the general population (Haglund and Schuckit 1977). The initiation of use of this substance, therefore, may be a response to factors which are quite different from those influencing temporary problems or longterm misuse (i.e., alcoholism). If "use" is defined as voluntary intake on multiple occasions in any one year, then it is likely that genetic factors play only a minor role. It is possible to hypothesize an inheritance of a certain level of anxiety or of other personality characteristics likely to influence the degree of risk taking one is willing to experience and which may affect the decision to begin to use drugs. The major factors having an impact on the initial use of a ubiquitous drug like alcohol, however, are more likely to be environmental. Anecdotically, the initiation of alcohol use probably follows experience with caffeine and tobacco and usually precedes experimentation with other classes of drugs, such as marijuana and stimulants (Kandel and Faust 1975). While alcohol intake probably begins in the early teens and becomes more routinized by the end of high school, the chances for initiation of use increase with a history of parental substance use, the degree of life instability (such as school or police problems), and the level of sensitivity to peer pressure. Certain environmental circumstances, such as entering an exceptionally heavy-drinking environment at a time of heightened stress (e.g., living in an isolated armed forces duty station) may also contribute greatly to the initiation of drinking in an individual otherwise not so inclined. Considering how this readily available and legal drug has become equated with a passage from adolescence into adulthood, it is not surprising that the vast majority of Americans at some time in their lives consider themselves drinkers. It is likely that the same types of factors are involved in the initiation of use of many other drugs. Whether or not one tries the more available substances like marijuana, hallucinogens, or brain-depressing or brain-stimulating drugs probably rests more with social than with biological factors. This would depend upon the type of peer pressure placed on the adolescent, the availability of drugs, parental models of drug use, and passing through levels of experience with the "less potent" drugs, as have been described by other authors (Kandel and Faust 1975). Here again, the ready availability of mind-altering drugs in a highly stressful setting may be important to the onset of drug use even in those individuals who might otherwise never have tried the substances, as exemplified by the high rate of use in Vietnam and the subsequent abstention in individuals returned to their home environment (Robins et al. 1975). For initiation into the "harder" or less available drugs such as heroin, genetically influenced factors such as personality type (e.g., the antisocial personality) may play a more important role. In the theoretical framework presented in this section, the reasons for initiating use may be quite different from those factors leading to repeated intake and persistent abuse. AVAILABILITY AND PRONENESS THEORY (p. 46) Smart According to the availability-proneness theory, drug use can start only when the values for both of the factors are above zero for an individual. Users will start using a drug because they meet it in their everyday lives, for example, when their friends, associates, older siblings, or parents use drugs. Drugs may be readily accessible in the school or workplace if there is no strong countervailing tendency not to use them, such as a religious or ethically based proscription. Some proneness is also necessary. In order to begin drug use of many types (e.g., cannabis, tobacco, hallucinogens), the proneness may consist only of an attitude of curiosity or a desire to experiment. Most users of drugs (including the opiates) initially intend to take them only a few times and then to stop. Proneness may be related to unusual stress, anxiety, or boredom, much as occurred among soldiers in Vietnam, many of whom experimented with opiates when they may not have done so at home in the United States (Robins et al. 1974b). The more dangerous the drug, the greater the proneness required in order to take the first dose, given equal availability of each drug. Since drugs such as tobacco and cannabis are known to have a low toxicity and addictive liability, users should require less "proneness" to try them than the opiates or exotic hallucinogens. PERCEIVED EFFECTS THEORY (p. 50) Initiation of substance use depends on availability; on behavior and attitudes regarding drug use of role models and "significant others": on attitudes, beliefs, and expectations regarding the immediate and longer term advantages and disadvantages of use; and on personality characteristics that facilitate or inhibit use. Although illicit drugs can be purchased at most schools, drugs are not equally available to all students. Availability depends on who the adolescent or preadolescent knows and how he or she is perceived by potential suppliers. If friendship groups include users, availability is greater, and the likelihood of initiation is increased; so is the likelihood of very early use. Attitudes and behavior regarding substance use on the part of friends and role models (e.g., older siblings, parents, salient members of reference groups) influence the probability of initiation. If use is practiced by (or is acceptable to) such "significant others," initiation is more likely; it is also more likely to occur at an early age. Although most initiates believe that the benefits of occasional use outweigh its risks, any particular initiate will have varied and mixed attitudes, beliefs, and expectations regarding the potential advantages and disadvantages of substance use. This complex mix of attitudes, beliefs, and expectations generates a net effect representing an overall predisposition that can range from extremely positive to extremely negative. The more positive the net effect, the higher the probability of initiation, and the earlier it is likely to occur. Longitudinal evidence now available indicates that certain personality characteristics are highly predictive of subsequent substance use. Details regarding these relationships are presented in part 1 in a more comprehensive manner. LIFE-THEME THEORY (p. 59) Our data indicate that initiation into the drug culture is more a matter of social exposure and contact than of intense personal need. That is, users do not at the outset specifically seek out drugs to solve personal problems. Rather, they are in a social situation where drug use is common, and a friend offers a sample of a new substance on a trial basis. Rarely are drug dealers or pushers directly involved at this stage. However, once inducted into the drug culture, the user soon discovers that the various substances produce predictably different ego states and hence may be used to provide "solutions" (albeit counterfeit) to problems in personal adjustment. At this point, the user begins