Addiction phobia: Foucault, abstract governance, and the fascination with materiality in contemporary critical studies of addiction

ABSTRACT

This article explores how the field of critical addiction studies – which can be traced back to the late twentieth century – has used Foucauldian social theory on governance to challenge dominant biomedical and moralistic models of addiction and to account for the ways in which addiction discourse and practice reproduce purifying, essentialist and singular assumptions about behaviour, bodies and desire. Starting from Foucault’s late critique of the neoliberalist phobia of the state, and Dean and Villadsen’s subsequent analysis of how this phobia ironically appears to haunt Foucauldian as well as other versions of poststructuralist social theory, the article asks whether a similar phobic tendency can be identified in Foucauldian accounts of addiction, although in this case directed towards addiction as a discursive centre. Analysing accounts of addiction provided by several critical addiction scholars, the article investigates how this more general tendency in relation to Foucauldian and poststructuralist theory is enacted in and structures a number of key points in contemporary critiques of addiction. Through detailed analyses of how critics have framed addiction as governmentality and an epidemics of the will, related addiction to habit, dealt with tensions within the discourse of addiction, raised issues of materiality, and aligned themselves with the heterogeneity of bodies, behaviours, and desires, the article claims that the field of critical addiction studies reduces addiction to abstract governance and avoids seriously engaging with the structure and dynamics of addiction from a decentred social theoretical perspective.

KEYWORDS:

• Addiction
• Foucault
• governmentality
• subjectivism
• materiality
• desire

Introduction

The field of critical addiction studies can be traced back to the late twentieth century, when scholars began challenging the dominant biomedical and moralistic models of addiction and substance use, thus laying the foundation for a social scientific critique of addiction research that emphasizes the crucial role of social, cultural, and political factors in shaping the phenomenon of addiction (Schneider 1978; Room 1985). This was, to paraphrase Derrida (1978, 280), the moment when history, culture, and language invaded the universal problematic of addiction science, insofar as the latter was forced to consider how its locus – addiction – was not simply a being-present, or real phenomenon, but at least minimally also a function of discourse and practice. This cultural turn radically altered the social critique of processes of medicalization related to issues of addiction. From that point onward, the abstract and reductive essentialism of addiction science was heavily questioned, and the discursive node or centre of ‘addiction’ (as well as related concepts such as ‘alcoholism’, ‘dependency’) increasingly came under fire as part and parcel of the more general disease view considered to structure Western medicine at its core (Levine 1978; Reinarman 2005; Valverde 1998).

The role of Foucault’s work in this critical decentring of addiction is notable, and his genealogy has undeniably provided a useful framework for addressing contemporary issues concerning governance, knowledge and subjectivity in the field of critical addiction studies. His account of how, during modernity, medicine emerged as a way to govern individual behaviour and desire has guided the critical framing of the rapid expansion of addiction throughout the twentieth century, and many addiction scholars today view the history of addiction as part of the larger bio-medicalization of modern society. As an instance of modern regimes of health, addiction is then conceived of as an instrument that supports the continued reproduction of highly problematic social norms masked by objective medical categorizations and essentialist beliefs (Keane 2009). In this sense, the concept of addiction translates a multitude of excessive behaviours into symptoms of one underlying and singular disorder of personality, and purifies (Latour 1993, 85–88) the heterogeneity of social reality through abstract models of good and bad behaviour and desire (Bailey 2005; Brodie and Redfield 2002; Keane 2004; Keane 2002; Kihlström 2007; Sedgwick 1994; Valverde 1998).¹

To be sure, Foucault himself was not unaware of the way in which his own framework risked reproducing a similar tendency of purification or simplification. Thus, his late seminars Security, Territory, Population (1977-8) and The Birth of Biopolitics (1978-79) broadened his earlier reflections on power through an elaboration of his notion of governance. One particularly important instance of this discussion concerned what he referred to as a fear of the state among neoliberal political thinkers (Foucault 2008, 167–8). While being explicitly directed against neoliberalism, this argument also aimed to respond to the looming critique of his own scepticism regarding discursive centres and universal notions. According to some scholars, there was a risk that his decentralized notion of the microphysics of power could result in a kind of anti-statism, and it was then partly this tendency that Foucault aimed to rebuke with his critique of neoliberalism. Because even if his framework represented a radical assault on totalizing and territorializing instances of power, the attitude of a more radical anti-statism was in fact at odds with the decentred premises of his framework insofar as it obscured the way in which no instance of modern governance could be treated as inherently essentialist or problematic. Thus, if he for instance considered sexuality a product or invention that emerged through modern regimes of governing, he nevertheless also viewed it as a phenomenon that allowed for resistance to such powers (Foucault 1978). In this sense, his account of the historical emergence of the neoliberal phobia of the state has an important take away message in relation to his own view on governance and the modern state – although the state, as a historically determined centre of power, might be deeply problematic in many ways, it is nevertheless not the case that it blocks a more authentic or original reality (as that of the market in neoliberal thought).

In this context, Mitchell Dean and Kaspar Villadsen’s critique of this phobic tendency in contemporary Foucauldian and poststructuralist social theory is highly relevant. In their book State phobia and civil society: The political legacy of Michel Foucault, they argue that contemporary Foucauldian social theory often treats the state as a kind of ‘no-go zone’, and they particularly link this tendency to the influential perspective on governmentality developed by Nikolas Rose (Dean and Villadsen 2016, 1). More precisely, they argue that Rose's account of core instances of modern power (see Rose 1999; 1996) – such as the state and governmentality – fits into a wider interpretation of Foucault’s work, which simplifies the question of the state as the centre of power, supporting the claim that the state ‘should be deconstructed or dissolved, whether analytically, normatively, or politically’ (2016, 165). Indeed, they particularly address how this critical view of the state appears to go hand in hand with a vitalist decentring of power and celebration of heterogeneity (or what Rose, along with Foucault and Deleuze, calls the molecular in opposition to the molar). This celebrated heterogeneity then takes on the role of a reality blocked by the state. In the present context, it is crucial to observe that Rose’s understanding of Foucault’s notion governmentality informs many Foucauldian and poststructuralist accounts of addiction (Valverde 1998; Keane 2002; Keane and Hamill 2010; Fraser and Valentine 2008), and thus it seems important to ask whether this phobic tendency of central societal instances of power (like the state), which Dean and Villadsen identify in contemporary Foucauldian and poststructuralist social theory, could be said to inform critical addiction studies as well.

