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increase unless the individual has alternative ways of feeling good about himself or herself. Thus, the individual most likely to move from experimentation to continued usage is having difficulty coping with anxiety and, most critically, believes that continued effort or struggling will not be successful.
The drive behind continued heavy, destructive use of a substance results from the "addictive cycle," in which the individual is constantly seeking to relieve aversive effects from the substance rather than to reproduce initial positive reinforcing effects. In fact, continued use may be motivated by a need to do both: feel good and stop from feeling bad. The essential point is that continued abuse of a drug producing harmful effects suggests "addiction," and one theory of addiction (mine among others) is that the person uses the drug more to relieve bad feelings from the drug than to achieve good. In other words, during the period of drug use and for a time afterwards, the abuser is experiencing a series of minihangovers and what drives the use to destructive levels is the repeated attempt to relieve subclinical withdrawal symptoms.
The research literature has not distinguished carefully between initial and continuing stages of drug involvement, but some studies (e.g., Jessor and Jessor 1978) suggest that the causative factors in initial use are still at work in continuing drug involvement. The nonsocialized individual will continue to use drugs based upon availability and motivating factors such as sensation seeking. The prodrug socialized person will continue use as an expression of habitual involvement in that culture and from a conformative motive. The iatrogenic drug user continues to seek drug benefits on occasions of mental or physical anguish.
But for continued drug use there is one other feature which is unique and has potentially powerful effects: the initial drug experience itself. Unfortunately research in this area is difficult since most descriptions of the initial drug experience are reported long after that experience has occurred and are influenced strongly by later perceptions. General retrospective studies give expected conclusions: Those who continue their experience report positive initial experiences. Those who stop after the first initial experience feel that they might have continued use except for the bad experiences.
The existence of a drug-using peer group appears important to the continuing use of illicit drugs. First, psychological research suggests that interpretation of the drug experience is influenced by the setting and group norms. If the initial experience is with prodrug peers, the
peers would encourage positive interpretations of initial experiences and provide support to reduce the negative aspects which might occur, thus encouraging continued drug experiences. Second, continuing illicit drug users tend to replace their previous friends with new friends who are also drug users. This has not only the advantage of camaraderie but also of providing ready access to drugs. The drug peer group may become somewhat stronger than other peer groups for two reasons. First, there is societal pressure against illicit drug use. This means that the individual must rely upon a close network of associates who are also drug users in order to guarantee availability of the drug, thus encouraging a distinctive subculture. Second, although the research is not conclusive on this point, it may be that those in the nondrug culture reject the drug users, who are then left only with other drug users as potential friends. (Note that this occurrence will cause a shift from the iatrogenic or nonsocialized model to the prodrug socialization model.)
latrogenic drug users seem to be least likely to become involved in a drug peer group. Their need is the obvious one of satisfying a particular internal motivation which has little relationship to other people. Indeed the primary motivation is one of return to normalcy, not the development of a new lifestyle. Availability through peers is not a critical factor in this model, as people in this group generally have medical or quasi-medical sources.
This theory makes no unique contribution to the understanding of continued use. Such use may be indicative of excessive dependence on "passive euphoria," may be situational in character, or may be related to peer-group pressure or other social psychological effects. In any event, except for the illegal status of most drug use, guilt reactions, and anxiety reactions, drug use, as such, is felt to be of little clinical significance.
Continuation of drug use on an occasional basis may occur if the drug relieves tension, increases sociability, or just makes the individual feel better. Continuation on a regular basis without abuse suggests that the drug suits the individual's adaptive needs. Although such controlled use may not present a problem, most drug abuse usually begins this way.
It is important to define the adaptive functions a particular drug or drugs serve. Is the drug used to deal with the rage and frustrations of relationships within the family? (Zinner and Shapiro 1974) Is it used, as marijuana often is, to ease the pressure of academic life? (Hendin 1973a) is it used, as amphetamines often are, to push young
women toward achievement that runs counter to their inner feelings? (Hendin 1974b) Is it used, as heroin often is, to create a barrier to intimacy? (Hendin 1974a) Is it used to achieve a defensive fragmentation, as psychedelics often are? (Hendin 1973b, 1974c)
Adolescence is a period in which youngsters experiment with many forms of behavior that they then reject as not suitable for themselves. It is from this perspective that the occasional heavy use of drugs for a brief period of time must be evaluated. During a one- to two-month period of experimentation with heavy use, such youngsters would seem to be drug abusers; over a longer period it becomes clear they are not.
BIOLOGICAL RHYTHM THEORY
Whether or not a given drug, or combination of drugs, continues to be used will be a function of the efficacy of the drug(s) in meeting the physiological and psychological needs of the user. If the drug(s) permits some degree of control over environmental experiences or internal perceptions, it may continue to be used. If the drug is found effective in affecting either the regularity or the amplitude of the chronobiological rhythm, its use may continue.
Drug taking is maintained primarily by its reinforcing effects, broadly conceived. These effects may be in the form of alleviation of pressure to perform undesirable behaviors, affect enhancement, a change in organismic status, or desirable consequences on the personality, cognition, perception, or consciousness systems. Thus, psychopharmacological reaction to the drug is but one type of reinforcer. Systems which are directly affected by the ingestion of drugs may themselves secondarily influence other systems. For instance, changes in psychological status or of perceived behavioral pressure may cause an individual to redefine members of the intimate culture, alter family relationships, or change friends. To the extent that such direct and indirect changes are ultimately desirable to the individual, in either the short or the long term, drug taking will be maintained.
