chance of not being destroyed by drug abuse even if he or she becomes involved later. There appear to be several powerful interacting factors which determine the vulnerability of the social deviant to initial addiction. The first, which has been discussed at some length by others, is that such behavioral equipment is found most frequently in the underprivileged and slum areas in which opiates and other drug supplies have "high" availability (Chein and Rosenfeld 1957; Cohen 1955; Clausen 1957) and in which both narcotic addiction and alcoholism are common. The environmental conditions which produce the deviant in these areas also provide more ready access to opiates than in the larger society, and with regard to both opiates and alcohol, provide a greater degree of exposure to models of excessive use. But, to a more limited degree, this would appear to hold also for the social deviant in all societal strata. Second, lack of social controls (shared responses) appears to determine the degree of acceptability, to the deviant, of experimentation with drugs as well as with other forms of unusual behavior (Chein and Rosenfeld 1957). Although a certain degree of privation and social isolation in the "fringe" areas are contributing factors to social deviance as well as to addiction, they appear to be neither necessary nor sufficient causal antecedents of such behavior. The following appear to be the chief factors which produce the special vulnerability of social deviants to addiction. They are deficient in daily pursuits which are reinforced by and bring satisfaction to the larger society; they are not deterred from unusual behavior by counteranxiety, which in the "mature" adult can be partially identified as inhibitions; because of these deficiencies they are especially susceptible to short-term satisfactions, and if drugs are available they can themselves rapidly manipulate their personal state. One of the most difficult problems in the etiology of the addictions, and one which apparently has a direct connection with specific effects of drugs, is concerned with the use of a particular agent when others are equally available. Alcohol and opiates, although having some effects in common, perhaps even some common effects on conflict and anxiety, frequently produce diametrically opposite actions. It thus seems apparent that alcohol and opiates differentially but specifically alter the probability of occurrence of particular classes of responses. Briefly, in this connection, it is assumed for the general case that the behavioral equipment of the individual is composed of specific responses or response patterns which have certain probabilities of occurrence (strength) in any given situation. Since different responses of the individual differ in strength, they form a response hierarchy for a given situation ranging from the response which is most likely to that which is least likely to occur (Hull 1934; Miller and Dollard 1941). As an organizing principle in research on psychopharmacology, and for its applicability to the addictions, it is hypothesized that drugs rearrange the individual's response hierarchy in ways which are specific for a particular drug and for a given situation. BIOLOGICAL RHYTHM THEORY (p. 262) Hochhauser The chronobiological control theory suggests that an individual who perceives himself or herself in a helpless situation, in terms either of behavioral or internal events, may resort to drug use in an effort to achieve some degree of perceived control over these experiences, especially when other nondrug alternatives are not available or have been found ineffective. In summarizing what is known about these early drug experiences, Gorsuch and Butler (1976a) suggest that initial drug use may occur (1) to respond to a state of physical pain; (2) to deal with mental anguish; (3) to provide relief from boredom through sensation seeking. Future research must focus on the sources of the physical/mental pain and how a particular strategy is selected in order to cope with such pain. INTERACTIVE FRAMEWORK (p. 95) Huba/Wingard/Bentler In our current conception, we believe that initiation of drug use, particularly when it occurs during adolescence, is almost entirely derived from self-perceived behavioral pressure resulting from the intimate support system. This support system plays a role in moving the individual to drug use through peer values, models, and reinforcers, and one of inadequacy in reinforcing alternative, healthy behaviors and goals that would inhibit susceptibility to drug use. The personality system plays a much smaller role, with such dimensions as extroversion, leadership or autonomy strivings, and rebelliousness needs seeking fulfillment in drug-taking behavior. This manifestation is particularly true when the majority culture defines drug taking as illegal and dangerous, in which case we posit that a negative psychological cycle may be instigated with initiation into use. The "backlash" effect is captured in the current model by the