Aim and scope of the article

It is then this question of a potential tendency to simplify, and in a way do away with, the notion or phenomenon of addiction in critical studies of addiction influenced by Foucault and his analysis of modern processes of governance that the present article aims to explore. On the more general level of contemporary social theory, the article engages with the question of how currently influential social theories and frameworks are translated into more specialized fields of research. In this particular case, this involves questions of how conceptions of addiction are formed when related to issues of governmentality and contemporary bio-politics. Can addiction be said to be treated as a no-go zone in Dean and Villadsen’s sense? If so, is this zone opposed to a heterogeneity of bodies, behaviours and desires? And, finally, how is resistance to contemporary governance imagined as a consequence of this framing of governance and desire?

To address such questions, the article studies a selection of important contributions to critical addiction studies made by scholars highly influenced by the cultural turn to issues of discourse and practice, in general, as well as to Foucault’s ideas on governmentality, in particular. Most attention will be paid to a cluster of critical researchers who have collaborated in numerous projects and who also seem pivotal to the constitution of critical addiction studies as a field. Of these, the works of Suzanne Fraser and Helen Keane will be most in focus. Fraser and Keane have both engaged extensively with addiction discourse over more than 20 years (for instance, the first mentioning of critical addiction studies as a research field appears in their book Habit: Remaking addiction). However, as the reader will see, their work often involves other addiction scholars like David Moore, kylie valentine and Kelly Hamill. The article also considers Eve Sedgwick’s early text ‘The epidemics of the will’ (1994), partly because it is regularly cited in critical addiction studies, and partly because – although Sedgwick admittedly was never part of the field of critical addiction studies as a scholar – it seems to have contributed a number of key critiques of addiction, most importantly the notion that addiction is a social epidemic organized around will and freedom, as well as the proposition that habit could provide an alternative for conceptualizing the behaviours involved. Another work discussed is Mariana Valverde’s historical account of alcoholism as presented in The Diseases of the Will (1998), which is included because it provides one of the most systematic genealogical engagements with the topic of governance in relation to issues of alcoholism and addiction. Her book has been referred to as a classic work by scholars in the field, such as Fraser and Keane, and Valverde has also collaborated with Rose directly on research related to issues of addiction. Finally, several other scholars who draw on Foucauldian and related poststructuralist ideas, like Granfield and Reinarman (2015), Carr (2011) and Campbell (2008), will also be included in the discussion, although to a lesser degree.

This sample of critical addiction works is not meant to perfectly represent the use of Foucault and related poststructuralist frameworks in critical addiction studies. Naturally, there are other ways of using these frameworks in the field (see Palm 2021; Weinberg 2019; Oksanen 2013). Also, as the reader will see, many researchers here discussed do not exclusively draw on Foucault, but also rely heavily on other theorists, such as Gilles Deleuze, Bruno Latour, John Law, and Karen Barad. Nevertheless, it is argued here that the sample – despite neither being purely Foucauldian nor embodying the only Foucauldian position within the field – is adequate for the purpose of the present article, which is to address questions concerning the tendencies towards simplification and purification in the field of critical addiction studies. What it does, then, is to allow us to get a glimpse of how decentred accounts of addiction regularly seem to end up in a position that reduces addiction to the abstract other of the materiality of bodies, desires and habits. In critical studies of addiction, this is related to the influence of the framework of governmentality, particularly as suggested by Rose. As will be discussed, this framework comes dangerously close to reducing addiction to a simple product of governance. It also risks neglecting questions of the sociopsychosomatics of addiction, and the crucial issue of how this sociopsychosomatics could be said to relate to and feed into contemporary societal and capitalist structures and dynamics (Palm 2023).

If the critique the present article develops may seem a bit harsh, this is done to disrupt a persistent view in critical addiction studies that addiction discourse is characterized by a profound degree of genetic continuity – to borrow a term used by Foucault in his critique of neoliberalism. According to this view, addiction discourse comes across as a highly effective and unified modern regime of power, at the same time as it lacks proper substance. Against this, the present article suggests that it is not necessary to adhere to some monolithic tree of governance to endorse addiction as a notion. Although addiction is certainly part of contemporary processes of bio-politics and stigmatization, it is argued that addiction discourse could also play a role in resisting and questioning similar processes. What is ultimately at stake in the article is the establishing of such a critical space of resistance within addiction discourse. By deconstructing the continuity of addiction discourse, the aim is to undermine both the tendency to reduce addiction to an abstract discourse of governance and the alignment of critical thinking with a political space of vitality, desire, and materiality beyond addiction as governmentality (i.e. Dean and Villadsen 2016, 44).

Is addiction a no-go zone for critical addiction studies?

The claim that there is a tendency to treat addiction as no-go zone for critical addiction studies would surely be objected to by many scholars in the field. Are examples of outright rejections of addiction as a concept truly representative of critical addiction studies? Have critical scholars after all not engaged closely and extensively with addiction discourse? Have they not suggested that abstract, reductionist understandings (e.g. biological and psychological ones) of addiction should not be abandoned altogether, but rather must be supplemented with more complex and social explanations? To recognize such potential objections and yet stay with the critical task at hand, this section addresses how addiction is concretely constructed in a recurring topic in the literature, which the analysis suggests produces a distance between the critique and the addiction concept. This topic concerns the relation between addiction and habit, and it has been discussed in numerous important works (Sedgwick 1994; Valverde 1998; Keane 2002; Fraser, Moore, and Keane 2014). The article will particularly deal with it as discussed by Fraser, Moore, and Keane in their book Habit: Remaking addiction (2014) and discuss how the meaning they give to the attempt to remake addiction contributes to the tendency discussed. The argument here is not that these discussions simply reject addiction or addiction discourse. However, insofar as their re-making appears to hinge on their distinction between addiction and habit, it also seems to be caught up in the opposition that this distinction produces in the text.

