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The theoretical model is based upon the postulate of the self-esteem motive, whereby, universally and characteristically, a person is said to behave so as to maximize the experience of positive self-attitudes, and to minimize the experience of negative ones. Self-attitudes refer to the person's (more or less intense) positive and negative emotional experiences upon perceiving and evaluating his or her own attitubutes and behavior. The model does not apply in the rare instances in which a basic condition for the development of the self-esteem motive is not present. This condition is the early and continued existence of stable relationships between self and significant others in the context of which the behavior of significant others is predictably contingent upon the responses of self. Such a condition is not present where the responses of significant others are either uniform (whether in a punitive or rewarding direction) or random.

lntense self-rejecting attitudes are said to be the end result of a history of membership group experiences in which the subject was unable to defend against, adapt to, or cope with circumstances having self-devaluing implications (that is, disvalued attributes and behaviors, and negative evaluations of the subject by valued others). These encompass a range of variables apparent in other theories including peer rejection, parental neglect, high expectations for achievement, school failure, physical stigmata, social stigmata (e.g., disvalued group memberships), impaired sex-role identity, ego deficiencies, low coping abilities, and (generally) coping mechanisms that are socially disvalued and/or are otherwise self-defeating. The likelihood of experiencing circumstances with self-devaluing implications and/or failing to possess effective adaptive/coping/defensive patterns (which would forestall or assuage the experience of circumstances with self-devaluing implications) is in turn influenced by complex patterns of interacting social (value system, available social support mechanisms, complexity of the social system, rate of social change, positions in the social system, etc.) and ontogenetic (including constitutionally given deficits) variables.

By virtue of the actual and subjective association between past membership group experiences and the development of intensely distressful negative self-attitudes, the person loses motivation to conform to, and becomes motivated to deviate from, membership group patterns (those specifically associated with the genesis of negative self-attitudes and, by a process of generalization, other aspects of the membership groups' normative structures). Simultaneously, the unfulfilled self-esteem motive prompts the subject to seek alternative (that is, deviant) response patterns which offer hope of reducing the experience of negative (and increasing the experiences of positive) self-attitudes. Thus, the person is motivated to seek and adopt deviant response patterns not only because of a loss of motivation to conform to the normative structure (which has an earlier association with the genesis of negative self-attitudes) but also because the deviant patterns represent the only motivational ly acceptable alternatives that might serve self-enhancing functions effectively.

Which of several deviant patterns is adopted, then, would be a function of the person's history of experiences influencing the visibility and subjective evaluation of the self-enhancing/self-devaluing potential of the pattern(s) in question. A particular drug use/abuse pattern is more likely to be adopted, for example, if, due to the greater availability of the drug its use was more apparent among peers at school or in the neighborhood—that is, if the pattern was more visible. The

subjective likelihood of self-enhancing consequences of the behavior will reflect such variables as the subjectively perceived attitudes toward the illicit drug abuse pattern by members of positive and negative reference groups (peers, family, authority figures, school), the visibility of more or less prevalent adverse consequences of use of the illicit drug (arrest, loss of control, etc.), and the perceived compatibility of the consequences and concomitants of the drug abuse pattern with behavior (in)appropriate to (dis)valued social roles.

Adoption of the deviant response has self-enhancing consequences if it facilitates intrapsychic or interpersonal avoidance of self-devaluing experiences associated with the predeviance membership group, serves to attack (symbolically or otherwise) the perceived basis of the person's self-rejecting attitudes (that is, representations of the normative group structure), and/or offers substitute patterns with self-enhancing potential for behavior patterns associated with the genesis of selfrejecting attitudes. Avoidance functions might be served through the consequent rejection of the subject who adopted the drug abuse pattern by the normative membership groups in which the self-rejecting attitudes were developed (resulting in decreased vulnerability to continuing self-devaluing experiences), facilitating regressive return to a more dependent state (thus avoiding one's responsibilities and the risk of failure to carry them out), the pharmacologic effects of detachment or anesthetization of self-punitive feelings, etc. Attacks upon the normative structure are symbolized by the illicit nature of the behavior pattern. Substitute gratifications may be provided by identification with a community of users who accept the subject by virtue of his or her conformity to group norms, pharmacologic induction of feeling in control of one's moods, facilitation of self-enhancing social interaction, replication of an earlier time (the womb) of feeling more accepted, etc.

