This phenomenon is not limited to developed/industrial countries. Nicholas Kristof writes:

If the poorest families spent as much money educating their children as they do on wine, cigarettes and prostitutes, their children’s prospects would be transformed. Much suffering is caused not only by low incomes, but also by shortsighted private spending decisions by heads of households.

And it’s not just premature deaths and worse education, these types of behaviors cost a lot. Just take the May headline, Governments’ Drug-Abuse Costs Hit $468 Billion, Study Says. Most of those costs were in health or law enforcement, with just 2 percent spent on prevention, treatment, and research.

This is where we need really innovative approaches to understanding consumption, human decision making, and how we regulate our behavior. Behavioral economics is not all that; we do WEIRD research, instead of MYOPICS studies; we say poverty poisons the brain, but forget about just how poverty comes to be; we blame bad behavior on bad hormones, rather than doing more substantive work to understand people’s behavior.

Neuroanthropology can offer novel approaches, from understanding the development of addiction in four steps to better grasping the integrated dimensions of post-traumatic stress disorder to examining different components of food, obesity and eating and understanding the complexities of video games and other modern obsessions.

These problems are not all caused by biological mechanisms or social construction, they are not all rooted in human psychology or deviations from rationality. They are human phenomena, requiring that we integrate ideas across multiple domains. To do that, anthropology needs psychology and neuroscience, just as they need anthropology. The impact of what we DO is enormous. And I’m betting that understanding what we do better will help us become more human – to find ways to deal with our own decisions and flaws, not just through technical fixes or imposed solutions, but also through finding ways to better promote our potential.

Of the 23 million people who struggle with alcohol or drug abuse on a yearly basis, roughly 1.2 million regularly attend Alcoholics Anonymous (AA) meetings as a way to stop drinking. AA was the first 12-step program to be created. Founded on December 14, 1934 by Bill Wilson and Robert or “Dr. Bob” Smith, AA combines self-assessment, reconciliation, group therapy, and surrendering control to a “higher power” in a progressive plan consisting of 12 distinct steps to combat impulsive cravings to use.

“Secret of AA: After 75 Years, We Don’t Know How It Works”, written by Brendan Koerner for Wired, does a thorough job explaining the history and approach of Alcoholics Anonymous in the United States. Koerner writes that, “There’s no doubt that when AA works, it can be transformative. But what aspect of the program deserves most of the credit?… Stunningly, even the most highly regarded AA experts have no idea.”

Koerner then examines how research in the behavioral sciences and neurology can provide insights to AA’s intermittent success. Here we learn that it’s not just the twelve steps but also the power of the group, from the commitment the individual feels to forming close relationships that can provide a sense of security to the opportunity to relearn how to connect to others without alcohol. Koerner also argues that the experience of public confession, both doing it and seeing it, helps individuals strengthen the regulatory powers of their prefrontal cortex, weakened after years of drinking.

However, in trying to account for the modest but significant beneficial effects AA can have for many individuals, Koerner leaves out important “soft sciences”, such as anthropology. Why do people attend AA? It’s not just to strengthen their prefrontal cortices.

In this post I will outline some societal forces that have led to AA’s popularity. I will also argue that the social sciences are integral for crafting new and effective addiction treatments. The ideas and data presented here come in large part from my comparative research on alcohol use and abuse among homeless men, college students, and veterans struggling with post-traumatic stress disorder.

Societal Forces at Play in Biomedicine

AA has been the subject of countless studies, yet reported success rates vary enormously: between 5 and 75 percent. This may be due to AA’s shunning of individual identification and the ease with which members enter and leave the program. However, several studies indicate that AA does not work for everyone and that, for most people, does not work at all.

While scientific support for AA or other 12-step programs is inconclusive, most medical practitioners strongly recommend it as a primary means to treat addiction. In Wired, addiction-medicine specialist Drew Pinsky states: “In my 20 years of treating addicts, I’ve never seen anything that comes close to the 12-steps. In my world, if someone says they don’t want to do the 12-steps, I know they aren’t going to get better.”

This contradiction between the little if any definitive scientific proof that AA reliably treats those suffering from addiction and the wide-spread endorsement of AA by medical and governmental officials raises an important sociological question:

Why do so many science-based medical providers recommend AA?

It’s free.

This is the number one response that has been given to me by a diverse set of experts: medical doctors, counselors, sociologists, anthropologists, and long time AA members. In addition, it’s a response that accounts for socio-economic forces unseen in the nightmarish immediacy of alcohol dependent bodies.

Many individuals suffering from alcohol or drug dependency have gotten to a point where all fiscal resources are dedicated to obtaining more substance to consume. Consequently, addicts may only enter treatment when all money and social support nets have run out. This precludes any possibility of entering a treatment program that costs money.

At a time when the health care industry is much more frugally minded, it makes sense to take advantage of low or no cost treatment options that rival recovery rates of higher cost methods. While it could be argued that other current methods may have a higher success rate, nothing beats the price of AA.

It’s convenient

AA has 55,000 groups globally. There is already a structure in place that has acclaimed effectiveness, whether common or not, from varied demographics. It is much more prevalent than other, lesser known non-12-step addiction treatments, and is found in virtually every major city’s business listing in the United States. This expert, from a life history recorded during my college thesis research, demonstrates the ease of locating a group:

On February 23rd, 1978, Chris [a pseudonym] began complete alcohol abstinence and substance sobriety. His brother, whom he was staying with, forced Chris to either get treatment or leave his home. “‘But I don’t know the first place to start,’ I told my brother,” Chris said. “My brother threw me a phone book and said, ‘start looking’”. Chris soon found a local Alcoholics Anonymous and entered into treatment.

In addition, AA is embedded in the criminal justice/ law enforcement system which tends to have frequent interactions with alcohol dependent individuals.

AA is something immediately and universally available that has been around for 76 years; it is a socially accepted norm that alcoholics go to AA.

Passionate Anecdotal Evidence

While AA does not work for most people, those it does work for are dramatically changed. While conducting my own research, I have encountered numerous individuals from varied backgrounds who swear by AA and claim that without AA, they most likely would not be living. Many people’s lives have been saved by AA, even if those people are a statistical minority.

