stage of development, and that users who are part of that culture are helped to cope with their experiences. For example, the notion that a "bad trip" can be brought to a speedy conclusion by taking Thorazine has spread. Knowledge of other safeguards is also becoming more widely known. Insofar as this emergent culture spreads so that most or all users share the belief that LSD does not cause insanity, the knowledge about dosage, effects, and so on, as well as the incidence of "psychoses" should drop markedly or disappear." On the other hand, the ease with which LSD can be taken may negate the helpful influence of an LSD culture. No special paraphernalia is necessary, no special technique. A sugar cube can be swallowed without instruction. Consequently it is possible that many people will take the drug without having acquired the presently developing cultural understanding, that many users will be people with no previous experience of recreational drug use, and that they will take it without the presence of supportive, experienced users. Changing mores about youth use may add to the number of people who take the drug without being indoctrinated in the new cultural definitions, in which case the number of episodes may go up." We have been talking of drug use in which taking the drug is a matter of choice and in which the desired effect is a subjective one. But people also delegate control of their drug use to others, most commonly to physicians. When people take drugs prescribed to them by doctors, they do not rely on trial and error or a drug culture for knowledge concerning dosage, main effects, and side effects, but usually on the doctor. While the doctor wants to alleviate some dangerous condition the patient is suffering from, doctor's and patient's desires do not necessarily coincide. Moreover, the doctor may not give patients sufficient information to anticipate the effects a drug may have, with the result that patients are sometimes unnecessarily frightened or may suffer dangerous reactions without connecting them with the drug. The doctor may not give patients all the information he or she has for fear that the patient will disobey orders (Lennard 1972). Sometimes the doctor does not have adequate information about the experience the drug will produce. In either case, the drug experience is amplified and the chance of serious pathology increases. The patient, not knowing what is likely to happen, cannot recognize the event when it occurs and cannot respond adequately or present the problem to an expert who can provide an adequate response.' CONTROL BY EXTERNAL AGENTS People sometimes find themselves required to ingest drugs involuntarily. In some instances, the agent administers the drug believing it to be for the good of the patient, as when a doctor gives medicine to a baby, who cannot resist. Or the agent may administer drugs "for the Material in these paragraphs was taken from "History, Culture and Subjective Experience: An Exploration of the Social Bases of DrugInduced Experiences." See footnote 1. 'Material in this paragraph was taken from "Consciousness, Power and Drug Effects," pp. 71-72. See footnote 1. good of the community," as when people with tuberculosis or leprosy are medicated to prevent them from infecting others (Roth 1963). But sometimes the external agent's purposes conflict directly with those of the user, as when people find themselves the victims of chemical warfare. Those who administer drugs to involuntary users are either indifferent about providing recipients with any knowledge about it or actively attempt to prevent them from getting that knowledge. Where destruction or incapacitation of the target population is the aim, the agent may try to conceal the fact that a drug is being administered. In this way, the agent hopes to prevent the taking of countermeasures and, in addition to the drug's specific physiological effects, create panic at the onslaught of the unknown.R CONCLUSION If drug experiences somehow reflect or are related to social settings, we must specify the settings in which drugs are taken and the specific effect of those settings on the experiences of the participants. This analysis suggests that it is useful to look at the role of power and knowledge in those settings: knowledge of how to take the drugs and what to expect when one does, and power over their distribution, the acquisition of information about them, and the decision to take or not to take them. The need for further research extends both to the licit and illicit use of drugs, to the danger of taking drugs for recreational purposes (including "prescribed" drugs), into the profit orientation of pharmaceutical manufacturers, and to the sometimes inadequate knowledge and sometimes ambivalent motives of doctors who share or do not share their knowledge with their patients. Material in these paragraphs was taken from "Consciousness, Power and Drug Effects, pp. 74-75. See footnote 1. Material in this paragraph was taken from "Consciousness, Power and Drug Effects," p. 75. See footnote 1. Drug Abuse as Calvin J. Frederick, Ph.D. Although there are recognized physiological factors involved in hardcore addiction, the sine qua non for drug abuse/addiction is to be found in learning theory. A variety of components, such as cultural environment, availability, exposure to drug use patterns, and self-perceived needs, contribute to the acquisition of a drug habit. The fact that physical relief occurs in the addictive cycle cannot be separated from the psychological aspects which accompany it. The impact of profound relief adds appreciably to the learning process. What was so satisfying during the initial period of tension reduction will be likely to repeat itself under similar circumstances on the next occasion. A learning framework can explain not only drug abuse/addiction but other related behaviors as well. This has been noted previously by the author (1972, 1973), by Frederick and Resnik (1971), and by Frederick et al. (1973). The learning theory paradigm tends to follow a particular sequence. When an intense stimulus situation remains relatively unchanged, it will inevitably be followed by anxiety, a state which requires diminution. In terms of traditional reinforcement theory, anxiety is a secondary reinforcer, since the attainment of the goal object (drug) possesses its own reinforcing properties. This occurs because, through