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
Expressions of Addiction goals are to:
Increase awareness and understanding of
addiction as a prevalent and non-partisan mental health
and behavioral disorder.
Contribute to community
programs and resources to prevent and treat addiction
and support addiction-related public policy.
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
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
- 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
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.)
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  of art
provides an opportunity for viewers to project their
emotions and empathize with a photograph. The decisive
moment  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
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
- 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
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
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
Expressions of Addiction has been shown in:
- Radisson Hotel, Boston, October
- Rio Las Vegas Hotel and Casino,
Las Vegas, November 2006
- State House, Boston, February
- Boston Museum of Science, April
- Boston's St. Francis House &
Roxbury Community College Performing Arts Festival,
- Massachusetts Council on
Compulsive Gambling Annual Conference, UMass Boston,
- 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
www.abouthealth.com, which reports approximately
100,000 visitors monthly.
- 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.
- Odegaard, S., A. Peller, and H.J. Shaffer, Addiction
as Syndrome. Paradigm, 2005. 9(3): p. 12-13, 22.
- 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.
- 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.
- 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.
- National Comorbidity Survey. National Comorbidity
Survey Publications. [Word Wide Web] 2005 [cited 2006
January 30]; Available from:
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The Journal of Clinical Psychiatry, 1994. 55(1): p.
- 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.
- 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:
- Musilli, J., et al., Camera three. Objective camera,
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