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rewards for exemplary behavior, feelings of self-worth and good selfesteem do not develop.
Good social interest can be developed only as a result of otherdirectedness, i.e., a concern for others. Other-directedness is a primary phenomenon that is healthy in conjunction with socially useful goals.
Goal orientation is very important to self-esteem theory, because success and failure can only be understood subjectively and not objectively; outward symbols of success must be understood in terms of the individual's own perceptions. Those who, to others, seem to have the world by the tail may see themselves as failures (e.g., Marilyn Monroe). In this respect, Adler says,
In this psychological schema there are two approximately
(Ansbacher and Ansbacher 1956, p. 245)
Insecurity in childhood causes the individual to set high goals and to develop compensatory safeguarding measures: "If I didn't have this headache, I would have done better" or "If I hadn't drunk so much last night but had studied, I would have done better on my exam." The individual may well resort to drug abuse as a coping mechanism.
Individuals are constantly striving for superiority; all behavior is an effort to achieve success (positive situations) and to overcome obstacles (negative situations). Motivation is a goal-directed drive; lack of motivation is a symptom, not the cause, of neurotic behavior.
To cope with over-life-sized goals and low self-esteem, the individual may turn to drug abuse.
Adler defined lifestyle as "the wholeness of his individuality" (Adler 1933), the guiding line of the personality. He originally called it "Lebensplan" (life plan), then "Lebenstil" (lifestyle), and finally, style of life. He further says,
In other words the child must have formed a guiding line
(Adler 1912, p. 33)
Max Weber (1974) was the first to use the concept of lifestyle to refer to a way of life of a subculture--a group-guiding principle. Adler
used it to refer to the individual's guiding principle. Thus, lifestyle refers to the individual's orientation toward social behavior--the guiding line of the personality, the core around which the personality revolves. Lifestyle is the whole which unifies the parts.
It is the uniqueness of humans that made Adler call his theoretic development individual psychology, stressing this uniqueness. Every person is the same as every other, and every person is different from every other: Culture is the unifying principle.
There are two forms of deviant lifestyle--pampered and neglected. A pampered lifestyle results from an overprotective mother who takes all responsibility for her child's behavior, preventing the child from developing a feeling of self-worth from his or her own accomplishments. Here rewarding success does nothing to establish a feeling of self-worth. Approval and reward are seen as coming only from superior performance. Love is perceived as a response to this performance rather than as a feeling for himself or herself as a person, producing very weak selfesteem.
The counterpart of the pampered lifestyle is the neglected lifestyle of the impoverished environment, in which the individual receives almost no attention and is left to his or her own devices. The patterns of drug abuse as coping mechanisms may vary between these two polar situations, for example, heroin addiction among ghetto youths and marijuana abuse among middle-class college youths (Steffenhagen 1974). Today we see marijuana abuse among lower class youths and heroin addiction increasing among the middle/upper middle-class youths, showing that the type of abuse is a function of the zeitgeist as well as the availability of the drug, which may account for the kaleidoscopic nature of the present drug scene.
Sutherland's (1939) differential association theory of deviance is directly applicable to our Adlerian model. Adler was keenly aware of the role of society in shaping the individual's behavior. Differential association has a direct impact upon the form deviance will take, given low selfesteem. Sutherland postulates that deviance is learned and that the internalization of such behavior is a function of duration, frequency, intensity, and priority of deviant associations. It becomes clear in the college milieu that the more time an individual spends within a drugusing group, the more likely he or she is to use drugs. Becker and Strauss (1956) clearly indicate the role socialization plays in this situation. I mentioned previously how heroin use became a problem in Vietnam. Boredom and social stress, which led to a need for a social release of tension, and the acceptance of heroin by the peer group were sufficient criteria for the development of a drug problem without any need for neurotic coping mechanisms. This is an example of individuals with relatively high self-esteem becoming drug abusers as a result of the social milieu. The relevance of this to the rehabilitation process will be discussed in detail later.
Peer pressure during adolescence is particularly powerful. The need for acceptance, while always an important drive, is especially strong during this formative period, and helps to account for the heavy drug use in the youth subculture. The pressure is not always overt or
obvious but may be covert or subtle: The fact that an activity may be the agent around which the group coalesces may provide the impetus for experimentation. In the case of marijuana, differential association is particularly important since the individual must associate with users in order to try the drug and then to obtain a supply. Both the preference resulting from association and the necessity prevail.
SELF-ESTEEM AND DEVIANCE
As I have said, who will become a drug user or abuser cannot be explained on the basis of any single psychodynamic factor but must take account of the social milieu. Our postulate is that an individual with low self-esteem will become a prime target for drug abuse as a result of the prevalence of drug information--true or false--provided by the mass media. Behavior accompanying low self-esteem can best be explained by the following model:
The behavior need not occur singly, but can also occur in combination. Gross multiple-drug users in college show more emotional disturbance than the nonusing population (McAree et al. 1969, 1972), indicating neurosis coupled with drug abuse. In 1974 I further postulated that drug abuse (and neurosis) may also move toward the occult, in which case the drug use may continue or be replaced by the occult support. Participation in the occult may provide an immediate source of power as a coping mechanism or may provide a form of group self-esteem (Lieberman et al. 1973).