When individuals experience an event that forever changes his or her life, whether it be good or bad, that event has a large chance of forever coloring future experience. To come out of such a distorting condition as alcohol dependency, I have been told, is like being immersed into a pool of profound clarity. This clarity helps individuals with success through AA to speak with deep conviction and a high level of charisma.

The outsized charisma and passion that emanates from a relatively small number of AA members may be enough for medical providers to overestimate its success level.

How Sociological Insights Can Aid in New Addiction Treatment

David Brooks, in support of Kroener, raises a point that has been echoed by psychologists and addicts alike: perhaps we will never fully understand addiction so as to be able to craft better treatment options. In an Op-Ed in the New York Times, entitled “Bill Wilson’s Gospel”, Brooks states:

“… we should get over the notion that we will someday crack the behavior code — that we will someday find a scientific method that will allow us to predict behavior and design reliable social programs. As Koerner notes, A.A. has been the subject of thousands of studies. Yet “no one has yet satisfactorily explained why some succeed in A.A. while others don’t, or even what percentage of alcoholics who try the steps will eventually become sober as a result.”

Each member of an A.A. group is distinct. Each group is distinct. Each moment is distinct. There is simply no way for social scientists to reduce this kind of complexity into equations and formula that can be replicated one place after another.

While it is true that science may not be able to reduce the complexity of an addict going through recovery into “equations and formula,” this is not the only way to understand “the behavior code.” Social science can provide insight into crafting better, more suitable treatment initiatives for addicts.

Although every addict is an individual, this individual comes from specific social and contextual backgrounds. Each individual also belongs to particular cohorts, or small social groups. Learning how barriers to treatment for alcohol dependency fluctuate with social groups must be addressed in order to know how best to implement successful interventions. This is especially important for disadvantaged socioeconomic groups (i.e. homeless individuals) or groups with syndemic disorders, or secondary health conditions that affect and complicate the overall illness one experiences (i.e. individuals with post-traumatic stress disorder).

The importance of understanding the social component of dependency and addiction through rigorous methodological means cannot be overstated. While tremendous advances in “hard sciences” have demonstrated truly important chemical and biological correlations with addiction, such as the permanent changes in the brain resulting from chronic substance usage, these insights remain hollow without the connection to an addict’s lived experience. By integrating social, contextual, and psychological knowledge with biological and physiological understandings, researchers and clinicians can expect to make unprecedented improvements to the overall treatment provided to substance dependent individuals.

Here’s a quote that caught my eye on Sunday:

For in the anything-goes atmosphere of our recent past, it wasn’t just external controls that went awry; inwardly, people lost constraint and common sense, too. Now there is a case to be made that problems of self-regulation — of appetite, emotion, impulse and cupidity — may well be the defining social pathology of our time.

In the late 1970s, the historian Christopher Lasch famously described America as a culture of narcissism. Today we might well be called a nation of dysregulation. The signs that something is amiss in our inner mechanisms of control and restraint are everywhere.

It came from the NY Times article Dysregulation Now by Judith Warner. She featured the work of Peter Whybrow in the second half of the piece. Whybrow directs the Semel Institute for Neuroscience and Human Behavior at UCLA.

Whybrow is the author of American Mania: When More Is Not Enough. It definitely looks like a neuroanthropology-friendly work, with the Amazon description reading: “The indictment of American society offered here—that America’s supercharged free-market capitalism shackles us to a treadmill of overwork and overconsumption, frays family and community ties and leaves us anxious, alienated and overweight—is familiar. What’s more idiosyncratic and compelling is the author’s grounding his treatise in political economy (citing everyone from Adam Smith to Thorstein Veblen) as well as in neuropsychiatry, primatology and genetics.”

Building on Whybrow’s work, Warner writes near the end of her piece:

The larger structural problems that create our widespread envy, greed, overconsumption and debt — gross income inequality, for starters — will be much more difficult, politically, to address… [T]he pressures that drive the dysregulated American haven’t abated any since the fall of 2008. Wall Street is resurgent, and unemployment is still high. For too many people, the cycle of craving and debt that drives our treadmill existence simply can’t be broken.

It’s the “modern misfits” story, where human nature no longer matches the human culture we’ve created. That too is familiar. But at least there is an appreciation of causation at different levels, from human psychology to structural problems, and that’s good. And I do happen to think that issues surrounding consumption and self-regulation are rather important, and not sufficiently recognized as problems that need more than simple answers like a Drug War or a pill to break the cycle of craving…

Dysregulation Nation article link.

Peter Whybrow’s website.

One of the ‘Quotes of the day’ in Time Magazine on the 21st of April 2010 was:

“They have made the mistake of letting the Marlboro Man into the country. “

A photo is featured alongside the quote. In the photo, there is a billboard advertising L.A. Lights cigarettes and an upcoming Kelly Clarkson concert in Indonesia. The Tapei Times writes: “Just a few kilometers after passing a towering Marlboro Man ad, a second billboard off the highway promotes cigarettes with a new American face: Kelly Clarkson.” Radiosophie report: “The marketing ploy comes two years after Alicia Keys objected to a similar tobacco-fuelled sponsorship deal in Indonesia.” The Los Angeles Times and Jakarta Globe also covered the story.

Since the scandal, Kelly Clarkson has allegedly cancelled her tour and her Tobacco-company sponsorship, but the same cannot be said for the Tobacco-company sponsored tours of Incubus (Jakarta, 5 March 2008), James Blunt (Jakarta, 21 May 2008), or Jamiroquai (Bogor, 8 April, 2009). Tickets to these concerts cost little more than Four US dollars ($US4), so it is clear that without huge sponsorship deals from Tobacco companies, the big artists simply would not perform in Indonesia. It makes me wonder, how many other Pop artists escape the Paparazzi radar and perform with Tobacco-company sponsorship in Indonesia?

For me, these billboards exemplify what globalisation brings and what it doesn’t bring to the developing world. It brings the products but not the ethics. 

