Power, Powerlessness and Addiction, by Jim Orford

In what is very much a personal statement by a distinguished researcher in the field of addiction, Jim Orford has drawn on both his knowledge of addiction research literature and some considerable experience of contact with people with a variety of addiction problems and their families. The result is a book that is both scholarly and accessible to readers who do not have specialist knowledge. Its central theme is power, and the way in which people with addiction problems, their families and their wider communities are relatively powerless in comparison with those who supply the materials or opportunities underpinning their addiction, and who profit from doing so. Both what are commonly termed “legal” addictions, such as alcoholism and gambling, and “illegal” addictions, to drugs such as heroin and cocaine, are characterised in this way.

Power is the construct used to critique traditional perspectives on addiction, notably the view that addiction indicates some form of personalised dysfunction that may arise from an individual’s genetic endowment, socialisation, or some interaction of these two. While this approach can be valuable and thought-provoking, it is also the source of the book’s central weakness, namely the fact that the role of power itself in addiction is not also the subject of critique.

In the opening chapter, Orford uses three fictitious case histories of addiction involving alcohol, gambling and illegal drugs, respectively, as illustrative examples of power-based relationships in addiction. This is a perfectly valid way of developing an argument, and the case histories are true to the existing literature and the professional experience of those of us who have worked in addiction for a long time. However, being fictitious, they are to some extent idealised, and there is obviously no opportunity to ask about the individual factors that may have precipitated addiction. The role of the power relationships described in initiating and maintaining addiction cannot therefore be examined in a truly critical way by the reader. To put it rather crudely, not everyone with similar biographical details to the fictitious addicts described here goes on to develop an addiction problem.

In chapter 5, Orford looks at the supply-side industries for both alcohol and gambling. While it is doubtful that anyone outside those industries and their constituent companies would argue that they are blameless, there is a conspicuous lack of acknowledgement here that they are not only legal (for the most part), but that they serve what Western societies generally consider to be valid and acceptable activities. To the extent that this is true, it would seem difficult to argue that these companies do not have valid commercial interests as profit-making enterprises and large-scale employers, but such considerations are missing from this critique. With an estimated 54 per cent of the adult population of the UK consuming alcohol at least once a week, according to the 2010 General Lifestyle Survey, Orford’s concentration on the alcohol industry almost exclusively as a purveyor of addiction seems disproportionate. This is not a plea to exonerate the alcohol industry from instances of genuinely bad behaviour, some of which Orford cites, such as the marketing of alcopops in a way likely to encourage underage drinking. Instead, it is a plea for a little more balance in the consideration of the place of alcohol in society.

Overall, however, this is a potentially important contribution to our understanding of the social context of addiction. Although it should be read critically, it is well worth reading.