reciprocal arrows from perceived behavioral pressure to personality (figure 1, p. 96). The "backlash" may also be exacerbated when the individual's felt pressure not to use drugs is communicated to members of the intimate culture who argue convincingly that drug taking is desirable. It should also be noted that financial resources may preclude the initiation of certain forms of drug taking, although this is unlikely within current youth cultures. We do not think that organismic status plays any major role during the initiation stage since the individual has had no direct experience with the mood-altering properties of the drugs. To the extent that individuals attribute their initiation of use to pharmacological properties, we may infer that they have been educated in drug effects by either the intimate culture or sources in the sociocultural influence system. DRUG SUBCULTURES THEORY Johnson (p. 110) Initiation to drug use was studied carefully in the 1970s (Johnston et al. 1978; Jessor and Jessor 1977; Jessor 1979; Kandel 1975, 1976, 1978b). All studies show that initiation to marijuana is critical to the initiation to other drugs (except alcohol). Three major factors have been identified in the initiation of marijuana: (1) prior use of alcohol, (2) predisposing factors (sex, family cohesion, political conservatism/ leftism, ethnicity, religiosity, etc.), and (3) friends' use of marijuana. Borrowing from reference-group (Sherif and Sherif 1964), differentialassociation (Sutherland 1939), and social-learning (Akers 1977) theory, drug-subculture theory hypothesizes that the predisposing factors indicate the influence of the parent culture upon youths; parent culture values may also influence the choice of friends and patterns of friendship choice. The activities of friendship cliques are also strongly influenced by the peer culture. Many peer groups, following peer culture values and conduct norms, expect group members to engage in various forms of unconventional behavior of which cigarette and alcohol use are usually begun earliest. In addition, one or more peer group members may, through contact with other friends, by following examples given in the mass media, or by learning via other informal communication (Fine and Kleinman 1979), also orient themselves toward the cannabis subculture and begin use. As the proportion of the peer group or other friends (or other reference group) using marijuana increases, the probability that any individual member will begin using marijuana increases steadily (Kandel 1978b). Nonusers may be directly pressured by friends ("Are you afraid to try pot? It's harmless and gives a great high ") or indirectly pressured because of the belief that most of their friends are using marijuana (even though they may not be) or the feeling that use is expected by their friends. The actual initiation to marijuana use almost always occurs among relatively close friends, from whom the nonuser learns the smoking techniques and how to define the sensations of intoxication as a pleasurable and valuable experience (Becker 1963; Orcutt 1978; Akers et al. 1979). Thus, cannabis subcultural values and conduct norms are mediated through the peer group. The precise order of events leading to marijuana use probably varies from case to case, and the causal order, if it exists, has yet to be untangled. Initiation to the nonmedical use of drugs other than marijuana generally occurs after marijuana initiation and subsequent use. Initiation to the cannabis subculture (and to the alcohol misuse subculture) teaches the critical value common to all drug subcultures--the desire to get "high" via the consumption of substances. After this value is learned, euphoric experiences continue to reinforce it, and, as a result, other substances are frequently and easily redefined as potential sources of enjoyment. The neophyte user may also be expected to initiate the use of one or more other substances, to which he or she may be introduced by friends or other associates, thus becoming involved in the multiple-druguse subculture (Single et al. 1974). Initiation to the heroin-injection subculture is strongly influenced by having heroin-using friends that may have been gained via extensive involvement in selling marijuana and other drugs (Johnson 1973) and after relatively extensive use of cannabis and other drugs (O'Donnell and Clayton 1979). DEVELOPMENTAL STAGES THEORY (p. 120) Kandel The findings that different social psychological factors predict adolescent initiation into different stages of drug use provide evidence for the existence of stages. We have combined the notion that adolescent drug use involves sequential stages with a longitudinal research design in which the population at risk for initiation into each of the stages could be clearly identified. This has allowed us to assess the relative importance of various factors in predicting initial transitions into various types of drug behaviors. The three sequential stages of adolescent drug use are hard