Exploring the Evolving Sociocultural Frameworks of Substance Use

In the Age of Enlightenment when Liotard was painting, the availability of chocolate was expanding across European societies, eliciting criticism and even moral panic reminiscent of coffee and tobacco [3]. These dialogues encompassed religious ideologies with divergent Protestant and Catholic standpoints on whether drinking chocolate was permissible during fast [2,3]. Further, certain physicians highlighted negative health outcomes from the stimulant properties of chocolate [3].

In the authors’ opinion, Liotard’s focus on the serving girl, with consumers missing from the frame, perhaps gestures towards this contentious status insinuating hidden and illicit undertones without taking an explicit position.

Conversely, at this time, others championed the therapeutic advantages of chocolate. In some regions, chocolate was deemed helpful for digestive issues and a variety of medical conditions including anaemia, gout and tuberculosis [4]. Throughout the centuries, chocolate would gain mainstream acceptance and become extensively commoditised [5], demonstrated by its almost universal accessibility.

The evolving attitude towards chocolate resemble the alternating societal trajectories of other substances. For example, alcohol has been consumed for different purposes throughout history but its moral, social and health perceptions have fluctuated [6]. Specifically, in medieval and post-medieval Europe, alcohol has been deemed to contain selected health benefits [7]. Yet, messaging from 19th and 20th century temperance movements emphasised its detrimental effects, resulting in prohibition in the United States (US) and European countries like Iceland and Finland [8].

Similarly, morphine-based substances and other opioids have frequently been prescribed as medicine and at times, used recreationally [9]. However, as evidence demonstrating their addictive and harmful impact has developed, so have societal patterns. The recent opioid crisis in the US underlines this, and across distinct jurisdictions, illicit heroin use has been both punitively controlled and to a lesser extent, commercially appropriated [10,11].

Similarly, psychedelics have generated both intrigue and controversy. Used in religious and spiritual contexts and traditions, possible therapeutic applications for psychedelics attracted scientific attention in the early- to mid-20th century, before they were socio-politically stigmatised, politicised and criminalised during the “war on drugs” in the US [12]. This impeded clinical trials, though lately there has been a substantial resurgence in research and interest in their medicinal potential, particularly for mental disorders [12]. Notably, the Australian drug regulator allowed for the prescription of psychedelics for treatment-resistant depression and post-traumatic stress disorder, sparking a range of supportive and opposing sentiments about their safety [13].

As illustrated throughout history, views on substances do not always align with established scientific notions or risks. Despite its well-documented and extensive consequences, alcohol has become ingrained within Western sociocultural practices and is legal in most parts of the world [14].

Significantly, alcohol consumption is linked with global disease and injury burdens, social and economic costs, elevated mortality and disability rates, and other deleterious outcomes [15]. Its associated dangers notwithstanding, alcohol intake remains high throughout Europe (although, this could be changing in some countries as suggested by Swiss data [16]). Interestingly, alcohol and its multivarious connotations also preoccupied later European artists after Liotard. For instance, like “The Chocolate Girl”, Vincent Van Gogh’s (1853–1890) “Café Table with Absinthe” (1887) foregrounds the substance with the consumer being absent from the scene [Image 2].

In contrast, heroin consumption with its substantial harms, is generally prohibited and remains widely marginalised and stigmatised, even by some healthcare professionals [17]. This has created barriers for drug policy advances and sufficient treatment for individuals with substance use disorders, who have pronounced vulnerabilities for psychiatric and somatic comorbidities [17,18].

Returning to the Enlightenment when Liotard was painting, the positive health-related aspects of chocolate may have been influenced by capitalistic incentives, with a growing consumer base strengthening economic drivers [3]. Taken together, these paradigms all imply a complex and continuous interplay between social, cultural, economic, judicial and political forces in shaping macro-level attitudes towards specific substances.