Below is a summary of the sections I found most interesting in the article I read today. The article is titled, “The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations” (Robinson & Adinoff, 2016). What stood out to me was the discussion on the history of drug use. It explained how cultural, political, religious, and societal influences can change the legality, perception, treatment, and overall consumption of various substances. The authors described how negative connotations around alcohol intoxication and morality are found in the Bible. That stigma carried forward and still exists in today’s society. It was and still is sometimes viewed as a moral issue. AA helped to begin to try to shift the view from a moral handicap to a medical condition/disease (Robinson & Adinoff, 2016).
During the American Industrial Revolution, the article explains is when substance use became seen as interlinked with criminal behavior. The authors then discussed how plantation owners provided slaves leafs of coca to increase productivity. This began to connect drug use, criminalization, and race. Cocaine, cannabis, and alcohol became seen as vices due to their connection with racial minorities and lower-class individuals (Robinson & Adinoff, 2016).
Understanding the above history was extremely eye-opening to me. This is why I love education. It helps take what once was a very narrow limited view and helps expand the scope. The authors describe time as the factor that brings to light the societal and cultural influences on perceptions towards something. They gave an example in the article about how society’s view of homosexuality has altered over time from once being considered a mental disorder in the DSM, which it thankfully is no longer (Robinson & Adinoff, 2016).
Robinson & Adinoff (2016), then describes the existing stigma concerning Evidence-Based Practices (EBP). Some examples of pharmacological EBPs include Suboxone treatment for Opioid use and Naltrexone for the treatment of alcohol use disorders. Many providers still have a stigma for EBPs either due to the culture, level of education, training, affiliations…etc (Robinson & Adinoff, 2016). The stigma is very real in 12-step communities concerning these types of treatment. It seems hard to believe there will come a time when it might be a common practice and accepted. At one time treating mental health conditions with medication was also highly stigmatized within 12-step communities. This has for the most part changed although pockets of that still exist. One day there may be a pharmacological treatment as commonly practiced for SUDs as patches are for nicotine replacement therapy.
One of the recent changes with the DSM-5 is the removal of legal problems as a criterion for substance use disorder. Robinson & Adinoff (2016) theorize that it is perhaps the beginning of the shift to try to undo some of the long-standing stereotypes around racial, minorities, and criminalization associations with substance use. There has been increased recognition concerning the racial differences in sentencing for drug charges (Robinson & Adinoff, 2016).
Robinson & Adinoff (2016) believe that the inclusion of behavioral addiction (pathological gambling) under addictions is an indication of another big perception/attitude shift within society. There is a lot of debate around the inclusion of this as an addictive disorder. Many feel including behavioral addictions lead to over-diagnosing of general human behavior which could discredit the field of psychology (Robinson & Adinoff, 2016). I think for some there can be a linear continuum progression from SUD to certain behavioral addictions. I am curious about the link between the two. There have not been enough peer-reviewed research studies on other behavioral addictions for them to be included along with the other classified addictions in the DSM (Robinson & Adinoff, 2016). I hope to contribute in this area of research.
My summary of this article does not do it justice. Really great article. I got a lot out of it.
Robinson, S. M., & Adinoff, B. (2016). The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations. Behavioral Sciences (2076-328X), 6(3), bs6030018. https://doi.org/10.3390/bs6030018
Cover: Photo by Annie Spratt on Unsplash
Shaynanigans 