History of the Human Sciences

23(4) 52–67
Birth of a brain disease: ª The Author(s) 2010
Reprints and permission:
science, the state and sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/0952695110371598

addiction neuropolitics hhs.sagepub.com

Scott Vrecko
University of Exeter, UK

Abstract
This article critically interrogates contemporary forms of addiction medicine that are
portrayed by policy-makers as providing a ‘rational’ or politically neutral approach to
dealing with drug use and related social problems. In particular, it examines the historical
origins of the biological facts that are today understood to provide a foundation for con-
temporary understandings of addiction as a ‘disease of the brain’. Drawing upon classic
and contemporary work on ‘styles of thought’, it documents how, in the period between
the mid-1960s and the mid-1970s, such facts emerged in relation to new neurobiological
styles of explaining and managing social problems associated with drug abuse, and an alli-
ance between a relatively marginal group of researchers and American policy-makers
who were launching the ‘War on Drugs’. Beyond illustrating the political and material
conditions necessary for the rise of addiction neuroscience, the article highlights the pro-
ductivity of neurobiological thought styles, by focusing on the new biological objects,
treatments and hopes that have emerged within the field of addiction studies over the
last several decades.

Keywords
addiction, biopolitics, neuroscience, social problems, styles of thought, War on Drugs

Introduction
Today, addiction is understood to be fundamentally a disease of the brain – at least by
those who are most influential in determining how drugs and their use are governed

Corresponding author:
Dr Scott Vrecko, Department of Sociology & Philosophy, University of Exeter, Amory Building, Rennes Drive,
Exeter, Devon EX4 4RJ, UK
Email: S.Vrecko@exeter.ac.uk
52

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 53

in contemporary industrialized societies. According to the American National Institute

on Drug Abuse (NIDA), which funds most of the world’s research on addiction:

Addiction is defined as a chronic, relapsing brain disease that is characterized by compul-

sive drug seeking and use, despite harmful consequences. It is considered a brain disease
because drugs change the brain – they change its structure and how it works. These brain
changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse
drugs. (NIDA, 2007: 5)

NIDA’s position – a fundamentally biological one – is that addiction represents a patho-

logical state of brain functioning that can occur because the brain structures involved in
rewarding human behaviour cannot distinguish between the chemistry of naturally
occurring neurotransmitters on the one hand, and of artificial drugs on the other. Because
such drugs can mimic endogenous neurotransmitters at the molecular level, they are able
to ‘hijack’ (Leshner and Koob, 1999) the brain’s reward system, and cause an artificial
over-production of pleasure. Over time, and repeated drug use, the brain adapts to these
elevated levels, and the amounts of pleasure available from ‘natural’ activities (such as
eating or having sex) become relatively insignificant. All this can be summed up in the
claim that ‘Addiction is a disease of the brain, and it matters’ (Leshner, 1997).
And yet, at the same time that scientific and political authorities unequivocally assert
that addiction is a brain disease, other sorts of experts declare that ‘addiction is a myth’
(Davies, 1997; Hammersley and Reid, 2002); prevailing perspectives on addiction
within the social sciences and humanities tend to take for granted that there is no real
biophysical basis to addiction – that addiction is ‘merely cultural’, a social construction
that enables and justifies a variety of forms of social control (see Dunbar et al., 2010).
Since the 1970s, and in the wake of the anti-psychiatric movement (in which some key
figures, such as Thomas Szasz, dismissed the reality of addiction and other mental ill-
nesses altogether [Schaler, 2004; Szasz, 1961; Szasz, 1974]), social analyses have tended
to focus on the arbitrary standards and taken-for-granted ideals of health and function-
ality that addiction medicine often relies upon. For example, they have noted that while
addiction is generally explained in terms of biological factors (genetic influences, phy-
siological processes, etc.), it is almost always (1) diagnosed in terms of impairments in
social functioning (such as problems at work or in interpersonal relationships) or unde-
sirable subjective feelings (e.g. guilt, shame, or loss of control), and (2) treated with the
goal of restoring social orders and personal capacities (Keane, 2002; Weinberg, 2002).
While constructionist analyses of addiction have usefully highlighted the socio-
political aspects of addiction medicine by demonstrating that addiction treatment may
perform normalizing operations through the creation of pathological identities (Gusfield,
1996; May, 2001; Truan, 1993), they have generally left unexamined the scientific and
technical content of addiction science. This seems to reflect a long-standing assumption
(inspired by critical theory) that science is not more objective or robust, but only more
dominant, than other types of knowledge. According to such a science-as-ideology view
(e.g. Habermas, 1970), one might argue that addiction science is best analysed as a form
of ideology that is essentially political in nature, and is best understood as the result of
efforts to establish new programmes of social and medical discipline over individuals’
53