To begin with, Fraser et al. turn to habit in an attempt to shape a more inclusive and less pathologizing concept that disrupts what they conceive of as traditional understandings of addiction. Like Sedgwick and Valverde before them, they draw on William James’ idea of the originally habitual character of human conduct in order to claim that traditional notions of addiction often ignore the fact that most behaviour is highly patterned and thus not based on some autonomous will or freedom (Keane 2002; Sedgwick 1994; Valverde 1998).² Thus, drawing attention to addiction’s affinity with this highly normal component of human behaviour becomes a way of disrupting the association between addiction, on the one hand, and deviancy and disease, on the other. It is then only by being opposed to the ideal of the free act that addiction seems to be pathological or other. In this sense, the use of the term habit would allow addiction science to sever particular acts from their association with abstract notions such as will and identity.

What do we mean by this notion of habit, and how does it differ from addiction? As each of the three sections on specific substances and their encounters with notions of addiction shows us, expert discourses are working […] to enact new addictions: addiction without withdrawal (methamphetamine), addiction without daily use (methamphetamine and alcohol) and addiction without an exceptionalist substance or recourse to a pathology of daily use (food). These addictions are enacted however as part of a project to constitute a singular addiction concept refined to fewer and fewer features and attributes […] The expert discourses of addiction also find their way in partial enactments […] into our interviews with the people who in one way or another are the targets of such expertise. […] [W]e do not offer their words as an ideal alternative to the dissatisfactions thrown up by the expertise. At the same time they tell us a great deal about the potential of habit as an otherwise to addiction. Whereas addition is rigid, narrow and linear, habit is flexible, encompassing and diffuse. Addiction and habit both describe repetition and pattern, but only habit can recognise change, not as the end or antithesis of repetition but as part of it, entailed in it. […] Repetition and rupture. Stabilisation and change. Addiction is, at present at least, too rigid and polarizing for these inconvenient multiplicities, but habit is not (Fraser, Moore, and Keane 2014, 238)

The point offered above is clear. Habit is preferable to addiction insofar as it would allow us to recognize not only stability and repetition, but also multiplicity, heterogeneity, rupture and change, and if critical thinking is then required to remake the concept of addiction, it would be in order to establish a concept that allows for these latter qualities. As such, habit fits the critical project that Fraser more recently (in line with John Law’s work in Science and Technology Studies) described as an ontopolitical project to dismantle singular realities to create ‘mess’. In contrast to perspectives assuming a common reality reflected by singular concepts such as addiction (that is, as Fraser considers addiction), this ontopolitical approach would conceive of the world as fundamentally decentred, partial, contingent and emergent (Fraser 2020, 9).

There are problems with this argument, however. One is linked to the suggestion that addiction discourse is organized as a project that aims to constitute a singular addiction concept. The question that should be raised here is what is meant by the statement that addiction should be considered rigid, narrow and linear. The weak interpretation of this statement would be that addiction tends to be enacted in this way in addiction discourse. In this perspective, the problem would not really be addiction per se, but the reductive or essentialist framings that have largely structured addiction discourse. If so, this weak interpretation also appears to allow for an affirmative remaking of addiction along the lines of a decentred ontology. However, in critical discussions of addiction – as in the excerpt above – a significantly stronger statement indicating that addiction is singular often organizes how it is approached. According to this position, addiction appears to be originally or inherently singular and rigid, as well as fundamentally flawed insofar as it does not allow for change and heterogeneity. In this sense, one could claim that, ironically, many critical accounts of addiction tend to come dangerously close to the very essentialism they aim to dismantle.

A related problem is that habit does not do a particularly good job of capturing the common phenomenon that addiction denotes, because addiction obviously does not denote any form of habituation, but a particularly stubborn one. To account for this specific form of habituation, it is arguably not very productive to think of habit as an ‘otherwise’ to addiction. Habit and addiction, rather, must be thought about within the same ontology, placed on the same plane, but considered to describe somewhat different phenomena – addiction signifying a more limited phenomenon within the broader category of habits, which as Deleuze suggested reifies habit and makes it highly resistant to change (Oksanen 2013). Today, mobilizing decentred ontologies to account for the structure and dynamics of this particular form of habituation is unfortunately very limited, and combined with the strong critique of addiction presented above, this reluctance seems to add to the impression that, in critical addiction studies, there is a tendency to treat addiction as a no-go zone.

To further support this argument, these issues can also be linked to the way in which the increasingly important topic of materiality is raised by critical scholars such as Fraser and Keane. For the argument developed in the present article, it is crucial to understand that this material turn, as we encounter it in critical studies of addiction, largely ignores the question of how to account for addiction as a material-discursive, sociopsychosomatic sub-category of habituation (for exceptions to this rule, see Weinberg 2019; Palm 2023). Processes of materialization are instead attended to with a view to stating something else. For instance, in Fraser and Valentine’s (2008) study of methadone maintenance treatment (MMT), addiction is generally presented as an abstract construct deeply associated with liberalism, and as such described as being organized around the dualism of autonomy and dependence (2008, 173). As such, it is then disrupted by the processes of materialization of MMT that they explore (176). For instance, they argue that the hegemonic identity of the drug addict is challenged by new (contradictory) identities that emerge through the materialization of methadone treatment (119). This appears to be quite a typical frame in critical addiction studies: Addiction, as an abstract idea, is seen as being upset by the materiality of particular practices, bodies and desires. And, hence, although Fraser and Valentine acknowledge that ‘methadone ‘itself’’ ‘co-constitutes’ these processes of materialization, their study does not really explore the ‘intra-action’ (Barad) of MMT, drugs, habituation, bodies, subjectivity and social processes. Their purpose seems to be different (or, as they say ‘otherwise’), namely, to indicate how attending to processes of materialization and practice brings more nuanced and complex understandings to the table than essentialist frameworks that either reduce addiction to individual or biological processes or to discourse.

In this sense, the discussion in this section has indicated how both habit and materiality are constructed as instances that addiction discourse ignores. Insofar as this would be an argument about the need to rearticulate addiction along the lines of frameworks that stress a decentred ontology as well as to recognize how addiction is continuously accomplished in practice, the present article has little to object to. However, when addiction is approached as a no-go zone, and habit and materiality are posited as alternatives, others or outsides of this zone, something much more problematic occurs. Here, the remaking of addiction instead becomes a kind of undoing that treats the rethinking of addiction per se as redundant. This is perhaps not stated explicitly, but in practice it is clear that the critique rarely crosses over into the terrain where, today, the decentred re-doing of addiction is taking place.

