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An Existential Theory of
Drug Dependence

George B. Greaves, Ph.D.

Existential psychology deals primarily with the phenomenal and emotional state of individuals, with a person's experience of the quality and meaning of his or her life, and of means and methods of therapeutic intervention, both verbal and nonverbal, which can lead to an enhancement of an individual's life state. Within the framework of existential theory, human beings are seen to be motivated primarily to satisfy and sustain basic needs and to fulfill certain aspirations (Maslow 1954). The payoff for such satisfaction and fulfillment is a sense of personal wholeness and well being (Maslow 1962; Rogers 1962). The failure to secure basic needs and self-enhancing aspirations leads to a sense of dis-ease and despair, which, in turn, gives rise to activities, both destructive and productive, aimed at reducing such dis-ease and despair. My existential theory represents an attempt to understand and account for destructive patterns of drug use within the framework of existential psychology (Greaves 1974).

Ever since the 1920s, clinicians and researchers studying drugdependent and drug-dysfunctional persons have commented on the pathological personality patterns of such individuals and have offered various taxonomies to describe the range of personality disorders seen. This line of speculation received a major boost with the publication of Pescor's work in 1943, based on a very large sample of drug-addicted persons at the then new Federal narcotics rehabilitation center in Lexington (Pescor 1943a).

The prevailing impression one gathers from a reading of this literature is that certain individuals, as a result of aberrant or unhealthy personalities, represent high risks for drug dependency if they are exposed to certain psychoactive drugs. ln other words, in any H sample of individuals under identical stimulus conditions, there is not an equal chance that any given individual will become or remain drug dependent. Rather, there are systematic and identifiable personality factors which interact with the drug-taking behavior that leads to dependency. This apparent phenomenon has traditionally been called "addiction proneness" (Gendreau and Gendreau 1970).

Critics of the notion of addiction proneness have argued that the very methods which drug researchers have used have guaranteed the results Thus, the kinds of people who wind up in prisons, hospitals, and drug programs to be available for study are exactly those who have a higher incidence of aberrant personality traits: the young, the minorities, the poor. But later studies which have tapped other samples, and studies using matched-sample control groups, have tended to quiet the critics. Among physician addicts, for instance, the familiar elevation in the psychopathic deviancy scale of the Minnesota Multiphasic Personality lnventory (MMPl) was found, as in other addicts, although such an elevation in the Pd scale is not typical of physicians in general Similarly, l found that middle-class adolescents who were drug dependent resembled other adolescents who were hospitalized in a psychiatric hospital but were very unlike their adolescent peers residing in the same city (Greaves 1971).

Those researchers currently working within the area of addiction proneness are no longer content to document addiction proneness but are now working on specifying the personality variables at work in specific kinds of addictions, usually defined in terms of the abuser's drug of choice. Major distinctions have been drawn, for instance, between the personalities of those who prefer heroin and those who prefer amphetamines or barbiturates as drugs of dependency (Greaves, in press; Milkman and Frosch 1973).

Although l have been one of the contributors to the literature on one's drug of choice as a function of personality variables, my main interest has remained with the general phenomenon of addiction proneness. For a clue as to why persons come to abuse drugs, l first turned to the phenomenon of mind-altering or mood-altering drug-use behavior, of which abuse is an extension.

William James was the first to state explicitly and explore the existence of altered states of consciousness within the Western phenomenalist tradition. Writing in the Principles of Psychology, James observes:

Our normal consciousness, rational consciousness as we call
it, is but one special type of consciousness, whilst all about
it, parted from it by the flimsiest of screens, there lie
potential forms of consciousness entirely different.

(James 1890)

While James fell short of stating that individuals have an innate drive to experience these altered states, he did state that the popularity of alcohol derived from its ability to stimulate such states:

lt is the power of alcohol to stimulate the mystical conscious-
ness that has made it such an important substance in man's
history.

(James 1907)

lt remained for Andrew Weil, another Harvard physician, to state James' hypothesis explicitly:

lt is my belief that the desire to alter consciousness period-
ically is an innate, normal drive analogous to hunger or the
sexual drive.

(Weil 1972)

lf James1 hypothesis is true—that there are naturally existing alternative states of consciousness, and it seems almost certain that there are—then several hypotheses seem readily to follow:

1. Such alternative states serve an adaptive purpose to the organism.

2. lt is natural to pursue such states (Weil 1972).

3. Children, due to their relative lack of rational enculturation, are more readily in touch with some of these states (Fraiberg 1959; Weil 1972).

4. The use of drugs is one way to facilitate access to these states (Weil 1972).

l would further hypothesize that—

1. Some adolescents and adults are less able to access altered states of consciousness due to intervening anxiety states and other pathological states;

2. Such persons make use of drugs beyond the motive of accessing such states, using them rather to restore themselves to a state of being by which they are able to access both usual and alternate states;

3. The taking of drugs in an attempt to rectify an abnormal state of personality is a form of automedication, and forms the cornerstone of all drug dependency; and

4. lf persons could access altered states to a more normal degree, i.e., in the ways persons with normal personalities do, they might use drugs, but would not abuse (be dependent on) them.

The automedication hypothesis is, of course, not new (Wahl 1967). Alcoholics have been thought by many to be "treating" themselves chemically for depression, heroin addicts have been described as "numbing" emotional pain, and so forth.

