Articles & Speeches
A Change of Venue for Addiction: From Medicine to Social Science
(Revised 26 December 2010)
Bruce K. Alexander, Professor Emeritus, Psychology Department, Simon Fraser University
Global society has failed to control a devastating flood of addiction to drug use and innumerable other habits. A century of scientific research has not produced a durable consensus on what addiction is, what causes it, and how it can be remedied. Physicians, addiction counselors, social workers, and psychologists only succeed with a minority of addicted clients. Police and soldiers find themselves drafted into a cruel and futile "war on drugs". Hi-tech neuroscience, education, harm reduction, and spirituality cannot control today's flood of addiction either.
The only real hope of controlling the flood of addiction comes from the social sciences, which are uniquely suited to replace society's worn-out formulas with a more productive paradigm. Although many social scientists have analysed the cause of addiction in specific historical circumstances, this short article will focus on more general analyses by Karl Polanyi and a few more recent scholars. This overview shows that society's cardinal error in confronting addiction has been ignoring what Polanyi called "dislocation".
"Dislocation" is the condition of great numbers of human beings who have been shorn of their cultures and individual identities by the globalization of a "free-market society" in which the needs of people are subordinated to the imperatives of markets and the economy. Dislocation afflicts both people who have been physically displaced, such as economic immigrants and refugees, and people who have remained in place while their cultures disintegrated around them. Dislocation occurs during boom times as well as recessions, among the rich as well as the poor, among capitalists as well as workers. Today, dislocation threatens to become universal, as global free-market society undermines ever more aspects of social and cultural life everywhere.
Addiction has tracked the global spread of dislocation. This is because dislocated people, rich and poor alike, compensate for their unbearable lack of culture and identity by desperately clinging to the best substitutes they can find. Addictions to drug use and a thousand other habits and pursuits serve this compensatory function all too well. Society cannot control addiction until it stops the spread of dislocation that ultimately instigates it.
Of course, global society has evolved since Karl Polanyi's time. As the British Empire gave way to the Cold War and now the American Empire, and as laissez faire economics has given way to neo-liberalism, Polanyi's analysis has been augmented by contemporary social scientists whose writings shed light on the global surge of addiction since World War II. From the earliest clearances of the English commons to today's toxic economic bubbles, the underlying connection between free-market society, dislocation, and addiction remains evident.
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A paradigm shift is urgently needed in the field of addiction because, while the institutions of global health have expended vast resources over the past couple of centuries to control addiction to drugs, alcohol, and hundreds of other habits and pursuits, the flood of addiction has continued to deepen and spread. A large-scale "war on drugs" with annual costs reckoned in billions of dollars has also failed.
Society's failure to control addiction has been intellectual as well as practical: No durable consensus has been reached about addiction's essential nature, its cause, its remedy, or even its definition. Instead of consensus, there are hundreds of divergent theories and treatment practices, overshadowed by a simplistic, official wisdom that is vehemently proclaimed by governments and the mainstream media. The official wisdom is often called a "medical model" although its origins are as much religious as medical. Littered with contradiction, hyperbole, and repetition, conventional discourse about addiction adds an intellectual backwater to the rising flood of addictive misery.
The imminence of a paradigm shift is signalled by the fact that the British Medical Association gave a "high commendation" to only one of the many books published about addiction in 2009, The Globalisation of Addiction: A study in poverty of the spirit. I am honoured to be its author. The irony is that a medical honour was given to a book that argued unequivocally that addiction is not a medical problem! This irony is one of many indications of an approaching paradigm shift in society's approach to addiction.
The direction of the paradigm shift is indicated by the fact that, standing apart from confused conventional discourse, social scientists quite often agree on the causes of mass addiction when they encounter it in particular historical contexts. Social science theory, most notably the work of Karl Polanyi, provides a comprehensive basis for understanding addiction in the modern era and how it can be controlled. I believe that a paradigm shift is already underway, from the official wisdom to an analysis of addiction rooted in social science.
In The Great Transformation (1944), Polanyi traced the social and economic evolution of modernity back to the late 1500s in England. The evolution was from many societies in which markets were subordinated to social and religious concerns to a world society with the global market as the dominating institution, minimally regulated, fortified by state power, nourished by public funds, and evoking a kind of religious awe -- a secular Market God. Polanyi called this form of hypercapitalism "free-market society", although it has many other names today, including "neoliberalism", "neoconservativism", "casino capitalism", and "croney capitalism".
The loci of power in today's global free-market society are huge, multinational investment banks; enormous industrial corporations and cartels, globalized media; and international agencies that protect and expand global markets. National governments serve free-market society by engineering growth, productivity, and free trade – as well as providing bailouts when needed. The dominant nations of the world and most of today's public intellectuals are committed to free-market society. Nations that oppose it are disparaged, blockaded, invaded, or relegated to the axis of evil.
Why has Addiction Engulfed Globalized Free-Market Society?
Economists usually describe the negative consequences of free-market society in terms of externalities: environmental destruction, ill-health, and social unrest. Polanyi's great contribution was to emphasize psychosocial externalities. Free-market society fragments culture of every sort, breaking the social links that give people a sense of belonging, meaning, and identity. People find long-term dislocation from their cultural matrix unbearable, whether they are rich or poor, capitalists or workers.
Polanyi's "dislocation" emphasizes a different psychological process than Marx's "alienation", which was a kind of suffering experienced primarily by the working class and not by their exploiters in the bourgoisie. Polanyi's dislocation -- like addiction -- has no class boundaries. Dislocation frequently occurs in conjunction with material poverty, but they are not the same thing. Although material poverty can crush isolated individuals and families, it can be borne with dignity when people confront it together. On the other hand, dislocated people are devastated even if they are rich capitalists. Polanyi described the effects of free-market society on both the impoverished labourers and their masters as follows:
...the most obvious effect of the new institutional system was the destruction of the traditional character of settled population and their transmutation into a new type of people, migratory, nomadic, lacking in self-respect and discipline -- crude callous beings, of whom both labourer and capitalist were an example.
Dislocation, in Polanyi's sense of the word, does not necessarily imply geographic separation. Rather, it denotes a lack of psychosocial integration, which can befall people who never leave home as well as those who are geographically displaced. Historically, many dislocated people have moved from devastated peasant societies to urban slums, but many others remained where there were and became increasingly dislocated as their traditional culture further disintegrated around them.