To the extent that the person in fact experiences self-enhancing consequences, is able to defend against any intervening adverse consequences of the behavior (anticipated or unanticipated), and does not perceive alternative responses with self-enhancing potential the pattern is likely to be confirmed. Whether or not these outcomes occur will be a function of such mutually influencing variables as the nature of the deviant act, societal response to the act, and the person's need-value and adaptive/coping patterns. For example, a highly visible and highly disvalued act might lead to apprehension and adjudication with consequences of stigmatization, enforced deviant role enactment, exacerbation of a need to justify the act through continued performance of it, isolation from social control, isolation of the subject from legitimate opportunities, and exposure to self-enhancing illegitimate patterns, while at the same time being congruent with personal need disposition (e.g., power) and defense/coping mechanisms (e.g., attack). ln such a case the deviant pattern might become part of the subject's personal and (new) social lifestyle, with the pattern being performed as appropriate to the new lifestyle and with gratification coming from conformance with the lifestyle. lnsofar as the new lifestyle precludes the experience of self-devaluing life events which were characteristic of former membership group experiences, the deviant pattern should, a fortiori, have self-enhancing consequences.

Or, the deviant pattern may have a low probability of evoking severe (if any) sanctions from membership groups (whether because of low visibility or otherwise) but still have self-enhancing consequences, in which case the subject may be expected to perform the pattern in response to discrete life events with self-devaluing implications. The frequency of the deviant pattern becomes a function of the frequency of self-devaluing life events and continuity of a net aggregate of gratifying over punishing consequences of the deviant adaptation.

However, cessation of the drug abuse (or other deviant patterns) would be likely to occur if and when self-devaluing outcomes outweighed self-enhancing outcomes. ln that case the subject would be likely to experiment with alternative modes of deviance, since normative patterns would continue to be motivationally unacceptable as long as they were subjectively and in fact associated with self-devaluing experiences. But insofar as individual maturation and correlated changes in socioenvironmental experiences (including social support systems) reduce the likelihood of self-devaluing experiences, offer new opportunities for self-enhancement, and provide the person with effective coping mechanisms and a correlated realistic sense of control over the environment, the illicit drug use is likely to cease in favor of normative response patterns.

The person is likely to relapse into the deviant response pattern only in the face of erosion of personal and social support mechanisms, pervasive self-devaluing experiences, and a history of self-enhancing consequences of earlier illicit drug use.

Support for the theory is provided by a consideration of the compatibility of the theory with previous studies on deviant behavior (Kaplan 1972, 1975b) and by the results of a prospective longitudinal study of adolescents which was designed to test several aspects of this theory, including those concerning the postulate of the self-esteem motive (Kaplan 1975d), hypothesized antecedents of negative self-attitudes (Kaplan 1976a), relationships between antecedent level of (and increases in) self-derogation and subsequent adoption of deviant responses (Kaplan 1975a, 1976b, 1977b, 1978a), factors said to intervene between self-derogation and subsequent deviant response patterns (Kaplan 1975c, 1977a), and self-enhancing consequences of deviant responses (1978b).

SPECIAL POPULATIONS

The theory applies specifically to populations in which any particular drug use/abuse pattern under consideration is regarded as deviant. lt does not apply to populations in which the pattern is uniformly adopted and/or approved.

The Iowa Theory of
Substance Abuse Among
Hyperactive Adolescents

Jan Loney, Ph.D.

STATEMENT OF THEORY

Childhood hyperactivity is believed to affect approximately five percent of elementary school children and to represent perhaps 50 percent of children referred for evaluation to child psychiatrists and psychologists. lt is a complex condition, variously defined, and its cause and cure are unknown. Although described by several overlapping terms, some of which presume a subtle organic etiology (e.g., minimal brain dysfunction or MBD), diagnostic emphasis has centered upon the four As: activity (hyperkinetic reaction of childhood), attention (attention deficit disorder), aggression (conduct disorder), and/or achievement (learning disability).