liquor, marijuana, and other illicit drugs. Each of four clusters of predictor variables--parental influences, peer influences, adolescent involvement in various behaviors, and adolescent beliefs and values--and single predictors within each cluster assume differential importance for each stage of drug behavior. Prior involvements in a variety of activities, such as minor delinquency and use of cigarettes, beer, and wine, are most important for predicting hard liquor use. Adolescents' beliefs and values favorable to the use of marijuana and association with marijuana-using peers are the strongest predictors of initiation into marijuana. Poor relations with parents, feelings of depression, and exposure to drug-using peers are most important for predicting initiation into illicit drugs other than marijuana. Thus, at the earliest levels of involvement, adolescents who have engaged in a number of minor delinquent or deviant activities, who enjoy high levels of sociability with their peers, and who are exposed to peers and parents who drink start to drink themselves. The relationship with parental use of hard liquor suggests that these youths learn drinking patterns from their parents. The use of marijuana is preceded by acceptance of a cluster of beliefs and values that are favorable to marijuana use and in opposition to many standards upheld by adults, by involvement in a peer environment in which marijuana is used, and by participation in the same minor forms of deviant behavior that precede the use of hard liquor. By comparison, use of illicit drugs other than marijuana is preceded by poor relationships with parents, by exposure to parents and to peers who themselves use a variety of legal, medical, and illegal drugs, by psychological distress, and by a series of personal characteristics somewhat more deviant than those that characterize the novice marijuana or hard liquor user. SELF-DEROGATION THEORY (p. 128) Kaplan Drug use/abuse patterns are among alternative deviant patterns adopted in response to intense self-rejecting attitudes resulting from a history of being unable to forestall or assuage the self-devaluing implications of experiences in normative membership groups (family, school, peers, etc.). By virtue of the (actual) 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. Simultaneously, Which of several deviant patterns is adopted will 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. Given the predisposition to adopt some form of deviance, an illicit drug use pattern (rather than patterns of theft, interpersonal violence, suicide, etc.) would be adopted insofar as (perhaps due to the availability of the drug) the behavior was apparent in the environment, the person did not anticipate adverse consequences (e.g., loss of control, incarceration), and did anticipate self-enhancing outcomes (e.g., acceptance by a positive reference group, anesthetization of selfrejecting feelings). EGO/SELF THEORY (p. 29) Khantzian My work with drug dependency has focused on individuals in whom the initiation of drug use progressed to drug dependency. Therefore, my understanding of the initiation and subsequent drug use patterns has been necessarily influenced by my experience which involves more extreme cases. Nevertheless, taken from the psychoanalytic perspective, the meaning, causes, and consequences of drug use can be understood best by considering how the personality organization (particularly ego psychological and self structures) of an individual interacts with environmental influences and drug effects. Such an approach can account for and explain both more benign, self-limited degrees of drug involvement, and the more malignant patterns of misuse and dependency. I will focus on the latter instances where initiation has led to more extreme patterns of involvement and dependency. The nature of the ego and self disturbances of certain individuals leaves them more prone to begin drug use. The nature of these ego and self disturbances is related to failures or deficiencies in drive/ affect defense, self-esteem, and self-care. Having failed to develop adequate internal mechanisms for coping with internal drives and emotions, the addiction-prone individual is constantly involved with a range of behaviors and activities, including drug use, in the external world to serve the needs for a sense of well-being, security, and pleasure. Shaky or rigid defenses and low self-esteem cause him or her to turn more exclusively to the external environment for the satisfaction of such needs and wants. Wurmser (1974) has referred to this predisposition as an "addictive search" and has expanded eloquently on how such predispositions are part of the necessary and sufficient causes that lead to addiction. It is the constant search and hunger for satisfactions from one's environment interacting with the more incidental and adventitious influences such as exposure to drugs, availability, and peer-group pressures that determine the initiation of and experimentation with drug use. |