Figure 1 schematizes a dislocation view of addiction. It shows that global free-market society inevitably mass-produces dislocation and that chronically dislocated people are prone to depression, anxiety, irresponsibility, violence, suicide, etc. In addition (although Polanyi did not say this explicitly), chronically displaced people strive to compensate for their agonizing lack of belonging, meaning, and identity by clinging desperately to the best substitutes that they can find for an authentic social life. Addictive involvements with drug use and innumerable other habits often serve this compensatory function better than any other achievable alternatives. Dislocated people desperately cling to their addictions, because, without them, they have terrifyingly little reason to live.
Figure 1. A Dislocation View of Addiction.
The feedback arrows in Figure 1 reveal why the flood of addiction is so hard to control on a societal, as well as an individual level. Many people in free-market society adapt to dislocation by becoming addicted, and then addictions reciprocally increase society's dislocation, as addicted people damage themselves, their families, and their communities. As well, addicted people contribute to further expansion of free market society in many roles, from shopaholics to CEOs addicted to wealth and power, further increasing dislocation and addiction.
The Globalisation of Addiction assembles historical evidence both that dislocation has tracked the spread of free-market society and that addiction has tracked the spread of dislocation. This explains why medical and psychological interventions cannot control addiction. These interventions are emergency measures applied to a few drowning individuals, while free-market society continues to flood the globe with dislocation and addiction.
Figure 1 is not the only way of thinking about addiction. Figure 2 represents the official view of addiction that is incessantly promoted by governments, corporations, and mainstream media. Much of the public and many addiction professionals also accept this official view, although there is vigorous resistance to it as well. Although the official view achieved its modern form in the religious rhetoric of the 19th century temperance movement, it is generally understood today as a "medical model" of addiction and justified in terms of neurochemical research.
Figure 2. The Official View of Addiction.
From the official viewpoint, certain individuals expose themselves to one of the "addictive drugs" and this exposure transforms them, more or less irreversibly, to addicts. They may become "clear and sober" with heroic, daily effort, but their recovery will require prolonged treatment at best, since they are now "addicts" and addiction is a "chronic, relapsing disease".
Drug addiction is said to cause a cluster of serious problems, which are listed in Figure 2. Note that the consequences that are attributed to addiction by the official view (Figure 2) are essentially the same as those produced by dislocation (Figure 1), with the exception of addiction-specific consequences, such as withdrawal symptoms for people addicted to heroin or liver damage for alcoholics. The official viewpoint depicted in Figure 2 can be further articulated so that environmental, personality, neurochemical and genetic factors play significant roles, but the core concept is that, under the right conditions, addictive drugs rob people of their will power and transform them into destructive addicts.
The empirical inadequacy and practical inefficacy of the official view of addiction have been documented by dozens of scholars, past and present, and by the testimony of many clinicians and addicted people. Although this huge body of evidence against the official view cannot be compressed into a short article, it can be classified here into eight fundamental problems that the official view cannot solve. These are listed in Figure 3. The relevant evidence for all eight is discussed at some length in The Globalization of Addiction and in many other sources.
1. The flood of addiction has continued to spread in the half-century since the official view has prevailed. The interventions that have been justified on the basis of the official view, from the war on drugs to harm reduction, have demonstrated their limitations, separately and together.
2. Contrary to the official view, addiction is not exclusively, or even primarily, a drug problem. People can be addicted to virtually anything. Most severe addictions are to habits and pursuits other than drugs.
3. Contrary to the official view, natural recovery is very common – more common, in fact, than successful treatment.
4. Contrary to the claims of its advocates, the official view originated as a religious philosophy, not a scientific discovery.
5. Contrary to the official view, no drugs are intrinsically addictive. All the "addictive drugs" can be used safely and beneficially, and usually are.
6. Contrary to the official view, no transformation occurs when people become addicted. They remain human beings whose behaviour can be understood in normal ways.
7. Contrary to the official view, addiction is not an isolated problem, but part of a larger complex of problems. Concurrent disorders are the rule, not the exception.
8. Contrary to the claims of its advocates, the official view is intrinsically moralistic and punitive. It is the foundational philosophy for the war on drugs.
Figure 3. Eight Irresolvable Problems with the Official View of Addiction.
Rather than focussing on the mountain of empirical evidence against the official view, this short article outlines the scholarship supporting the dislocation view of addiction.The dislocation view can be dissected into three principles. Each is discussed below, drawing heavily on Karl Polanyi's writings. More recent lines of scholarship are discussed in the final section of this article.
Principle 1. Globalizing Free-market Society Produces Mass Dislocation.
A "free-market society" is a social system in which virtually every aspect of human existence is embedded within – and shaped by – unregulated, competitive markets. This dislocating social system would have been inconceivable up until a few centuries ago, but it is fast becoming the everyday experience of most people of the world. Whereas calamities can dislocate people in any society, including tribal, feudal, and socialist ones, and whereas the collapse of any society produces mass dislocation, only free-market society produces mass dislocation as part of its normal functioning, even at the best of times.
Polanyi showed that dislocation of individuals from their community, culture, meaning, and identity can be rare in a settled society for centuries, and then become nearly universal in a single generation. Mass dislocation can occur when free-market society encloses the commons of a peasant society for export-oriented agriculture; devastates a tribal culture by colonization; or bricks-over settled farms and villages in an industrial revolution. Polanyi also showed how sustained mass dislocation has been built into the contemporary free-market society that has swept the planet since the industrial revolution, and whose contemporary icons include Friedrich von Hayek, Milton Friedman, Margaret Thatcher, the Washington Consensus, and Goldman Sachs.
The promise that sustains free-market societies is that unrelenting competition at all levels will maximize everybody's well being in the long run by multiplying individual happiness and increasing the wealth of nations. The imperative that grows from this promise is that free, competitive markets must dominate every aspect of human life and that the only legitimate functions of government are to maintain the efficiency of markets and to help them grow.