The expansionist threat of a subjectivist epidemic of the will

One of the most sustained critiques that critical addiction studies has launched against addiction as a form of governance organized around abstract assumptions about habitual behaviour and desire concerns the early views on alcoholism, found in addiction discourse, depicting it as a disease of the will (Sedgwick 1994; Valverde 1998). Two mutually reinforcing problems are repeatedly associated with this notion of addiction as a disease of the will: its subjectivist and normative character, on the one hand, and its potential for limitless expansion, on the other. According to the critique, these problems together pose a particular kind of danger to modern societies, and it is this danger that suggests the problem of an unlimited expansion of subjectivism that Sedgwick refers to as the epidemics of the will. More recently, Granfield and Reinarman (2015) and Fraser, Moore, and Keane (2014) have repeated Sedgwick’s argument, although they use the concepts of addictification and addicting, respectively, to describe the phenomenon. Irrespective of the more precise terminology, the present article claims that it is the role this danger plays within the governmentality framework that needs to be attended to here.

To do so, it is useful to compare the problem suggested by these notions to that defined by the framework of medicalization. Like the governmentality framework, theories of medicalization target the progressive influence on society of medical knowledge and ways of approaching human behaviour (Conrad and Schneider 1992). Due to this similarity, medicalization theory has provided a useful point of departure for governmentality thinkers engaging in questions of health and addiction (Campbell 2012; Rose 2007; Valverde 1998). Yet it is also perceived as too linear and mechanistic, not least in the way it approaches questions of subjectivity (Keane 2002; Beck 2007; Rose 2007). Thus, what governmentality theory brings to critical addiction studies is a less linear framework that mobilizes addiction as part of a broader essentialist and subjectivist discourse. Unlike the medical colonization of the modern lifeworld, the notion of an epidemics of the will suggests a non-linear expansion and vague omnipresence related to modern liberal beliefs in the autonomous individual, free will and psychology. Combining the medicalization thesis with this more culturally informed critique of psy-science and subjectivist discourse, the scope of the threat becomes like that of the threat the state poses in neoliberal thought, according to Foucault. Like the state, addiction as a modern invention is considered a threat to some less abstract (that is, more original or real) aspects of social reality.

Sedgwick’s (1994, 130) idea of the proliferation of addiction as an epidemic of the will, in this sense, suggests that the predominant drive of addiction discourse is to naturalize the originally historical notion of the will. She argued that addiction began to take the form of an epidemic in the 1960s with the invention of behavioural addictions, like sex and gambling addiction. With these new forms of addiction, addiction changed from a circumscribed term or diagnosis within medical discourse to a broader instrument of governance organized around the idea of a specific addicted personality. It was, as she put it, clear from the moment that exercise became one of the objects of addiction discourse, that ‘nothing couldn’t be’ considered an addiction. Once decoupled from a particular substance, addiction was increasingly being treated as universal and as applicable to all behaviour, progressively repressing difference and heterogeneity (Sedgwick 1994). Hence, critical scholars have regularly claimed that bodies and desires are idealized in addiction discourse through this ongoing work of naturalizing cultural, liberal beliefs about the will (Keane 2002, 139–49; Bailey 2005; Kihlström 2007). And an important part of these historical processes of naturalization and epidemic dispersion of addiction has been associated with the psychologizing discourse and its attribution of causes to some inner, mental reference (e.g. a will or addicted personality) (Carr 2011, 4).

In their important introductory text to critical addiction studies, Granfield and Reinarman identify this critique as a core feature of the field. The problem with addiction, in this sense, is something different than that which medicalization theory suggests. Like the latter, their argument involves an abstract power. However, the problem with addiction is not primarily that of an instrumental or objectivist discourse that threatens to colonize societal processes more generally, but – perhaps a bit surprisingly – one linked to the vague and insufficiently scientific character of addiction.

The concept of addiction-as-disease has a history, a genealogy. It was not a scientific discovery, it did not emerge from the accumulation of research findings. Its current ubiquity is a different species of social accomplishment (Schneider 1978). It was invented, elaborated, redefined and reproduced by specific actors and institutions using specific language. (Granfield and Reinarman 2015, 2)

Here, one could here attention to the way in which the authors distinguish between a historical process of invention, on the one hand, and scientific discovery, on the other. Addiction, as Granfield and Reinarman argue, is not properly scientific and not adequately based on the accumulative procedures of science. It is a different kind of social accomplishment, a trope invented and produced by specific actors, institutions and language. Thus, if the authors explicitly signal their indebtedness to Foucault’s genealogy, their claim that addiction is an invention, rather than a scientific product, appears to do something different than Foucault’s analysis of how modern medicine produces its truths on insanity or sexuality through historical processes of power/knowledge. In fact, they manage to produce an account that combines the explanatory force of the Foucauldian framework with a much more conventional scientific framework. If, as they suggest, addiction represents an epidemic, it is a cultural epidemic, and not a medical reality confirmed by scientific evidence. As a result, addiction appears to confront us with a purely ideological threat of bio-political governance, not grounded in scientific knowledge.

This critique is closely related to Rose’s ideas on governmentality. Unlike the medicalization thesis, it posits a problem of abstraction that cuts across all modern social realms and that appears to be particularly fierce in the psychological and subjectivist discourse, insofar as these are conceived of as part of a ‘molar’ form of governance that propels processes of responsibilization and self-control through singular assumptions about subjectivity and desire. Note that some critics go even further in this tendency to move away from a critique of medicine and objectivism towards a critique of subjectivism. Thus, Keane and Hamill (2010) repeat the above critique of addiction discourse as essentialist, singular and molar, comparing it to medical, neuroscientific knowledge that they – drawing on Rose’s distinction between molar discourses and more decentred, molecular discourses – conceive of as fundamentally molecular.

