug use despite negative consequences. This scientific view is in tension with moral models that see drug use by addicted people as a matter of errant choice combined with inadequate efforts at control. This chapter explores the implications of these models for moral responsibility and legal culpability, and discusses the urgent need for advances in treatment.

This book explores the arguments put forward by advocates of drug courts and coerced treatment of drug users. It frames drug courts, often touted as “alternatives to incarceration,” within contemporary discussions of punishment, deviance, and drug addiction. It analyzes the claim that drug courts are a solution that allows the criminal justice system to regain legitimacy and retain control of drug users. In addition, it discusses medicalized theories of addiction employed by drug court advocates to stake their claim over addicts. It also examines medicine and punishment as important ideological vehicles for advancing the social control of drug users, along with the connection between drug use and crime.

This chapter examines the issues of drug addiction and rehabilitation in China. It explores some of the factors contributing to the rise of addiction in China; discusses how drug users in China are normally treated in compulsory or voluntary drug treatment centers; and explains how repeat drug abusers are often sent to labor education camps for one to three years. It also evaluates the effectiveness of these three treatment regimes and examines some of the new treatment models made available to drug users in China. It is shown that most of the drug abuse problems in China involve opiates, predominantly heroin. While the rates of illicit drug use and associated adverse consequences have continued to escalate across many areas in China, options for effective treatment have remained largely unchanged.

This chapter examines how drug court advocates make their “case for coercion” and how their perspectives about coerced treatment are informed by theories about the causes of crime as well as the role of courts in solving social problems such as drug addiction. It considers the institutional problems that advocates see themselves responding to, along with their goals for drug courts at the institutional level. In particular, it cites the “revolving door nature” of justice, which drug court advocates connect to a punitive approach to drug use, where incarceration becomes the dominant way of dealing with addiction. It also discusses the solution proposed by drug court advocates: to put rehabilitation back on the agenda of the criminal justice system in a way that rehabilitates the status of judges and the courts while “fixing” defendants.

This chapter highlights the Church's institutional view of HIV/AIDS in the context of morality, human rights, and the state. The Church sees drug addiction as a sin and a problem of immorality. But the sin is not simply a matter of immorality of the individual who uses drugs; it is also a reflection of the general lack of morality and spirituality in contemporary Russian society. To stop the spread of the epidemic, the Church has undertaken the task of reestablishing these foundations in society. The primary goal of the program is conversion. It is considered true recovery, which very few are able to achieve. To become enchurched, which is the acquisition of an embodied disposition of an Orthodox way of living, a person must come to embody Orthodox morality and learn to live a spiritual life. The notion of human rights is a driving moral motivation behind the Church's efforts. The approach to human rights, which provides the moral structures and standards of society, raises the question of the contemporary relationship between the Russian Orthodox Church and the Russian state.

Alcohol and drug abuse and misuse among older adults are one of the fastest growing public health problems in the United States. The problems, however, remain underdiagnosed and undertreated, and have been referred to as an invisible epidemic. With the aging of the baby boomers, a cohort with more liberal attitudes toward substance use than previous cohorts, the problem is expected to increase in the coming years. This chapter focuses on the three types of substance abuse among older adults: alcohol abuse, medication abuse and misuse, and illicit drug use.

Child welfare in the United States is in a state of a crisis. The system is unable to solve intense family problems relating to drug addiction, domestic violence, and criminal behavior. The system removes children from their homes, only to see them languish in a state of impermanence without the promise of a stable family. The system promotes extended family relationships to such an extent that it ignores children’s health and well-being, and makes a mockery of the government’s role as an intermediary in vulnerable children’s lives. And the system separates children from maltreating parents, too often placing them with caregivers who are either unprepared and ill-supported for the work, or who do not even meet the minimum qualifications to provide adequate care. This chapter calls for a re-examination of child welfare’s central mission with a fresh emphasis on protecting children who have been harmed by their parents.