Although movement towards this so-called free-market ideal has, paradoxically, required massive administrative and military force, and although there have been halts, counter-currents, corruption, and sham throughout its evolution, free-market society has been expanding and consolidating its hold on people's everyday lives around the globe for the last few centuries. Meanwhile, the forces that promulgate it have grown ever larger and more powerful. There is much more to today's globalization than economics of course, but free-market society is at the heart of it, at least at the level of the everyday existence of ordinary people.
Polanyi showed why, along with its dazzling benefits, the global movement towards free-market society must produce mass dislocation. To the degree that labour, land, credit, goods, medical care, entertainment, education, etc. are traded in free, competitive markets, dislocation becomes inevitable. This is because competitive free markets work efficiently only if each buyer and seller pursues his or her individual enrichment – however he or she individually defines it – competitively and acquisitively. Economic individualism allows the law of supply and demand to work its magic. The promise is that Adam Smith's "invisible hand" will bring the beneficence of the market to all, but only if they remember that "business is business" and that they must always "think for themselves".
People cannot be this individualistic if they are encumbered by loyalties to their family, friends, traditional obligations, customs, trade unions, or guilds. Nor can they be encumbered by the transcendental values of a religion, culture, ethnic group, or nation. A single, classic example used by Polanyi: the free market in labour, in its original form, used the threat of starvation to force masses of people into tedious, meaningless toil in factories. Forms of society which guaranteed that whatever food there was would be shared by all had to be crushed so that the market could supply the labour needs of the free-market society. Still today, sources of psychosocial integration in every type of society are being identified with "market distortions", that have to be eliminated.
For these reasons, the ideal form of free-market society would inevitably create universal dislocation. Although today's global society falls far short of this ideal, providing instead a garish cornucopia of individual corruption, corporate collusion, and market manipulation for geopolitical purposes, global society continues to impose "market discipline" on people at ground level in the name of the free market.
To the degree that western civilization approximates a free-market society in everyday life, dislocation is not the pathological state of a few but the general condition. Because dislocation makes parents desperate and families dysfunctional, it affects children as much as adults who participate directly in commerce. Because western free-market society is an essential component of globalization, mass dislocation has spread to every corner of the globe along with the Internet, the English language, and MacDonald's Hamburgers.
Free-market society is not the only possible cause of dislocation. For example, dislocation can be caused by an earthquake that destroys a village, a personal idiosyncrasy that a local society cannot tolerate, or the economic collapse of a nation or an empire. It can be inflicted violently by abusing a child, ostracizing an adult, or destroying a culture. It can be inflicted with the best of intentions, for example by donating cheap manufactured products that undermine a local economy. A person can choose it voluntarily by turning from social life to the single-minded pursuit of wealth in a "gold rush" or a "window of opportunity".
Most important in modern times, however, dislocation becomes the norm when the economic system systematically curtails psychosocial integration in all or most of its members. Polanyi's analysis leads to the realization that there are billions of severely dislocated people in today's world and there will be billions more, because dislocation is inescapably built into the free-market society that has been, and continues to be, globalized.
Principle 2. Sustained Dislocation is Unbearable.
The human psyche is anything but self-sufficient. From early childhood until old age, individuals in every culture devote themselves to finding and developing a place in their society. In a complementary manner, society's subgroups and institutions, starting with the family, cultivate maturing individuals at appropriate stages of development. These subgroups give as much latitude as possible to individuals' unique needs, but always within limits that allow the group to carry out its essential economic and social functions. This complex state of interdependence of individuals and their societies has been called "psychosocial integration".
Psychosocial integration not only gives individuals a sense of belonging, but other essential experiences as well. Psychosocial integration confers a sense of individual identity, because stable social relationships entail expectations and obligations that establish, in people's own minds, exactly who they are. Psychosocial integration imbues nature with a sense of meaning, because viable societies share and reinforce a conceptualization of their rightful and traditional place in the material world. Psychosocial integration usually provides people with a sense of the divine, because members of viable societies validate and elaborate each other's images of the unseen world that environs mundane space and time.
The use of the word "soul" has been banned from psychology because it carries an implication of immortality in various religious traditions. But, Polanyi pointed out that, "The discovery of the individual soul is the discovery of community...Each is implied by the other." Polanyi saw the individual's "soul" as an essential part of the experience of psychosocial integration of individuals in their communities. The word "soul" is used in this naturalistic sense in this article, without theological connotations.
The delicate interpenetration of person and society enables people to simultaneously satisfy both their needs for autonomy and their needs for community – to feel free and still belong. It enables society to simultaneously benefit from the diverse, creative abilities of its individual members and still maintain order and collective purpose. Psychosocial integration is a marvellous balancing act that makes human life bearable, and even joyful at its peaks. Moreover, psychosocial integration is the key to the success of the human species, which flourished by simultaneously evolving the capacity for individual autonomy and close cooperation.
Lack of psychosocial integration is equivalent to "dislocation". Severe dislocation eventually leads to depression, anxiety, shame, rage, anguish, boredom, bewilderment, and suicide. This is probably why dislocation, in the form of ostracism, excommunication, exile, and solitary confinement has been a dreaded punishment from ancient times until the present, and is an essential part of the most up-to-date technology of torture.
Principle 3. Addiction is a Way of Adapting to Sustained Dislocation.
However dislocation comes about, it provokes a desperate response. Dislocated people struggle desperately to establish or restore psychosocial integration – to somehow "get a life", "figure out who they are", "find themselves", or "build community". Many do eventually achieve adequate psychosocial integration. Those who do not, however, often compensate by devoting themselves to narrow lifestyles that function as substitutes for psychosocial integration. Individually, these substitutes have distinct names: junkie, miser, shopaholic, workaholic, crackhead, alcoholic, religious zealot, anorexic, etc. Collectively, they comprise the full spectrum of addiction. Addiction is neither a disease nor a moral failure, but a narrowly focused lifestyle with an intensity that partially compensates for a lack of adequate psychosocial integration. The function of addiction to drugs is no different from the function of addiction to any other habit or pursuit.