In a discussion of the implications of neurochemical styles of thought for the management of mental pathologies, Rose contrasts the notion of the ‘correctible anomaly’ with the older model of the abnormal personality. The former is a surface model, which implies that a targeted readjustment of brain chemistry will remove the undesirable mood, emotion or conduct. It has no need for the deep psyche of psychoanalysis, nor the unflinching work on the self demanded by the 12-step programmes. Naltrexone treatment for heroin addiction is an example of this molecular approach: it blocks the desire for drugs by acting directly on the opiate receptors rather than attempting to reform the whole person. For Rose, the moral significance of addiction is profoundly altered by the shift from disordered subjects to neural anomaly. If addiction is a correctible error in an otherwise normal process, rather than a deviation from a single norm of health, then the diagnosis is relieved of its moral weight. (Keane and Hamill 2010, 53)

According to Keane and Hamill’s analysis, we then appear to have a fundamental tension running through the discourse of addiction, separating the totalizing gaze of deep psychology from the decentred surface gaze of medical branches like that of neuroscience, insofar as the view that addiction is a ‘correctible error’ dissociates neuroscience from the molar logic of governmentality. This analysis is confirmed by Vrecko, who – like Keane and Hamill – points to the radically decentred ontology of neuroscience, insofar as its direct manipulation of the brain’s reward system takes place outside the molar apparatus of addiction, psychology, morality and neoliberal capitalism (Vrecko 2010, 48).³

In a way, the present article sympathizes with these authors’ effort to not seek complete abandonment of addiction as a concept, but to instead point to how it could be remade along the lines of more decentred perspectives. And yet, they unfortunately do so in a way that reinforces another problematic aspect of the critical framework, namely the repeated linking of psychology and subjectivity to abstract discourse, as if the only way to escape molar thinking would be to stop thinking that addiction is related to issues of psychology and subjectivity. As the present article argues, these representations of addiction discourse are far from neutral, but relate to the core problem of governmentality studies such as described by Rose. In the following section, the article therefore expands on the way in which the critique constructs addiction as governance. This construction adds to what was said in this section regarding the excerpt from Granfield and Reinarman – because while addiction, on the level of scientific evidence, is seen as fundamentally incoherent and lacking, it is, on the level of governance, considered a highly efficient apparatus.

Establishing the continuity of governmentality

Many critical scholars have argued that inconsistency has been a feature of the addiction discourse since its outset, and that it – as Keane has stated – is characterized by ‘conceptual chaos’ (2002, 8–9). This fundamental lack of continuity on the level of scientific knowledge in addiction does not, however, prevent a more practically oriented continuity on the level of power and governance (Fraser, Moore, and Keane 2014; Keane 2002; Sedgwick 1994; Valverde 1998). As an ideological tool, originating from the processes and programmes of normalization, addiction produces subjectivity and fosters conduct (Levine 2015, 33). As Reith claimed, addiction functions as a fetish that, despite being epistemologically contradictory, is treated as a reality by those who identify with it (Reith 2004, 292).

This construction of a continuous discourse of governance clearly structures Mariana Valverde’s genealogy of alcoholism in The Diseases of the Will, even if her argument at the same time belongs to those that acknowledge tensions and ambiguities that do not necessarily support the governmentality argument. To illustrate this, the analysis will turn to several discussions in Valverde’s book. Unlike Sedgwick’s emphasis on the subjectivist shift in the mid-twentieth century, Valverde observes how medical treatment of alcoholism, since its very outset, was entangled in assumptions of free will and regarded the moral work of patients as key to curing inebriety (1998, 64). This is true even in the earliest medical representations of inebriate patients, which portray these patients as heroes of a moral, free and courageous struggle (1998, 65). Importantly, however, she admits that this example of governmentality is ambiguous. The early figure of the heroic patient upset traditional and pastoral forms of authority, including the standard hierarchy between patient and medical expert, and as she notes, it was primarily inebriates belonging to privileged groups who were the objects of this governmental celebration. Ultimately, however, she reduces this potential break with dominant medical practice to a shift in governance towards forms relying on freedom and subjective self-regulation. Her narrative is one of transformation from despotic to liberal power, in which celebration of the patient as subject operates as a technology of freedom that turns individuals into instruments of their own oppression.

At this point, it is interesting to note that when Foucault considers similar examples in his analysis of Christian, pastoral power, he does so to introduce his vital discussion of counter-conduct (Foucault 2007, 202–5). In this respect, his analysis emphasizes how particular discourses within Christianity undermine pastoral governmentality, for instance, by opposing the authority of the priest and the passive role of the laity in the Catholic Church. Thus, Foucault’s approach implies both that counter-conduct always constitutes a form of resistance that operates from within governmentality (it is never wholly outside power) and that, in order to identify such resistance, we must note how different elements in a discourse might disrupt governance.

What should be noted in Valverde’s account (and this is also the tendency in critical addiction studies in general) is the absence of accounts of resistance within addiction discourse. In fact, counter-conduct is not an issue in her genealogy. This avoidance of the topic of resistance is also discernible in her discussion of the fundamental role of shifts and specificity in genealogy in the introduction to her book. In a brief comment about the tension between continuity and specificity, she uses the founding of Alcoholics Anonymous (AA) as an example of something novel in this history, insofar as it marks a kind of ‘democratization of pastoralism’. This crucially introduces the reader both to the specificity of the case of AA discourse (a theme that will return throughout her book) and to Foucault’s discussion of how Protestant sects, such as the Quakers, disrupted the pastoral institution of the Catholic Church through decentralized and horizontal forms of organization. However, framing these events as mere ‘novelties’ in a broader history of governance allows her to precisely avoid the topic of counter-conduct and struggle within addiction discourse, and to turn what might be conceived of as a historical process of political democratization into a history of a less appealing popularization of the pastoral. Through this discursive shift from democracy to popularity, her argument distances the alcoholic discourse from the realm of political struggle and resignification and reinstalls AA discourse in the signifying chain of the control-as-freedom narrative (Valverde 1998, 19).