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

54 History of the Human Sciences 23(4)

bodies and desires (cf. Bourgois, 2000). However, some social scientists suggest that
things are not quite so straightforward; that molecular biology and neuroscience may
challenge traditional sociological analyses, and require a ‘rethinking of the sociology
of mental illness’ (Busfield, 2000). Such a rethinking does not suppose that addiction and
other mental disorders should be accepted simply as matters of transcendent facts, but
that social analyses need to pay closer attention to developments arising within the con-
text of the laboratory-based brain sciences and clinical research sites (e.g. see Lakoff,
2007; McGoey, 2010; Vrecko, 2010), and should strive to ‘take biology seriously’ (as
Kushner [2006] suggests in relation to addiction).
This article investigates how the biological reality and political governance of addic-
tion have been reconfigured within the contemporary brain sciences and how develop-
ments related to the War on Drugs have led to new social, scientific and cultural
understandings of persistent and compulsive substance users – particularly understand-
ings associated with the notion that addiction is a ‘disease of the brain’. What new facts
about drugs and drug use have taken shape over the last few decades? What new ways of
studying, representing and intervening on drug users, and drug-using populations, have
come into being? What new techniques and objects has it become possible to put to work
in government drug control strategies and therapeutic programmes? Such questions are
of social, not just intellectual, importance, for as addiction has become a disease of the
brain, a range of therapeutic and social reorientations has transpired: addiction has
become treatable with new sorts of brain-targeting medications, which are understood
to act on specific parts of the brain affected by drug use (O’Brien, 1997); individuals are
increasingly incited to make decisions about drug use on the basis of knowledge of how
drugs affect the brain (Vrecko, 2006); and personal, social and legal issues associated not
only with drugs, but with a range of compulsive and problematic behaviours – including
criminal offending, spending and debt, gambling, and obesity – are coming to be
represented as, at least in part, problems of the molecular body and brain (Burnham and
Phelan, 2001).1
The analysis below examines the historical, social and scientific origins of contempo-
rary neuroscientific accounts of addiction in terms of an ‘addiction neuropolitics’2 that
emerged in the late 1960s and early 1970s, as addiction neuroscience moved from being
a marginal, almost non-existent field, to a well-funded, state-sponsored specialty that is
today understood to have played an important role in the molecular revolution that has
occurred within psychiatry. Drawing upon the work of Ludwik Fleck – whose early con-
tributions to the sociology of science are increasingly recognized (Hedfors, 2007; Löwy,
2004), but still arguably under-appreciated (Latour, 2005: 112) – and contemporary
scholarship that Fleck has inspired, the first section following this introduction discusses
how the analytic notion of ‘styles of thought’ can provide a basis for thinking about the
history, biology and politics of addiction in a way that neither dismisses biology out of
hand, nor embraces the view that addiction is and has always been a disease of the brain.
Subsequently, the article explores the emergence of a neurobiological style of thinking
about drugs and addiction in the context of the US War on Drugs, when both scientists
and politicians sought new possibilities for explaining and managing drug abuse. Rather
than focus on addiction science as an exclusively ideological and/or repressive endea-
vour, a key concern here is to elucidate the field’s productive powers: how it has given
54

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 55

rise to new biological objects, new medical treatments, and new forms of politics and
control since the 1960s and 1970s. Emphasis is placed on developments within the USA
because (as will be discussed below) the very origins of neuroscience studies of drugs
and addiction in the postwar era were closely tied to American social and political con-
cerns about drugs; indeed, funding from the US government was one of the key material
factors that allowed addiction neuroscience to become a viable field. Moreover, although
brain research into addiction is today a global enterprise, it remains the case that the vast
majority of this research is supported by the American National Institute on Drug Abuse;
until recently NIDA’s website boasted of funding 85 per cent of the world’s research on
addiction.

Addiction and Biological Styles of Thought

A range of political, scientific and institutional authorities today takes addiction to be a
disease of the brain, as a matter of objective facts. What exactly this means – to assert
that addiction can be taken to be a disease of the brain on the basis of objective facts
– depends largely on what one takes to be a ‘fact’. Governing authorities consider a fact
to be a truth that transcends history, culture and politics; in this view, the facts of addic-
tion neuroscience may be taken to provide a value-free basis for understanding what
drugs do to brains, bodies and individuals – and, by extension, may be taken to provide
an evidence base for developing a range of social and legal policies that protect and pro-
mote the health of populations. Such a view, however, contrasts sharply with the concep-
tions of facts and objectivity that have become increasingly prominent within the
sociology, history and philosophy of science over the last few decades, and that can
be traced back, particularly through the work of Kuhn (Babich, 2003; Kuhn, 1996), to
Ludwik Fleck’s pioneering study, The Genesis and Development of a Scientific Fact
(1977). Fleck, and the analyses he has inspired (e.g. Rosenberg, 2003; Young, 1995),
offer a conceptualization of facts not as things to be revealed, but as historical events,
which only come into existence within a ‘style of thought’ (Fleck, 1977) or ‘style of rea-
soning’ (Hacking, 1992) that engenders a collectively accepted way of perceiving the
world. Thought styles themselves are historical phenomena that would disappear if not
continually reproduced within epistemic networks (Fleck refers to these as ‘thought col-
lectives’, and notes that such networks include not only academic experts but also a wide
range of other social actors) that are contingent upon a complex assemblage of personal,
social, material and political factors. The point here is not that facts ‘don’t really exist’
because they arise in certain times and places, and in relation to certain social circum-
stances; it is that facts always exist within a historically situated, ‘simultaneously con-
straining and determining’ (Arksey, 1994: 50) thought style that has allowed them to
come into being. It is only when limits are placed on the possibilities of thought, and
when requirements are specified that qualify some utterances to ‘count’ within a field
(and that disqualify others from counting), that facts can develop at all.
By emphasizing the temporal and collective structuring of cognition rather than the
ontological content of truth, Fleck’s approach makes possible the investigation of scien-
tific facts as dynamic phenomena, rather than as static, unchanging orders of reality.
Following Fleck’s dictum that ‘truth is the up-to-date stage of changes of thought-style’
55

