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The psychological focus identifies as the major causative factors those which operate directly within the person's life space. lndividuals are directly influenced only by internal processes or by that which happens in their immediate environment. lnternal processes include physiological processes; the residuals of past experiences, including beliefs, opinions, expectations, attitudes, and values; and psychological processes. Direct environmental influences consist of the objects and events in the immediate environment which actually affect the individual. For example, friends taking drugs when the individual is not present is not a direct influence, but learning about friends taking hard drugs is.
This psychological perspective defines other environmental influences as indirect factors which produce or influence the objects and events in an individual's life space. For example, a law which increases the availability of a particular drug would be an indirect influence, producing the direct influence: the presence of the drug in the person's environment.
While a simple, one-element theory is widely desired, our own experiences suggest that such univariate theories are seldom appropriate. Many decisions, including those about drugs, are the result of multiple factors. Because of this, we held open the option in developing our models for multiple causative elements, although, following Occam's razor, we did not wish it to be so unless it were necessary.
Multivariate models are basically of two types. The first and most common is the linear model, in which each element is applied equally to everyone. Ordinary statistical analyses operate from this model; for example, one mean is the estimate of the performance of everyone in a particular group. The multivariate linear models of causation give a unique weight to each causative factor, and the prediction for an individual is a function of the weight for that causative factor and the degree to which it is present for that person.
ln a second type of multivariate model, it is recognized that different individuals may be influenced by radically different situations, producing different effects on their behavior. Moreover, the same behavior may have totally different causes in different people; what is sufficient cause for one individual to engage in illicit drug use may not be for another. ln these situations, simple multiple regression weights, for example, do not apply equally to everyone, and the ordinary statistical procedures of chi-square and ANOVA can be misleading. lnstead, several different causative models need to be developed so that the model applied to an individual is the most appropriate for his or her situation. ln this theory, each of the different causative models which can lead to the same illicit drug use provides a description of a different path by which a person might proceed to a particular behavior.
The allowance for multiple paths as separate models makes the theory more comprehensive. For example, a path in existence prior to the 1914 Harrison Act may no longer exist because of the impact of that act. But the ability to describe that path with the general theory is important for two reasons. First, only as we are aware of a former path to illicit drug use will we be able to avoid accidentally recreating it. Second, it is possible that there are special groups which, from a
psychological perspective, exist today in an atmosphere comparable to that of the general public prior to 1914.
lf multiple models are possible, the question of whether one model is the model does not occur. lnstead the question is whether a model actually describes a group of people who currently or potentially exist. lf so, then that model is important for our total understanding of the phenomena. lt is hoped that demographic studies will provide us with descriptions of which models apply to the greatest number of people, but the therapist interested in the drug abuse of a particular client will be concerned with the most appropriate model for that individual rather than the "popularity" of the model in society.
Another characteristic of our theory is the explicit consideration of multiple stages of drug involvement. lt does not assume that initial drug use and drug addiction have the same causes. Admittedly, some theories do take a single-stage, "take it once and hooked for life" approach. However, we found the evidence strong that many who do have an initial experience with a particular drug do not become continual users, and that many who become continual users do not become addicts. Hence, the causes for each stage may be different, and a set of stages is necessary. Our stages are initial drug use, continual use, and addiction.
While the paths and the stages are summarized here as discrete and unique, they can be expected to blend more in life than they do on paper. A person may follow only one or may follow many paths to drug use and may even function at intermediate points between the stages. The paths and stages are merely theoretical devices to aid our conceptualization for research and intervention purposes and, so, oversimplify the phenomenon somewhat.
Each of the three sections below provides a model for how individuals may try a drug for the first time. Each model represents a major and distinct pathway, but it is important to bear in mind that there may be many individuals who wander back and forth between two or more paths.
NONSOClALlZED DRUG USERS MODEL
One of the more consistently found precursors of illicit drug use is a lack of socialization. Numerous studies have compared the personality characteristics of those who use illicit drugs with those of nonusers. (See Gorsuch and Butler 1976a.) Regardless of the personality scale used, drug abusers are lower on social conformity and social responsibility scales than are nondrug abusers. This is to be expected, for the person without internalized norms against drug abuse is a person who is open to being swayed into drug use by situational factors. As Bowers (1968) showed, those with strong personal norms against it will not use a substance even if the environment allows it, but those
without strong norms will fluctuate widely in their usage depending upon the environmental characteristics.
According to our theory, not being socialized to the traditional culture is a necessary but not a sufficient condition for drug abuse. Hence, socialization is expected to be a unidirectional predictor, with the highly socialized not being involved in drug abuse regardless of peer pressure or the availability of the drug, for example, but with the nonsocialized person engaging in use as a function of situational aspects of availability, peer pressure, and so forth.
For the nonsocialized person, peers play a major role in our contemporary culture. The role they play is twofold. First, it is most often through peers that illicit drugs are made available, since these drugs can seldom be purchased through ordinary means. The peer group may either supply the drug directly or provide information on obtaining it. Having a large number of drug-using friends means that the nonsocialized individual has ready access to drugs. Since there is no internal mechanism to prevent drug usage for this person, such ready access leads to the high rate of initial use. This is what gives the peer group the predictive strength often found in research studies (e.g., Johnson 1973).