One of my early fieldwork conversations was with a middle aged gentleman who was explaining to me why so many people smoke in his country. “It’s to help our economy,” he said, “People in the developed world are buying less cigarettes and a lot of our economy depends on Tobacco. So we have to buy more cigarettes because you are buying less.” 

From this man’s words, it suddenly became apparent to me that the widespread middle-class ethics that encourage people in the developed world not to smoke had effects in the developing world that I had never thought of before. Packets of cigarettes in Indonesia may have a wrapper that states “Merokok dapat menyebabkan kanker” (Smoking can cause cancer), but the shere quantity of smokers in Indonesia indicates that these few words have little effect on cultural habits. As the developed world weens itself off nicotine, is the developing world compensating for our lack of demand?

I remembering talking more with this gentleman as we walked down a busy litter-filled street. I unwrapped a snack and looked for a rubbish bin but saw none in sight. I pocketed the plastic wrapper and continued attending to the conversation. My companion stopped. “I love that about foreigners,” he said.
“What?” I asked.
“I love that foreigners look after their environment like you just did and don’t throw their rubbish everywhere. Us, we don’t do that. I really admire that you kept your rubbish.”
I really didn’t know what to say because keeping the wrapper until I could dispose of it appropriately seemed so natural to me. In fact, I was surprised that this man even noticed my behaviour. Judging by the amount of rubbish around the streets, in public parks and even in rice paddies, I just assumed that littering was not something they really thought about. I would have liked to know more about this gentleman’s thoughts on the matter but unfortunately I didn’t find the right question to ask. We started to talk about other matters. After a short while, the gentleman pulled out a packet of cigarettes to have a smoke. He peeled off the plastic wrapping and threw it on the ground by the side of the road. Products may be expediently transported and consumed through the global economy, but ethical behaviour takes a longer time to adopt.

“Why do I pregame?” The third year American History student repeated our question with a bit of sarcasm in his voice. He put down his textbook and then delivered his jovial response:

“Why wouldn’t I pregame?! It makes everything better- bars, parties, dances, football, class, work…”

This is the pregaming mentality expressed by a current undergrad at our mid-Western university. This mentality can be summarized: if you have to go to something, why not be buzzed when you do it?

Across the country, on any given weekend night, college students are often consuming four or five, sometimes even 10 drinks, before they even make it out of their dorm room for a night of partying, the dorm dance, or even the latest sports event.

They consume what many medical professionals construe as dangerous, sometimes lethal, amounts of alcohol in a short period of time. Then students often find themselves passing out, throwing up and even being taken to the hospital. And that’s before they even make it to the party.

From an outsider’s point of view, this may not sound like a lot of fun. For college students, pregaming is often the best part of the night. Our question as student researchers was, Why?

Our Research

Due to the recent emergence of pregaming, little is known about the mentality behind it. Working with the university group in charge of helping to prevent and treat alcohol abuse, we aimed to understand the social and cultural bases for high-risk drinking and pregaming. Previous student research on pregaming focused on gender differences, and can be found in the post “College Drinking: Battle of the Sexes?”

The statistics were already clear for the university office in charge of alcohol education and prevention – almost 80% of students who have gotten in trouble for alcohol-related events were pregaming on the night of the incident. Counselors there feared that the high-risk drinking habit of pregaming has become synonymous with students social lives.

Our project aimed at both understanding students’ general attitude towards pregaming as well as why students stop drinking on a given night. These questions could offer insight and clues to effective handling of the problem of pregaming by students and the university alike.

Throughout the Fall 2009 semester, we surveyed over 400 undergraduate students along with conducting student and counselor interviews. The surveys included nine questions regarding students’ drinking and pregaming habits. Ten student interviews of females and males were conducted to focus on attitudes toward pregaming. We also drew on our own insights and experiences as undergraduate students.

A Social Need

The main theme emerging from our research is the intense social aspect of pregaming. We were surprised to find out that many students actually enjoy the pregame over the party itself, simply because they enjoy being with a smaller group of friends.

“Pregames are usually a fun part of the night because you’re just with a few close friends before you go out and meet up with a lot more people and can’t chat and laugh with your close friends as much,” said one student.

Another student talked about how pregaming was a good way to organize your friends before going out. By getting together a group of people before the party, you’re not left with the possibility of going out to party alone.

Additionally, we found that many students pregame to lower their inhibitions, making them more fun, outgoing and less awkward when they’re at a party. Whereas they may feel comfortable showing up to a pregame sober, they are very uncomfortable with the idea of showing up to a party sober.

As several students put it, pregaming “gets rid of potential awkwardness at the beginning of parties.” It gives you a “confidence boost” and makes you “more loose and able to socialize”. As described in previous student research Why Do They Do It? Portrayals of Alcohol on Facebook and MySpace, drinking is a way for students to “portray themselves as social, attractive, and popular.”

In general, students did not feel any need to “pregame” the pregame. This suggests that students do not have the same reservations about being at a pregame sober as they do about being at a party sober. The people they pregame with are oftentimes the same people they study with, eat with and simply hang out with on a regular basis. They are used to being sober with these people and therefore don’t worry about having to carry on what might other times be awkward conservations with them.

However, when students make it to a party, bar, or dance, they are surrounded by students they are not used to interacting with. They may feel self-conscious and uncomfortable talking to people they don’t know, and thus use alcohol as a “social lubricant,” getting them drunk before the party to avoid these potential awkward encounters.

Our surveys also showed that many students admit to pregaming so hard that they never make it to the intended event or “blacking out before the party even starts”. Every student interviewed remembered instances when they or one of their close friends did not make it to the main event they were pregaming for. When students pregame they are oftentimes more concerned about the pregame itself than the event they’re going to afterwards. “Pregaming is the party,” one student noted while laughing nonchalantly.

Drinking to Dance

One particular concern counselors have is the pregaming that goes on before dormitory dances. Throughout the school year different resident halls host both informal and formal dances. These events are intended to be a fun outing for the residents of each hall.

Unfortunately, in recent years these dances have turned into excuses for massive amounts of pregaming. Because alcohol is not typically served at the dances many students feel an added pressure to get drunk prior to attending the dance itself. Moreover, many students, as mentioned earlier, feel awkward and uncomfortable at these events unless they have already been drinking.