Even the most harmful addictions serve a vital compensatory function for dislocated individuals. For example, the barren pleasures of being a "junkie" – membership in a drug-injecting sub-culture, transient relief from pain, the excitement of petty crime, identification with a tragic junkie mystique – provide desperately-needed relief from the unrelenting torment of social exclusion and aimlessness. At the other end of the social hierarchy, the barren pleasures of amassing expensive consumer goods and organizing them for display and consumption provide some kind of meaning and identity for people bereft of richer purposes, sometimes reaching grotesque "shopaholic" proportions. Similarly, religious or political fanaticism provides some sense of belonging and purity for people whose sacred traditions have been profaned beyond recovery. "Co-dependent relationships" within dysfunctional families provide emotionally captivating substitutes for a network of healthy relationships. Addictions often serve many functions simultaneously, but their raison d'être is substituting for psychosocial integration. 
Addictions may last for days, for years, or for a lifetime, but they are not sufficiently close, stable, or complex to afford a complete substitute for psychosocial integration. Nevertheless, people for whom addiction is the best achievable substitute for psychosocial integration cling to their addictions with grim resolution, despite the harm that ensues. Often they deny the harm, ignoring unmistakable evidence of the harm they do.
To acknowledge that addiction is "adaptive" for dislocated people is not to imply that it is desirable either for the addicted person or for society, but only that it buffers people against the unbearable anguish of dislocation. Since addictions have neither the depth nor the breadth of psychosocial integration, addiction cannot provide the full contentment that dislocated people desperately need. Often dislocated people appear insatiable, since no amount of addictive consumption can replace what is missing. In their futile attempts to achieve psychosocial integration by narrowing their lives, addicted people often exacerbate their own dislocation; for example by ruining their health or by irrevocably alienating people who care about them.
The simplistic popular wisdom depicted in Fig. 2 depicts addiction as maladaptive and explains it with malign hidden causes like loss of will power to "addictive drugs," unconscious fixations of the libido, deficiencies in the brain reward system, neural sensitization to the reinforcing effects of drugs, damage to brain areas responsible for choice, genes for addiction, psychopathy, or some combination of these. But theories based on these hidden causes have failed to generate either a generally believable account of addiction or anything more than marginally effective forms of therapy. A reasonable conclusion after more than a century of futile searching is that the hidden, underlying cause of addiction does not exist. The quality that severely addicted people have in common is somewhat more severe dislocation than the rest of us in globalized free-market society.
Although only dislocated people become addicted, many severely dislocated people live and die in ways that cannot be called "addiction" without stretching the word too thin. Many of them adapt by dint of admirable resolution and a little help from their friends. Others may become clinically depressed, suicidal, apathetic, murderous, or mentally erratic, rather than addicted. Thus, dislocation is a necessary, but not sufficient, cause of addiction.
Since free-market society, by its nature, produces mass dislocation at all times (not just during times of economic collapse), and since addiction is the predominant way of adapting to dislocation, addiction is endemic and spreading fast. Free-market society can no more be addiction-free than it can be free of intense competition, income disparity, or economic volatility. There can be no "technical fix" or "market solution" for problems that are embedded in the structure of free-market society itself. Instead, today's society must either modify its free-market structure enough to keep dislocation and addiction under control or endure their continuing spread.
A General Theory of Addiction in the Modern World
When properly qualified, the dislocation view becomes a general theory of addiction in the modern era. It can encompass the broad range of problems that the official view and the plethora of other theories cannot explain. Some of the necessary qualifications are as follows:
The dislocation theory of addiction is not meant to explain every instance of addiction throughout human history, but rather to explain the great flood of addiction in the past two or three centuries. How well it can be applied to other periods of history remains to be determined.
The dislocation theory of addiction does not explain all drug use. Most drug use is not addictive and requires no special explanation.
The dislocation theory is not intended to deny the fact that individual factors such as genes and childhood traumas affect the susceptibility of individuals to addiction. Rather, it is intended to remove individual factors from the foreground of attention because social factors are more powerful determinents. For example, when aboriginal societies collapse, alcohol addiction frequently becomes universal or nearly so, regardless of individual's genes and unique childnood experiences. In the case of childhood trauma, free-market society puts great economic and psychological pressure on families, increasing the probability that large numbers of parents, driven to desperation, will traumatize their children.
The dislocation theory is not intended to deny the importance of personal strength and courage in the dramas of addiction and recovery that fill modern life. Rather, the dislocation theory offers an understanding of dislocating free-market societies in which these individual dramas are common and the kinds of psychosocially integrated societies in which they are rare.
Finally, the dislocation theory of addiction is not intended to derogate the efforts of doctors, counsellors, social workers, harm reduction experts, self-help groups, community police, and other practitioners in the field of addiction. Their interventions often help individuals to overcome addiction or to deal with it more effectively. Even when they do not help overcome addiction, they offer a gift that can never be discounted -- the gift of compassion and recognition for suffering people. Rather than belittling front-line workers, the dislocation theory of addiction explains why their efforts cannot bring the addiction problem under control in a free-market society, and points to the social conditions under which they can be more successful.
When the evidence is carefully evaluated, I am convinced that the dislocation theory of addiction will provide the theoretical basis for the coming paradigm shift in the field of addiction, reorienting its major efforts from individual intervention to structural change in society.
From my point of view, structural change in world society does not imply a simple overthrow of capitalism. Our current catastrophes do not arise from capitalism per se, but from an unholy alliance between grotesque hypercapitalism and unprincipled governments. What is required, I believe, is a rigorous reconceptualization of the vague notion of "mixed economy" so that it describes a system that is designed to be not only just and efficient, but also fit for habitation by non-addicted human beings. In such a system, corporations, markets, and economies must serve society, rather than the other way around.
Addiction under the American Empire
The declining British Empire provided the background for Polanyi's analysis of free-market society. After World War II, the British Empire gave way to the Cold War and to a modified form of global free-market society, now sometimes characterized as neoliberalism under the American Empire. In this same post-World War II period, addiction has flooded the globe, especially in countries that have undertaken the most drastic moves toward neoliberalism, including the U.S. after World War II, the U.K. after 1970, China after 1980, and Russia after 1989.
Is the world under the American Empire mass-producing addiction for the same reasons that the British Empire did? Although market discipline straitens the everyday life of ordinary people, it is not applied consistently in the corporate and geopolitical stratosphere today. The most obvious example is that the US does not apply free-market principles to itself with nearly the same rigor that the European nations did under the British Empire. Nor do the IMF and World Bank impose free-market constraints on the US. Nor are the largest financial institutions anywhere subject to "market discipline" when bankruptcy threatens." Does not abrogation of free-market principles anywhere in global society produce market distortions everywhere? How can free-market society be the cause of addiction if markets are not really free?
