Addictionology as biography

Here we reproduce in full a special editorial published by Tom Babor in the journal Addiction in 2012. In it, Professor Babor summaries the first hundred ‘Addiction Interviews’, a series published in the journal Addiction since the late 1970s. The entire series can be accessed as a virtual issue of the journal here. Future entries in the series will still be commissioned by the Addiction journal editorial team, but will appear in full on the SSA website. This will allow us to provide enhanced content, included audio or recordings of the interview and a hyperlinked reading list of the subject’s work, and it is fitting that the first subject to be featured in the new format with be Tom Babor himself.

One hundred ways to have a successful career in addiction science

The history of science is often written as the progress of ideas, but it can also be written as lives in progress. Diogenes Laertius, the 3rd century Epicurean author of a biographical compilation called Lives of the Eminent Philosophers, was one of the first to recognize the value of exploring the evolution of a field through the lives of its creators. Like philosophy, it is perhaps the sign of the maturation of addiction studies when its story can be told in the lives of its eminent and wise pioneers. Laertius represents a tradition that sees a field of inquiry not only as a set of precepts but also as a network of wise people who have an impact on the world because they knowhow to translate ideas into practical accomplishments.

Starting in 1979 with D.L. Davies, who is best known for his seminal paper on alcoholics who were thought to have returned to moderate drinking [1], Addiction has now published 100 interviews with eminent members of the field, or with those who have influenced it in some important way as outsiders. The interviews represent a broad cross-section of the lives of men and women whose careers, indeed the major part of their lives, were devoted to research, teaching, writing, clinical work and program management in what has come to be known as the addiction field. This editorial note pays tribute to those individuals who literally built, one life at a time, the intellectual foundations and physical infrastructure of an international, multidisciplinary field of inquiry that has now matured into a prototypical global health policy network in the service of research, treatment and policy. The Appendix lists the names of the 100 people who are the subject of the interviews.

Although every life is unique and well worth exploring as an individual work in progress, summary statistics can also be instructive in that they describe the characteristics of the most influential individuals in the addiction field during the latter part of the 20th century. As reflected in their demographics, the most eminent addictionologists over the past 30 years were overwhelmingly male (92%), very likely to be American (42%) or a citizen of a British Commonwealth state (31%), whose main professional responsibilities were focused on research (50%), health administration (38%), or clinical practice (12%). This diversity of interests is reflected in the interviewees’ institutional affiliations, which include universities (40%), hospitals (25%), government agencies (23%), international organizations (7%) and non-governmental organizations (3%). Professional training is dominated by medicine (27%), psychiatry (17%), psychology (14%), and the biological sciences, but approximately 40% of the group is populated by people trained in sociology and other social sciences. One thing that sets these 100 individuals apart from the thousands of other addiction professionals who joined the field during the period following the end of WorldWar II is their scholarly output and their impact on others. The average number of publications was 98 (range = 0, 775). The average number of total citations to their work was 1706 (range = 0, 16 378).Ten interviewees have been recognized by ISIHighlyCited.com as being among the 250 most cited researchers in their respective disciplines. These researchers were: M. Douglas Anglin; Raul Caetano; Deborah Dawson; Avram Goldstein; Michael Kuhar; Charles S. Lieber; Raphael Mechoulam; William R. Miller; Rudolf Moos; and Marc Schuckit.

What, if anything, unites the seemingly diverse subjects of these interviews? For those who have read them, the thread is clear. They are all intelligent, creative people who cared profoundly about one or more aspects of addiction: a passion for science without neglecting its social value; a devotion to patients without uncritically accepting the conventional wisdom that addiction is incurable or not worth the effort to even try; an appreciation of institutions without allowing the bureaucracy to smother effective service and creative ideas. In generational terms, they epitomize both the ‘Greatest Generation’ (born before 1928) and the ‘Silent Generation’ (born between 1928 and 1945, in that they were children of the Great Depression and World War II and their lives were characterized by their civic-mindedness and willingness to work together for the betterment of society [2].

There have now been three books that have collected the original interviews and presented them with commentaries from others in the field. In the Introduction to the first book (Addictions: Personal Influences and Scientific Movements) [1], Griffith Edwards explained that ‘Through the medium of interview transcripts, this book offers contact with the experience, thinking and values of 27 men and women who, over the post-war decades, have taken varieties of highly important leadership roles in shaping national and international scientific and policy responses to alcohol and drug problems.’ In the second instalment of the interview book series (Addiction: Evolution of a Specialist Field), Edwards [3] noted that the next 30 careers covered in interviews tell the story of a ‘multi-substance, international, multidisciplinary field to which scientists, practitioners, activists and policy makers all contribute . . .’.

