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The Expressions of Addiction: The Many Faces of a Syndrome

A Public Awareness and Education Project


Expressions of Addiction is an exhibit of original photographic portraits that depict people in various stages and expressions of addiction. Each portrait includes a biosketch of the subject. This photography exhibition will help the public better understand addiction by reaching hundreds of thousands through gallery exhibitions, television programs, and Internet sites.


Specific Goals

Expressions of Addiction goals are to:


To achieve these goals, Dr. Howard Shaffer draws on his experience as an award-winning photographer and 33 years of experience as a clinician and scientist specializing in the field of addiction [1, 2]. Dr. Shaffer has served in the following positions: Director of the Division on Addiction, Harvard Medical School; Director of the North Charles Institute for the Addictions, an affiliate of a Harvard Medical School Teaching Hospital; Director of the Division on Addiction at The Cambridge Hospital Department of Psychiatry; and private clinical practice.


The Need


Addiction is a major public health concern. Consider these alarming facts [3-9]:


  • The lifetime prevalence of alcohol abuse or dependence is 13.2%.
  • The lifetime prevalence of drug abuse or dependence (other than alcohol) is 8.0%.
  • The lifetime prevalence of nicotine dependence is 24%;
  • 19.5% of the US population experiences some substance use disorder during their lifetime.
  • The US population experiences other addictive behaviors: gambling-related problems (4%); heroin dependence (1%); cocaine dependence (1%); and shopping-related problems (1%).


Whether addiction is to a substance (e.g., alcohol) or activity (e.g., gambling), addiction has the capacity to change how the brain works, thereby potentially compromising every aspect of daily life.


Many people view addiction as separate and distinct disorders rather than a “syndrome.” New research, however, shows that, just as HIV is associated with many opportunistic infections, various addictive behaviors (e.g., drugging, gambling, eating) represent different opportunistic expressions of a common underlying biopsychosocial vulnerability—when this vulnerability mixes with exposure to an object of addiction and a desirable subjective shift occurs within the context of such exposure, people are at risk for the addiction syndrome.


When adverse consequences result from a continuing pattern of behavior, the addiction syndrome is evident. (Click here for the article, Toward a Syndrome Model of Addiction: Multiple Expressions, Common Etiology.)



Why Photography?

Photographic portraits are an ideal venue for raising awareness about addiction. As Eugene Smith’s classic photographic essays demonstrated, the objectivity of photographs combined with the subjective truth [10] of art provides an opportunity for viewers to project their emotions and empathize with a photograph. The decisive moment [11] of a photograph provides the ultimate opportunity for personal projection.


Expressions of Addiction is intellectually and emotionally relevant, in part, because of the biosketches that accompany each portrait. These biosketches include: personal information about each participant, their progression to addiction, and the factors that influenced their addiction and/or recovery. This strategy extends the case-oriented teaching method at the core of the Harvard Medical School and Harvard Business School curricula.


We intend for Expressions of Addiction to (a) build an alliance between people struggling with addiction and (b) enhance the relationship between doctor/caregiver and people struggling with addiction.


By creating a “photographic formulation” for each subject who participates in this project, Dr. Shaffer stimulates understanding and compassion for those living with addiction among viewers of Expressions of Addiction. He wants viewers to recognize their vulnerability to addiction and the need for everyone to care for people suffering with addiction because they are us.


As a clinical psychologist and a scientist, Dr. Shaffer observes addiction from a different perspective than most. As a photographer, he sees the inner struggle that characterizes the ambivalence typically associated with addiction [12, 13, 14]. By integrating these unique perspectives, Dr. Shaffer creates images that evoke an empathic response from viewers.


Brief Project Methods and Plan

Identifying Portrait Subjects

Treatment programs committed to collaborating on Expressions of Addiction:


  • St. Francis House’s Moving Ahead Program (for homeless substance abusers seeking to curb their addiction and enter the workforce.
  • The Massachusetts Council on Compulsive Gambling (an organization that coordinates the treatment of gambling disorders)
  • The North Charles Institute for the Addictions (an outpatient drug treatment program that provides methadone maintenance and drug-free psychosocial treatment)
  • The Drug Treatment Services of the Cambridge Health Alliance
  • The Tewksbury State Hospital
  • The Driving Under the Influence of Liquor (DUIL) Program (an inpatient treatment program for those convicted of multiple driving under the influence offenses).

In addition to identifying participants through these programs, people with some past or present expression of addiction who are interested in joining this project can apply to be considered for inclusion.


Public Distribution of the Expressions of Addiction Exhibit


The Division on Addiction has announced, on its Web site (currently, 50,000 annual visitors with approximately 38,000 weekly visitors), the availability of the exhibit and has invited community organizations, galleries and museums to apply to host the exhibit.