Michael Hudson has detailed how Great Britain proved the austere reality of its commitment to free trade by repealing its Corn Laws, the basis of its agricultural society, in 1846. The repeal of the Corn Laws caused a painful upheaval in British agriculture, which could not compete with cheap imported food, but it also established a credible international free-market milieu. Likewise, after World War I, Britain and France almost bankrupted themselves in the attempt to pay off their huge war debts, in accordance with the principle of a free market in finance capital. After World War II, Britain, its economy in ruins, agreed to laissez-faire trade in manufactured goods, rather than insisting on protectionism to rebuild its industries.
Whereas European nations generally followed free market principles rigidly, the US has excepted itself when they proved too costly, even as it imposed them on its conquered enemies, its allies, and the third world. US agricultural policy has remained fiercely protectionistic throughout the post-World War II period until the present day. The US has refused to honour its international debts after 1950 by using political power and military threats to prevent its debtors from redeeming their dollars from American gold reserves and from purchasing US industries. By leaving no option to creditors holding US dollars other than purchasing US treasury bonds, the US created a "treasury bond standard" of wealth to replace the gold standard, and officially abrogated the gold standard in 1973. The treasury bond standard is a pillar in the so-called dollar hegemony of the world economy. The US also excepted itself from international free-trade rules established at Bretton Woods by imposing tariffs and non-tariff barriers at will. Despite this "monetary imperialism", as Hudson calls it, the US gushes the purest free-market rhetoric even now and imposes stringent free market discipline on people under its dominion, including its own citizens of the lower ranks. The US has led the way in subsidizing huge financial institutions in the current economic collapse. Many nations have followed the American model, shattering the illusion of a global free market in finance capital.
At this stage of history, highly visible deviations from the free-market ideal at the highest levels do not reduce dislocation in today's world, but rather exacerbate it. People find themselves dislocated from reality itself, as the official reality contradicts what they see. For example, people who believe that their government practices free-market capitalism are shorn of their own perceived reality when their government bails out financial giants. People in third-world nations can see that the IMF free-market principles that have been imposed upon them like acts of God do not apply to their creditors. These glaring discrepancies can only amplify the experienced dislocation of people whose communities, families, and traditions are already in tatters. By exacerbating dislocation, these discrepancies increase people's vulnerability to addiction and other psychological problems.
As the American Empire took shape after World War II, addiction, already a serious problem, became a greater one and global society undertook a perpetual "War on Drugs." The United States, leader of the American empire and prime mover in the War on Drugs also appears to lead the countries of the developed world in the prevalence of addiction. No comprehensive data set on the prevalence of addiction as a whole is available, but here are some representative comparative data on drug addiction.
Figure 4. National Prevalence of Problem Drug Use, 1999-2004
Why would the US, which conspicuously excepts itself from the rigors of free-market doctrine and leads an enormous War on Drugs, suffer the worst addiction problem of all?
The dislocating effects of the free-market discipline that continues to dominate everyday life globally have already been discussed, as has the additional dislocation provoked everywhere by the discrepancy between official reality and observable facts. However, there is a cause of dislocation that is more particular to the enormous change that has occurred in the US. Once an electoral democracy, the US has evolved into an oligarchy controlled by the giants of finance capital and a huge military establishment, managed by politicians who appear more inspired by Leo Strauss than its Founding Fathers. Hudson calls this oligarchy a "kleptocracy", Engdahl calls it "crony capitalism", Hedges speaks of the "death of the liberal class", and Wolin calls it a "managed democracy". Wolin has shown how the sham democracy of the U.S. further fractures the identity of Americans who have been raised to see their country as the beacon and font of democracy. The genuine American exceptionality that de Tocqueville documented in 1835 has degenerated into the fantasy-doctrine of "exceptionalism". This particular dislocation is likely to be most intensely felt among Americans themeselves, because they have believed in the shining national ideal most deeply. This may explains why addiction and other symptoms of dislocation, are so much more abundant in the US than in other developed nations.
The gradual collapse of the American political ideal also explains why the US is the most enthusiastic promoter of the War on Drugs. This "war" responds to an ever-increasing addiction problem, but it also draws attention away from the unthinkable fact that the origins of the addiction problem are embedded in the basic structure of American society. The drug war serves as a rearguard ideological defence. It violently redirects attention from the unspeakable reality to overworked scapegoats — demon drugs and dark drug lords. Moreover, the war on drugs provides a convenient pretext for military interventions with economic and geopolitical aims, for example the "war on drugs" that has been underway for a decade in Colombia.
If global addiction is to be brought under control, it will necessarily be in the context of a radical restructuring of the modern world. This restructuring may already be underway. It will certainly not come from the US, which is dominated by its own financial and military establishment. Nor is it likely to come from Europe or Canada, which have travelled too far down a similar path to turn back quickly. It is more likely to originate in Asia and Latin America.
As I see it, social scientists of the futue will be in a position to explain why the coming global restructuring should take into account the psychological as well as the material harmfulness of free market society and to insist that the new system that replaces it respsects people's psychosocial as well as material needs. The acutely painful lesson of the last half-century of dislocation and addiction is that a political-economic system that disregards the human soul can generate mass psychological catastrophes that are as serious as the ecological, political, and economic crises that are already upon us.
 Addiction is defined in this article as "Overwhelming involvement with any pursuit whatsoever that is harmful to the addicted person, to society, or to both." This definition is derived from the traditional English use of the word "addiction" which appears as definition 2a in the first edition, and subsequent editions, of the Oxford English Dictionary. This article ignores definition 2b, which arose from the temperance movement and the drug wars and first appeared in the OED only in the 1933 Supplement, although it is currently the basis of most mainstream definitions used by addiction professionals. The history of the word "addiction", along the reasons that definition 2a is the most useful definition for the current era, is discussed in chapter 2 of my book, The Globalisation of Addiction: A study in poverty of the spirit (Oxford University Press, 2008). Naturally, a fuller exploration of addiction in the traditional English sense of the word would include those instances of definition 2a that are not harmful as well, but that is beyond the scope of this short article.
