In what systems do alcohol/chemical addictions make sense? Clinical ideologies and practices as cultural metaphors

Based on 17 years of clinical teaching, supervision and participant observation in United States settings, this paper inquires into the cultural plausibility of the disease-model of chemical addictions in the U.S. The model is linked to (a) the targeting of pariah groups for scorn and punishment, (b) the resurgence of social darwinism and its distinction between 'fit' and 'discountable' people, and (c) increased nationalism, militarism, and the spectre of nuclear war. In an era of neopuritanism, addicts serve as reservoirs of 'badness' for mainstream society that wages war against them in the idiom of treatment. An ethnographic model for bridging 'critical' and 'clinical' concerns is proposed.