If the first two volumes describe growth and development, the third book of collected interviews, Addiction and the Making of Professional Careers, [4] represents the maturation of the addiction field. At the beginning of this book, Griffith Edwards expressed the hope that by reviewing the lives of the world’s most eminent addiction professionals one might ‘enhance understanding of how to make careers in addiction more effective and more rewarding.’ He also expressed the wish that ‘the lives sketched in this book will help to inform and inspire young people now making their own choices.’

In a real sense, this series of interviews provides a vicarious opportunity to follow the lives of a wide cross section of addiction scientists as told in their own words, and to learn from the individual and collective wisdom gained through a lifetime of work and experience. It was Socrates who said that ‘the unexamined life is not worth living.’ Actions as well as words are the hallmark of many of these examined lives, but what is missing from this list are the stories of the people who, like Bruce Rounsaville, died in their prime before they had their retirement party and their Addiction interview. Also missing are the unsung heroines who never had a chance to enjoy a productive scientific career because of their sex, but we are grateful for women like Sheila Blume, Martha Sanchez-Craig and Joy Moser, who overcame the obstacles of their gender in order to create better opportunities for women entering the field after them.

If the lives in this book offer a moral to the story of addiction science, that message is neither simple nor obvious. At the very least they prove beyond doubt that addiction science can offer a creative, rewarding and socially valuable career to young professionals, one that can be abstract and personal, reflective and practical, humanitarian and humanistic. Perhaps this is too much to infer from an exit interview with a group of people who recently were awarded the proverbial ‘gold watch’ for many years of service. The interviews are by definition unstructured, anecdotal and subject to the biases of recall and self-aggrandizement. Unfortunately, this is often the only material we have in a field that is remarkably a-historical and unreflective. This and the physical record of the remarkable infrastructure of research centers, professional societies, treatment programs, national institutes and addiction journals that they built one piece at a time.

Beyond strengthening our historical understanding, there is also the practical aim of finding out how such careers can be better nurtured and supported. People like Bill Miller, Robin Room, Harold Holder, Jorge Mardones and Griffith Edwards had the kind of magnetic personalities, idea systems and philosophies of science that were capable of inspiring promising young scientists and practitioners to enter the field.

The aim of these interviews was not only to enhance the appreciation of the people who have had enormous success in the field of addiction, but also to demonstrate the ways in which addiction careers contribute to the public good. As such, they reveal the collective convergence of parallel lives into what some sociologists have called a global health policy community. These are cross national networks of individuals, groups and organizations that share a concern for a particular health issue such as malaria, polio, cancer or addiction. Policy communities may include many types of individuals (physicians, researchers, advocates, policy-makers, public health professionals), and different kinds of organizations and groups (governments, non-governmental organizations, foundations, private sector organizations, informal academic networks). To be effective in a particular health area, a global health policy community needs to secure political attention and resources for the problem, enable the adoption of evidence-based policy at the national and international levels of government and facilitate widespread uptake of scientifically-backed interventions. The adoption of the Framework Convention on Tobacco Control by 165 national parties under the auspices of the World Health Organization (WHO) is one such example in the addiction field, and the recent WHO Global Strategy on Harmful Use of Alcohol is another [5,6,7]. If the addiction field has evolved to the point where it is capable of acting like a global health policy community in the service of the public good, it is clear that the story of its emergence can be read in the first 100 interviews published in Addiction.

by Thomas F. Babor

Department of Community Medicine & Health Care, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6325, USA. Email: babor@nso.uchc.edu

References

1. Edwards G., ed. Addictions: Personal Influences and Scientific Movements. New Brunswick, New Jersey, USA: Transaction Publishers; 1991.

2. Taylor P., Keeter S. Millennials: A Portrait of Generation Next. Pew Research Center Report; 2010.

3. Edwards G., ed. Addiction: Evolution of a Specialist Field. Oxford, UK: Blackwell Publishing; 2002.

4. Edwards G., Babor T. F., eds. Addiction and the Making of Professional Careers. Piscataway, NJ: Transaction Publishers; 2012; in press.

5. Levine, R. et al. Millions Saved: Proven Successes in Global Health. Washington, DC: Center for Global Development; 2004.

6. Zeigler D.W., Babor T. F. Challenges and Opportunities Implementing the WHO Global Strategy on Alcohol. World Medical & Health Policy 2011; 3: 4, Article 6.

7. Warner K. E., Mackay J. The global tobacco disease pandemic: Nature, causes, and cures. Global Public Health 2006; 1: 65–86.

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