To overcome these problems, students will pregame, consuming up to 8-10 drinks in a matter of an hour or two before going to the dance. This inevitably leaves many students vomiting in bathrooms, passing out on the dance floor and sometimes even being rushed to the hospital because of alcohol poisoning. During a recent dorm dance, between 20-23 students were either personally walked home or ejected from the dance for alcohol related incidents.

Why Should I Stop?

Determining why students stop drinking on a given night gave us insight into why students are drinking in the first place. By finding out what students are trying to avoid when they stop drinking, we have gotten better insight on what to educate students on.

Students reported two top reasons for why they stop drinking. The first is because they “reach [their] limit” which involves throwing up, passing out or being hung over the next day. The second was that their friends stopped drinking. Students stop when their friends stop because they didn’t want to look bad in front of their friends or their friends told them to stop. Pregaming would accelerate the occurrence of both reaching one’s limit and of friends drinking ending.

Since “limits” and social reaction are the two most important reasons students quit drinking, these are two areas that should be focused on when creating alcohol education systems.

While a few students admit they “don’t see the appeal of pregaming,” the majority of students do not agree. Counselors must seek to better understand why students want to “get the juices flowing” and “get drunk as early as possible,” before they will be able to help students avoid the penalties, embarrassing events and hospital visits that often accompany this high-risk action.

Now What?

Unfortunately, many students do not always realize the serious health risks that come with pregaming. Surveys indicate that students are more concerned about getting caught pregaming than they are about any potential health risks.

Counselors fear that the “work hard, play hard” mentality of many students will not disappear after graduation. Counselors worry that upon entering the work force, graduates will continue to turn to alcohol to cope with stress, simply because that is what they have trained themselves to do.

So what do we do about pregaming and the risks it brings? The current modes of educating students about the risks associated with pregaming are very limited. Pregaming is a relatively new phenomenon and many universities are just beginning to assess ways to combat it. Current alcohol education programs focus on abstinence from drinking, which has not been shown as affective.

Since research shows that students do not worry about the health risks associated with pregaming, it would be prudent to focus future education initiatives on the health effects of such practices. College students respond to facts and information. They are past the age of being told that if something is bad they shouldn’t do it. This might help explain why programs that ask students to abstain from drinking because it’s unhealthy do not seem to be working. However, if programs focused on laying out the proven effects of alcohol consumption on an adolescent body, students may respond more favorably.

Based on our research, we believe that a particular focus should be placed on dances, which attract the highest levels of pregaming and its negative consequences. It is believed by group members that dormitory regulations currently in place before and during school sponsored dances need to be rethought. Rules regarding time limits on social gatherings that were originally put into place to keep students safe are becoming more and more detrimental to students’ health.

In the end, counselors’ best hope for cutting down student pregaming and the risks it entails is to address the social issue. Provide options on other social activities for students to take part in. Use students’ social networks to their advantage; use friends to get friends to cut down on their heavy pregaming habits. We know that if our friends told us we were drinking too much, we would most likely stop.

-//-

Acknowledgements: A special thanks to the director of our local university alcohol education and prevention program for insight and support.

It was a very stimulating visit, and given their technology gurus there, I can share with you two key parts of it.

First there is the video of my lecture on Evolution, Behavior and the Encultured Brain. You don’t actually get to see me, however – you see my Powerpoint slides and hear my accompanying lecture. In the talk I cover a lot of my work on evolutionary theory and addiction, and then discuss how that work has lead me to neuroanthropology and how neuroanthropology works as a good complement to evolutionary biology.

I also took part in a podcast, where I got involved in a great discussion with students at Binghamton about my research on substance use and abuse in Colombia. So in the podcast I range more widely over my work, in particularly discussing some of the cultural anthropology work I have done. So you can also get the Daniel Lende podcast.

They also had a page providing a brief introduction to my talk, and there you can access the pdf of my Evolutionary Medicine and Health chapter “Evolution and Modern Behavioral Problems: The Case of Addiciton.”

“Calling this book ethnography would be like calling The Wire a cop show: what comes roaring out of its pages is almost as visceral and devastating as spending a night in ‘the hole’ itself.”
-Mike Davis, author of Planet of Slums

“Philippe Bourgois and Jeff Schonberg provide a riveting narrative of the daily struggles for survival of homeless people with a physical and emotional addiction to heroin. The authors’ poignant account of these experiences features sophisticated analytic themes that enable them insightfully to integrate discussions of agency and moral responsibility on the part of homeless addicts with an analysis of the powerful structural forces that shape the addicts’ lives. Righteous Dopefiend is a must-read.”
- William Julius Wilson, author of More than Just Race: Being Black and Poor in the Inner City

Here’s the UC Press description:

This powerful study immerses the reader in the world of homelessness and drug addiction in the contemporary United States. For over a decade Philippe Bourgois and Jeff Schonberg followed a social network of two dozen heroin injectors and crack smokers on the streets of San Francisco, accompanying them as they scrambled to generate income through burglary, panhandling, recycling, and day labor. Righteous Dopefiend interweaves stunning black-and-white photographs with vivid dialogue, detailed field notes, and critical theoretical analysis. Its gripping narrative develops a cast of characters around the themes of violence, race relations, sexuality, family trauma, embodied suffering, social inequality, and power relations. The result is a dispassionate chronicle of survival, loss, caring, and hope rooted in the addicts’ determination to hang on for one more day and one more “fix” through a “moral economy of sharing” that precariously balances mutual solidarity and interpersonal betrayal.

And here’s Publisher’s Weekly starred review:

In this gritty ethnography exploring the world of San Francisco’s homeless heroin addicts, Bourgois, anthropology and community medicine professor at the University of Pennsylvania, and Schonberg, a photographer and graduate student in medical anthropology, draw on a decade immersed in this subculture to eloquently elaborate on the survival techniques and intimate lives of black and white addicts who live in self-made communities and work the economic fringes for survival. The authors explore racial boundaries and crossings, love stories, family relations, parenting, histories of childhood abuse, as well as the constant work of navigating hostile police enforcement, exploitative and helpful business owners, overburdened medical services and social service bureaucracies.