In the lower class, low self-esteem may take the forms of neurosis, drug abuse, and delinquency. In this milieu, drug abuse and delinquency are a much more likely pair than drug abuse and occultism. The occult appeals largely to the intellectually curious, especially college students. In both social classes, we may find drug abuse and suicide pairing together. Alcoholics are much more likely to commit suicide than are nonalcoholics:
Drug abuse is seen generally as an expression of the pam-
(Steffenhagen 1974, p. 249)
It is important to realize that while low self-esteem is postulated as the underlying psychodynamic mechanism for drug abuse, it is not a sufficient or necessary condition for initiation. The social milieu can also provide the impetus (differential association plus existence of the drug). The initiation into drug use may then stem from the social milieu, but the abuse of the nonaddicting drugs would be associated
with low self-esteem. Further, although a cessation may be superimposed by the social structure, relapse would be likely to occur in the case of low self-esteem. As in the example of Vietnam and heroin, the impetus came from the social situation--drug use continued as long as the social situation remained constant, whereas when the situation changed cessation occurred. We have two possible outcomes: (1) the individuals with good self-esteem remained drug free whereas (2) those individuals with low self-esteem were likely to relapse since an already tried neurotic coping mechanism was within their repertoire.
I also postulate that self-esteem is important in determining the effect that stress will have upon the individual. A person with low selfesteem will respond much more negatively to stress than a person with high self-esteem. In the case of the pampered lifestyle the individual may function adequately as long as he or she has the support system provided by the family but may quickly resort to neurotic coping mechanisms when this support system is removed--such as by the death of parents or by merely going away to college.
The following paradigm is offered:
Self-esteem + Lifestyle + Personality + Goal orientation +
Self-esteem--high or low
These are not mutually exclusive categories, since they all interrelate, and the lifestyle of the parent is superimposed upon the child. Selfesteem is posited not as the apex of the personality but the foundation,
The theory postulates that the psychodynamic mechanism underlying drug abuse is low self-esteem. Self-esteem develops through experiential behavior involved in mastery, the ability to master situations and achieve one's goals. Low self-esteem may result either from setting goals too high or from not achieving realistic goals because of a lack of confidence in the ability to attain them. The latter situation may happen when a parent or a significant other does everything for the child, never allowing him or her to develop talents for mastery. William James' formula, success over pretentions equaling self-esteem, reflects this situation (James 1890, p. 310). This is not solely a result of intrapsychic processes but also of the social order. Goals are set by the individual (the individual's uniqueness), but they are provided by the social system. According to Merton (1938), success as defined by the American credo is largely equated with the attainment of money. This is further evidenced by the fact that America is a secular/materialistic culture, as opposed to a religious/spiritual culture (Roszak 1975). The American credo provides the basis for the goals (which sociologists frequently call aspirations), but the social structure
does not always provide the means (expectations) for attainment. However, although many forms of deviance cannot be explained solely within the framework of this perspective, e.g., marijuana use among the youths of today, nevertheless we must look to the social milieu for part of the answer.
Even when the goals prescribed by the culture are not readily attainable due to social deprivation, low self-esteem is not inevitable. The individual may be able to lower goals appropriately so that attainment is possible, and thereby achieve satisfaction and develop a feeling of self-worth.
All behavior is goal directed or goal striving--it is the energizing state of the organism. Since all behavior becomes goal striving, individuals evaluate themselves in terms of their perceptions, their evaluation of themselves in terms of achievements. High self-esteem is achieved when the evaluation is good and socially useful; when the evaluation is bad or on the socially useless side of life, low self-esteem results. Thus, it becomes apparent that self-esteem is the key variable underlying drug abuse. If individuals feel inadequate (inferior), they feel a need to protect their poor self-image, frequently through compensatory mechanisms which create further problems in interpersonal relations and add to the feelings of inferiority.
Our theory also helps us explain why Alcoholics Anonymous (AA) and Synanon are only rehabilitative' and not curative. It is generally accepted that alcoholics are never cured but remain functional only as long as they remain active in AA, and a similar condition seems to prevail for the members of Synanon and even Weight Watchers. It is our contention that this can be easily explained within the self-esteem theory, because both of these organizations do nothing to build individual self-esteem but, rather, build a form of group self-esteem resulting from and depending on group support cohesion (as the pampering mother). All of these organizations provide a socialization function, and the individual is socialized to remain problem free only within the framework of the group.
With the self-esteem theory we can explain nonuse, social use, and abuse of drugs as well as why various therapeutic models are or are not successful. It is possible that an ex-AA member may remain sober, but this can be explained within the context of the support system or unique circumstances where the drug as a coping mechanism loses its function as a self-esteem protecting mechanism.
'By rehabilitation I mean that the individual is returned to a state of "normal" functioning but not cured of the pathology, which can become reoperative due to trauma.