Johan Edman

How can we conceptualize behavioural addiction without pathologizing common behaviours

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

A weak scientific basis for gaming disorder: Let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

What's in a name? : Alcohol and drug treatment and the politics of confusion

Aims The aim of this article is to investigate the use of a rather vague medical conceptual framework within the compulsory treatment of alcohol and drug users in Sweden during the 20th century. The focus lies on exploring how a phenomenon came to be described as pathological, what the causes are for certain actions being suddenly interpreted in medical terms, and what consequences that might lead to. Design Supported by theoretical speculations on medicalization processes and conceptual history, two empirical cases (the compulsory care of alcohol abusers in the 1950s and the legislative process leading to psychiatric compulsory care of drug users in the late 1960s) are investigated. The first case draws mainly upon official reports and archive material from alcohol treatment institutions, whilst the second case is built from reading official reports and parliamentary material. The research task for the two empirical cases has not quite been the same: whereas the first case is illustrated by the discrepancies between the labelling of treatment activities and the treatment actually carried out, the second case rather draws upon the enlargement of the field of signification of the disease concept to cover most aspects of drug use. Results A medicalization process on different levels is traced both in the post-war compulsory treatment of alcohol abusers as well as the compulsory psychiatric care for drug abusers that was introduced from the late 1960s onwards. Conclusion The investigated cases show how the medicalization processes benefited from conceptual vagueness, leading to a widening of the conceptual dimensions of both the treatment and disease concepts. In this, the medicalization of alcohol abuse in the 1950s and drug abuse in the 1960s made way for a paternalistic justification of compulsory care measures that might otherwise have become politically troublesome.

Conceptual carpentry as problem handling: The case of drugs and coercive treatment in social democratic welfare regimes

BACKGROUND The drug and alcohol fields are characterised by continuous contestations of key concepts and the competing uses of concepts by various actors, in different geographies and over time. This study investigates the political processes leading to legislation enabling coercive treatment of (non-psychotic) drug users in Finland and Sweden from the 1950s until the early 1980s. The drug treatment policies are analysed through conceptual changes and innovations. METHODS The article analyses conceptual discussions in public reports in Finland and Sweden, focusing on the work preceding the first legislations where both alcohol and drug treatment were included (in Finland 1961, in Sweden 1982). Theories from conceptual history are applied. RESULTS The Finnish and Swedish discussions carry arguments from two periods of the Nordic welfare state: in an early development stage and a fragile situation in Finland, and in a more mature and affluent time in Sweden. The paternalistic arguments vary over time and between countries. Still, in both countries and time periods, the view of the drug problem as a youth issue, as particularly enslaving and on societys obligation to protect drug using individuals from damaging their future give enough motivation for coercive treatment. The conceptual work included avoidance of certain terms but in other cases, a broadening of their meaning, to adopt them to the political goals. CONCLUSION Close analyses of conceptual history can reveal new features of drug policy struggles and show how central concepts in drugs and alcohol field are continuously contested.

The Swedish drug problem: Conceptual understanding and problem handling, 1839–2011

Aim To analyse the Swedish drug question by examining dominant concepts used to portray the problem in the years 1839-2011. Theoretically, we understand these concepts as ideological tools that shape the political initiatives and administrative efforts to deal with the problem. The study is based on two kinds of source material: articles in medical journals from the years 1839-1964 and public reports on vagrancy, the alcohol problem, mental health and the drug problem from the years 1882-2011. Findings During the nineteenth century and the first part of the twentieth century the drug problem remained an individual problem handled by doctors. When the Swedish drug problem was established as a political question from the 1960s on, it also came to disengage itself from the medical frame of understanding. Medically oriented descriptions of “dependence” and “addiction” have appeared adequate or attractive when, for example, the socially motivated coercive treatment solution has been discredited (as in the 1970s), when there has been a desire to connect with an internationally accepted terminology (as in the 1990s) or when a new organisational model with a stronger professional support has been on the agenda (as in the 2010s). But otherwise the social problem description has called for concepts that have more or less explicitly dissociated themselves from speculations in physiological or psychological predispositions for substance abuse.

An ambiguous monolith – The Swedish drug issue as a political battleground 1965–1981

BACKGROUND The drug problem has been a highly ideologized topic in the political debate in Sweden ever since the mid-1960s. The aim of the article is to investigate dominant conceptions of drugs, drug use, society and the individual in the political discussions on drug use in Sweden during the years 1965-1981. METHODS The empirical basis for the textual analysis consists of 146 parliamentary bills and 135 parliamentary protocols. RESULTS The unwanted drug appear as a sensitive litmus paper, an indication that something had gone wrong in society and as a suggestion of how the good society could be accomplished. The drug problem was connected to ideological core values such as class struggle, Christianity or criticism of urbanism and modernity. CONCLUSION The analysis suggests that the drug problem was used as political ammunition, to pick holes in political opponents and to highlight ones own ideological stance. The hegemonic conversational order, the consensual spirit and the agreement that this was the most serious problem, did not hamper these political moves. Rather, the cross-party conception of the problems severity and accelerating deterioration contributed to a common ground for political arguments and ideological visions. It also meant that the political discussions moved away from the more obvious drug policy issues.

Behavioural Addiction Open Definition 2.0-using the Open Science Framework for collaborative and transparent theoretical development : Commentaries

Behavioural Addiction Open Definition 2.0—using the Open Science Framework for collaborative and transparent theoretical development

The ideological drug problem

Purpose - This article investigates the ideological visions embedded in the political formulation of the Swedish drug problem and in the bureaucratic management of the Swedish drug treatment servic ...

Swedish Drug Treatment and the Political Use of Conceptual Innovation 1882–1982

This article investigates the concepts applied to drug use and drug users in Sweden during the years 1882–1982. As a theoretical point of departure, concepts are treated as political tools and conceptual descriptions as political work. From an analysis of 43 public reports, three distinct periods stand out. In the first period, 1882–1962, there was no specific political need for conceptual clarity. During the second period, 1964–1969, the political need for certain (medicalized) concepts is more evident. Drug users were understood as sick and as potential objects for compulsory treatment. In the third period, during the mid-1970s and early 1980s, the process was reversed: specific concepts of sick drug users gave way to creating the political means for bringing alcohol and other drug users under joint treatment legislation.