The book details the gruesome material toll of addiction, infection and homelessness and the risks of ongoing personal and institutional violence. Bourgois and Schonberg create a deeply nuanced picture of a population that cannot escape social reprobation, but deserves social inclusion. Schonberg’s photographs capture the scars of addiction, the social bonds between romantic pairs and drug-running partners and the concerted efforts at domesticity without a domicile. The collage of case studies, field notes, personal narratives and photography is nothing short of enthralling.

Robin’s Bookstore gives us some more details on the methods and analytic lens Bourgois used:

The book chronicles the lives of 10 drug users (in the Bernal Heights area of San Francisco), developing portraits of these individuals to assess the means by which the dynamics of gender, race, and class find expression in their lives… Its gripping narrative develops a cast of characters around the themes of violence, race relations, sexuality, family trauma, embodied suffering, social inequality, and power relations. The result is a dispassionate chronicle of survival, loss, caring, and hope rooted in the addicts’ determination to hang on for one more day and one more “fix” through a “moral economy of sharing” that precariously balances mutual solidarity and interpersonal betrayal.

Finally, the Chronicle of Higher Education recently reviewed Bourgois’ Righteous Dopefiend, and I’ve excerpted a few relevant parts below.

Having an interdisciplinary perspective, in a sense, means you serve different masters, and that is unusually evident in Bourgois’s case. On the one hand, he is a cultural anthropologist in the humanistic, participant-observer tradition. He can emit at will great clouds of jargon that draw on the writings of Michel Foucault and Pierre Bourdieu. But he also produces concrete recommendations about treating drug abuse and limiting the spread of blood-borne diseases, which is why the National Institutes of Health has long financed his work.

American drug policies, he says, “turn the filthiest nooks and crannies into the only objectively safe places for the indigent who are physically addicted to heroin to inject.”

Robert Borofsky, a professor of anthropology at Hawaii Pacific University who oversees the California Series in Public Anthropology, which includes Righteous Dopefiend, offers a sweeping defense of the ethics of the project. “Philippe Bourgois and Jeff Schonberg are doing a wonderful job of giving life and voice to these homeless drug addicts,” he says. “It brings them more fully into the human community and lets us understand more fully their understanding of the world.”

On the policy front, some of Bourgois’s proposals are fairly mainstream: more mobile health, psychology, and methadone clinics; better case management for frequent emergency-room visitors (or separate clinics for them); expanded access to single-room-occupancy hotels with in-house medical staffs. (Without such staffs, SRO hotels can be deadly, because unlike at Edgewater, there’s no one to revive you if you OD.)

Other proposals are more forward-looking. Bourgois has come to believe that the culture of shared needles and drug paraphernalia is so ingrained among addicts that you have to assume people will share when they are desperate. “I think the most important piece of information to get out is to rinse needles thoroughly,” he says — even if that means just with water. On the West Coast, he has written in a paper with Ciccarone, people tend to rinse thoroughly out of necessity, because the black-tar heroin that is common there clogs syringes.

For more you can visit Phillippe Bourgois’ website, check out the UC Press Righteous Dopefiend page, and read this interview with Phillippe about the book and his ethnographic work.

Compulsion III by Sandra Doore

Here are all the student posts from this year in the order I put them up. As a group they’ve already proven popular, getting attention from a range of high-power sites and social networks. That’s great, and well-deserved!

Below I also outline how I approached this project with my students. If you want to incorporate something similar into your teaching or comparable work, feel free to use and/or adapt these guidelines. Of course any suggestions or alternative approaches are always appreciated. Leave a comment below or email me at dlende at nd dot edu

The List

Why Do They Do It? Portrayals of Alcohol on Facebook and MySpace

Gambling and Compulsion: Neurobiology Meets Casinos

What’s the Dope on Music and Drugs?

Tobacco Worse Than Cocaine?

Caught in the Net – The Internet & Compulsion

Lights, Camera… Alcohol?

Confessions of a Shopaholic

Can Videogames Actually Be Good For You?

The New Performance Enhancing Drugs

These nine posts join the eight from last year, which went from understanding brain imaging to the differences between men and women drinking on campus – those were rounded up in Why A Final Essay When We Can Do This?

All these posts came out of my class ANTH 20220 “Alcohol and Drugs: The Anthropology of Substance Use and Abuse.”

I divide students into groups of four to work on posts. I explain the topics broadly quite early in the semester, then have students write down their top three choices. I form the groups based on students’ choices.

The basic order of work over the semester is: (1) a general in-class presentation on the topic; (2) a first draft of their post, with an emphasis on developing a concrete argument and specific focus for their writing; (3) two more rounds of revisions, where they both improve the quality of the writing and add in images, links and further research; and (4) some editing/revisions by myself to make sure each post reaches its potential.

Unlike last year, this year students did an in-class presentation on their assigned topic. That was helpful for everyone, for me to give feedback as necessary, for groups to get started on their work, and for students to give some impromptu reactions. The presentations were generally broad. I discussed with the groups, either in class or by email, how their presentation was coming along.

For the presentation itself I emphasized the need to do something engaging (make it fun!), to provide some in-depth coverage of their specific topic (as they were things that I wouldn’t necessarily cover – they were in charge of everyone’s learning that day), and to aim to provoke discussion for the class as a whole after their presentation.

Now onto the first draft. From the general presentation the students had to develop a specific focus and a concrete argument. What did they want to share with the world? That was the basic question they had to answer for themselves.

I also provided students with this basic format for writing a blog post (so feel free to use it): (a) The Hook, those opening lines that grab the readers’ attention in some way; (b) The Argument, something that invites the person to keep reading, usually by indicating what this post will do or cover; (c) Main Points, where there are a set of issues or specific points that the post will cover (generally the main body of the post); and (d) The Finish, generally some sort of pay-off for the reader who makes it that far – a rhetorical flourish or something extra that helps close the piece with some flash.