To continue, we see similar examples of subtle but crucial interpretative manoeuvres in the construction of AA discourse throughout her book. Thus, her discussion of the field of alcohology that emerged at the Yale Center of Alcoholic Studies during the 1940s suggests that this case presents us with clear evidence of the link between the early discourse of alcoholism as a disease of the will and later instances of alcoholism discourse. Although alcohology rephrased the traditional concern with lack of willpower as ‘loss of control’, Valverde claims that they shared the same emphasis on the ‘soul’s relation to itself’ (1998, 25) and partook in the same discourse of willpower (1998, 113). But this is debatable, and obscures how alcohology drew on AA’s notion of loss of control, which is highly critical of the belief in self-control. Thus, even if AA identifies the condition of alcoholism as one of being powerless over alcohol (AA’s first step states ‘we admitted we were powerless over alcohol – and that our lives had become unmanageable’), it does not assume that the solution lies in control being regained (see Bateson 1972; Denzin 1993; O’Halloran 2008). If alcohology then repeated AA’s emphasis on powerlessness, it could also be argued that it thereby went against liberal assumptions concerning will and self-control (see Palm 2021).⁴

To be fair, Valverde at one point explicitly turns to this role of powerlessness in the AA discourse, recognizing how the trope of powerlessness marks a break with neoliberal beliefs that recovery is all about the will, and that ‘the poor can become business executives by sheer willpower’. Yet she insists that AA targets alcoholism as part of a larger culture of individualism (1998, 129). Thus, while her description is more nuanced than, for instance, Keane and Hamill’s claim of a direct continuity in the addiction discourse between the pragmatic view of the self in AA and subjective notions like ‘deep psyche’, Valverde ultimately concludes that AA’s framework of the soul deprives its pragmatic and ethical self-governing of critical potential (1998, 120).⁵ Once again, she then re-inscribes AA into her narrative of control as freedom and the mainstream of addiction discourse (1998, 127), in the process minimizing the significance of tensions between, for instance, AA, medicine and psychology. Together, these snapshots from Valverde’s genealogy indicate how a sense of continuity might be established across the addiction discourse terrain, at the expense of the specificity of particular approaches within the field. This continuity allows the critique to treat addiction as a unified discourse of governance, and as the final section will now argue, it is against the background of this unified discourse of abstract power that the vitalist celebration of materiality Dean and Villadsen observe in some governmentality frameworks emerges.

Framing power and its outside

At this point, however, we should remind ourselves of Foucault’s fundamental notion of productive power, for instance, as he formulated it in The history of sexuality: Will to knowledge. The originality of Foucault’s perspective lies in his well-known claim that modern power/knowledge regimes of sexuality incite discourse on sexuality by listening to, discovering and multiplying the variations of what he terms ‘the sex in itself’. That is, they govern sexuality by establishing knowledge about, for instance, the perversions or the sexuality of children, knowledge that is then disseminated in society. Indeed, this productive notion of power is regularly stated in critical addiction studies, and key to both Valverde’s The Diseases of the Will and Keane’s What’s Wrong with Addiction.

Valverde describes her genealogy as a study ‘of alcohol as a site in which our wills, our health, and our consumption patterns are governed’ (1998, 11), and in a bit more elaborated passage, Keane aligns herself with a similarly Foucauldian approach that sees power as productive.

Discourses of addiction can be understood as part of a peculiarly modern regime of disciplinary power and knowledge. Foucault’s formulation that there is no power relation without the correlative constitution of a field of knowledge and knowledge that does not also constitute power relations is useful here. Thinking of the relationship between knowledge, including self-knowledge, and power in these terms enables a critical engagement with processes and programs of normalisation which create rather than constrain individual subjects, which are based on freedom rather than subjugation. (Keane 2002, 8)

This argument, according to which modern power relies on creativity and freedom rather than on constraint and subjugation, is clearly in line with Foucault’s critique of the repressive attitude that structured the morality of the Victorian era. This attitude is of course not the main target of his critique, but rather provides the background for his description of the particularly modern drive to govern sexuality by way of listening to it and in a way allowing it to multiply. One should note at this point that Foucault’s critique of modern power is aimed precisely at the liberal spirit that intends to emancipate sexuality and thus questions more traditional forms of repressive and moralizing attitudes towards desire. And if, for instance, the figure of the homosexual emerges within this liberal scientia sexualis as deviant and perverse, then it is also through this regime of governance that a space for resistance is created. In comparison, the critique of addiction, as we encounter it in Keane and Valverde, rather appears to target forms of governance that unambiguously block and constrain desire. Thus, if they argue that addiction and alcoholism produce identities and desires, this does not give the impression of a governance organized around any attempt to emancipate desire.

Thus, when Keane discusses sex addiction discourse, it is with a clear emphasis on its moral and normative character. Keane insists that the knowledge developed in this area is highly normative and classifies concrete desires along the lines of moral, essentialist and totalizing categories that confirm traditional heterosexual and romantic beliefs about sex. Like Foucault’s scientia sexualis, it is a discourse that produces both bad forms of sex that it conceives of as artificial (sexual fantasies, pornography, masturbation, etc.), and good ones assumed to be natural (i.e. intimacy, honesty, coupledom, etc.), and along with these forms of sex, it also produces good (natural, healthy, self-enhancing) and bad (addicted) subjectivities (Keane 2002, 8–9). But the sexuality produced here appears to inherently belong to the abstract subject and discourse of power targeted by critical addiction studies. Whether healthy or addicted, the sexuality produced by sex addiction discourse belongs to an abstract discourse that assumes a ‘totalized self’ that is not based on reality. In other words, the reality that is encouraged here is altogether normative, essentialist and artificial, and excludes actual, heterogeneous sexualities in the process. Moreover, the discourse appears to offer little space for counter-conduct or negotiation.

In line with this, Valverde restricts her study of power to a concern with governance as it is exerted by state authorities and ‘the establishment’ of alcohol regulations (1998, 12).⁶ Thus, the privileged problem in her genealogy concerns how the state governs the space of alcohol consumption through institutions like alcohol licensing and the organization of specific sites for alcohol consumption. In a way, this definition might seem to be a valid empirical clarification of her case, which would then signal a focus on concrete social spaces or sites where alcohol has been administrated and controlled throughout the history of alcoholism. Yet the way in which her approach equates power with state-enforced regulations and restrictions also signals disengagement with questions concerning the production of desires. In her genealogy, power only appears to produce behaviour and institutions that aim to curb drinking.⁷

On the level of empirical analysis, this means that Valverde’s selection of cases is mostly in line with a kind of state phobia. Although it includes examples of how drinking is produced, these are as a rule cases of behaviours that restrict desire, such as the promotion of moderate drinking, social scientific theories on alcoholism, or the pragmatic work with alcoholism done in AA. These practices are productive, but in a way that negates drinking and contributes to restrictive governance. In one revealing discussion, she touches on the important role of the market in the production of alcoholic desire. It is symptomatic of her way of framing power, however, that she does so by considering how the market supports the regulation of alcohol through the example of the Coca Cola Company. Thus, she uses a case that illustrates the problem of how the market (as part of modern power) constrains drinking by producing alternative, non-alcoholic drinks.⁸ This allows her to discuss a case of how a positive substance as well as a corresponding desire are produced, although the real interest lies in the way in which these new technologies delimit alcoholic desire/behaviour (Valverde 1998, 184). The more complex question concerning the possible ways in which the market contributes to the production of various forms of desires, alcoholic or not, remains a non-issue.