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

56 History of the Human Sciences 23(4)

(1986: 111), facts can usefully be understood as originating at a place in time, and as
existing only as long as they continue to receive collective support. From this perspective
of ‘comparative epistemology’ (cf. Camargo, 2002; Heelan, 1986), which takes for
granted that facts and criteria of objectivity do not stand on their own, in a realm of pure
reason and truth, the interesting endeavour is not to simply ‘disprove’ or ‘expose’ as
mere ideology the factual claims made by experts, but rather to examine the concrete
cases and contexts in which facts are produced and continually reproduced – for exam-
ple, by focusing on the local networks in which ideas and practices circulate, the material
and institutional factors that make research possible, and the scientific and political con-
tests in which rules for objectivity are decided upon (as exemplars of such an approach,
see Chiang, 2009; Gaudillière, 2004). More fundamentally, it is to recognize the genera-
tive capacities of thought styles, and to accord thought collectives ‘a certain power to
create objects’ (Fleck, 1977: 181). As Nikolas Rose points out, ‘a style of thought is not
just about a certain form of explanation’, it is also about creating new things to explain;
styles of thought shape and establish ‘the very object of explanation, the set of problems,
issues, phenomena that an explanation is attempting to account for’ (Rose, 2007: 12).
Below, in relation to the postwar history of research on drug use, I examine the for-
mation, practices and problems of a specific thought community, whose work was tied to
an emerging neurobiological style of thought and brought about new modes of inquiry,
new methods of inquiry and new scientific objects within the field of addiction studies. I
explore how it has become possible to think about and research addiction in terms of the
molecular structures of the brain; and how the facts of addicted brains actually began to
be brought into existence – so that decades later we can state, as a matter of biological
fact, that addiction is a disease of the brain. I focus in particular on a development which
played a pivotal role not only in establishing the legitimacy of a neuroscience of addic-
tion, but in the broader ‘molecular revolution’ that occurred in the neurosciences in the
1970s, namely the ‘demonstration’ of the existence of chemical receptors in brain tissue.
Before this, however, the following section situates the emergence of bioscientific styles
of thinking about addiction within the formations of biopolitics that arose as US policy-
makers sought new strategies for combating drug use.

Mutual Enrolments: Addiction Science and the War on Drugs

The decade between the mid-1960s and the mid-1970s is often described as marking the
beginning of the contemporary era of addiction medicine and treatment, when
approaches based on laboratory research and knowledge of biological processes began
to be devised in order to deal ‘rationally’ with the harms and problems associated with
drug abuse. Nora Volkow, current director of the US National Institute on Drug Abuse,
explains that prior to this contemporary period, ‘scientists studying drug abuse labored in
the shadows of powerful myths and misconceptions about the nature of addiction’. She
asserts that tremendous progress in research has been made over the last several decades,
and that ‘Today, thanks to science, our views and our responses to drug abuse have chan-
ged dramatically’ (2007: 1). Volkow’s expression of gratitude toward ‘science’ reflects
the dominant accounts of the development of neurosciences models of, and treatments
for, addiction, which assume that science has progressed more or less on its own (see
56

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 57

Courtwright, 2010). It is not at all clear, however, that the march of progress in addiction
science would have begun as it did in the 1960s, if a small group of relatively marginal
clinicians and researchers had not found themselves in the midst of social and political
developments associated with what has come to be known as the War on Drugs. In this
period, the very notion of an ‘addiction science’ seemed dubious, both to mainstream
basic scientists and to clinical addiction professionals. On the one hand, basic neuros-
cientists and psychopharmacologists did not consider addiction a very prestigious or
interesting field, and support for experimental research in this area was not easily come
by. On the other hand, biological perspectives on mental illness were still marginalized
within both American psychiatry and the clinically oriented field of addiction studies. As
one addiction scientist who was trained in this atmosphere recalls:

A psychiatric trainee who expressed a strong interest in basic biological research was
regarded as somewhat peculiar, perhaps suffering from emotional conflicts that made him
or her avoid confronting ‘real feelings’. An interest in science was regarded almost as sick,
some sort of stratagem to avoid the psychoanalytic issues that mattered by fleeing to sci-
ence. (Snyder, 1989: 10)

With psychologistic perspectives dominant, among addiction experts there was not much
agreement at all that addiction really was a brain disease, and among brain scientists,
there was no strong conviction that addiction was an important research area.
While a small, loosely connected community of scientists interested in investigat-
ing addiction as a matter of neurobiology had developed by the end of the 1950s, this
community remained marginal until the end of the 1960s, when the US federal gov-
ernment began to supplement its legislative drug control strategies with biomedical
ones (Drucker, 1999; NCMDA, 1973). The introduction of methadone maintenance
programmes in 1965 was an early clinical example of this new (at least partly) ther-
apeutic approach (cf. Dole and Nyswander, 1965); but it was when Richard Nixon set
out on his presidency in 1969 that federal agencies began to make support available
for basic laboratory scientists interested in neurobiological aspects of addiction. Nixon
entered office at a point when tumultuous social change in the USA, as well as wor-
sening political and military problems associated with the Vietnam War, had led to a
sense of national emergency. Drug problems were identified as one of the main
sources of crisis on both of these fronts by the US government: the military
had reports that over 15 per cent of returning war veterans were addicted to heroin
(Halloway, 1974; Jaffe, 1999), and as drug use among white, middle-class youth
began to increase, addiction was considered by some to be reaching epidemic propor-
tions. As one scientist described the links between drug-related moral panics and
research funding:

Among national authorities, apocalyptic visions of opioid-dependent armed United States

soldiers, as well as similarly afflicted anti-war, anti-American anarchists roaming the streets
looking for a ‘fix’, provided necessary impetus to both the Executive and Legislative
Branches of the Government to authorize funding for expanded research and treatment of
opioid dependence. (Julius, 1976: 5)
57