Evidence that the global prevalence of addiction to drugs and a multitude of other habits are spreading appears in my book as well (Alexander, 2008, op. cit., esp. pp. 37-42).
 Some examples: Hobsbawm, E.J. (1962, p. 202). The age of revolution: 1789 - 1848. Cleveland, OH: World Publishing; Hughes, R. (1987). The fatal shore: The epic of Australia's founding. New York: Knopf; Heath, D.B. (1987). A decade of development in the anthropological study of alcohol use: 1970 - 1980. In M. Douglas (Ed.), Constructive drinking: Perspectives on drink from anthropology (pp. 16-69). New York: Cambridge University Press; Warner, J. (2002). Craze: Gin and debauchery in an age of reason. New York: NY: Four Walls Eight Windows; Samson, C. (2003, pp. 150-151). A way of life that does not exist: Canada and the extinguishment of the Innu. London, UK: Verso; Homer-Dixon, T. (2006). The Upside of Down: Catastrophe, Creativity, and the Renewal of Civilization. Toronto, ON: Knopf, pp. 197-198. For more examples, see Alexander, B.K. (2008), The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, chap. 6).
 Polanyi, K. (1944). The Great Transformation: The political and economic origins of our times. Boston: MA: Beacon.
 See endnote 1 for the definition of addiction that is used in this article and a source for a detailed discussion of the complex issue of multiple definitions of addiction.
 Alexander, B.K. (2008). The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press.
 See endnote 2 for references.
 Polanyi (1944, op. cit.).
 Polanyt and many authors have discerned the presence of this new god over the last couple of centuries. For me the clearest is the theologian Harvey Cox. See Cox, H. (1999, March). The market as god. Atlantic Monthly, pp. 18-23.
 See Peck, J. (2008). Re-making laissez faire. Progress in Human Geography, 32, 1, 3-43.
 Polanyi (1944, op. cit., p. 128).
 Graphics for Figs. 1 and 2 by Curt Shelton.
 Polanyi (1944, op. cit.).
 This conclusion goes beyond Polanyi, who, to my knowledge, never addressed the psychology of addiction explicitly, although he often wrote in psychological terms that suggest this concusion. The supporting evidence for this conclusion is summarized in Alexander (2008, op. cit., chap. 6-8).
 Alexander (2008, op. cit.)
 For a full statement of this official wisdom which quotes its most prominent advocates, see Hoffman, J. and Froemke, S. (2007, op. cit.).
 These sources are reviewed at some length in Alexander (2008, op. cit.), especially chapter 8. See also Heyman, G. (2009). Addiction: A disorder of choice. Cambrige, MA: Harvard University Press.
 Ramonet, I. (2009). Le Krach parfait: Crise du siècle et refondation de l'avenir. Paris: Galilée, chapter 1.
 Polanyi (1944, op. cit.) and many other economic historians have shown the free markets do not come into existence freely, but are formed and sustained by whatever degree of administrative and military force is required. See also Panitch, L. (2008, 26 November). The financial crisis and democratic public finance. Retrieved 27 November from http://www.globalresearch.ca/index.php?context=va&aid=11181
 Among the reversals was the Speenhamland period in England (1795-1832; see Polanyi, 1944, op. cit.) and the "welfare state" period in Western Europe and North America in the 30 years following World War II. See also Bayly, C.A. (2004, The birth of the modern world, 1780 - 1914. Oxford, UK: Blackwell, pp. 295-300) for a description of various forms of resistance to the spread of Western economics throughout the long 19th century. See Teeple (1995, pp. 79-83) for a description of the sham aspects of free market society after World War II. See Stiglitz, J.E. (2002. Globalisation and its discontents. New York: W.W. Norton) for failures and reversals precipitated by the International Monetary Fund in the 1990s. The most obvious reversals in the 21st century have been in numerous Latin American countries that have retreated from extreme forms of free trade and privatisation. The sham has been evident in the double standard of free-market principles imposed upon third-world countries by the US, the IMF and the World Bank after World War II, but on the United States itself (Hudson, M., 2003. Super imperialism: The economic strategy of American Empire, 2nd Ed. London: Pluto Press.) and in the use of free market rhetoric to mask the imperial ambitions of the US in the 21st century (Wolin, S.S., 2008, Democracy, Inc.: Managed Democracy and the spectre of inverted totalitarianism. Princeton, NJ: Princeton University Press.)
 Economists Michael Hudson (2003, op. cit.) and F. William Engdahl (2004, A century of war: Angle-American oil politics and the new world order, Revised Edition. London: Pluto Press) emphasize the role of free-market society more as an ideology than an operating principle in a world where markets are profoundly influenced by geopolitical force, particularly that of the United States. They do not deny, however, that the ideology is actually enforced on the everyday level for most of the world's population most of the time. A.C. Bayly's (2004, op. cit.) influential history of the modern world stresses the importance of a variety of economic and non-economic factors in the genesis of modernity, in contrast to the stricter economic determinism of other scholars. Nevertheless, Bayly (2004, op. cit., pp. 3-5, 290-292, 473-475) explicitly acknowledges the definitive role of capitalism in shaping the modern world and provides abundant examples of its fundamental importance throughout his account.
 K. Polanyi (1944, op. cit.). See also Friedman, M., & Friedman, R. (1979, Free to choose: A personal statement. San Diego, California: Harcourt, Brace, Jovanovich); Bayly (2004, op. cit., pp. 290-292), O'Meara, M. (2004, pp. 63-64, New culture, new right: Anti-liberalism in Post-Modern Europe. Bloomington, IN: First Books.
 K. Polanyi (1944, op. cit., pp. 163-165).
 For an example of the application of this principle in modern times, see Cordonnier, L. (2006, December, Guerre aux chômeurs! Des experts aux idées fracassantes. Le Monde diplomatique. pp. 1, 4, 5) on the campaign of the OECD against the European welfare state.
Teeple (1995), Soros, G. (1997, The capitalist threat. Atlantic Monthly. pp. 45-48; Stiglitz (2002, op. cit.); Hudson (2003, op. cit.); Engdahl (2004, op. cit.).
 Ramonet, I. (2009). Le Krach Parfait: Crise du siècle et refondation de l'avenir. Paris: Galilée.
