Addiction: What's Society Got to Do with It?
Dr. Sophie Nathenson breaks down why treating addiction means thinking far beyond the individual.
"Consider the metaphor of a flooding room, where we are furiously mopping up the floor ... Addressing societal factors starts to turn off the faucet."
104554 The Sociology of Addiction
This presentation introduces factors influencing substance use and addiction beyond the individual, including societal drivers and sociocultural influences on addiction and recovery. Contemporary sociological theories will be discussed, along with an exploration of the historical context of addiction within societies. A multi-level, holistic theoretical approach will be presented to inform the development of policy and intervention strategies for prevention and...
When I stumbled upon the field of medical sociology nearly 15 years ago, I was shocked by just how much the structure of our society can affect our health.
While "sociology" examines broad factors and differences between groups, "medical sociology" is the study of society and how our social structure, culture, and health systems impact our collective well-being. In contrast, "psychology" can zero in on factors unique to an individual, studying individual defenses.
Just like individuals can seek out health professionals, make small changes, and also face major barriers to well-being, our society has its own psychology, behavior patterns, and dysfunctions.
Rates of addiction and health outcomes are not randomly distributed in societies—there are distinct patterns that can give us a big picture view of why we are collectively struggling with an issue. When 1 in 6 people in our society have been diagnosed with substance use disorder, and 1 in 3 struggle with mental illness (SAMHSA National Report, 2024), we start to wonder, what's going on? This is more than just an individual problem.
Addiction is Never Just One Thing
Addiction, pain, and trauma, like any other health condition, are multifactorial. There is not one single cause for increased risk of addiction, substance use disorder, or behavioral addictions. Not only do biological, genetic, psychological, social, and environmental factors shape health and illness, but they also interact with each other in powerful ways. Even our genetic predispositions can be activated by our social environments, and they trickle down to the next generations.
From a sociological perspective, social conditions are not just background context—they are known as fundamental causes of health and illness. Poverty. Violence. Racism. Displacement. Social Isolation. Chronic stress.
And all of these factors are connected:
- Genetics can influence vulnerability.
- Trauma can shape coping strategies.
- Displacement can cause social support breakdown.
- Social isolation can intensify substance use.
- Economic instability can limit access to care.
- Policy environments can either protect or harm.
- Discrimination and poverty cause chronic stress.
Society as a Petri Dish
Our society is like a petri dish, where health or illness may flourish. In it lies our culture (no pun intended). Our societal paradigm is focused on the individual level and reflects a deep desire to numb and eradicate pain. Our systems are also a part of that petri dish.
"When 1 in 6 people in our society have been diagnosed with substance use disorder, and 1 in 3 struggle with mental illness, we start to wonder, what's going on? This is more than just an individual problem."
Our healthcare system, for example, exists to address health issues, using a specific model. Yet our biomedical model can fall short in addressing addiction, because of the focus on individual pathology and symptom reduction, often by nature overlooking the social and psychosocial dimensions of trauma and addiction.
So, what are these societal, underlying factors in addiction?
- Lack of stable housing
- Food insecurity
- Limited access to healthcare
- Exposure to trauma and adverse childhood experiences (ACEs)
- Structural racism and discrimination
- Disconnection from community and belonging
Research consistently shows that these conditions shape both risk and recovery trajectories (Jose et al., 2024; Pitman et al., 2024; Farhoudian et al., 2022; Zhu et al., 2023; Jegede, Bellamy, & Jordan, 2024; Booth & Shaw, 2023).
Are You Mopping the Floor, or Turning off the Faucet?
Addiction rates continue to rise in communities (and fall, in others) across the nation, as we try to grapple with the problem as best we can with the tools we have. Consider the metaphor of a flooding room, where we are furiously mopping up the floor: We are overwhelmed and eventually get burned out in our efforts to help.
Addressing societal factors starts to turn off the faucet.
An alternative way of viewing substance use and addiction is the idea that these behaviors are adaptations to environments where basic needs are not being met. In this way, the use of substances can be an important, albeit detrimental, way of coping.
We all have a core need for food, shelter, water, and a sense of belonging. One way humans try to adapt to harsh environments is by using substances. Substances can actually serve as a strategy to meet these basic needs.
For example:
- Quelling unrelenting stress
- Self-medication for emotional trauma or physical pain
- Staying alert to potential dangers and alleviating hunger
- A pathway to connection, identity, or belonging
When food, shelter, safety, and connection are inconsistent or absent, substances can become a reliable alternative. That doesn't make them safe, and it doesn't discount the damage addiction can cause to individuals, families, and communities—but it does make it more understandable. And understanding matters. It is a powerful influence on the therapeutic alliance.
The Case for Expanding Access to Care
One-on-one therapy, treatment, social support, and behavioral health services are critical, impactful, and lifesaving.
It's essential to expand access to services such as:
- Medication-assisted treatment (MAT)
- Harm reduction services
- Trauma-informed care
- Mental health support
If you work with populations facing substance use disorders, you may never know just how dramatic a difference you've made in someone's life and their entire social circle.
"We all have a core need for food, shelter, water, and a sense of belonging. One way humans try to adapt to harsh environments is by using substances. Substances can actually serve as a strategy to meet these basic needs."
