HLTHAGE 2L03, Winter 2021, Instructor: Dr.

Savelli SAS Notes

January 11-15: Lecture 1

Topics: Defining addiction with the 4 C's; Frameworks of addiction; Larger questions for
the course

Opening comments
 Students will be receiving pre-recorded discussions between Dr. Savelli and the TA's on a weekly
basis
 Discussions will generally coincide with the PowerPoints on A2L

A little bit about Aneeqa

 Social worker: worked at CAMH, currently working at a mental health organization that focuses
on working with youth and their families; veteran TA for Dr. Savelli

Dr. Savelli's reflection from his time living in Bucharest, Romania

 He was struck by the children he would often see on the streets; they were poorly behaved,
often seen with white powder/paint on their clothes, and people had negative attitudes toward
them (going so far as to hit them)
 He was told they were referred to as "Aurolac Kids" (Aurolac = an industrial paint)
o Was cheap and easy to use; many of these kids (often homeless) became addicted
 There were three perspectives towards the Aurolac Kids:
o Poorly behaved, evil children that disrupt others and need to be punished
o Deserved sympathy; they lacked judgement and needed intervention
o Their addiction was a product of their circumstances; many had been born as
orphans/grew up in the streets; Aurolac gave them a sense of purpose/structure to their
day

HOW DO WE DEFINE ADDICTION? The 4 C's (or rather, the 5 C's):

1. Compulsion references a need to use, often with a psychological component (preoccupation
with substance use)
2. Craving references a physical component, where you experience a physical craving for a
substance - like how we crave food
3. Control is the idea that when using a substance, you lose control of yourself (i.e., the ability to
stop using, monitor your use, etc.,)
4. Consequence references a lack of regard for the ramifications or negative impacts of substance
use; the consequences do not deter someone from using
5. Contested references the fact that not everyone agrees on what defines addiction
 For example, the varying perspectives about the Aurolac Kids

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HLTHAGE 2L03, Winter 2021, Instructor: Dr. Savelli SAS Notes

FRAMEWORKS – Perspectives on addiction

1. Addiction as a VICE assumes that people are autonomous decision-makers who are grounded in
moral and social norms; supports the idea that addiction is a personal choice to transcend or
break the norms
o Consequently, shame and blame are inherent to this model
 Individuals engage with drug use by choice (out of their own free will), which
leads to the perception that they must be punished and held accountable for
their decisions
o This model "works" because it's simple to understand (i.e., reductionist)
 "Those who have addictions are bad people"... Everyone can understand that
this simplified conclusion of addiction
 Naturally leads to a simplified solution: "We should punish them to show other
people/deter others from also using
2. Addiction as a DISEASE takes on the idea that addiction itself is a function of an underlying
biological mechanism, therefore the individual cannot control it
o Differs from the vice model's consequences of shame and blame by seeing the addicted
individual as sick with no choice in their addicted behaviours
o Could be a result of brain chemistry or a genetic disposition; addiction is a biological
disease
o The approach is medical (healthcare approach) and tries to help those who have been
labelled addicted; could be more helpful because it reduces stigma - displaces blame
from free will to biology
o Though, there are people that argue addiction is far more complicated because the
disease model negates autonomy and responsibility for one's own actions
o In medical terms, what is dependence?
 It's related to craving and compulsion - without a substance, the individual will
experience an undesirable physical/physiological state with aversive symptoms
(individual to each person); their body needs it, so when going without, they
might experience dizziness, nausea, hallucinations, delusions, etc.,
o In medical terms, what is tolerance?
 To achieve the same feeling from the substance, one must increase their dosage
o There are TWO offshoots of the Disease model...
 Susceptibility: certain people are at risk for developing addiction; they have a
genetic/hereditary predisposition that makes them prone to be addiction
 The addiction problem resides within the individual
 Exposure: the substance/behaviour is addictive in itself; anyone who uses that
substance is at risk for addiction
 The addiction problem resides within the substance
 Both these models think of addiction a disease, but differ in how they attribute
responsibility

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HLTHAGE 2L03, Winter 2021, Instructor: Dr. Savelli SAS Notes

 One says that certain people need to watch their use, while the other says that
all people need to monitor their use
o Inherent to the disease model is the notion that addiction is progressive, and individuals
will eventually hit "rock-bottom" (term coined by AA)
 Addiction gets worse over time
o Another assumption is that addiction is permanent; the addiction is there even if
someone stops using, which is the reason why AA preaches total abstinence
o Some people say that a symptom of this disease is denial/the inability to acknowledge
they're addicted
o Drawbacks of this model?
 Some argue it removes personal responsibility
 Addiction becomes viewed as a lifelong experience, which leads to the concern
idea that one will always be an addict, disempowering them; might foster a
sense of hopelessness/caused a negative shift in self-identification
 The research indicates that not all people with addiction are
"permanent" addicts; some people return to moderate use and others
never lose control of themselves (which challenges the exposure model)
2. Addiction as an ADAPTATION points to the fact that there are larger sociopolitical issues that
make addiction a complex subject; how people live (societal structures) can make them feel
powerless, ungrounded, lacking roots, and detachment from society... Substances might serve
as a coping mechanism to that distress (i.e., addiction is a symptom of a larger structural issue)
o Alexander argues that it's not just the social environment, but a particular part of the
social environment (i.e., free market, neoliberalism, capitalism)
o He argues that in our economic structure, both ends of the spectrum are vulnerable to
addiction (i.e., the poor and the wealthy)
 Free market systems uproot people from their communities
 They're why people move far away for jobs
 They're why people must work long hours and feel alone
 They're what make people look at their neighbours with a sense of
distrust (conditioned to be believe we are units competing against each
other)
o Some people will "fail" in this system; substance abuse gives the poor a purpose/reason
to exist - if you have no autonomy in your work, addiction makes sense as an adaption
o Some people will "thrive" in this system, but it comes at the cost of community ties as
they put in more and more hours into their work
o Addiction becomes an ultimate lifestyle; a way to make sense of things

Wrapping up the discussion:

 This course will explore the strengths/limitations of each model
 There are different actors in society that favour one model over the others
o People will selectively highlight/ignore evidence to support what they favour

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HLTHAGE 2L03, Winter 2021, Instructor: Dr. Savelli SAS Notes

 However, the models are conceptual ideals... The disease and vice models should not coexist,
yet they are the two dominant perspectives and DO coexist
o Ex. We see this in drug courts where people are sentenced to treatment...

Questions to think about throughout this course:

1. Who or what is to blame for addiction? The individual? The substance? The social environment?
What do we do what that information?
2. What's the relationship between social structures (social status) and addiction? The identity of
the "imagined addict" is greatly influenced by how we feel about substances...
3. Why is the scope of addiction (as a concept) becoming wider? Why does it now apply to more
than just drugs? Why do we describe certain behaviours as addictions?