Ron Roizen, Journal of Studies on Alcohol 58:107-108,1997.

Book review:

False Fixes: The Cultural Politics of Drugs, Alcohol, and
Addictive Relations, by David Forbes. Albany, N.Y.: State
University of New York Press, 1994, 278 + xvii pages,
$21.95 (cloth)

Two familiar axioms of substance abuse prevention hold that (1) "substance abuse causes social ills (i.e., poverty, crime, violence, etc.)" and (2) "social ills cause substance abuse." Together, the pair forms an unhappy vicious circle.  Considered separately, however, the two assertions harbor remarkably different meanings and implications. The drugs-cause assertion provides in effect a narrowing causal perspective on social ills--narrowing our gaze to the deleterious effects of a single problem-causing factor, substance abuse.  The society-causes assertion, on the other hand, provides a widening causal perspective -- inviting our attention to a wide array of social factors that may contribute to substance abuse.  Moreover, whereas the drugs-cause assertion explains social ills in terms of individual misconduct, the society-causes assertion explains individual misconduct in terms of social ills.

Not surprisingly, the drugs-cause and society-causes assertions have strikingly different political valences.  The drugs-cause assertion fits neatly into a conservative political perspective. From its vantage point, prevailing social ills may be blamed in varying degrees on substance abuse.  Since substance abuse in this perspective is regarded as an individual and not a social-structural failing, the drugs-cause assertion offers powerful rhetorical buttressing to the social-structural status quo ante.  In the drugs-cause perspective, moreover, substance abuse can be regarded as an alien and exogenous problem-causing factor--something akin to a cancerous tumor whose excision returns the body social to its former healthier condition.

The society-causes assertion fits equally neatly into a radical, "progressive," or social-change-seeking political perspective. In its conceptual viewfinder, substance abuse becomes both a symptom and a product of social malfunction and malorganization. Substance abuse presents reform-minded advocates with a call to action and, perhaps also, with clues to the kinds of social changes that should be sought. In the society-causes perspective, moreover, substance abuse is a direct product of society's faulty social-structural arrangements. From the society-causes perspective, therefore, the notion of excising substance abuse from society without also undertaking significant social-structural changes is mere folly and wishful thinking.

David Forbes' book, False Fixes, offers readers an object lesson in the struggle to define a "progressive," society-causes perspective on substance abuse in the conservative political climate of the 1990s. Most of Forbes' frustration is directed at three major contemporary institutionalized responses to substance abuse in the U.S.: the controversial "war on drugs," the school-based and community-based prevention-education enterprises, and the recovery or 12-step movement. All three, he contends, lack a meaningful appreciation of substance abuse's integral relation to the American sociocultural complex.  In order to redress this shortcoming Forbes constructs what he terms "a cultural politics of everyday life" -- that is, an analysis of how substance abuse is grounded in proximate sociocultural sources or causes. The author's task is considerably complicated by his perception that American society is in the midst of a fundamental transformation from a "modern" to a "postmodern" form. Forbes lavishes a good deal of ink on exploring both the crumbling condition of modernist institutions (from which, incidentally, he sees current prevention enterprises emanating) and the very different, inchoate, and open-ended characteristics of postmodemist cultural arrangements.  The author sees many favorable prospects and some perils for prevention in the emergent, postmortem reality.

Forbes is on considerably stronger ground when he criticizes contemporary anti-substance-abuse enterprises than when he proffers his own model of the sociocultural springs of substance abuse. The logic of his case obliges Forbes to offer an account of the major sources of substance abuse in the American sociocultural complex. The author locates these in a pervasive and pernicious sociocultural malady he calls "addictive relations." Unfortunately, the concept as the author articulates it is vague, amorphous, circular and, perhaps most importantly, wholly conjectural and speculative.

"Addictive relations," Mr. Forbes writes, "are characterized by all-or-nothing thinking, by perfectionism, and by the need to control some thought, thing, or person" (p. 14); in addictive relations, he writes, "people lose their sensuous, fluid nature and the flexibility to maintain connectedness within shifting contexts and become fixed or dependent on one form of expression" (p. 4). Addictive relations are also associated with low tolerance of ambiguity and excessively hierarchical power structures. "At the heart of the cultural politics of addictive relations," concludes Forbes in the book's epilogue, "lies the longing for desire and democracy, the struggle to create full, satisfying relations for all" (p. 267).

If and how such a society might be achieved -- and whether one would find in it competent airlines, a decent hotdog, or a reasonably priced dentist -- is left to the reader's imagination. Forbes also states in the epilogue that "the best preventive policy against addiction is a just, caring society which guarantees decent income, education, housing, health care, and recreation to all" (p. 267). My own conclusion is that, if the drugs-cause perspective can be justly criticized for turning a blind eye to society's problems, then Forbes' exercise in constructing a case for a society-causes perspective can be equally justly criticized for resulting in utopian fluff.  Mr. Forbes eschewed the rigors of building a closely marshaled empirical case for the causal or explanatory import of his concept of "addictive relations."  His central concept is merely presented ex cathedra. In the end, therefore, the author's argument hangs from a visionary skyhook--that is, from the notion of the potential existence of a society where nonhierarchical, fluid, spontaneous and not-all-or-nothing human relationships and thinking prevail. Such fanciful thinking, despite the book's often well-aimed critical observations, makes False Fixes an impassioned exercise in political rhetoric rather than a disciplined attempt at sociological or historical reconceptualization.

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