A major indicator of what social-control authorities refer to as drug abuse (although drug-subculture theory avoids this term) is the frequency and amount of drugs dealt. Escalation from casual transfers of marijuana between friends to the purchase and subsequent sale of a pound or more of marijuana and mid-level sales of other drugs shifts the user/seller into a fundamentally different role in drug subculture. The dealer's role is central to the drug subculture in several respects (Langer 1977). Mid-level dealers assure the availability of drugs to less frequent users; without dealers, supplies of drugs would be cut off to the average user (indirectly or directly). Dealers are respected because they take the risk of committing a felony for which a stiff prison sentence could be imposed. Users know that the dealer must pick friends and buyers carefully to avoid arrest. Dealing is frequently a means of supporting the consumption of more drugs (both in quantity and frequency) than most nondealers use. Many dealers also obtain a majority of income from such activity. Dealers generally are very likely to exhibit the most extreme patterns of drug-related behaviors; they also symbolize or teach innovative behaviors to those peer groups and individuals to whom they sell (Carey 1968; Preble and Casey 1969; Johnson 1973; Blum and Associates 1972a; Langer 1977; Waldorf et al. 1977; Johnson and Preble 1978; Smith and Stephens 1976). Dealers frequently use large quantities of drugs for relatively little or no cash expenditure, and a high proportion exhibit other nonconventional behaviors (crime, poor performance in legitimate roles). Thus, dealers are very likely (Waldorf et al. 1977; Johnson 1973; Single and Kandel 1978) to be the heaviest drug abusers. These same behaviors, however, are widely respected, envied, and important to drug-subculture participants and to the continued maintenance of subcultural values and conduct norms (Waldorf et al. 1977; Feldman et al. 1979).

EGO/SELF THEORY (p. 29)

Khantzian

The addiction-prone individuals' ego and self disturbances predispose them to dependence on drugs, given the general and specific appeal of drugs. Given this appeal, there is a natural tendency in such individuals to use heavier and heavier amounts, resulting in physiological dependence on one's drug or drugs of choice. However, I also believe there is a psychological basis to depend increasingly on drugs. I have concluded that heavy drug use and dependence predispose persons to progression in their drug-use patterns, with a tendency to preclude the development of more ordinary human solutions to life's problems. In repeatedly resorting to a drug to obtain a desired effect, the individual becomes less and less apt to come upon other responses and solutions in coping with internal life and the external world. It is in this respect that an addiction takes on a life of its own. Consequently there is an ever-increasing tendency for regression and withdrawal which is further compounded by society's inclination to consider such behavior as deviant and unacceptable. Regressed and withdrawn individuals discover that in the absence of other adaptive mechanisms the distressing aspects of their condition can be relieved only by either increasing the use of this preferred drug or switching to other drugs to overcome the painful and disabling side effects of the original drug of dependence (Khantzian 1975).

Since the theory places the source of craving in the experience of relieving withdrawal distress, it is centered on this stage--the shift from use to abuse (addiction). In order for this effect to occur, it is necessary that the user correctly identify and understand this distress. Prior to this point of no return, she or he may have been totally unaware of the identity of the drug and of becoming physically dependent on it; indeed, the user could have been unconscious during this entire preliminary period. But if the user recovered consciousness just before the drug was withdrawn, she or he could still become an addict if the whole situation was explained and if allowed to use drugs to cure the withdrawal distress that was being experienced and understood for the first time. It should be noted that addiction produced in medical practice by the administration of morphine to a patient with a chronic, painful disease, such as terminal cancer, ordinarily involves no self-administration of the drug. This form of addiction should probably not be identified as "drug abuse."

As implied by the theory, users' first experiences with withdrawal in a fairly severe form are sometimes sufficient to start a cognitive revolution in their minds as they begin to restructure their conceptions of the drug habit, of drug addicts, and of themselves. As the craving grows and expands with continued use, they first begin to fear and then to admit that they are junkies just like the other junkies they know.