Expressions of Addiction has been shown in:


  • Radisson Hotel, Boston, October 2006
  • Rio Las Vegas Hotel and Casino, Las Vegas, November 2006
  • State House, Boston, February 2008
  • Boston Museum of Science, April 2008
  • Boston's St. Francis House & Roxbury Community College Performing Arts Festival, April 2008
  • Massachusetts Council on Compulsive Gambling Annual Conference, UMass Boston, May 2008
  • St. Francis House All the Way Home Gala, Boston, October 2008
  • Sheraton Hotel, Braintree, St. Francis House, April 2009
  • UMass Boston Health Education and Wellness, October 2009
  • North Charles Institute for the Addictions and Mental Health, January - May 2010
  • Foundation for Recovery, Art of Recovery Exhibit and Auction, University of Las Vegas Tam Alumni Center, March - April 2010
  • Massachusetts Council on Compulsive Gambling, National Conference on Problem Gambling, July 2011
  • Cold Spring Harbor Laboratory, President's Council Meeting, The Science of Addiction, October 2011


Expressions of Addiction was featured on About Health TV, a half-hour talk show (click here to watch). This program, co-produced by the City of Boston and Family Health Productions, aired in the following cities: Boston; Atlanta; Denver; Detroit; San Diego; Phoenix; St. Louis; Cleveland; Spokane; Miami; Orlando; Arlington, Texas; Jersey City, New Jersey; and Athens, Ohio.


About Health TV transcripts, including the transcript about Expressions of Addiction will be posted on, which reports approximately 100,000 visitors monthly.




  1. Shaffer, H.J., et al., Toward a syndrome model of addiction: multiple expressions, common etiology. Harvard Review of Psychiatry, 2004. 12(6): p. 367-374. If you would like to have access to this document, email us your name and the name of the article you are requesting.
  2. Odegaard, S., A. Peller, and H.J. Shaffer, Addiction as Syndrome. Paradigm, 2005. 9(3): p. 12-13, 22.
  3. Kessler, R.C., et al., Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 2005. 62(6): p. 593-602.
  4. Breslau, N., Johnson, E., Hiripi, E., Kessler, R. (2001). Nicotine Dependence in the United States: Prevalence, Trends, and Smoking Persistence. Archives General Psychiatry, (58), 810-816.
  5. Kessler, R.C., et al., Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Archives of General Psychiatry, 1997. 54(313-321).
  6. National Comorbidity Survey. National Comorbidity Survey Publications. [Word Wide Web] 2005 [cited 2006 January 30]; Available from:
  7. Christenson, G.A., et al., Compulsive buying: descriptive characteristics and psychiatric comorbidity. The Journal of Clinical Psychiatry, 1994. 55(1): p. 5-11.
  8. Shaffer, H.J. and D.A. Korn, Gambling and related mental disorders: a public health analysis, in Annual Review of Public Health, J.E. Fielding, R.C. Brownson, and B. Starfield, Editors. 2002, Annual Reviews, Inc.: Palo Alto. p. 171-212.
  9. Shaffer, H.J., M.N. Hall, and J. Vander Bilt, Estimating the prevalence of disordered gambling behavior in the United States and Canada: a research synthesis. American Journal of Public Health, 1999. 89: p. 1369-1376.
  10. Musilli, J., et al., Camera three. Objective camera, subjective truth--W. Eugene Smith. 1975, United States: CBS-TV. 1 videocassette of 1 (VHS) (29 min.).
  11. Cartier-Bresson, H. and E. Tériade, The decisive moment. 1952, New York: Simon and Schuster.
  12. Smith, W.E. and A.M. Smith, Minamata. 1st ed. 1975, New York: Holt, Rinehart, and Winston. 192.
  13. Shaffer, H.J., Denial, ambivalence and countertransference hate, in Alcoholism: Dynamics and Treatment, J.D. Levin and R. Weiss, Editors. 1994, Jason Aronson: Northdale, N.J. p. 421-437.
  14. Shaffer, H.J., The psychology of stage change, in Substance abuse: a comprehensive textbook, J.H. Lowinson, et al., Editors. 1997, Williams & Wilkins: Baltimore. p. 100-106.
  15. Gopalan, R., et al., Evaluation of a model curriculum on substance abuse at The Johns Hopkins University School of Medicine. Academic Medicine, 1992. 67(4): p. 260-266.
  16. Shaffer, H.J. and M. Robbins, Psychotherapy for addictive behavior: a stage-change approach to meaning making, in Psychotherapy and Substance Abuse: A Practitioner's Handbook, A.M. Washton, Editor. 1995, Guilford: New York. p. 103-123.
  17. Shaffer, H.J. and G. Simoneau, Reducing resistance and denial by exercising ambivalence during the treatment of addiction. Journal of Substance Abuse Treatment, 2001. 20(1): p. 99-105.


Copyright © 2013 Howard J. Shaffer. All rights reserved.