past experience, drug ingestion has become associated with a primary drive state, such as a physiological need or imbalance. For our purposes here, any stimulus condition which contributes to this drive state is sufficient to support the notion of drug abuse as learned behavior. The response that follows is likely to become progressively more prominent as a specific act which brings results, since it evokes dramatic attention along with a need for drug ingestion. The ensuing tension reduction from the drug brings relief and reinforcement of the act which induced the administration of the drug in the first place. As this process is repeated, the sequence of events is shortened in time because the decrease in tension reduction becomes so powerfully reinforced, and every point in the sequence becomes an associative cue for the ultimate relief. With each reinforcement, the act of substance abuse becomes strengthened, and the likelihood of its recurrence under similar conditions is increased. In cases when the tension is particularly acute, such an act may be learned very quickly. The paradigm looks like this: stimulus situation (stress, shame, guilt) tension (anxiety) → addictive acts (drug seeking/receiving/ingesting) → tension reduction→ stimulus situation--and the cycle repeats itself. Other authors (Wikler 1965, 1973b; Jaffe 1970a; Crowley 1972), have also commented upon the learning components inherent in drug abuse. A description of the theoretical contribution of each of the major elements in this treatise can not only illustrate the theory but can make each of the five elements of drug abuse--initiation of use, continuation, shift or transition from use to abuse, cessation, and relapse-more understandable, especially to the therapist. Drug abuse is expressed as a ratio of destructive factors to constructive factors operating in the personality. These factors are multiplicative functions of each other as they contribute to drug behavior. This may be illustrated as follows: Md = Hd = Drug addiction or abuse Personality components that are weak and destructive Motivation or strength of drive state toward destructive, undesirable behavior Habits as a function of the number of reinforcements Rd = Risk-taking stimuli associated with drug ingestion Pc Motivation or strength of drive state toward constructive, desirable behavior Hc = Habits as a function of the number of reinforcements Rc = Risk-taking stimuli associated with constructive responses Let the value of 1.0 be considered the point where drug addiction or abuse will definitely occur; zero represents the value where no likelihood of such behavior obtains. As the proportion moves upward from the equally weighted value of 50 percent (0.50), the probability of drug abuse, thereby, increases as the value of 1.0 is approached. Conversely, the likelihood of drug abuse occurring decreases proportionately as the numerical value approaches zero. Each of the variables listed in the formula will possess its own weights, according to past experience and those influences currently operating in the life of the individual. Since destructive and constructive factors in drug addiction or abuse may be expressed illustratively as a ratio, strong personality and motivational variables predominate as constructive forces in the denominator, while habits and motivation are equal in both the numerator and denominator. In order to show the learning principles involved, let us assume that there is an equal chance for the growth of destructive and constructive factors which contribute to the development of drug-related behavior. A 50-percent probability represents this situation numerically. This may be shown by substituting arbitrary values for each of the variables in the formula, as follows: = Pd x Md x Hd x Rd 2 x 3 x 1 x 5 30 = When the risk-taking aspects of the destructive factors increase even slightly, there is a growth in the likelihood that drug abuse will develop. This will obtain even when other factors remain the same as those in the situation noted above, with a 50-percent probability in the level of occurrence. This change may be demonstrated by increasing the risk factor (Rd) by one point in the formula, since the ratio value now becomes 0.60, which is closer to 1.0 than is 0.50. Conversely, when the constructive aspects of risk are strengthened by one point in the formula, the likelihood of drug abuse developing decreases, inasmuch as the resulting proportion of 0.42 is closer to zero than is 0.50. Obviously, when the other factors in the equation change through reinforcement or nonreinforcement, the ratio changes accordingly. If one or more of the variables is weakened through nonreinforcement, the scales are tipped in either a destructive or constructive direction, depending upon the total value of the proportion. For purposes of simplification, only the risk factor has been varied here to illustrate the importance of a single value in the ratio. Moreover, factors other than those noted may be involved, although these seem to be the most prominent, especially if environmental influences are subsumed under those listed. Risk-taking behavior, in particular, is likely to be responsive to environmental stimuli, for example. The abuser/addict should be aware of the increase in risk-taking behavior as a destructive force since mere geographic placement into an old, familiar environment can often stimulate the recurrence of a previous drug problem. This is due to the strength of past associations as they contribute to old habits of drug use. Substitute medications, such as methadone, may alter the balance of destructive factors in the behavioral equation by reducing anxiety and a tendency toward depression on a tentative basis. Frederick et al. (1973) report that clinical depression recurs during methadone abstinence, and, hence, the abuser/addict and the therapist should be cognizant of this fact as well as of the temporary palliative effects of drug substitutes like methadone. This must be taken into account in the readjustment process of a therapy program. Substitutes in effective living can be supplied, rather than replacing one drug with another, particularly at a point in treatment when the habit has begun to lose strength. The relearning process affects every facet of the treatment program through the same principles by which abuse/addiction develops and continues. |