 This analysis uses the logic and vocabulary of Erik Erikson. Although Erikson, writing in a literary style, used a great variety of other words such as "wholeness" or "healthy personality" more frequently than he used "psychosocial integration" (Erikson, E.H., 1963, Childhood and society, 2nd ed., New York: Norton), this book will doggedly stick to "psychosocial integration". Although this bit of jargon is less lyrical than some of its synonyms, it conveys the essential idea with greater precision.
 Polanyi, K. (1944, op. cit. Boston, MA: Beacon). See also Glendinning, C. (1994, My name is Chellis and I'm in recovery from Western civilization. Boston, MA: Shambhala). Although the author of this fascinating book of popular psychology speaks of living in a "primal matrix" more often in environmental and spiritual than in social terms, this seems to me primarily a difference in emphasis. Dufour, D.-R. (2005, On achève bien les hommes: Des conséquences actuelle et future de la mort de Dieu. Paris: Denoël, esp. pp. 117-120) speaks of human identity as founded more on a relationship to some sort of god than to society. However, he says that a relationship with god can only be achieved in conjunction with other people who help to socially construct the deity (see pp. 121-124; 213) and, conversely, enduring relationships with other people can only become established when people share an understanding of transcendent reality (pp. 132-133, 277-278). See also O'Meara, M. (2004, op. cit., pp. 50-51, endnote 44, pp. 99-102).
 Polanyi, K. (1935, The essence of fascism. In J. Lewis, K. Polanyi, & D.K. Kitchin, Eds,, Christianity and the social revolution, pp. 359-394, London, UK: Victor Gollancz, quote from p. 370).
 Darwin, C. (1981). The Descent of Man and Selection in Relation to Sex, 1st Ed. Princeton, NJ: Princeton University Press. (original work published 1871).
 For a historical example, see Sproat, G.M. (1987). The Nootka: Scenes and studies of savage life. Victoria, BC: Sono Nis Press, 1868/1987, pp. 185-191. For a more specific example, the case of suicide, see Durkheim, E. (1951) Suicide: A study in sociology J.A. Spaulding and G. Simpson, trans., Glenco, IL: Free Press (original work published in 1897), who argued that the primary cause of suicide in 19th century Europe was the failure of people to achieve or maintain integration with their society. His conclusion was based on minute analysis of suicide statistics, which showed that suicide was less frequent at times and in places that favored psychosocial integration. Although this classic study has been challenged in the more recent literature, Chandler and colleagues carried out quantitative studies of suicide among aboriginal children in British Columbia over two time periods, 1987–1992 and 1997–2000. These studies showed that the relative frequency of suicide was much higher among aboriginal children whose bands were more estranged from their traditional culture than those whose bands were less estranged. In both studies, bands that had a positive rating on all seven of the 'cultural continuity variables' had no suicides at all, whereas those bands with a positive score on none of the cultural continuity variables had child suicide rates of 137.5 and 61 per 100,000 of the population (Chandler, M.J., Lalonde, C.E., Sokol, B.W., & Hallett, D. (2003). Personal persistence, identity development, and suicide: A study of native and non-native North American adolescents. Monographs of the Society for Research in Child Development, 68, 2, Serial No. 273). Many more examples appear in Alexander (2008), The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, chap. 5).
 Naomi Klein (2007, The shock doctrine: The rise of disaster capitalism. Toronto, ON: Knopf Canada) showed how social isolation has become a key component of today's most advanced forms of torture.
 Alexander (2008), The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press,, chap. 8).
 Chein, I., Gerard, D.L., Lee, R.S., & Rosenfeld, E. (1964, The road to H: Narcotics, delinquency, and social policy. New York: Basic Books, chap. 9, p. 216); Granfield, R., & Cloud, W. (1999, Coming clean: Overcoming addiction without treatment. New York: New York University Press, chap. 2); Dalrymple, T. (2006, Romancing opiates: Pharmacological lies and the addiction bureaucracy. New York: Encounter Books., chap. 2).
 Naomi Klein (2000, No logo: Taking aim at the brand bullies. Toronto, Ontario: Random House of Canada) has described this brilliantly for the youth culture and the "branded" merchandise of the late 20th century. See also Homer-Dixon, T. (2006, The upside of down: Catastrophe, creativity, and the renewal of civilisation. Toronto, Ontario: Knopf, pp. 197-198).
 Here I am distinguishing between "addiction" in the Oxford English Dictionary meaning of the term and simple dependence on drugs for relief of symptoms. The crucial issue of definition is considered at length in chapter 2 of Alexander (2008, op. cit.).
 This is an necessary oversimplification in the interest of brevity. The kinds of addiction discussed in this article are those that are the topic of public concern, i.e., those that do not form an adequate substitute for psychosocial integration. There are other kinds of addiction that do. See Alexander (2008), The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press, chap. 2).
 Hoffman and Froemke (2007, op. cit.)
 See Durkheim, E. (1951, op. cit.); Bourdieu, P. (2003, June, Ce terrible repos qui est celui de la mort sociale. Le Monde diplomatique, p. 5, Original work published 1981); Homer-Dixon (2006, op. cit., p. 198).
 Many people have shown logically or empirically that the woes enumerated in this paragraph cannot be eliminated in free-market society (e.g., Lenin, N.,1966, L'imperialisme, stade supreme du capitalisme. Pékin, Chine: Editions en langues étangères, Original work published 1916); Velásquez, G., 2003, July, Hold-up sur le médicament: Le profit contre la santé. Le Monde diplomatique, pp. 1, 26-27; Rivière, P., 2003, July, Mobilisation contre le SARS, inaction contre le sida. Le Monde diplomatique, p. 27.)
 This crucial point is made eloquently by Velásquez (2003, op. cit.) and by Peele, S., Brodsky, A., & Arnold, M. (1991, The truth about addiction and recovery: The life process program for outgrowing destructive habits. New York: Simon & Schuster, pp. 374-378).
 Alexander (2009, op. cit., chap. 3).