Their revisions normally emphasized three things: improving each aspect of the basic format, deepening the ideas and research for the post, and taking advantage of what an online environment can do much more effectively than a final essay – images, video, links, and so forth. I provide a lot of written feedback and suggestions while also encouraging students to keep developing what they want to say to a wide-ranging audience.

The final step is getting the posts from the students’ electronic copy onto Neuroanthropology.net. This is my chance to provide some further light editing, as well as at times include other research articles or links that I might recall and/or find. Though I do guide the students through how I want their final submission to look, at times they forget obvious things – like including links that work outside the university’s system. So it’s a little bit of work to get their document onto WordPress in a way that looks like a professional final product.

So that’s how we did it. As always the students did a great job!

Also for your reference, here are the relevant sections from the syllabus:

Working in groups of four, students will take charge of developing and delivering a polished, entertaining and insightful presentation on their assigned topic. Each presentation should accomplish four things: (a) provide some basic overview of the topic at hand, (b) develop an argument or analysis utilizing both background research and the students’ own research, (c) give us a sense of how this particular topic plays out in everyday life, and (d) make us have fun.

These presentations should be at least 20 minutes long, and each student in the group must speak before the class. Students will be expected to engage in Q&A after their presentation; the presentation will also serve as the impetus for further in-class discussion, something presenters should bear in mind as they develop their multimedia extravaganza.

Here are the presentation topics and dates:

Jan 29: Movies & Alcohol
Feb 5: MySpace/Facebook & Alcohol
Feb 12: Internet & Compulsion
Feb 19: Video Games & Compulsion
Feb 26: Shopping & Compulsion
Mar 5: Smoking & Compulsion
Mar 26: Gambling & Compulsion
Apr 9: Music & Drugs
Apr 16: Cognitive Enhancers & Compulsion

To stimulate class discussion, students who are not presenting will bring in a one page summary and brief analysis of their own favorite example of the topic at hand.

The blog will build off the student presentation. Each group will work over the course of the semester to develop a post for the Neuroanthropology blog: http://neuroanthropology.net . Students will be expected to do significant library research on their particular topic and to draw on insights from their presentation, class discussions, and our readings and lectures. Developing a specific focus for the blog post is a crucial task – without that focus, the post will not engage readers. To help that process along, students will submit an initial draft (April 14th) and a second draft (April 28th) of their blog post. The final post is due May 7th at 12:30 and has a 1500 word limit.

Blog posts rely on good writing, additional media (such as images and videos), and links. All three elements are necessary for a successful post. Very high standards will be held for the final draft, as what each group writes will be posted on a public website. Your blog entry could very easily be read by hundreds or even thousands of people. The most successful post from the last class has been read by 2500 people! To see what previous students did, see this link: http://neuroanthropology.net/2008/05/09/why-a-final-essay-when-we-can-do-this/

Do you feel a thrill when you swipe your card at the register? Come home from the store with things you didn’t plan on buying? Buy things you never use? Run your credits cards up to the limit? If your answers to these questions are yes, you may be a shopaholic.

Shopping and Other Addictions

Newsflash: Shopping addictions are not as glamorous and humorous as the media often portrays them to be. In fact, shopping compulsions are similar to other serious drug addictions that our culture faces today. Donald Black, MD, professor of psychiatry at the University of Iowa, College of Medicine states:

“Like other addictions, it basically has to do with impulsiveness and lack of control over one’s impulses. In America, shopping is embedded in our culture; so often, the impulsiveness comes out as excessive shopping.”

As is seen with all other addictions, compulsive shopping can destroy a person’s life, family, and finances. Take a look at this clip from the show Intervention, which starts with Heidi on a shopping spree.

As you can see, what helps makes shopping addictive is the high experienced while spending. Heidi herself says she feels like someone who just snorted a few lines of cocaine!

Individuals can get a “high” from shopping because endorphins and dopamine get switched on. This can makes the shopper feel good and engaged in what she or he is doing. Note in the video that it wasn’t the actual product that made Heidi feel all giddy and excited. She hastily pointed at which make-up she wanted with little consideration for the products. What really triggered her was the attention from the sales woman, swiping her credit card, being in the store – in other words, the whole experience.

The euphoria itself – that hit of feeling good – can reinforce the overall behavior, making the person more likely to shop again (see this good reflection from 3-Penny Princess on getting hooked on shopping). Given the way stores and credit cards work together, shoppers can spend an enormous amount of money on things they don’t need, as MTV’s True Life: I’m A Compulsive Shopper attests to. So if ever see someone’s closet filled to the brim with items with the tags still on, you may have a shopaholic on your hands!

When the high starts to fade, these individuals can be left with feelings of guilt and shame. It is a bit of a Catch 22 because this emotional distress ultimately leads to a need to alleviate the bad feelings through another shopping binge. Some shopaholics “black out” and claim they do not recall purchasing items at all! Others will hide their purchases, or even pick up a second job to pay off all of their debt.

American Consumer Culture

In American culture, this type of excessive spending is not only acceptable; it is encouraged and even celebrated! For this reason, it is fair to say that this culture actually encourages different parts of the viscous shopping addiction cycle. The U.S. is famous for having holidays centered around shopping. The “Christmas” shopping season begins as early as Halloween.

Thanksgiving holiday has become synonymous with the “Black Friday” sales (see these photos). Black Friday is infamous for having massive crowds camping out or standing in line for hours the day before, only to literally trample each other once store doors open. These holidays and events provide addicts with a rationalization of their behavior. I’m sure you’ve heard many people say, Oh! I should buy this, it’s okay, it’s on sale! It’s clear that this type of culture is only fueling a shopaholic’s addiction.

The Experience of Consumption

Taking a step back, let’s look at the entire experience of consumption. In Forces of Habit, David Courtwright explains that often mass consumption derives its popularity not from the product itself but from the experience that surrounds it.

We saw this in Heidi’s intervention. Another good example from history is coffee. Students today often feel compelled to drink coffee because their friends like to gather at coffeehouses and socialize, or their coworkers or professors utilize coffee shops as a meeting space.

