CULTURE‐BOUND CONCEPTS OF ADDICTION—STILL A POTENT INFLUENCE

In his reflections on a study tour of alcoholism research and treatment centres in North America, made at the start of his career in this field, Griffith Edwards makes an eloquent argument for the advantages of such a visit 1. In his brief but pointed observations on each of the centres that he visited, he notes the marked differences that existed between the American and British scenes at that time, and sets out a number of advantages that such a tour can confer upon the young investigator, including the building of personal contacts that can lead to international collaborative efforts and life-long friendships, recognition of the gap between research and clinical practice and a clear awareness of the extent to which theories and definitions about alcoholism are culture-bound. This last may well be the most important of the potential benefits of such a trip, for a number of reasons. There are now many high-quality journals in the field that did not exist in 1961, and national and international societies holding annual or biennial research meetings that are attended by researchers and clinicians from many different countries. In addition, a variety of governmental and non-governmental agencies provide funds for international visits that enable young researchers to spend time working in other countries. As a result, there are now far more opportunities for establishing personal contacts leading to collaborative research. It is probably no longer necessary to visit other countries to become aware of the continuing gap between research and clinical practice in the addictions field. For the same reasons, one might question whether concepts of addiction are still culture-bound, 47 years after the visit in question. Given the world-wide adoption of definitions such as those in the DSM-IV and the ICD-10, are there really still significant differences between major theories and definitions in, for example, the United States, United Kingdom, France, Finland, Japan and Chile? Has the wide and rapid global dissemination of research findings not brought about a common language and common concepts shared by all who now work in this field in the various parts of the world? Unfortunately, the answer is: to only a very limited degree. The cultures which may constrain concepts, definitions and practices are not only those of the respective general populations, but also those of different governments and even of different national research bodies. In North America, for example, the major research funding agencies in the addictions field have a strongly biomedical culture that favours research on neurobiological, genetic and molecular aspects, as reflected in the concept that addiction is a metabolic disease of the brain that should be amenable to pharmacotherapy. In many European and Latin American countries, the prevailing emphasis is on the adverse health effects of excessive alcohol or other drug use, such as malnutrition, liver disease or human immunodeficiency virus/acquired immune deficiency syndrome (HIV-AIDS). The Scandinavian countries have long fostered sociological and epidemiological research into addictions as public health or social problems. In relation to prevention and treatment research, the international differences in underlying philosophy and emphasis are sufficiently marked to require no further elaboration. These differences are, of course, not absolute and total, but are differences of proportional emphasis and influence. As a result, the spectrum of addiction-related research questions that are asked, the manner in which they are formulated, the relative amounts of resources and effort devoted to them and the range of research opportunities open to young investigators, all differ very substantially from one country to another. If the resulting advances in knowledge were, in fact, spread rapidly and widely throughout the world, and incorporated into the prevention and treatment approaches of all countries regardless of their original sources, this would not be a problem. However, a recent study suggests that the enormous proliferation of electronic sources of information has made researchers more rather than less restricted, both temporally and in range of sources, in their use and citation of the work done by others 2. To one beginning a career in this field, the extent of these differences may not be apparent, and exposure to the thinking in different societies and cultures could still be an eye-opening experience. If Edwards' account of his own experience as a young visitor in new surroundings causes today's beginners to become aware of such influences on their own thinking and scientific orientation, it will have served a valuable purpose indeed. None.

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