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

58 History of the Human Sciences 23(4)

Intent on reducing drug use and crime rates (which he saw as obviously interrelated), in
1971 Nixon created a Special Action Office for Drug Abuse Prevention (SAODAP) with
the mandate to administer the drug control resources of the federal government, and also
to develop government initiatives in the areas of research, treatment and prevention
(Nixon, 1971; Walsh, 1971).
Jerome Jaffe, a young addiction scientist committed to the view that addiction was
rooted in an individual’s biochemistry, became the first director of SAODAP, charged
with the objective of steering the USA’s national drug policy toward a rational, more
pharmacological approach to treating addiction (SAODAP, 1972). Just as Jaffe was
enrolled in the US government’s War on Drugs, he was able to enroll the government
in the support and advancement of his addiction science thought community. Although
US policy-makers were mainly interested in making funds available for clinical initia-
tives that would ‘do something’ about the addiction problem, when Congress passed the
1972 Drug Abuse Office and Treatment Act to fund a vast expansion of clinical treat-
ment programmes, a small but nevertheless significant proportion of SAODAP’s budget
was allocated to basic research. Decades later, Jaffe indicated that ‘[t]hat early funding
put money into things that really had an amazing impact. ... [W]e accomplished some-
thing in really jump-starting the research activities in substance abuse and – not the least
– we laid the foundations for the current treatment system’ (1999: 23).
As addiction scientists were able to position themselves as part of the solution to the
problem of drug use and social disorder, they became embedded in a new sort of juridi-
cally willed research economy, in which legislative powers provided a variety of
resources that allowed the field of addiction science to develop at a remarkable pace. The
formation of a state–science alliance in relation to a particular style of thinking about
addiction may not explain how we arrived at the facts of addiction that we currently have
(as would be suggested by an ideology- or interest-based explanation), but it helps
explain how the neuroscientist’s laboratory became an ‘obligatory passage point’ (Cal-
lon, 1986) for producing truths about addiction, and how it became possible to produce
evidence of specific ‘receptor’ sites in the brain on which drugs act – structures which
today provide a basis for the most basic neuroscientific facts of addiction.

The Birth of a Brain Disease

It was in 1973 that Solomon Snyder and Candace Pert, of Johns Hopkins Medical
School, reported in Science that, thanks to a new experimental procedure called radioli-
gand binding, they had demonstrated the presence of opiate receptors in nervous tissue:
that is, the neurological structures to which heroin and similar drugs attach themselves in
order to affect the brain. The demonstration of the existence of opiate receptors was a
significant event for neuroscience in general, for it was taken to indicate the possibility
of moving from knowledge of the brain as an organ, to knowledge of the brain in terms of
molecular structures; and thus, the ‘receptor revolution’ (Pert, 1997) is taken to mark the
beginnings of an era in which neuroscience could obtain knowledge of the workings of
the mind, down to the smallest possible detail. This demonstration, and the subsequent
flurry of research that arose in relation to it (Hughes, 1975; Terenius, 1973; Wikler,
1976), also contributed considerably to the consolidation of the neurobiological thought
58

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 59

style within the field of addiction studies: the ability to define exactly where chemicals
interacted with the central nervous system met one of the fundamental criteria for estab-
lishing addiction as a disease of the brain, and thus helped to secure the future of basic
neuroscience research on addiction.
Up until this point, the notion of addiction as a brain disease could be considered ten-
tative at best, given that the precise neurobiological structures and mechanics had only
been posited hypothetically. With the publication of their article, many researchers felt
that Snyder and Pert brought to an end decades of speculation about the existence of
receptors (e.g. Ahlquist, 1948; Bradley, 1958; Stephenson, 1956), and doubts about the
involvement of the brain in addiction. For anyone who might wish to explain these devel-
opments as the result of neutral science and its discovery of the unmediated nature of the
brain, Snyder himself has offered a book-length account of the opiate-receptor research
of the 1960s and 1970s that details how the development of knowledge about the mole-
cular anatomy of addiction and the brain cannot be dissociated from the political econ-
omy or the intellectual and technological history of neuroscience. Indeed, Snyder’s
Brainstorming: The Science and Politics of Opiate Research (1989) suggests that he and
his colleagues had not been attempting to let the neurological truths of addiction appear
through an experimental process designed to let the brain reveal its essential nature, as
much as they had been engaging in the production of facts along lines already partially
specified by (as his book’s subtitle indicates) the science and politics of the era.
Demonstrating how politics matters in science on a personal or individual level,
Snyder asserts that his interest in opiates ‘cannot be divorced from American political
events in the early 1970s’ (Snyder, 1989: 6), when Nixon’s recently declared offensive
on substance use led to the funding of drug abuse research centres, one of which was
awarded to Snyder’s group with a specific mandate to study opiate receptors (Snyder and
Pasternak, 2003). Snyder and his team had not chosen either addiction as a field, or the
opiate receptors as an object of investigation, because of a particular interest in or con-
cern about opiate addiction; indeed, Snyder admits that in the late 1960s, he ‘hardly
knew heroin from horseradish’. Research on opiates was chosen as the object of inves-
tigation simply because funding had been readily available for researchers whose proj-
ects could be aligned with the US government’s War on Drugs.
But how did Snyder’s team come to focus on the receptors? In the late 1960s, evidence
of the existence of receptors was, after all, extremely vague – as it had been since the 1940s
and 1950s, when addiction researchers began to seize on the receptor concept to explain
how incredibly small amounts of drugs could have such dramatic effects on the body:
drugs must stimulate some small bit of the nervous system, it was reasoned, that in turn
yields a chain reaction of biological events that produces the observable effects of the drug
(Fraser et al., 1958; Small et al., 1938). The pivotal moment establishing receptors’ impor-
tance in the field of addiction research came in 1965 - well before any hard evidence had
materialized - when the British pharmacologist Harry Collier published an article in
Nature that offered a theoretical explanation of addiction in terms of receptor activity.
Based on the concept that ‘a chemical substance acts on a living system through its mole-
cules becoming attached to particular sites (receptors) on cells’ (1965: 181), Collier’s arti-
cle explained that drugs cause dependence by altering the activity of these sites, and that
these disruptions lead to addiction.
59

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

60 History of the Human Sciences 23(4)

Collier’s paper quickly became one of the most influential and widely cited papers in
addiction science research, despite the fact that it seemed to depend upon the force of
imagery and rhetoric, rather than substance or proofs. Indeed, looking back 35 years after
the publication of Collier’s ‘general theory of drug dependence by the induction of
receptors’ (Collier, 1965), the eminent pharmacologist John Littleton notes that the influ-
ence of Collier’s theory did not seem to be seriously affected by the fact that it was based
on tentative, almost unsupportable claims:

Since in 1965 ‘receptors’ were only a vague concept [Collier’s] hypothesis was outrageous
and untestable, as well as brilliant. Its publication at that time does credit to the imagination
of the Editor of Nature, and to Collier’s powers of persuasion. After this, regulation of
receptors rapidly took center stage as a potential explanation [for the biological basis of
addiction]. (Littleton, 2001: 89)

Retrospectively, Littleton seems surprised that Collier’s hypothesis encountered so little

resistance, given that the neurological receptors Collier deployed in his explanations did
not demonstratively exist until almost a decade later; disputes at the time tended to be
about particular aspects of the receptor-based model rather than about its fundamental
propositions. Littleton emphasizes the importance of the rhetorical and imaginative
dimensions of the receptor hypothesis to its acceptance, noting that other cellular and
biochemical explanations for addiction had also been suggested at the time, but captured
the popular imagination much less. Collier’s hypothesis was attractive because it was
tidy and elegantly simple; and Littleton suggests that the ‘beauty’ of the proposal should
not be underestimated in understanding why it was seized upon so readily.
And so, from 1965, receptors became a major focus for researchers and research-
funding agencies even though the receptor remained indefinite up until 1973. Nervous
tissue, in this period, became subject to a series of ‘phenomenotechnological’ operations
(cf. Bachelard, 1984): brain tissue was brought into laboratories, probed, measured and
experimented with until it yielded to Pert and Snyder the results that researchers had ima-
gined would be produced. Even before Pert’s and Snyder’s successful experiments, the
discovery of opiate binding sites seemed virtually inevitable, and the existence of recep-
tors was taken more or less for granted. In 1972, for example, the author of a review of
leading pharmacological explanations of addiction stated that in order for such explana-
tions to appear plausible:

It is necessary ... to accept that a drug is a chemical which when administered gains access to
a cell and affects the function of the cell by one of a variety of means, bio-physical, bio-
chemical, etc. This alteration is triggered off by the drug molecule being attached no matter
how tenuously to a part of the cell capable of binding it (the receptor). The drug molecule
produces changes as a consequence of its adhesion which may start a complex chain of
events involving temporary or permanent change in the function etc. of the affected cell.
(Graham, 1972: 83)

Despite the fact that in 1972 the ‘receptor’ was only a hypothetical entity, it was neces-
sary to accept its existence for pharmacological theories to make sense. And thus it is not
60

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 61

entirely surprising that once such conceptualizations had arisen, the experimental means
developed to select, purify, filter and shape the physiological phenomena that came to be
identified as receptors. The ‘nebulous phenomena’ (Bachelard, 2002) suggested by
hypothetical conjecture about receptors entered into practical and political trajectories
through which they would become technically constituted as laboratory objects, and
as matters of fact upon which neurobiological understandings of addiction have been
built.
The demonstration of the opiate receptors greatly intensified optimism that addiction
(and other mental illnesses) could ultimately be known and modelled at the biomolecular
level, and that effective treatments could be developed which would go beyond simply
maintaining addiction in less harmful forms (as critics accused methadone maintenance
therapies of doing). A few decades later, addiction is no longer imagined as a brain dis-
ease; it is a brain disease as a matter of facts (cf. Institute of Medicine, 1996) – though of
course these are state-sponsored, historically contingent facts. This does not mean that,
even for the most biologically reductionist researchers, only the brain matters in addic-
tion research; however, non-brain phenomena are increasingly reimagined in terms of
what goes on in the molecular biology of the brain and central nervous system. As a
report by the (American) Institute of Medicine’s Division of Neuroscience and Beha-
vioral Health aimed at improving understanding of and strengthening research on addic-
tion puts it: ‘A sophisticated understanding of how the brain works recognizes that an
individual’s life experience and social context exert powerful effects on the brain and,
therefore, behavior’ (Institute of Medicine, 1997: 39). Within such a style of thought,
which Courtwright (2010) refers to as ‘the NIDA paradigm’, psychological and sociolo-
gical factors (‘life experience and social context’) which contribute to what individuals
think and do (‘behavior’) become considerations of what at its core ‘involves a biological
process’ (Nestler and Aghajanian, 1997: 58). As Nancy Campbell (2010) notes, the con-
ception of the social that is embedded in such formulations is considerably thinner than it
might otherwise be, and thus needs to be subjected to sustained critical interrogation.

Conclusion
From the mid-1960s to the mid-1970s, researchers began to situate addiction within a
newly developing problem space – the interior space of the brain. This was a critical
period for contemporary understandings of addiction, when our current scientific repre-
sentations of addiction, and means of intervening on drug use and drug-using popula-
tions, began to emerge. The preceding analysis, of the formation of this new,
neurobiological problem space, and of how the brain and the scientist’s laboratory have
become obligatory points of passage for those who wish to produce truths about addic-
tion or deploy scientifically rational strategies to manage addiction, is intended to chal-
lenge the popular and mainstream view that the theoretical and technical advances made
since the advent of addiction neuroscience were ‘based primarily on simple scientific
logic’ (Akil et al., 1997: 70). Certainly, as the laboratory sciences have extended their
lines of penetration into the molecular make-up of the central nervous system over the
last few decades, we have obtained facts about what the brain is (i.e. its structure), how
the brain works (its processes), and what the brain does (its functions). But the conditions
61