While Foucault’s The Will to Knowledge offered an account of modern sexuality in general (that is, of how various regimes of power produce both normal and pathological versions of sex), Keane and Valverde both restrict themselves to questions concerning how the addiction discourse more particularly produces normal and pathological desire/behaviour. This unfortunately results in a critique that primarily targets social powers that block desire, and whether anything appears to end up repeating the liberal discourse that Foucault aimed to unsettle, that is, a position that aligns itself with a desire believed to be more original than the abstract and artificial discourse that represses it. This contradicts the productive perspective on power that Foucault suggests, insofar as it assumes a desire that has its origins outside the addiction discourse, which does not appear to be related originally to power, but rather seems to be opposed to the unifying apparatus of addiction in terms of a more heterogeneous and decentred bodily reality.

In this context, it is telling that Keane opposes the abstract discourse of addiction to materiality. This results in the theoretical establishment of a concrete outside to power. For instance, she insists that addiction discourse is based on (abstract) ‘fantasies of transcendence’ as opposed to our (concrete) ‘physical existence’.

Notions of addiction can operate as fantasies of transcendence, circulating the hope that we can transcend our physical existence, escape our histories and be cleansed of our pasts, while ‘remaining (or becoming more fully) ourselves.’ (Keane 2002, 192)

Linking ‘notions of addiction’ to tropes such as fantasy, transcendence, escape, and cleansing, here Keane effectively opposes addiction as discourse to something real, namely the reality of ‘physical existence’ and ‘history’. As she argues, the recovery discourse refers us to the abstract hope of being able to transcend our personal biology and history as well as to repress and subordinate existence to abstract ideas; it removes us from our concrete being and returns us to the dualistic relation between mind and body and the metaphysical belief in the former’s control over the latter. This opposition between abstract health and concrete desire then structures Keane’s discussion of sex and love addiction.

Here I examine both sides of the issue; that is, the construction of some sorts of sex as pathological and addictive, and the construction of other types of sexual relationships as healthy. This model of healthy intimacy has little space for the body and its desires, except as servants of a higher goal of self-realisation. (Keane 2002, 139)

The claim that the sex addiction discourse ‘has little space for the body and its desire’ underlines the understanding of addiction discourse as essentially abstract and repressive in relation to concrete physical desire. In this respect, her analysis undermines cultural and artificial norms believed to repress and deny the natural multitude of desires and sexualities. This seems to re-introduce something akin to a pre-Foucauldian imaginary of a historically recent and abstract power that represses the natural heterogeneity of materiality. In this sense, behaviours that interfere with desire (e.g. abstaining from behaviours such as use of alcohol, cocaine, gambling or masturbation) tend to be associated with governance, while behaviours such as using drugs, gambling, masturbating, etc., are considered elements that are excluded from and somehow exist outside of power. As Keane states, the aim of her project is to ‘suggest that other ways of approaching ethical self-formation and transformation are possible, outside the demands of normality and the model of disease and health and recovery’ (Keane 2002, 9).

Although Keane’s outline of a Foucauldian project of ethical self-formation outside the demands of normality – given the more recent ontological or material turn among critical addiction scholars – might feel slightly outdated, it prefigures a broader tendency that still arguably structures critical studies of addiction. Thus, even if her more recent work (Fraser, Moore, and Keane 2014; Keane and Hamill 2010) is marked by more systematic attention to issues of materiality, it still suggests an ethics or politics that relies on a materiality that seems to be outside power. This can be seen in Fraser, Moore and Keane’s outline of a materialist framework that aligns itself with ‘a multiverse of differences’ (Fraser, Moore, and Keane 2014, 240), as well as in Keane and Hamill’s celebration of neuroscience as an example of molecular science that disrupts molar sciences and knowledge regimes organized around language and psychology. Something similar could be said of Fraser’s suggestion of a new materialist ‘onto-politics’ (2020), which ties in with recent efforts in critical drug studies to recognize the role of desire in drug taking and to allow for a critical interrogation of pathologizing discourses and the ongoing stigmatization of drug-using bodies (Bunton and Coveney 2011; Dennis 2020; Keane 2009; Malins 2017, 132; Valentine and Fraser 2008, 411–2).

In this sense, it could be argued that the shift from frameworks based in Foucault to more materialist ones changes little in relation to this vitalist celebration of the materiality of bodies and desires found in critical addiction studies. Indeed, as Dean and Villadsen show, Foucauldian frameworks pre-figured the turn to materiality in social theory (often in combination with Deleuze as in Rose).

Thus, if the earlier critical Foucauldian interrogation of the way in which addiction as governance blocked desire, behaviour and bodies (Sedgwick 1994; Valverde 1998; Keane 2002) appears today to be increasingly infused with and supported by a more materialist framework, they both seem to subscribe to the critique of abstract subjectivist discourse. Power, in effect, is ultimately to be resisted by aligning the critique with a multiverse that ought to be seen as essentially material, insofar as subjectivity and discourse are considered inherently abstract.

Ironically, the field of critical addiction studies, in this sense, seems to reproduce an opposition that is similar to the one they seek to deconstruct – an opposition between essentialist understandings of healthy and good desire, on the one hand, and addictive and excessive desire, on the other. Whether this is done within the Foucauldian framework primarily studied here or within the more recent turn to materiality and bodies, it is still the abstract artifice (here, the discourse of addiction) that appears to be on the losing side. One may ask whether a genealogical account would not need to consider the production of desire as always and already entangled in, and therefore inseparable from, a multitude of other productive power/knowledge processes that together make up the nexus of bio-power? Avoiding the broader discussion of how contemporary desires originally emerge through regulation, Keane, Valverde, and other critical addiction thinkers shun the issue of how bio-power already participates in the production of excessive, not-yet pathologized desire.

