In the study of human behavior, it is sometimes necessary to go through in vitro experiments, studies with cells, tissues or organs. Sometimes it is even necessary to go through computational models. Neuroscience can have numerous ramifications that address different aspects of behavior. However, a discipline somewhat forgotten by white coats is sociology. It is essential to remember what sociologists tell us when we want to understand the big picture of a subject. Why?
Our knowledge is built on the basis of concepts we create in society. Let’s take the example of gambling addiction: is the relationship between humans and gambling the same all over the world? The answer is no. Society’s perception of the behavior and the way institutions define it are determinant in our understanding of it. Therefore, how we study gambling addiction (or addiction in general) depend on the context.
The best way to understand an issue is to look at it from all possible perspectives. To understand addiction, it is not enough to understand the biochemistry behind the nervous system. Indeed, relying only on what happens in the brain can be limiting. Thus, the neuroscience of addiction can be completed by the sociology of addiction.
To give the reader a new perspective, to promote critical thinking and to avoid the reductionism that can emerge from trying to explain everything from an organic point of view, we talked with Michael Egerer. A sociologist by training and currently a researcher at the University of Helsinki, Michael Egerer is interested in the regulation of the gambling industry and the concept of addiction.
Juan García Ruiz: How do you study addiction?
Michael Egerer: Currently I am involved in a study looking at what is called the brain disease model of addiction (from a social point of view). The aim is to understand the implications of considering addiction as a matter of the brain, and how this can affect treatments and prevention, or yet how it is used by public discourse.
JGR: Have you already reached any conclusions?
ME: I just finished a manuscript on focus group interviews with persons in treatments for addiction. Probably I have to start a little bit by explaining the background. This brain disease model of addiction is promoted heavily by the National Institute of Drug Abuse in the USA. They are strategically pushing the idea that addiction is a chronic relapsing brain disease. This idea implies that what you do with the brain and medication can be good for treating addiction, and I am not discussing this part because this is not my topic. But they also argue that this model would decrease stigma saying that addiction is a disease. But you have other groups of researchers that think that if you say that these people have no autonomy anymore of what they are doing, then it actually increases stigma. People that have no agency in post-modern society, they cannot lead their own life.
With these interviews, I came to the conclusion that it is not only a matter of autonomy, but also a matter of the biography. The brain disease model of addiction would then help them build a consistent biography. So in some way, we are saying that both sides (disease terminology creating or decreasing stigma) only capture part of the story, but they are forgetting about the biography part.
JGR: How do we become addicted? Is there such a thing as a predisposition to addiction?
ME: We start to consider gambling a problem, as soon as it causes problems. So, the etiology converges with the definition of the phenomenon. Of course there is a precise catalogue of criteria for identifying and diagnosing what is nowadays called Gambling disorder in the diagnostic manuals. Jim Orford simplified addiction basically towards the excess (with e.g. loss of discrimination, i.e. losing the ability of normative appropriate use) and the appearance of problems. But then, such a definition risks including (and pathologizing) unlimited amount of unusual behaviours.
There are obviously factors predisposing persons to addiction, but I really would say that instead of continuing the pointless contest between nature and nurture, I would like to put more emphasis on regulation. One becomes more easily addicted, others less, that is true. But both benefit from efficient regulation and prevention. Prevention should of course not be limited to education only, but offer also regulatory incentives. Normalisation is a key-matter here, though overdoing de-normalisation has its downsides as well.
JGR: How long has gambling addiction existed?
ME: Gambling addiction has probably always existed as long as there has been gambling. Although I want to point out that gambling itself is not human nature, there are cultures without gambling. But if you look at how addiction emerged you have to consider two factors. The first one is the nature of the problem which has changed over the last 200 years, and especially in the last 50 years. You have a globalization of gambling, industrialization and digitalisation of gambling. All these changes increase the offer of gambling and makes it more available. The second one is the perspective of social control. In comparison to previous times, people are expected nowadays to control themselves. Obvious external control, like sanctions, has diminished in the last 200 years. That puts the individual in the centre of the control of gambling, and the same goes for the control of substance abuse.