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

62 History of the Human Sciences 23(4)

required for producing such facts are historically contingent, and dependent upon a range
of social, political and economic factors that play an important role in determining what
becomes a problem, what is imagined as a possible explanation, and what possible expla-
nations are actually investigated and brought into the realm of truth.
Thus, it seems necessary to re-evaluate the status of the contemporary era of addiction
medicine, as an era characterized by ‘rational’ approaches to dealing with the harms and
problems associated with drug use. Describing contemporary approaches to addiction as
rational may be accurate and valid to an extent, insofar as such a description demarcates
a strategy of intervention based on deductions from general principles obtained through
scientific inquiry, and not on moral or empirical forms of reasoning. However, ‘rational’
tends to be used synonymously with other adjectival terms such as ‘value-free’ and
‘politically neutral’ – terms that would be misleading if applied to this era. This period
was one in which the US government sought to make addiction and drug-related social
problems matters of the brain, requiring that the mechanisms of those problems be
brought into the realm of explicit neurobiological calculation. Thus, if we want to cap-
ture what is most distinctive about the contemporary era, it is perhaps more appropriate
to describe the shift that began to occur in 1965 as a movement towards a neuropolitics of
addiction. These developments did not consist only of a simple medicalization of social
control; they also involved a broader realm in which truths about drug use and human
physiology are produced, and in which these truths began to form the basis of new ways
of monitoring, optimizing and organizing drug-using individuals and populations.
If all facts are events in the history of thought, and are all dependent on technological,
social and political economic support, why should we be concerned with the particulars
of addiction science? Quite simply, because, as Fleck points out, it is when we become so
used to ‘seeing’ objects or facts within a prevailing thought style that we lose awareness
of our own historically contingent perspective, that these things come to be thought of as
having a natural existence. As the US government continues both to fund the majority of
research into addiction and to prioritize neurobiological styles of thinking about drugs
and drug users, the facts of addiction as a disease of the brain will continue to be repro-
duced, and to challenge other styles of thought and explanations – particularly those that
avoid reducing the social to the biological. Close consideration of the historically and
politically contingent processes through which we increasingly come to think and act
as on ourselves in terms of our neurobiology is needed as a continuous reminder that our
biologies, our behaviours and our experiences are spheres open to potential contestation,
political intervention and reconceptualization.

Notes
1. Another important issue that is beyond the scope of this article relates to the re-evaluations that
are occurring, particularly with moral philosophy and medical ethics, about notions of ‘respon-
sibility’. One might assume that, to the extent that addiction is framed as a disease of the brain,
individuals diagnosed with addiction would not be held responsible for their condition and its
consequences. However, this is certainly not what most scientific experts suggest. More
common is for attributions of responsibility to be divided between causes and consequences.
For example, individuals are not considered to be at fault for becoming addicted since it is the
62

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 63

power of drugs that causes a loss of control: ‘At some point after continued repetition of vol-
untary drug-taking, the drug ‘‘user’’ loses the voluntary ability to control its use. At that point,
the ‘‘drug misuse’’ becomes ‘‘drug addicted’’ and there is a compulsive, often overwhelming
involuntary aspect to continuing drug’ (O’Brien and McLennan, 1996: 237). But while not held
responsible for becoming ‘addicted’, individuals are generally considered responsible for their
behaviours and for seeking treatment (cf. Bonnie, 2002; Morse, 2000).
2. In using the term ‘neuropolitics’, my intention is to suggest a neurobiologically inflected bio-
politics. This conception is principally informed by Foucault’s (1990) conception of biopower,
which indexes the connections between the modern state and expert authority that are formed in
relation to efforts to administer the health and well-being of populations; it thus diverges from
William Connolly’s conceptualization of neuropolitics as ‘the politics through which cultural
life mixes into the composition of body/brain processes’ and the ‘layered character’ of thought,
ethics and politics (2002: xiii).

Bibliography
Ahlquist, R. P. (1948) ‘A Study of the Adrenotropic Receptors’, American Journal of Physiology
153(3): 586–600.
Akil, H., Meng, F., Devine, D. P. and Watson S. J. (1997) ‘Molecular and Neuroanatomical Prop-
erties of the Endogenous Opioid System: Implications for Treatment of Opiate Addiction’,
Seminars in Neuroscience 9(3–4): 70–83.
Arksey, H. (1994) ‘Expert and Lay Participation in the Construction of Medical Knowledge’,
Sociology of Health & Illness 16(4): 448–68.
Babich, B. E. (2003) ‘From Fleck’s Denkstil to Kuhn’s Paradigm: Conceptual Schemes and
Incommensurability’, International Studies in the Philosophy of Science 17(1): 75–92.
Bachelard, G. (1984) The New Scientific Spirit. Boston, MA: Beacon Press.
Bachelard, G. (2002) The Formation of the Scientific Mind: A Contribution to a Psychoanalysis of
Objective Knowledge. Manchester: Clinamen.
Bonnie, R. J. (2002) ‘Responsibility for Addiction’, Journal of the American Academy of Psychia-
try and the Law Online 30(3): 405–13.
Bourgois, P. (2000) ‘Disciplining Addictions: the Bio-Politics of Methadone and Heroin in the
United States’, Culture, Medicine and Psychiatry 24(2): 165–96.
Bradley, P. B. (1958) ‘Studies on the Effects of Drugs on the Electrical Activity of the Brain and on
Behaviour’, British Journal of Addiction 54(2): 9–21.
Burnham, T. and Phelan, J. (2001) Mean Genes: from Sex to Money to Food, Taming our Primal
Instincts. London: Simon & Schuster.
Busfield, J. (2000) ‘Rethinking the Sociology of Mental Health’, Sociology of Health & Illness
22(5): 543–58.
Callon, M. (1986) ‘Elements of a Sociology of Translation: Domestication of the Scallops and the
Fishermen of St Brieuc Bay’, in J. Law (ed.) Power, Action and Belief: A New Sociology of
Knowledge? London: Routledge, pp. 196–233.
Camargo, K. R. de, Jr (2002) ‘The Thought Style of Physicians: Strategies for Keeping up with
Medical Knowledge’, Social Studies of Science 32 (5/6): 827–55.
Campbell, N. D. (2010) ‘Toward a Critical Neuroscience of ‘‘Addiction’’’, BioSocieties 5(1):
89–104.
63