a search for those substances or palliatives which are most congruent with his unique needs and concerns. Usually, the drug of eventual choice is not the first substance the person tries. Most of the men we studied had experimented with a wide variety of drugs before making a commitment to a specific substance or a class of drugs. As might be expected, alcohol and marijuana are usually the first drugs taken with any degree of regularity. However, there is no evidence that these are maliciously employed by dealers to seduce people into taking more serious substances. FAMILY THEORY (p. 147) Stanton Most initial drug use appears to be a peer-group phenomenon of adolescence. It is tied to the normal, albeit troublesome process of growing up, experimenting with new behaviors, becoming self-assertive, developing close (usually heterosexual) relationships with people outside the family, and leaving home. This stage is nearly always accompanied by a certain amount of rebellion and self-assertion, and the use of drugs as a means for such expression is certainly abetted if parents indulge in compulsive drug use or heavy drinking themselves. Obviously, drugs are now more a part of the process than they were, but if we had no drugs, other things would probably take their place. Programs aimed simply at keeping all young people from trying a substance several times may be overly ambitious, even if nobly intended. Blum (1972) has concluded that drug education has rarely helped young people's decisionmaking about use, and, further still, he states that actual failure experiences may be what are needed in order for youth to reorient toward less dysfunctional alternatives. The problem may be more one of parental fears than of actual dangers. This is not to deny harmful drug effects so much as to question how effectively we can prevent young people from doing a few "stupid" things, whether drug related or not (Stanton 1979b). One might legitimately ask, then, how realistic it is for adults to mobilize and direct energy to eradicate one symptom of a process that will probably always exist. In other cases, drug use can initiate in response to other types of stress, such as (a) with the "empty nest" syndrome, (b) with families facing an economic or other sort of crisis, (c) with family deaths or losses, or (d) when parents immigrate from other countries or other sections of the same country. As with adolescence, these are stages within the family developmental life cycle, and they require new coping and readjustment to the alterations of the family structure which accompany them (Minuchin 1974; Stanton 1979a,b,c, 1980). From a broader perspective, much of the drug use (and misuse) vis-avis the family stems from changes in the fabric of the larger society. Bronfenbrenner (1974) lists a number of societal trends (fragmentation of the extended family, use of television as a substitute for child supervision, etc.) which have led to alienation and isolation of young people from others older and younger than themselves; the informal peer group has filled in the vacuum. In addition, belief in (and media coverage of) the efficacy of drug consumption, with a concomitant increase in overall adult drug usage, have served to provide a proper setting for greater drug use and misuse by citizens both old and young. In this sense, drugs are a symptom and a result of societal trends and of the relationships among people within the society (Stanton 1979b). SELF-ESTEEM THEORY (p. 157) The preservation of the "self" is the most important variable underlying human behavior. Drug use is a compensatory mechanism, an excuse for life's failures, which can insulate one from social responsibility. Low self-esteem can provide the impetus for initiation for one looking for immediate gratification, but low self-esteem, by itself, is not sufficient to account for initiation into drug use. For that we have to look to the social milieu which provides the basis for such initiation. The peer group provides the greatest pressure and opportunity for the initiation into drugs, although we have to look to a wider community to see what drugs are provided, and how: One cannot use a drug which does not exist or for which the zeitgeist is not right. For example, marijuana has been known since the colonial period in the United States but did not become popular until the late 1960s. CYCLICAL PROCESS THEORY (p. 164) van Dijk In principle, drugs are taken for their desired pharmacological effect or action on mood states, although there is a wide variability for any specific drug effect across individual users. Personal factors encompass: (a) need for relief from feelings of intense discomfort or tension; (b) absence of possibilities to master, sublimate, or canalize such feelings, and (c) occasional influence of such factors as age (e.g., there is increased risk during adolescence), or the potentially debilitating effects of physical and psychiatric illness. The social meaning of a drug (and of drug taking) is viewed as critically important in the motivation to use the drug, but also as an important influence on the individual's perceived effect of the drug. Social meanings and values of a drug and drug taking entail such factors as its cultural or subcultural acceptance, ritualization, social and legal norms and sanctions, the symbolic significance of the drug (i.e., a symbol for masculinity, potency, or perhaps nonviolence and nonauthoritarianism), and as a signifier of in-group or out-group membership. CONDITIONING THEORY (p. 174) Wikler Psychoanalytical theories of addiction virtually ignored the specific pharmacological actions of the drug of addiction but stressed the importance of alleged intrapsychic "impulses" and "archaic longings." Thus, Rado (1933) stated, ". . . not the toxic agent, but the impulse to use it, makes an addict out of a given individual. Fenichel (1945) wrote, ". origin and nature of addiction are not determined by the chemical effect of the drug but by the psychological structure of the patient." Be this as it may, the author is not aware of any data on the results of psychoanalytical therapy in the treatment of addicts; indeed, apart from the prohibitive cost of such therapy, it would seem that in view of the prevalence of psychopathy (sociopathy) and thinking disorder among detoxified opioid addicts (Hill et al. 1960; Monroe et al. 1971), psychoanalytical therapy would be futile. Furthermore, the fact that rats and monkeys, equipped with intravenous cannulas for self-injection, will readily take and maintain themselves on morphine, amphetamines, cocaine, and pentobarbital (Schuster and Thompson 1969) casts some doubt on the necessity of such psychoanalytical variables for the genesis of addiction. In the cases of young persons with prevailing moods of hypophoria and anxiety and with strong needs to belong to some identifiable group, self-administration of heroin is often practiced in response to the pressure of a heroin-using peer group in a social environment in which such a peer group exists. |