Of mice and men.....The unforgettable narrative of how social factors shape substance use, addiction, and recovery

Abstract

The currently predominant model to explain addiction is the brain disease model of addiction, which emphasizes drug-induced brain changes at the individual level, producing an uncontrollable, chronic relapsing disease. It tacitly de-emphasizes the complex sociocultural, contextual, and other environmental determinants of substance use and addiction. In this oration, I challenge these assumptions with a hop-and-stop tour of five countries: Canada, the USA, India, Vietnam, and Iceland. The journey covers five narratives: isolation, pain, frustration, and then the positive narrative of recovery, and finally the narrative of hope. The socially enriched rats in the “Rat Park” in a laboratory in Canada consumed much less morphine than the isolated, caged rats. People dying of opioid overdose in the worst-ever opioid epidemic in the USA might be using opioids as an escape from broadly defined “pain,” where pain is an emblem of deeper societal isolation and suffering. In Punjab, India, frustrated youths due to complex socio-political-economic reasons are falling easy prey to the profiteering drug mafia. On the positive side of the narratives, most of the Vietnam war veterans who had been using heroin heavily while in Vietnam quit after returning to the comfort of their home, family, and friends, thus providing the narrative of recovery. Finally, the Icelandic Model, a series of pro-social policy measures at the government level targeting the children, the parents, the school, and the environment in Iceland, where teenage substance abuse had been peaking alarmingly in the mid-1990s, demonstrated the preventive prowess of these measures. All in all, this journey teaches us vital lessons not to forget the social psychiatry of addiction. It also teaches us that it would be a wise investment to improve the social determinants of health, including mental health and addiction.