Addictology and prejudicesResearch

“A cup of coffee to wake up, a drink with a meal, cannabis to relax: psychoactive substances are a familiar part of our lives. Yet research on them remains largely focused on risks, harms, and addiction,” says Jean-Sébastien Fallu, professor of psychoeducation at the University of Montreal. 

Drawing on three decades of research, intervention, and participation in public debates, he calls for a reexamination of the foundations of his field, arguing that this imbalance undermines our understanding of substance use and could harm those who consume these substances. In a recent article, he advocates for a science that pays greater attention to its own biases, to the diversity of uses and knowledge, to pleasure, autonomy, and contexts of use—while remaining rigorous and without denying the risks and harms. He tells us more about this.

What does addiction science still fail to understand?

Essentially, what we fail to understand is what is not pathological—that is, normality and the diversity of everyday use.

The use of psychoactive substances is not, in and of itself, synonymous with a problem or addiction. Yet the mainstream field of addiction studies focuses far more on problematic use than on other forms of consumption. One need only look at the titles of academic journals in the field to see this.

We still understand relatively little about the functions and meanings of these uses, as well as the self-determination of those who use substances. What roles can substance use play in a person’s life? What are they seeking: pleasure, a social experience, exploration, a sense of belonging, or an altered state of consciousness? These are questions that deserve scientific study.

I also advocate for the idea that we should focus more on the science of drug use and the disorders associated with that use, rather than solely on the science of addiction. This would prevent us from reducing the entire population of users to the minority who experience difficulties.

Furthermore, we must give those directly affected a genuine voice in the production of knowledge. When I attended parliamentary hearings or public health conferences on the legalization of cannabis, for example, I was struck by the absence of people who actually use it. This represents a form of epistemic injustice: certain experiences and forms of knowledge are considered less legitimate than others. 

Science therefore focuses primarily on the risks and problems, but much less on the pleasurable, beneficial, functional, or simply unproblematic aspects of drug use. It also still has a limited understanding of the effects of stigma—which, incidentally, it may help to create or reinforce. When the concepts and language used portray people who use drugs as lacking autonomy, this can contribute to their dehumanization.

All these problems reinforce one another. Furthermore, their impact extends beyond scientific publications and shapes funding, interventions, public policy, and the way society views drug users—and vice versa.

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