JGR: Are there cultural differences in gambling? I read an interesting article you wrote about Finnish and French differences in alcohol consumption. Maybe you know something about Spain practices?
ME: Unfortunately, I don’t know very much about gambling in Spain, I know a little bit about Spanish regulation, but that’s it. But there are definitely cultural differences in gambling. You just have to look at the status of gambling: is gambling an everyday activity, or a form of time-out and signifier of celebration? This has an influence on the overall consumption, and what is considered as acceptable. Also institutions have an influence on what gambling addiction is. We focused on Finnish and French alcohol consumption because they constitute quite well examples of different alcohol consumption and gambling styles.
JGR: What is the gambling network?
ME: It’s a Finnish seminar of gambling research. People who are doing gambling treatment and prevention are also participating, and a person from the ministry responsible for gambling regulation is participating as well so they can talk to researchers about the kind of questions they would like to be able to answer. It is basically a wide network, and it meets twice per term, so four times per year. Now with the corona we didn’t have it.
JGR: Policies can be difficult considering the money this industry generates. For instance, the number of smokers is decreasing, and I do not think this is economically interesting for the state. What can be done from your position?
ME: This is of course a political question. Independently from what I think, there has to be a compromise between the different stakeholders that are involved. There are no magic bullets. Regulation has advantages and disadvantages. It needs to be balanced somehow. What is important is to keep in mind the weakest groups and keep them in the public and political discussion. It is much easier for the industry to lobby their interests (or even for the state itself). In the gambling field, looking at the research that has been done, it has been beneficial to disentangle the different interests institutionally. It’s good to create independent organizations that supervise the industry. Clearly gambling regulation shouldn’t be managed only by the same ministry, which has specific interests in gambling revenue. It’s politically easier to get the money from gambling than to raise the income taxes for instance.
JGR: Is gambling regulation only focusing on setting limits, or education also matters?
ME: Of course, education matters, and there are lots of prevention and education programs on gambling. The problem is not necessarily that gambling regulation focus on setting limits, but the wrong limits are set. Gambling regulation focuses so far on individualizing the responsibility. Maybe you heard about the so-called responsible gambling. That concerns mostly the responsible gamblers. So gamblers need to make the right choices, with the help of gambling tools for instance. But the thing is that whenever they get into trouble, this is also their fault. The industry get often away with only mild limits concerning gambling addiction. So setting limits should also take into account regulatory framework on the industry.
JGR: What have you learnt about addiction so far?
ME: I could tell about the interviews I made at an outpatient treatment institute in Canada. This is really experience based. I have to admit that I was really surprised about how well informed, nice, helpful and smart the participants were. I know this is probably a white middle class experience from my side, because I have not met any person with strong addiction problems before. But I guess many people have this image of an addict in mind. I have to assume that the interview participants were hardly the most difficult cases, but still it is something I think everybody should know and keep in mind. Persons with addictions are pretty much normal persons, except when it comes to their addiction. The addiction has an influence on them, but it doesn’t define them totally.
JGR: A message you would like to share?
ME: The dichotomy is not state paternalism versus individual freedom, as it is often claimed. At least not if we are talking about individual citizen freedom. The real dichotomy is between state paternalism and industry freedom, I would say. So again, the issue is to find the right spot between the two ends of the continuum. If you have only freedom from state paternalism, then you are more vulnerable to industry manipulation. If you let the industry to run free, then the individual citizen becomes manipulated in many ways. One should not be fooled that a minimal state control increases citizen freedom. It is important to be aware that state regulation also secures individual freedoms.
JGR: Would you recommend a book to our readers?
ME: I find very interesting Ian Hacking’s Rewriting the soul (1995). He is a Canadian philosopher. This book does not specifically deal with addiction, but it deals with mental health. I think it demonstrates very well how crucial are concepts like mental health or addiction in defining what we consider reality, or defining the framework that allow us to understand who we are and who other people with these problems are. As a plus, I would say that for a philosopher book, it is relatively easy and fast to read.