Hyperactive children are generally considered to be at significant risk for the development of low self-esteem, academic skill deficits, and a variety of delinquent behaviors—including substance abuse. A body of data connects childhood hyperactivity with subsequent antisocial and alcoholic diagnoses (e.g., Goodwin et al. 1975). That connection has been shown to be familial (Cantwell 1972; Morrison and Stewart 1971) and is considered by some to be genetically determined. Many experts on hyperactivity endorse what is often called the primary-secondary theory (Cantwell 1978; Wender 1971). According to that theory, hyperactivity and a variety of closely related symptoms, such as inattention, are primary or constitutional features of the hyperkinetic child's condition. ln medical terms, these primary symptoms are assumed to covary across time and situations, and they constitute the core hyperkinetic syndrome or attention deficit disorder. Secondary or resultant symptoms, such as aggression, are assumed to be the product of negative interactions between the hyperkinetic child and his or her environment: punitive parenting, academic failure, peer rejection, etc. Thus, antisocial and norm-violating behaviors such as substance abuse are viewed as secondary consequents of severe primary hyperkinesis. Another popular theory might be called the conduct disorder theory (Barkley, in press; Quay 1979). Proponents of that

theory stress the inseparability of hyperactivity and aggression, and they maintain that hyperactive children (i.e., children with conduct disorders) are noncompliant, destructive, explosive, aggressive, and antisocial at all ages. Adolescent substance abuse would thus be viewed merely as an age-appropriate expression of the hyperactive individual's lifelong conduct disorder.

The theory of drug use developed at lowa is derived from ongoing multivariate and multisituational studies of several hundred hyperactive boys (Loney et al., in press a; Loney et al., in press b). Youngsters in these studies were referred for outpatient psychiatric evaluation between four and 12 years of age. All were diagnosed as having the hyperkinetic syndrome or minimal brain dysfunction. Each was then treated either pharmacologically (with a central nervous system stimulant) or psychologically (with behaviorally oriented parent and teacher consultation). They are being followed up as adolescents (at 12 to 18 years of age) and as young adults (at 21 to 23 years of age).

Hyperactive children are often lost to school-based questionnaire studies because of reading disabilities, truancy, early school dropout, and placement in special education classes. Data from a presumably vulnerable clinic population such as ours are therefore well suited for answering some initial questions about the attitudinal and behavioral precursors of experimentation with substances early in the substance abuse sequence (Kandel 1975). We have used multivariate statistical techniques to identify those variables from the referral and early treatment periods which predict variation in adolescent behavior and to estimate their relative importance in accounting for that variation.

The results of our studies to date suggest that hyperactivity and aggression are essentially independent (Loney et al. 1978). Childhood hyperactivity is neither a precursor of adolescent aggressive and self-destructive behavior in general, nor a predictor of teenage substance abuse in particular. ln our data, the anticipated link between early hyperactivity and later delinquency is missing. Although adolescent aggression js apparently exacerbated by negative environmental events, it does not appear to be a secondary result of primary or core hyperactivity. lnstead, the link is between early aggression and later delinquency; thus, childhood aggression is apparently primary (Werry 1979). Hyperactive children are not at risk for later illegal substance use unless they are also aggressive; aggressive children are at risk for later illegal substance use whether they are hyperactive or not.

Thus, the outcome for any particular group of children considered to have hyperkinetic reactions, attention deficit disorders, specific learning disabilities, or minimal brain dysfunction syndromes will depend on what proportion of the group is also aggressive. And that proportion will depend in turn on such factors as: (1) whether children with aggressive temperament and behavior (e.g., irritability, defiance, fighting, cruelty) or with diagnoses of conduct disorder or unsocialized aggressive reaction are included in the group because their aggressive behaviors and diagnoses are considered to be inseparable from or developmental expressions of their hyperactive syndrome; (2) whether selection criteria favor the inclusion of youngsters who are both hyperactive and aggressive (e.g., by including children who live in foster and group homes) or hinder their inclusion (e.g., by excluding children from chaotic, punitive, and disadvantaged backgrounds); and (3) whether the circumstances of the study lead, de facto, to an increased probability that children will be sampled who are aggressive as well as

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