What characterizes the theory proposed here is the specific range of variables believed to lie at the personality and emotional core of all substance abusers. These variables were derived from three sets of empirical observations. As originally set forth, these were as follows:

The first observation is that drug-dependent persons seem
to have fundamentally disturbed sex lives. They are frigid,
impotent, indifferent, prudish, angry, or resentful concern-
ing sex. Whatever their particular disturbance, sex is not a
great or reliable source of pleasure. For many it is frankly
dysphoric. Furthermore, this lack of sexual enjoyment
seems to predate the period of drug dependence and is
certainly aggravated by drug use. Among humans, l have
come to suspect that drug dependence does not supersede
sexual pleasure—it replaces it (Bell and Trethowan 1961).

(Greaves 1972)

The second of my observations has been that drug-dependent
persons as a group do not know how to play—at least not
without their drug. Very few things hold interest in the
straight world; almost nothing is seen as exciting. They
often appear jaded and disinterested in anything around
them that does not directly relate to the drug life style.
They have lost contact with their natural child within them,
and with it their spontaneity, creativity, and joy.

The third observation, and this may be the primary factor
on which the other two are based, is that drug-dependent
persons seem to be remarkably out of touch with pleasurable
somatic feedback. Alcohol-dependent persons are observed
to drink massively more alcohol than nondependent persons
as a function of their blocking the pleasurable effects of
alcohol in low doses. Because of this, they are less able to
pace themselves as drinkers. Whether this lack of somatic
feedback is due to some physiological deficiency which
requires higher dosages of the drug to obtain arousal, or
whether there are specific psychodynamics at work is another
moot point, but an empirical one. My own work strongly
suggests that there are chiefly psychological and attitudinal
factors at work. Whatever the case, if persons who are
drug dependent, or who become drug dependent, are,
indeed, out of touch with primary somatic feedback which
other people would experience as pleasure, this may be the
reason that they do not enjoy sex or play—there is simply
nothing in it for them.

(Greaves 1974)

ln summary, "persons who become drug dependent are those who are markedly lacking in pleasurable sensory awareness, who have lost the child-like ability to create natural euphoria through active play, including recreational sex, and who, upon experimentation with drugs, tend to employ these agents in large quantities as a passive means of euphoria, or at least as a means of removing some of the pain and anxiety attending a humorless, dysphoric life style" (Greaves 1974).

Based on this work and subsequent clinical experience which tends to confirm it, I have been an outspoken critic of drug-treatment programs based on asceticism, privation, and harsh behavioral treatment. Such programs, by their nature, tend to promote dependence on passive forms of euphoria, undermining the very purpose for which they were allegedly designed. As originally put:

The therapeutic implications of this present set of contentions
are clear. lf we are to minimize drug dependence, we need
to teach drug-dependent persons to turn themselves on as a
substitute for the euphoria-producing properties of drugs,
and to relax in order to replace the anxiety-reducing effects
of drugs. The reason our present methods of treating drug
dependence are failing so miserably is that we are both
making unreasonable demands on our clients and focusing on
the wrong things. Our major unreasonable demand is that
we want a person to give up something that gives him pleas-
ure and/or relieves distress, while offering little in return
except vague, distant promises of a better life and improved
self-esteem. As to focusing on the wrong things, we are
headed in precisely the wrong direction in drug programming:
toward asceticism, which emphasizes good behavior and
de-emphasizes the importance of pleasurable feelings, thus
unwittingly encouraging passive-dependence on chemical

sources of pleasure; and away from humanism, which
emphasizes the importance of pleasurable experience and is
suspicious of passive-dependence on drugs. We seem to
have drawn the absolutely backward conclusion about the
drug addicted person that he is an actively hedonistic,
pleasure-seeking, turn-on freak when he never was that.
What he was and is is a chronically uptight individual who
experiences great difficulty securing his need for pleasure in
ways that others do.

We emphasize the importance of the drug dependent person's
acquiring a job as a condition of his rehabilitation, when
very little evidence supports the contention that having a
job is a decisive element in successful withdrawal from drugs.
lnstead of conceiving of drugs as the enemy and seeing drug
abstinence as a great struggle against the enemy, to be
hopefully brought about through great striving and strictly
regimented behavior, we need to adopt a human growth and
need-fulfillment model. We need to help persons to become
the agents of their pleasure, not the passive recipients. We
need to provide body-sensory awareness programs, medita-
tion, expressive art therapy, psychotherapy. We need to
turn our clients on to music, dancing, fishing, camping,
boating, photography, and sex. ... We need to help
clients to realize that not only is it all right to pursue
actively a wide range of pleasurable experiences, but how
to. Yet none of the five major treatment modalities over-
viewed by Ball (1972)—a) detoxification, b) maintenance,
c) individual and group psychotherapy, d) therapeutic
communities, and e) religious communities—effectively, in
and of themselves, come to grips with the dysphoric under-
lay of drug dependence.1

(Greaves 1974)

During the past several years, drug abuse treatment programers, using these and other ideas, have placed increasing emphasis on "alternatives" to drug-abusing behavior. The jury is still out as regards the outcome benefits of this approach, though preliminary results are encouraging.

SPECIAL POPULATIONS

As a general theory of drug dependence, the existential theory does not deal with special risk populations except to comment that inherent in special subpopulations are the factors that give rise to personality maldevelopment, situational stress pathology, or unusual opportunity (such as availability or peer support), which give rise to abuse.

'Reprinted with permission from G. Greaves, "Toward an Existential

Theory of Drug Dependence," Journal of Nervous and Mental Disease,

159(1974):263-274. Copyright © 1974 by The Williams 6 Wilkins Co., Baltimore, Md.

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