 Hudson (2003, op. cit., pp. 117-118), Liu, H.C.K. (2008, 30 July, China's Dollar Millstone, Part 1: Breaking free of dollar hegemony. The Asia Times Online. Retrieved 21 October 2008 from http://www.atimes.com/stimes/China_Business/JG30Cb02.html); Lordon, F. (2008, October, Le jour où Wall Street est devenu socialiste. Le Monde diplomatique, pp. 1, 4-5); Wolin, S. (2008, op. cit.). ; Amin, S. (2008, 24 November). Débâcle financière, crise systémique: réponses illusoires et réponses nécessaires. Mondialisation.ca: Centre de recherche sur la mondialisation. Retrieved 25 November 2008 from http://www.mondialisation.ca/index.php?context=va&aid=11116
 See Peck, J. (2008, op. cit.).
 Alexander, B.K. (2009, February). An open letter to Margaret Wente: We need to think more analytically about harm reduction. The CCPA Monitor: Economic, Social, and Environmental Perpsectives, pp. 21-25
 Alexander (2008), The Globalisation of Addiction: A Study in Poverty of the Spirit. Oxford, UK: Oxford University Press,, pp. 143-144). See also Qiu, J. (2009) China clamps down on controversial therapies. The Lancet, 373(9677), 1834-1835; Jacobs, A. (2010, 7 January). China turns drug rehab into punishing ordeal. New York Times, p. A4.
 Klein (2007, op. cit., pp. 286-287, 596); Walker, S. (2009, 11 March). Russia finally admits to its hidden heroin epidemic. The Independent (London). Retrieved 11 April 2009 from http://www.independent.co.uk/news/world/europe/russia-finally-admits-to-its-hidden-heroin-epidemic-1642103.html
 Hudson (2003, op. cit.).
 Johnson, S. (2009, May). The quiet coup. The Atlantic. Retrieved 31 March 2009 from http://www.theatlantic.com/doc/200905/imf-advice
 Taibbi, M. (2009, 8 November). The great American bubble machine. Rolling Stone; Arlidge, J. (2009, 8 November). I'm doing 'God's work'. Meet Mr. Goldman Sachs. The New York Times.
 Hudson (2003, op. cit.)
 Hudson (2003, op. cit., p. 380).
 Hudson (2003, op. cit., chap. 2).
 Hudson (2003, op. cit., chaps. p. 282).
 Hudson (2003, op. cit., chaps. 1-9); Chossudovsky, M. (1997, The globalisation of poverty: Impacts of IMF and World Bank reforms. London, UK: Zed Books); Stiglitz (2002, op. cit.)
 Hudson (2003, op. cit.), Bulard, M. (2008, November, Finance, puissances...le monde bascule. Le Monde diplomatique. pp. 1, 18-19..
 Liu (2008, op. cit.), see also Reuters (2008, 25 October, U.S. has plundered world wealth with dollar: China paper. (retrieved 29 October 2008 from file:///Users/brucealexander/Desktop/U.S.dollar hegemony: China paper.webarchive).
 Hudson (2003, op. cit., chaps. 11-15), See also Liu (2008, op. cit.)
 See Stolberg, S. G. (2008, 19 October, Leaders move toward meetings on economic crisis. The New York Times. Retrieved 19 October 2008 from http://www.nytimes.com/2008/10/19/washington/19summitweb.html?ref=todayspaper); McCarthy, S. (2008, 14 November, Harper lines up with Bush on reform. The Globe and Mail, pp. B1, B2.
 There are many indications that addictions of all sorts are flourishing everywhere (Alexander, 2008, op. cit., pp. 37-42).
 Reuter, P., & Stevens, A. (2007). An analysis of UK drug policy: A monograph prepared for the UK Drug Policy Commission. London, UK: UK Drug Policy Commission.
 Chossudovsky, M. (2008, 15 November). The great depression of 2008: Collapse of the real economy. (Retrieved 16 November 2008 from Global Research. ca at http://www.globalresearch.ca/index.php?context=va&aid=10977);.Johnson, S. (2009, May). The Quiet Coup. Atlantic Magazine. Downloaded 30 March 2009 from http://www.theatlantic.com/doc/200905/imf-advice; Taibbi, M. (2009, 8 November). The great American bubble machine. Rolling Stone; Arlidge, J. (2009, 8 November). I'm doing 'God's work'. Meet Mr. Goldman Sachs. The New York Times.
 Johnson, C. (2005). The Sorrows of Empire: Militarism, secrecy, and the end of the republic. New York: Owl Books; Engdahl, F.W. (2009). Full Spectrum Dominance: Totalitarian democracy in the new world order. Baton Rouge, Louisiana: Third Millenium Press.
 Drury, S. (2005). The political ideas of Leo Strauss, updated edition. New York: Palgrave Macmillan; Wolin (2008, op. cit., chapter 9).
 Faulkner, B. (2008, Interview with Michael Hudson). The new kleptocracy: Biggest "Giveaway" in American History. Global Research.ca. (Retrieved 30 October 2001 from http://www.globalresearch.ca/index.php?context=va&aid=10731).
 Engdahl, F.W. (2008, 10 October). Behind the panic: Financial warfare and the future of global bank power. Global Research. Retrieved 20 October 2008 at http://www.globalresearch.ca/index.php?context=va&aid=10495
 Hedges, C. Death of the Liberal Class.
Wolin (2008, op. cit.)
 See Wolin (2008, op. cit., chap. 5, 6). Perhaps the most amazing demonstration of the confusion and anguish of Americans under a "managed democracy" comes from the outpouring of hope in the internet postings that followed Jon Stewart's exposure of the corruption in an instantly-famous interview with television market guru Jim Cramer that took place on television on 12 March 2009. See http://www.huffingtonpost.com/2009/03/13/jim-cramer-on-daily-show_n_174558.html
 S. Page, "Obama and America's place in the world," USA Today, 21 December 2010, pp. 1, 2A
 Wilkenson, R. and Pickett, K. (2009). The Spirit Level: Why Greater Equality Makes Societies Stronger. New York: Bloomsbury. The data in this book serve to support my point, although Wilkenson and Pickett are interpreting these data within a different theoretical context.
 Alexander (2008, op. cit., p. 113).
 See endnotes 54 and 55 for references.
 Halimi, S. (2008, November). Penser l'impensable. Le Monde diplomatique, p. 1.
 Amin (2008, op. cit.), Bulard, M. (2008, op. cit.)