This idea of experience applies to shopping as well. Shopping in contemporary times isn’t just about the procurement of goods. Many women go shopping simply because going to the mall is fun, a social experience with their girlfriends. Many of you reading are shaking your heads yes because you too have been a victim of this engaging yet budget pressing experience. Often times, you aren’t going shopping because you have specific items you need to buy. Bonding between mothers and daughters can also revolve around shopping trips.

Corporations, very aware that shopping has become an experience, exploit this fact to their advantage. In Forces of Habit David Courtwright asserts that there are always industries that profit from addictions. Today, for example, the healthcare industry, drug manufacturers and exercise equipment companies all profit from obesity. Similarly, credit card companies derive enormous profits from addictive shopping. Credit card companies make it extremely easy to obtain credit, and allow people to run up to thousands of dollars in debt even when they have a history of inability to pay it back. Heidi’s credit card company allowed her to register for multiple cards and run up debt on each one, further exacerbating the problem.

Retail companies in general make enormous profits from compulsive shopping. Companies often manipulate consumers by luring them with sales that give people the false impression they are getting a good deal, encouraging them to purchase more.

Another example of manipulation is when grocery stores place necessity items in the back so that shoppers have to go through other aisles to get to them, increasing the chances they will buy extra goods. Retail constantly think of ways to make shopping more convenient. Catalogs, online shopping and TV infomercials allow people to shop 24 hours a day if they wanted. While living in an economic and cultural environment like ours may not directly cause compulsive shopping, it certainly creates multiple opportunities for someone to become compulsive. Additionally, it makes it extremely difficult for someone in recovery.

Shopaholics Anonymous

Consumer culture and company profit are part and parcel of the whole phenomenon of shopping addiction and the difficult road to recovery. Shopaholics Anonymous, similar to Alcoholics Anonymous, helps individuals, families, and groups conquer their compulsive spending. They even offer a Compulsive Shopping Checklist.

The Shulman Center offers professional treatment for “all types of theft and spending addictions.” The path to recovery can be difficult one due to the prevalence of shopping in our society. With high availability, there can be opportunities on every street corner, rather like anorexics or bulimics learning to deal with their compulsive behavior even as they need to continue to eat. Shoppers cannot get away from the need to negotiate buying basic things for life. The Shulman Center offers up this testimonial of success:

“Thanks to Terry Shulman, our lives and especially our financial picture has greatly improved. He helped both my husband and me to deal with my husband’s compulsive overshopping and overspending problem.”
– Mary, Florida

Like many other treatments for addiction, the Shulman Center offers individual and family counseling; recommends attending a version of Alcoholics Anonymous (Shopaholics Anonymous) or other support group; and offers specific interventions aimed at dealing with activity/substance-specific aspects of the person’s problem (e.g., addressing financial and legal issues). Rather than complete abstinence, however, the programs aims to help individuals and their families keep their spending and finances in balance.

Shopaholics Anonymous is not the only rehab that is offered for compulsive shoppers. Debtors Anonymous is a debt support group offered to help break the cycle of unsecure debt and gain financial recovery through a 12-step program. Stopping Overshopping is another recovery program that focuses on educating compulsive shoppers through books, exercises, new material introduced in each meeting, and having the individuals set personal goals. These meetings are held in person or on the phone for 12 weeks.

Like alcoholics and drug addicts, recovering shopaholics need certain principles in their lives that will help them with recovery. One of the most important principles is stability. As a recovering shopaholic you need stability in your life, not just therapy. For those looking for more information and insights, the book To Buy or Not to Buy: Why We Overshop and How to Stop is a good place to start.

So as you can see, shopping addiction is a multifaceted problem and doesn’t always have a fairytale ending. Unlike the movie Confessions of a Shopaholic, a girl’s problems won’t be whisked away with romance and Daddy won’t be coming to the rescue to unfreeze the credit card.

Shopaholics cannot just be thrown back into the same contexts or lifestyles that they used to live. Like with other addictions, both a person’s own behavior and his or her life situation need to change to move to a path of recovery.

More Research

Helga Dittmar, Are You What You Have? (pdf) & Understanding and Diagnosing Compulsive Buying

Donald Black, A Review of Compulsive Buying Disorder (pdf)

Koran et al., Estimated Prevalence of Compulsive Buying Behavior in the United States

Hollander & Allen, Is Compulsive Buying a Real Disorder, and Is It Really Compulsive? (pdf)

Kellett & Bolton, Compulsive Buying: A Cognitive-Behavioral Model

Let’s look at the statistics: “Research found alcohol use depicted in 92 percent of the films in a sample of 601 contemporary movies… Alcohol was used in 52 percent of G-rated films, 89 percent for PG, 93 percent for PG-13 and 95 percent for R”

The stone-cold-sober fact? Alcohol is everywhere in films and it shapes the consumption of alcohol by viewers. A 2008 study concluded that each year the average US adolescent (ages 10-14) was exposed to “5.6 hours of movie alcohol use and 243.8 alcohol brand appearances in the top 100 US box office films from 1998-2002.”

Beyond exposure, the magnetism of a drinking character can influence viewers. “Health educators and policymakers are alerted to the fact that the entertainment media too often portray glamorous characters as enjoying alcoholic beverages without facing negative consequences, which may particularly affect the viewers who feel attracted to the role characters.”

Hollywood cinema can be magical, with scenes that seduce the viewer and tattoo memory to mind. These mystical moments generally glamorize alcohol. Drinkers are frequently depicted in films as more attractive, more aggressive, more romantically/sexually active, and as having a higher socioeconomic status than nondrinkers.

In contrast, Hollywood alcoholics are regularly depicted as hopeless, broken deadbeats, chugging down whiskey while their lives crumble around them. Thus, the movie industry portrays the two polar extremes of alcohol use – glamorized celebration and desolate disease. There is no middle ground.

This skewed representation of alcohol has an influence upon viewers, creating faulty perceptions of alcohol’s role in reality. For example in the movie Casablanca, the seductive scenery of the saloon sets the stage for what becomes an exciting, passionate ‘champagne drenched’ courtship.

Overturning Prohibition

Alcohol has been prevalent in films since the movie industry first grew in popularity in the early 20th century. The fact that “movies were the most popular and influential medium of culture in the United States” even played a large role in the 1933 decision to repeal the national Prohibition Act of 1919 (Robin Room, 1988, p.11).

