cohesion is necessary for effective family functioning and individual development. The second dimension of the circumplex model is adaptability, which is defined as "the ability of a marital/family system to change its power structure, role relationships and relationship rules in response to situational and developmental stress." Both morphogenesis (change) and morphostasis (stability) must necessarily be balanced in an adaptive system. The circumplex model describes 16 possible types of marital and family systems with accompanying labels or descriptive terms relative to the level of adaptability and cohesion. These terms are used to describe the underlying dynamics of the marital/family system. The four types in the center of the circle represent balanced levels of adaptability and cohesion and are considered as most functional to individual and family development. The four types in the extreme area of the circle reflect very high or low levels of adaptability and cohesion and are viewed as most dysfunctional to individual and family development. In an effort to avoid the unidimensionality of many classification systems, which assume a linear relationship from one end of the continuum to the other, the circumplex model is dynamic and permits movement in any direction. Although only four drug-dependent families were diagnosed according to the circumplex model, they were all found to have extreme scores on both the adaptability and cohesion dimensions. The systems were very different despite the commonality of the presenting problems and the similarity of the extreme scores. This suggests that extreme scores might be characteristic of families in which drugs are abused, i.e., more dysfunctional, whereas families that are experiencing casual drug use could be placed closer to the central region of the circle, i.e., more functional. Within the context of the incomplete loss theory, the degree of pathology in family interactions might account for drug use becoming an abusive or addictive problem. It is suggested that many subtle factors accompany the loss experience, thus accounting for variations between families. Although they may have similar etiological components, the intervening family actions and reactions could clearly account for different response patterns. Certainly Eisenstadt's (1978) concept of creative bereavement is supportive of this premise. It is assumed that Eisenstadt's eminent subjects were able to master their loss because their family systems were closer to optimal with regard to their cohesiveness and adaptability, placing them in a more central part of the circumplex model. LEARNED BEHAVIOR THEORY (p. 191) In the transition from use to abuse, the most likely factor involved is one of risk taking (Rd). Within a given personality, if motivation and habits remain relatively constant, then merely an alteration in risktaking behavior in a negative direction will be enough to tip the scales toward drug abuse. Since the drug habit has already been formed by repeated use, it appears probable that seeking a more dramatic form of tension reduction becomes necessary. Seeking a "new high" or some other form of escape from the anxieties of the day would account for the increase in risk-taking behavior. The likelihood of drug-seeking activities mounts when the environment or cultural associations are such that it becomes easy for the individual to engage in drug abuse. This is particularly prevalent in the milieu of the so-called drug culture, yet this phenomenon can occur in far more banal settings of everyday life. The fact that our modern society has become oriented toward the acceptance of drug ingestion sets the stage for easy learning of drug abuse later. Children who mimic parents often request pleasant-tasting aspirin for headaches, having witnessed the taking of many tranquilizers, analgesics, and soporifics by their mothers, fathers, and other adults. Needless to say, emulating the behavior of older teenagers is a part of peer-group pressure, which young people find increasingly difficult to resist. Teenagers, of course, do not constitute the only high-risk group on the current scene. A menopausal woman, for example, can accomplish the same thing by obtaining prescriptions from a variety of physicians with whom she makes contact. Substituting the numerical values shown in the basic formula will illustrate the point. The move from drug use to abuse or addiction is seen as an intensification of the processes involved in the individual's move from experimentation to regular usage. The individual who is abusing drugs is now unable to cope with anxiety and conflict without the drug. Drugs have become the only way abusers can feel good about themselves, cope with anxiety, and feel in control. The stage of addiction is reached because of a vicious cycle established by continued use. As drug users rely more and more on drugs for feeling good and in control, they repeatedly confirm their belief that they are powerless to cope on their own. Each failure to function without drugs strengthens the belief that drug-free coping is impossible. The vicious cycle is complete when the drug abuser is convinced that these fears are true; the addict is powerless to cope with the environment without drugs. MULTIPLE MODELS THEORY (p. 18) With continued drug use at a fairly heavy level, one or both of two additional processes may occur. First, if drugs such as heroin are used on a daily basis then physical addiction can occur, with the complicating factor of withdrawal problems. Second, there are those individuals who have trivial withdrawal symptoms or who use a nonaddicting drug but who nevertheless have made the drug a focal point of their lives. These individuals are considered psychologically dependent. In the areas of psychological dependence and physiological addiction, there is little research because of difficulties inherent in examining the phenomena. Retrospective reports of the more important variables are open to subjective distortion and forgetting, so interviewing a group of those who have been addicted or dependent sufficiently long to be sure the condition exists provides little useful information on many matters of importance. In comparing both psychological and physiological addicts with others, one suffers from the problem of not knowing what is a cause of the addiction and what is a result of the addiction. The best research design, the longitudinal study, suffers from the fact that few individuals in the populations most readily accessible for longitudinal studies become addicts. For example, it would take a study involving thousands of college freshmen to obtain a sufficient sample for research purposes of college seniors who could be defined as addicts. Futhermore, although the phenomenon of addiction is apparent among long-term users, definitions which separate the continued drug user from the addict are difficult to develop for research purposes. Physiological addiction is associated with a major shift away from models