Conclusion

To conclude the argument, the author would like to return to the initial comparison between the analysis conducted here and Foucault’s argument about the neoliberal fear of the state. If the neoliberal fantasy relies on the opposition between the state and the market, and the fear that the former might swallow the latter, the present article claims that a similar fantasy organizes many accounts in critical addiction studies, although in this case the fantasy opposes addiction as an abstract and artificial form of governance (treated as an abstract no-go zone), and favours a more original materiality of bodies, desires, and habits. In this sense, the fantasy also structures what is to be opposed and what is to be celebrated and supported. The consequence of this perspective would appear to be that addiction discourse – like the state in neoliberal thought – ought to stand back from its interrogation of desire and behaviour. And while the present article agrees with the acute need to radically decentre the addiction discourse, it seriously questions the tendency to define the locus of such a remaking in terms of some material ontology not bound to issues of language and psychology. This is not in contradiction to frameworks emphasizing the material-discursive character of societal processes. Quite the contrary, it is in line with continued sensitivity to the ways in which ever new versions of binary metaphysics continue to creep back into each and every scientific endeavour.

For Foucault, the notion of an original desire outside power and language of course lies at the core of modern governmentality and science. It is thus tempting to suggest that the field of critical studies of addiction – despite its repeated critique of neoliberalism – harbours its own risk and tendency to reinforce the fundamental impulse of liberalism to defend the market, and the desire released by capitalist society. The ironic tone with which a critical scholar like Valverde (1998) mocks the very thought of something called ‘internet addiction’ displays a radical disengagement from decisive issues concerning how capitalist interests exploit psychological and neuroscientific knowledge in order to optimize the ‘addictive’ powers of the technology and algorithms of, for instance, social media platforms. As Natasha Schüll (2012) shows in her study of the gambling industry, important instances of contemporary bio-politics are aligned with maximizing enjoyment and pleasure as well as endorse what could be described as a culture of excess that structures our present social situation.

As the author of this article has argued elsewhere, Foucault provides us with a framework that allows us to think about how these forms of bio-politics could be resisted. For example, his last seminars on the ethics of truth-telling outline a critical attitude based on the values of being frank, ascetic and straight. These are values rarely appreciated by critical addiction studies. In contrast, they are crucial to a practice such as AA, which emphasizes the close connection between truth-telling and the ability to abstain from addictive behaviour (Palm 2021). Taking a cue from Foucault’s ethics, this affirmation of abstinence can be seen as something different than just being a product of traditional morality or some neoliberal ideology of responsibilization, as critical addiction scholars typically suggest (Reith 2004; Valentine and Fraser 2008). Rather, it could be seen as an act of resistance to certain instances of contemporary bio-politics. Because, as Wendy Brown (2019) points out, today’s far-reaching neoliberal financialization of every aspect of human existence does not only turn pleasure into an essential element of the deterritorialized machinery of neoliberal and hedonist power. It is also closely linked to the general decline in the functions of values, morality and conscience – a decline that leads not to freedom, but to undermining the individuals’ ability to establish a distance between themselves and the power that incites enjoyment.

Given this political situation, it is crucial to produce decentred theoretical frameworks that interrupt not only current discourses and practices aimed at curbing excess, but also those forces that rely on and strengthen their hold on modern individuals through what Zizek has referred to as the modern imperative to enjoy (Palm 2023). In this sense, addiction discourse does not only present us with a technology of modern governmentality. It can also offer critical research important tools for disrupting what could perhaps be described as a culture or society of excess. To be able to pick up and use these tools, however, critical thinking will probably have to distance itself from its aversion to addiction, as discussed in the present article.

Acknowledgements

The author would like to thank two anonymous reviewers for their valuable comments to earlier drafts of this article.

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No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Fredrik Palm

Fredrik Palm is Senior Lecturer in Sociology at the Department of Sociology, Uppsala University, Sweden. His research covers social theory, Lacanian psychoanalysis, and sexuality studies, and particularly concerns issues of subjectivity and desire in contemporary society. He is currently working on a project that explores different ways to develop contemporary frameworks on addiction through critical, social theory.

Notes

1 It should be noted that this abstract knowledge is referred to using an array of terms like ‘essentialist’, ‘universal’, ‘metaphysical’, ‘territorial’, ‘molar’, and ‘totalizing’, all denoting the same reductionist logic.

2 Keane notes, ‘Unlike compulsions and addictions, which require insight into buried feelings and conflicts to be remedied, habits can be altered without any excavation or examination of the self. It is this very characteristic of habits, their location on the surface of the subject, which can disrupt the understanding of addiction as the expression of a fixed, unified and fundamentally pathological identity’ (2002, 187).

3 In comparison, Robin Room’s (2011) analysis of the discourse on moderate drinking as part of liberal consumerism, even if it links the temperance movement, state regulations, neoliberal morality and the discourse on moderation, also indicates crucial tensions between, for instance, regulations and capitalist interests. Unlike the insistence on a fundamental molar apparatus, his discussion points to a more complex history implying different powers, each with their own particular logics and problematic tendencies.

4 This reduction is symptomatic of the continuity thesis developed in critical studies of addiction, and clearly discernible in often-cited works like those of Levine (1978, 2015). Levine’s historical description of the addiction discourse and the American temperance movement as parts of a single modern governance through will is, for instance, conditioned by his systematic way of obscuring the specificity of AA’s disease notion.

5 Thus, ultimately, Valverde’s position is similar to Keane’s claim in relation to the recovery discourse’s claim that ‘the addict identity operates as a master identity which comes to explain everything about the subject’ (Keane 2002, 187).

6 In this respect, Valverde’s study prefigures Melissa Bull’s genealogy of international and national drug control systems in Governing the Heroin Trade.

7 This is very much in line with Bull’s (2008, 153) argument that current forms of governance of drugs represent a kind of authoritarian control paradoxically committed to liberty, and as such are related to the will of the individual to control his or her desire.

8 For instance, this focus can be contrasted with Room’s analysis of tensions between strong state-sanctioned control systems around drinking and commercial interests and neoliberal, free-market ideologies pushing for a more open alcohol market (2010, 2011).