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

64 History of the Human Sciences 23(4)

Chiang, H. H. (2009) ‘Rethinking ‘‘Style’’ for Historians and Philosophers of Science: Converging
Lessons from Sexuality, Translation, and East Asian Studies’, Studies in History and Philosophy
of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences
40(2): 109–18.
Collier, H. O. J. (1965) ‘A General Theory of the Genesis of Drug Dependence by the Induction of
Receptors’, Nature 205: 181–2.
Connolly, W. E. (2002) Neuropolitics: Thinking, Culture, Speed. Minneapolis: University of
Minnesota Press.
Courtwright, D. T. (2010) ‘The NIDA Brain Disease Paradigm: History, Resistance and Spinoffs’,
BioSocieties 5(1): 137–47.
Davies, J. B. (1997) The Myth of Addiction, 2nd edn. Amsterdam and London: Harwood
Academic.
Dole, V. P. and Nyswander, M. E. (1965) ‘A Medical Treatment for Diacetylmorphine (Heroin)
Addiction. A Clinical Trial with Methadone Hydrochloride’, Journal of the American Medical
Association 193: 8–84.
Drucker, E. (1999) ‘Drug Prohibition and Public Health: 25 Years of Evidence’, Public Health
Reports (1974–): 14–29.
Dunbar, D., Kushner, H. I. and Vrecko, S. (2010) ‘Drugs, Addiction and Society’, BioSocieties
5(1): 2–7.
Fleck, L. (1977) Genesis and Development of a Scientific Fact. Chicago, IL: University of Chicago
Press.
Fleck, L. (1986) ‘The Problem of Epistemology’, in R. S. Cohen and T. Schnelle (eds) Cognition
and Fact:Materials on Ludwik Fleck. Dordrecht: Reidel, pp. 79–112.
Foucault, M. (1990) The History of Sexuality, vol. 1. New York: Vintage Books.
Fraser, H. F., Wikler, A., Van Horn, G. D., Eisenman, A. J. and Isbell, H. (1958) ‘Human Pharma-
cology and Addiction Liability of Normorphine’, Journal of Pharmacology and Experimental
Therapeutics 122(3): 359–69.
Gaudillière, J.-P. (2004) ‘Genesis and Development of a Biomedical Object: Styles of Thought,
Styles of Work and the History of the Sex Steroids’, Studies in History and Philosophy of Science
Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 35(3): 525–43.
Graham, J. D. P. (1972) ‘Recent Theories on the Pharmacological Basis of Tolerance and Depen-
dence’, British Journal of Addiction 67(2): 83–7.
Gusfield, J. R. (1996) Contested Meanings: The Construction of Alcohol Problems. Madison: Uni-
versity of Wisconsin Press.
Habermas, J. (1970) ‘Technology and Science as Ideology’, in Toward a Rational Society. Boston,
MA: Beacon Press.
Hacking, I. (1992) ‘‘‘Style’’ for Historians and Philosophers’, Studies in the History and Philoso-
phy of Science 23(1): 1–20.
Halloway, H. C. (1974) ‘Epidemiology of Heroin Dependency of Army Soldiers in Vietnam’,
Military Medicine 139: 108–13.
Hammersley, R. and Reid, M. (2002) ‘Why the Pervasive Addiction Myth is Still believed’, Addic-
tion Research & Theory 10(1): 7–30.
Hedfors, E. (2007) ‘The Reading of Scientific Texts: Questions on Interpretation and Evaluation,
with Special Reference to the Scientific Writings of Ludwik Fleck’, Studies in History and

64

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 65

Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical
Sciences 38(1): 136–58.
Heelan, P. A. (1986) ‘Fleck’s Contribution to Epistemology’, in R. S. Cohen and T. Schnelle (eds)
Cognition and Fact: Materials on Ludwik Fleck. Dordrecht: Reidel, pp. 287–308.
Hughes, J. (1975) ‘Isolation of an Endogenous Compound from the Brain with Pharmacological
Properties Similar to Morphine’, Brain Research 88: 295–308.
Institute of Medicine (1996) Pathways of Addiction: Opportunities in Drug Abuse Research.
Washington, DC: National Academy Press.
Institute of Medicine (1997) Dispelling the Myths about Addiction: Strategies to increase Under-
standing and strengthen Research. Washington, DC: National Academy Press.
Jaffe, J. (1999) ‘Conversation with Jerome H. Jaffe’, Addiction 94(1): 13–30.
Julius, D. (1976) ‘NIDA’s Naltrexone Research Program’, in Demetrios Julius and Pierre Renault
(eds) NIDA Research Monograph 9. Washington, DC: US Department of Health, Education
and Welfare, pp. 5-11.
Keane, H. (2002) What’s Wrong with Addiction? New York: New York University Press.
Kuhn, T. S. (1996) The Structure of Scientific Revolutions. Chicago, IL: University of Chicago Press.
Kushner, H. I. (2006) ‘Taking Biology Seriously: the Next Task for Historians of Addiction?’,
Bulletin of the History of Medicine 80(1): 115–43.
Lakoff, A. (2007) ‘The Right Patients for the Drug: Managing the Placebo Effect in Antidepressant
Trials’, BioSocieties 2(1): 57–71.
Latour, B. (2005) Reassembling the Social: An Introduction to Actor-Network-Theory. Oxford:
Oxford University Press.
Leshner, A. I. (1997) ‘Addiction is a Brain Disease, and it matters’, Science 278(5335): 45–7.
Leshner, A. I. and Koob, F. (1999) ‘Drugs of Abuse and the Brain’, Proceedings of the Association
of American Physicians 111(2): 99–108.
Littleton, J. M. (2001) ‘Receptor Regulation as a Unitary Mechanism for Drug Tolerance and
Physical Dependence – Not Quite as Simple as it seemed!’, Addiction 96(1): 87–101.
Löwy, I. (2004) ‘Introduction: Ludwik Fleck’s Epistemology of Medicine and Biomedical
Sciences’, Studies in History and Philosophy of Science Part C: Studies in History and
Philosophy of Biological and Biomedical Sciences 35(3): 437–45.
May, C. (2001) ‘Pathology, Identity and the Social Construction of Alcohol Dependence’,
Sociology of Health & Illness 35(2): 385–401.
McGoey, L. (2010) ‘Profitable Failure: Antidepressant Drugs and the Triumph of Flawed Experi-
ments’, History of the Human Sciences 23(1): 58–78.
Morse, S. J. (2000) ‘Hooked on Hype: Addiction and Responsibility’, Law and Philosophy 19(1):
3–49.
NCMDA (1973) Drug Use in America: Problem in Perspective. Washington, DC: National
Commission on Marihuana and Drug Abuse.
Nestler, E. J. and Aghajanian, G. K. (1997) ‘Molecular and Cellular Basis of Addiction’, Science
278: 58–63.
NIDA (2007) Drugs, Brains, and Behavior: The Science of Addiction. Bethesda, MD: National
Institutes of Health.
Nixon, R. M. (1971) ‘Special Message to the Congress on Drug Abuse Prevention and Control’,
Public Papers of the Presidents of the United States, Richard Nixon 1971. Washington, DC: US
Government Printing Office, pp. 738–49.
65