describing an initial drug experience. Whether the individual's path was through nonsocialization, prodrug socialization, or iatrogenic use is no longer relevant. The primary feature now is satisfaction of the physiological need and prevention of withdrawal symptoms. The limited research that has been done on psychological dependence indicates that it may stem from the "rush" experience or from the social reinforcement found in prodrug subcultures, where a person may develop a distinctive role for relating to others based upon the drug orientation. In addition, the research on aversive conditioning suggests that the individual who finds that taking an illicit drug prevents a negative experience (such as physical pain or anguish) from occurring may develop a particularly strong dependence which is extremely resistant to change even after the logical possibility of the negative experience becomes slight. Psychological and physiological addiction are not mutually exclusive. While psychological dependence may well occur without physical addiction, they may also appear together and reinforce each other. EXISTENTIAL THEORY (p. 24) Greaves According to Greaves' existential theory, some individuals are highly susceptible to drug dependency. These are primarily individuals who are dysphoric and who, by virtue of adverse patterns of personality development, have not learned to generate euphoria or to access altered states of consciousness in more normal and less destructive ways. The more severe the personality disturbance, the lower the threshold of abuse. Thus, severely disturbed users of drugs will abuse drugs. despite strong peer and social disapproval and despite major negative sanctions. Less severely disturbed individuals may be led to abuse drugs with sufficient peer support, but are malleable in their use patterns depending on their environment. With normal individuals the drug abuse threshold is high and any peer-stimulated or automedication abuse tends to be situational and transient, as continued abuse tends to interfere with normal adaptive and functional processes. In other words, healthy people cannot be consistently persuaded by other individuals or events to behave in need-frustrating ways. Thus, the drug abuse threshold can be defined as an interaction between an individual's personality state (healthy versus unhealthy), social factors (support versus dissuasion), and transient intervening events (crises versus stable states). The shift to abuse usually is a sign that the pressures of conflicts instigating the use are so great that larger doses of the drug are needed while the relief given by the drug is now being counteracted by the psychological, physiological, and social complications that result from its use. For example, young women who hate school but feel the need to comply with parental wishes for achievement may do so with the aid of massive doses of amphetamines. At some point, however, the amphetamine toxicity often causes them virtually to cease functioning, and in the worst cases causes a transient psychosis. Abuse usually indicates that the drug is not helping the user in even marginal attempts to deal with problems. At this point it can become a way of abandoning these efforts. A man may take a few drinks to ease his anxiety with a woman; he gets drunk to avoid having to deal with her or with his anxiety. A student may use marijuana to ease the competitive struggle of academic life; he or she may become a "pot head" when the struggle becomes overwhelming (Hendin 1973a, 1975). Something of a dividing line exists between drug abusers who will use drugs orally and those who will also inject them intravenously. Young people who are almost perpetually stoned may be nevertheless shocked at the idea of using drugs intravenously. Youngsters willing to do so are usually less self-protective, more reckless, and more self-destructive than those who will not. Frequently their attitude toward life is that they do not have much to lose. The initiation into intravenous use is therefore a critical variable suggestive of serious adaptive failure (Hendin 1974a, 1975). Most adolescents fluctuate in the intensity of their drug abuse. During periods of less use, they tend to gravitate to friends who are not drug abusers. During periods of their greatest abuse of drugs, their relationships with other drug abusers become more significant to them. Thus peer relationships seem to support the youngster's immediate adaptive needs rather than to cause them (Pittel et al. 1971). Some of the conditions necessary for transition from occasional drug use to abuse have been mentioned in part 1. Their "direct" reinforcing properties are ascribed to acceptance by the peer group and reduction of hypophoria, anxiety, and pains after tolerance and withdrawal occur. Wikler's principles (1953) of conditioning will almost surely be found to be operative, and some factors at which we now only speculate will emerge. Only in the last decade, 1970-1980, has a serious second look been taken at the role psychopathic and sociopathic characteristics may play in opiate and alcohol addiction and in criminality. The strong evidence recently reported by Martin et al. (1977) is one example of further psychological and physiological differences between opiate addicts, institutionalized alcoholics, prisoners, and the normal population. BIOLOGICAL RHYTHM THEORY (p. 262) If the drug(s) is effective in controlling the chronobiological rhythms or in generating perceptions of psychological control, the use may shift from a pattern of use to abuse. Since the drug use itself may interfere with chronobiological processes (e.g., sleep patterns), the individual may develop a vicious cycle behavior of using drugs to control rhythms, which are then disrupted by the drugs, which leads to more drug use, and so on. For the user/abuser, one perceived positive aspect of drug dependence may be an initial feeling of control-regular drug use may provide a relatively high degree of predictability and controllability. The addict in the early stage of addiction may have a high degree of internal control, especially if narcotic use is effectively reducing levels of physical and/or psychological pain. DRUG SUBCULTURES THEORY (p. 110) Johnson A theme of the theory developed by Johnson (1973) involves the importance of drug selling within and between drug subcultures. (Also see Single and Kandel 1978.) The reciprocity conduct norms shift to distributional conduct norms when individuals begin to provide or sell more drugs than they receive or buy for their own use. The distribution conduct norms change even more dramatically when the individual expects close friends to pay cash for the drugs they receive. An individual attains the role of "dealer" within the subculture when (a) sales are made to persons other than close friends, (b) sales are large enough to provide the person and/or close friends with "free" drugs, or (c) the net income from sales becomes a substantial portion of total income. |