Underlying broader social and economic conditions are fanning the flames of our addiction problem. And just as a headache isn't caused by a lack of a pain-relieving medication, drug crises are not caused by a lack of treatment.
To make a meaningful dent in addiction and overdose at a population level, we must also think upstream. This means investing in those root societal causes. It's possible. This is what it looks like:
- Affordable housing initiatives
- Living wages and economic supports
- Access to education and childcare
- Anti-racism and equity-focused policies
- Community-building and social connection programs
- Trauma prevention and early childhood support
These are not traditionally labeled as "addiction treatments", but they may be some of the most powerful forms of prevention we have.
What the Sociological Lens Offers Clinicians
The sociological perspective is a different angle to see health issues such as addiction. It's simply another dimension of something that's psychological, biochemical, and behavioral.
The sociological lens can enhance your ability to serve your clients, enabling you to:
- Contextualize client behavior without pathologizing
- Recognize structural barriers to recovery
- Integrate social determinants into assessment and treatment planning
- Advocate more effectively for clients
But this isn't just about helping those you serve. I firmly believe this can help you, too.
As a medical sociologist, I study how the big picture affects individuals, but my population served is you. I mentor high-achieving professionals as they navigate the balance between a deep commitment to their work and the nurturing of their own well-being.
Interestingly, sociology can help with this.
Understanding societal factors such as poverty, trauma, limited access to healthcare, stigma, and structural inequality can foster empathy and fight compassion fatigue (Zamorano, González-Sanguino, Fernández-Jiménez, & Muñoz, 2024; Wilkinson, Whittington, Perry, & Eames, 2017). How? It can decrease blame-based thinking, create more realistic expectations, relieve feelings of being fully responsible, and provide deeper meaning.
Societally, we are living through so many overlapping crises right now that it's hard to even wrap our heads around it all. And it's not our job to address everything. By focusing on what you can control and letting go of what you can't (a high level of difficulty there), you can potentially avoid burnout and connect with your part in the healing of the collective.
We can and will keep mopping the floor. It makes a difference, and it matters.
Meanwhile, the faucet is still running.
Social change is turning off the faucet. We can do both.
Join Dr. Nathenson and Other Clinicians on June 4th.
My continuing education course, "Sociology of Addiction," is designed to go deeper into these concepts, both historically and in our present moment. It brings together research and real-world applications in a practical and inspiring way.
No matter what chaos is happening around us, we can still play a role in humanizing addiction with understanding, dignity, and care.
104554 The Sociology of Addiction
This presentation introduces factors influencing substance use and addiction beyond the individual, including societal drivers and sociocultural influences on addiction and recovery. Contemporary sociological theories will be discussed, along with an exploration of the historical context of addiction within societies. A multi-level, holistic theoretical approach will be presented to inform the development of policy and intervention strategies for prevention and...
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- Anjaria, P., Asediya, V., Nayak, J., & Koringa, P. (2023). The epigenetic landscape: how environmental cues shape gene expression. Epigenomics, 15(5), 267–270.
- Booth, J. M., & Shaw, D. S. (2023). Examining parental monitoring, neighborhood peer anti-social behavior, and neighborhood social cohesion and control as a pathway to adolescent substance use. Journal of Child and Family Studies, 32(2), 626–639.
- Farhoudian, A., Razaghi, E., Hooshyari, Z., Noroozi, A., Pilevari, A., Mokri, A., … Malekinejad, M. (2022). Barriers and facilitators to substance use disorder treatment: An overview of systematic reviews. Substance Abuse: Research and Treatment, 16, 11782218221118462.
- Jegede, O., Bellamy, C., & Jordan, A. (2024). Systemic racism as a determinant of health inequities for people with substance use disorder. JAMA Psychiatry, 81(3), 225–226.
- Jose, R., D’Amico, E. J., Klein, D. J., Rodriguez, A., Pedersen, E. R., & Tucker, J. S. (2024). In flux: Associations of substance use with instability in housing, employment, and income among young adults experiencing homelessness. PLOS ONE, 19(5), e0303439.
- Pitman, S. A., Pasch, K. E., Poulos, N. S., & Velazquez, C. E. (2024). Food insecurity and substance use among young adults in the United States. Preventive Medicine, 189, 108148.
- Substance Abuse and Mental Health Services Administration. (2024). 2023 National Survey on Drug Use and Health. https://www.samhsa.gov/data/data-we-collect/n-sumhss-national-substance-use-and-mental-health-services-survey
Wilkinson, H., Whittington, R., Perry, L., & Eames, C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout Research, 6, 18–29. - Zamorano, S., González-Sanguino, C., Fernández-Jiménez, E., & Muñoz, M. (2024). A burnt-out health: Stigma towards mental health problems as a predictor of burnout in a sample of community social healthcare professionals. Behavioral Sciences, 14(9), 812.
- Zhu, J., Racine, N., Devereux, C., Hodgins, D. C., & Madigan, S. (2023). Associations between adverse childhood experiences and substance use: A meta-analysis. Child Abuse & Neglect, 106431.
Opinions and viewpoints expressed in this article are the author's, and do not necessarily reflect those of CE Learning Systems.