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

66 History of the Human Sciences 23(4)

O’Brien, C. P. (1997) ‘A Range of Research-Based Pharmacotherapies for Addiction’, Science

278: 66–70.
O’Brien, C. P. and McLennan, A. T. (1996) ‘Myths about the Treatment of Addiction’, Lancet
347: 237–40.
Pert, C. B. (1997) Molecules of Emotion: Why You Feel the Way You Feel. New York: Scribner.
Pert, C. B. and Snyder, S. H. (1973) ‘Opiate Receptor: Demonstration in Nervous Tissue’, Science
179: 1011–14.
Rose, N. S. (2007) The Politics of Life Itself: Biomedicine, Power and Subjectivity in the
Twenty-First Century. Princeton, NJ: Princeton University Press.
Rosenberg, C. E. (2003) ‘What is Disease? In Memory of Owsei Temkin’, Bulletin of the History
of Medicine 77(3): 491–505.
SAODAP (1972) Special Action Office for Drug Abuse Prevention answers the Most Frequently
Asked Questions about Drug Abuse. Washington, DC: Special Action Office for Drug Abuse
Prevention.
Schaler, J. A. (2004) Szasz Under Fire: the Psychiatric Abolitionist Faces His Critics. Chicago, IL:
Open Court.
Small, L. F., Eddy, N. B., Mosettig, E. and Himmelsbach, C. K. (1938) Studies on Drug Addic-
tion: With Special Reference to Chemical Structure of Opiate Derivatives and Allied Syn-
thetic Substances and their Physiological Action. Washington, DC: US Government
Printing Office.
Snyder, S. H. (1989) Brainstorming: the Science and Politics of Opiate Research. Cambridge,
MA: Harvard University Press.
Snyder, S. H. and Pasternak, G. W. (2003) ‘Historical Review: Opioid Receptors’, Trends in
Pharmacological Sciences 24(4): 198–205.
Stephenson, R. P. (1956) ‘A Modification of Receptor Theory’, British Journal of Pharmacology
and Chemotherapy 11(4): 379.
Szasz, T. S. (1961) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct.
New York: Harper & Row.
Szasz, T. S. (1974) Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers.
London: Routledge & Kegan Paul.
Terenius, L. (1973) ‘Characteristics of the Receptor for Narcotic Analgesics in Synaptic Plasma
Membrane Fraction from Rat Brain’, Acta Pharmacologica et Toxicologica. 33: 317–20.
Truan, F. (1993) ‘Addiction as a Social Construction: a Postempirical View’, Journal of Psychol-
ogy 127(5): 489–99.
Volkow, N. (2007) ‘How Science has revolutionized the Understanding of Drug Addiction’, in
Drugs, Brains, and Behavior: The Science of Addiction. Bethesda, MD: National Institutes
of Health.
Vrecko, S. (2006) ‘Folk Neurology and the Remaking of Identity’, Molecular Interventions 6(6):
300–3.
Vrecko, S. (2010) ‘Neuroscience, Power and Culture: an Introduction’, History of the Human
Sciences 23(1): 1–10.
Walsh, J. (1971) ‘Drug Abuse Control: Policy turns toward Rehabilitation’, Science 173(3991):
32–4.
Weinberg, D. (2002) ‘On the Embodiment of Addiction’, Body and Society 8(4): 1–19.

66

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010

Vrecko 67

Wikler, A. (1976) ‘The Theoretical Basis of Narcotic Addiction Treatment with Narcotic Antago-
nists’, in Demetrios Julius and Pierre Renault (eds) NIDA Research Monograph 9. Washington,
DC: US Department of Health, Education and Welfare, pp. 119–122.
Young, A. (1995) The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton,
NJ: Princeton University Press.

Biographical Note
Scott Vrecko teaches in the Department of Sociology & Philosophy at the University of Exeter.
His research focuses on the relationship between science, knowledge and power, particularly in rela-
tion to processes of social change and the governance of social problems. He is currently writing a book
on these themes for New York University Press.

67

Downloaded from hhs.sagepub.com by Martin Holland on October 1, 2010