Second, the peer group may provide models for drug usage, teaching its members when, where, and how to use the drugs. This theory does not, however, require socialization by the peer group into a drug culture for the nonsocialized individual to have the initial drug experience. The effect is more casual than that—the peer group needs only to provide models for attainment and use of the illicit drugs.
The impact of the peer group will differ for different age groups as a function of the amount of time spent within that group and the extent to which it is free of external controls. With children, peer-group activity is almost never free of adult supervision, so there is little availability of drugs for a nonsocialized child. But adolescents often function without supervision, and hence the channels are more open for illicit drug passage. ,
Parents influence their children, when not actually supervising them, only through the internal standards which they have imparted to them, and with the nonsocialized youth such internal standards are absent. Parents who have not socialized their children regarding drugs have little or no impact on whether the children will have an initial drug experience.
There is some literature to suggest that the absence of the mother or father relates to illicit drug use (Gorsuch and Butler 1976a), and this is probably true because such absences sometimes disrupt the socialization patterns. However, the fact that this effect is not always found is not surprising, because the major variable should be the parenting, not the presence of a particular biological parent. The literature does indeed suggest that parental relationships are poorer among those abusing drugs than among those not abusing drugs. Unfortunately the literature is incomplete, and it is difficult to decipher whether this phenomenon is a result of a lack of proper parenting or a reaction of the parents to a child who is nonsocializable, if such a child exists.
Religious membership has been included in more research studies than almost any other variable and has a highly consistent ability to predict the nondrug user (Gorsuch and Butler 1976a). Unfortunately there has been only one article specifically concerned with the impact of religion (Linden and Currie 1977), so the "why" behind this relationship is just beginning to be explored. ln the nonsocialized model, religious membership theoretically could be expected to operate in three ways. First, membership in a religious body indicates that the parenting figures have themselves been a part of and support traditional socialization and can be expected to pass such norms on to their children. Second, participation in a traditional group would provide for substitute parenting figures if the biological parents were incapable of or unwilling to provide appropriate models and traditional socialization. Third, the religious membership provides a peer group whose members are more likely to be traditionally socialized and supportive of traditional socialization. Such a peer group would be unlikely to make illicit drugs available to the nonsocialized individual. And since nonsocialized individuals have no particular drive for drugs per se, they will fit in with and conform to a nondrug-using subculture just as well as a drug-using subculture.
PRODRUG SOClALlZATlON MODEL
lt is often the case that a person is socialized into a prodrug lifestyle. Some of the clearest examples of this can be found in certain Native American tribes or religious or quasi-religious groups that use drugs for ceremonial or other such purposes. The socialization need not be to illicit drugs. A widely replicated finding in the research literature is that children who use a drug illicitly often come from families where one or more of the parenting figures used drugs. Even though parenting figures generally used licit drugs—over-the-counter drugs and tranquilizers prescribed by doctors—the effect was to teach their children that drugs are good and provide a solution for one's problems. lt is a small step from buying drugs at the corner drug store to buying drugs on the corner.
The parents described by this model are prodrug socializing forces. Because they are. highly respected by and spend more time with their children, the youths are likely also to be prodrug and hence to use drugs, whether licit or illicit. Note that this model does not describe parents who teach moderate or prescribed usage of drugs.
Peers are another source of prodrug socialization. The extent to which encouragement and active solicitation by peers actually occurs is currently debated, for there are counterarguments that the illicit drug subculture, which developed because of common needs for drugs, does not engage actively in socializing others into the culture. Despite the fact that the degree to which this occurs is unknown, it is apparent that it can occur, at least in some cases, and so must be included in the general model.
ln addition to socialization regarding drugs per se, socialization into a set of "sympathetic" personality characteristics may be also important in this model. lt is commonly found that the nontraditional values of individualism and experimentation, as well as the American "left wing" value systems, are predisposing to the use of illicit drugs in that they provide a set of attitudes and values that encourage the type of experiments that can include illicit drug use.
The model assumes that there are prodrug socializing agents in the individual's immediate environment that provide relatively easy access to illicit drugs, numerous opportunities for drugs to be used, and models for their use. With such a background, the motivation need not be strong for an initial drug experience to occur. The normal drive in children and youths simply to try whatever they see others doing is sufficient to account for the actual initial drug experience. To the extent that motivation plays any part in this scheme, the major motivating factors would be the need for status (e.g., to be "adult"), novelty seeking, curiosity, relief from boredom, and a motivation unique to this particular model: conformity.
The origin of the iatrogenic model is found in the initial use of opium and its derivatives for medical purposes before 1900. For many years the addictive properties of such drugs were not understood, and people unknowingly became addicted to these drugs which were used for medical purposes.
ln this model the primary motivation for the initial illicit drug use is the relief of physical pain or mental anguish. A person will seek out a drug not when life is going well—as could occur for the nonsocialized or prodrug socialized individual—but when life is going poorly. The fact that many individuals who try drugs illicitly have already undergone use of similar drugs in hospital settings suggests that they may be influenced by the success of the medical use of these drugs, and perceive illicit drug use as a simple extension of common medical procedures "without bothering the doctor."
Physicians and other medical workers have a considerably higher illicit drug use rate than the normal population. The iatrogenic model stresses the fact that these are the people who see on a day-by-day basis the positive uses of drugs for medical reasons and hence may succumb to the temptation to self-prescribe.