We would like to differentiate between early and later stages of maintenance, particularly for those drugs which foster either physical or psychological dependence. During the early stages, drug effects are probably evaluated by the individual as desirable because they change the systems in a way that is psychophysiologically desirable. That is to say, the ingestion of the drug serves to enhance some positive psychological function for the individual. During the later stages of maintenance, or dependence, it is likely that the effects for the individual are primarily those of warding off the unpleasant organismic effects
associated with cessation of the drug; these effects may operate directly on behavior without psychological mediation.
DRUG SUBCULTURES THEORY
After initiation to marijuana use, the cannabis subculture's maintenance conduct norms begin to apply. The new user is expected to use marijuana when offered; to seek out marijuana; to become as frequent a user as others in the group; and to learn the appropriate argot, rituals, and symbols of subculture participation. The routine and continued consumption of marijuana becomes defined as normal; what was once a risky and innovative behavior is now an expected behavior for all peer group members. As a person becomes increasingly involved, he or she will develop a self-identity as a marijuana user, which may become an important identity or role (Rubington and Weinberg 1973; Kandel 1975). In addition, other users and nonusers may informally label the person as a marijuana user. Thus, in a process that Lemert (1972) calls secondary deviance, the user may attain a social and self-identity as a user.
As marijuana use becomes increasingly regular, three major conduct norms of this drug subculture become operative. The user is expected to buy some marijuana and/or provide marijuana to others in the peer group (reciprocity conduct norms). While buying cannabis, the user will frequently be greeted as a friend by the seller and receive offers of an introduction to other drugs or may gain new friends who use other drugs. In addition, the regular user is increasingly expected to provide and to make small purchases to give or sell to friends; this reflects involvement in the cannabis subculture's sharing conduct norms and low-level distribution conduct norms. Of course, these low-level cannabis transactions violate criminal law (the potential penalties are serious), but as with regular use, such transfers quickly become defined as normal by subcultural standards.
Abiding by the maintenance, reciprocity, and distribution conduct norms of the cannabis subculture greatly increases the probability of adopting as a reference group (Sherif and Sherif 1964) and gaining friends among those who use other drugs. The process of initiation to other drugs appears to be similar to that for cannabis, with the person's frequency of cannabis use and the number of friends using other drugs being the immediate precursors to initiation to a specific substance (Johnson 1973; Kandel 1978b). The multiple-drug-use subculture has somewhat different maintenance conduct norms than the cannabis subculture. Participants are expected to use a variety of substances, although certain drugs may be emphasized within a particular peer group (Waldorf et al. 1977; Feldman et al. 1979). The weekly or more regular use of one noncannabis substance, however, is relatively uncommon, although two or more noncannabis drugs may be used during the week (Division of Substance Abuse Services 1978). Frequently, reciprocity and distribution conduct norms of the multiple-drug-use subculture are critical to the specific drugs used. That is, if one member of a peer group has a supply of barbiturates, these will be shared and used by other members. If peer group members who wish to use LSD cannot
find a dealer or supplier, they may buy and use another drug that will be offered, such as PCP or stimulants. Thus, the actual drug(s) used by peer groups or individuals is closely related to patterns of drug supply and availability within the community.
Multiple substance use continues for an individual mainly as a function of peer group activity. To the extent that the peer group seeks and obtains drugs as a source of recreation and a desired activity, the more regular the use episodes and the more different substances eventually used. While the individual learns the rituals, argot, and street pharmacology associated with various noncannabis drugs, the development of a social identity or a self-identity as a noncannabis drug user does not appear to be as strongly held as the identity of "pothead" or "addict." Persons who develop a strong self-identity or who acquire a social identity as a noncannabis drug user generally specialize in or heavily use a particular drug--which they frequently sell. But for every weekly user of a specific noncannabis, nonheroin drug, there are probably ten or more persons who abide by the multipledrug-use subculture conduct norms of using several different substances during a given time period and who use drugs in relatively low dosages in a controlled manner (Waldorf et al. 1977; Zinberg 1979; Division of Substance Abuse Services 1978).
The conduct norms of the heroin-injection subculture expect the individual to seek heroin constantly, to inject it at least daily, and to spend most resources to obtain heroin. While many heroin injectors have some days of nonuse (Johnson et al. 1979), the individual tends to remain routinely involved in the heroin-injecting subculture's role structure (as a user, buyer, or seller), participating in subculture argot and rituals, committing minor and major crimes to finance heroin purchases, and evading law enforcement. The individual quickly develops a self-identity as an addict, which is reinforced by the necessity for interacting with other heroin injectors and dealers to obtain the drug, and by social labeling and rejection by nonheroin-using family, friends, and neighborhood acquaintances.
DEVELOPMENTAL STAGES THEORY
At this time in history in the United States, adolescents' involvement in drugs appears to follow certain paths. Beer and wine are the first substances used by youth. Tobacco and hard liquor are used next. The use of marijuana rarely takes place without prior use of liquor or tobacco, or both. Similarly, the use of illicit drugs other than marijuana rarely takes place in the absence of prior experimentation with marijuana.
The documentation that different factors are important for different drugs provides additional support for the claim that drug involvement proceeds through discrete stages. The notion of "stage" itself allows a more fruitful specification of the role and structure of different causal factors at different stages of involvement.
For example, as regards interpersonal influences, we find at different stages not only differences in source of influence but also differences