Before the Prohibition Act, movies had become an alternative option for entertainment that steered customers away from the saloons. At this time, movies were often connected with temperance, as liquor was almost always presented negatively in films. However, the perception of alcohol in the cinema would change to the positive side in the following decade.

In the 1920s movie popularity soared, with attendance doubling in its final five years. In 1926, due to Prohibition pressure, film regulators actually attempted to restrict the prevalence of alcohol in movies unless its use was absolutely necessary for the progression of the plot. Clearly, this initiative did not prove successful. “A study of 115 films released in 1929-1931 found that 43% of them showed intoxication, 66% showed drinking, and less than 10% had no reference to or display of liquor” (Robin Room, 1988, p.14). Of these references to alcohol in films, most were in a favorable light, as alcohol use was frequently portrayed as funny or characteristic of the heroes or heroines of the movies.

The years of the Prohibition helped promote the glamorization of alcohol use. In the cinema, parties were portrayed as luxurious affairs of higher society, with alcohol as a necessary staple. Drinking in itself became symbolic in this era, as it represented a mode of liberation from the strict binds that government held over individual freedom. Along with this desire for liberation and rebellion, the Jazz Era greatly impacted the use of alcohol and drugs. Many performers and artists felt that the use of substances could improve their creativity when it comes to producing music. Popular artists such as Thomas “Fats” Waller even played for Al Capone the Prohibition gangster.

This sense of release and liberation were especially pertinent to women, as alcohol directly connected to their sexuality. In the 1929 film Modern Maidens, “sips of champagne on a gondola serve to motivate a woman’s successful seduction of her best friend’s fiancé” (Robin Room, 1988, p. 15). Linked to high society, popular music, and women’s sexuality, alcohol became fashionable in movies in the first half of the 20th century.

Alcoholism in Film

“Shot by shot, frame by frame, drink by drink, Hollywood has, for over half a century, presented drinking as a normal part of what ordinary and sophisticated people do when they engage in sociable behavior.” (Hollywood Shot by Shot: Alcoholism in American Cinema, p. xiii). Yet for each of these social drinkers there is always the deviant one, be that sad or laughable. Despite the frequent glamorization of drinking in cinema, there is always the other side.

The cinematic alcoholic drinker’s decline is charted until he or she gets sober, dies, or is laughed off screen. Films concerning alcoholism speak to contemporary life, shaping the alcoholic as diseased, sick and insane. These films influence how people view alcoholism and recovery as well as the family model of an alcoholic family.

A study by Elizabeth C. Hirschman and Joyce A. McGriff from 1995 researched recovering addicts’ responses to a more grave and serious portrayal of alcoholism and addiction in films. The researches showed thirty-five addicts of three different residential rehabilitation centers the four following films: Days of Wine and Roses, Clean and Sober, Drugstore Cowboy, and Jungle Fever.

In general, the addicts reported that while the films were still often exaggerated, showing worst-case scenario addictions, they felt that they could often relate to specific experiences that the fictional characters faced during their struggle from rock bottom to recovery. Some of the films highlighted the importance of Alcoholics Anonymous and Narcotics Anonymous, giving the recovering addicts hope and encouraging them to remain clean. Thus, in the case of the portrayal of the disease of alcoholism in movies, cinema seems to have a positive, constructive influence on modern society.

At the same time, such stereotypical displays of alcoholism in films may help to reinforce extreme views of alcoholics. As Caroline Knapp writes in her memoir, Drinking: A Love Story, “Alcoholic is a nasty word… the classic image of the falling-down booze-hound: an older person, usually male, staggering down the street and clutching a brown paper bag. A pathetic image hopeless and depraved… (12-13)” This classic image was entirely different from her own experiences as an alcoholic, a generalization that did not capture the reality of heavy drinking that ran through her family and her friends.

Herein lies the irony of alcohol in films: cinema vastly differs in its portrayal of the drinking of alcohol versus alcoholism. The first is associated with excitement, pleasure, and enjoyment while the second is dramatically portrayed as devastating and horrifying. The blurry line between serious social drinking and alcoholic drinking seems to be undefined in the films. Films seek drama, and in this case miss the truth.

Replicate in Reality

In recent times movies and the media hold a great influence over society, giving us a model to follow. Love, college life, and exaggerated gender stereotypes contribute to the glamorization of alcohol in movies. Drinking is portrayed as a celebratory action and necessary focal point of social gatherings. Furthermore, alcohol serves as the bridge between sober separateness and intoxicating love.

The glamorization of these particular images perfectly exemplifies the allure in drinking which viewers in turn try reproduce in reality. What young woman doesn’t want to be whisked away by a new lover?

And what real man wouldn’t step up to the challenge and prove his masculinity to the world?

In both of these cases, alcohol is the key ingredient to success.

Dueling Dualisms

Is the portrayal of alcohol in movies a reflection of society or does societal alcohol use reflect alcohol portrayal in films? This is a classic case of a “dueling dualism” – when two factors combat one another, yet are unable to exist individually as both mutually influence the other. This concept applies to many aspects of human existence such as defining gender – the biological and social factors work against each other yet rely upon one another in producing the definition.

In the case of the portrayal of alcohol in films versus societal alcohol use, initially alcohol social stereotypes influenced films. The early cinematic depiction of alcohol was that of a few select drinkers portraying a particular drinking style (heavier than that of the average citizen). While the representation in the films was only that of a minority, it was displayed as the societal norm and thus became the societal norm. As seen in the examples above, the presence of alcohol in movies has only grown to in turn affect and strengthen the societal stereotypes on which its use was originally based.

Looking Through the Lens of Truth

What does this mean for you? The next time the blockbuster of the year is coming to a theatre near you, take a second to think. Is the film’s portrayal of alcohol as glamorized as the movie star’s looks?

In Hollywood, what you see is rarely reality – this not only applies to the retouching of a model, but also to the inaccurate depiction of true societal alcohol use. Whether creating its own special effects or the key to dark drama, alcohol is like any other actor – dressed up and fit into a role.