HYPERACTIVE ADOLESCENTS THEORY

Loney

(p. 132)

Diagnosis and drug treatment of the hyperkinetic/minimal brain dysfunction syndrome were not widespread until the sixties (Clements and Peters 1962; American Psychiatric Association 1968; Laufer and Denhoff 1957), and adolescent followup studies of treated hyperkinetic children did not begin to appear until the seventies (Laufer 1971; Mendelson et al. 1971; Weiss et al. 1971). The majority of adults who were diagnosed and treated for childhood hyperactivity are still in their early twenties; and longitudinal studies of the precursors of drug use are only recently being undertaken, even with normal samples (Kandel 1978b). Thus, the attention of most investigators is still focused on attitudes and initial experimentation, rather than on clear-cut abuse, and on alcohol and marijuana rather than on opiates (Kandel 1975). Even among at-risk populations, abuse is relatively infrequent during early adolescence. Because stimulant drugs have been the medication of choice for hyperactive children, the major fear has been of subsequent stimulant abuse due to treatment-produced changes in the children's attitudes towards drugs. Therefore, it has seemed wise to study at-risk samples drawn from young, rural populations, who are known to prefer marijuana and stimulants. At the same time, the infrequency of opiate abuse among rural hyperactive individuals may ultimately preclude effective statistical inference at any age.

Considerable fear has also been expressed that hyperkinetic children will become "hooked" on their medication and continue it on their own. It has been assumed that such an addiction would be accompanied by the usual signs of dependency: euphoria, tolerance, withdrawal, etc. Such signs have seldom been reported. Our own subjects described a panoramic assortment of reactions to medication. Most were "calmed," but a few were rendered oblivious and immobile, while a few became "wound up" and high. These more dramatic effects may be dose related. Few of our subjects seemed to like the calmness that the medication produced; instead, they seemed to realize and eventually to value the fact that medication kept them out of trouble. In effect, the medication kept their parents and teachers calm as well. Less than five percent of the boys described positive mood reactions, and virtually all of those also had marked aggressive symptoms. Goyer et al. (1979) have presented a case study of an adolescent boy with an apparently addictive reaction to treatment with a CNS stimulant; that boy was clearly aggressive and antisocial as well as hyperactive.

COMBINATION-OF-EFFECTS THEORY (p. 137)

McAuliffe/Gordon

In common parlance, persons are said to be "addicted" when they have become physically dependent or at least seem unable to refrain from using a drug. We regard these events as merely signalling that a sufficient history of reinforcement has probably been acquired to impel a high rate of use. In the case of strong physical dependence, the user is confronted with the necessity of responding at a minimal rate (which happens to be also a high rate) if immediate use for whatever reason is to continue at all and if a negative reinforcer is to be successfully avoided. In our theory, there is no single point at which an individual suddenly becomes "addicted." Instead, the individual's addiction develops insidiously and varies continuously, so that what others seemingly mean when they label someone an "addict" is merely a person with a strong addiction (i.e., a history of reinforced drug taking sufficient to outweigh the more acceptable reinforcers of life, such as are associated with one's job, family, friends, sex life, and respectability).

Physical dependence on opiates is neither a necessary nor a sufficient condition for the development of addiction. Physical dependence simply sets the stage for experiencing withdrawal distress, reduction of which constitutes one of the drug's powerful reinforcing effects. Other effects (principally euphoria, but including secondary social gains, and relief of pain, anxiety, and fatigue) can themselves produce or contribute to addiction. Most, if not all, street addicts are reinforced in the early stages of heroin use by effects other than withdrawal, and their drug-taking response at that stage must be strong enough so that it occurs every day for a few weeks in order for them to develop physical dependence. Since contemporary opiate abusers know about physical dependence and usually prefer to avoid it, their daily use prior to dependence must reflect the existence of an addiction of some strength. We have interviewed heroin users who had never been dependent but who were either adamant about wanting to continue heroin use despite the risks and severe social pressures or convinced that they could not stop even though they wanted to. We and other

researchers (Lindesmith 1947; Robins 1974a) have also interviewed persons who have used opiates compulsively on a daily basis for many months without ever interrupting long enough to experience withdrawal sickness.

The distinction between addiction and physical dependence is also evident in detoxified addicts who are temporarily free of dependence but who are still strongly addicted, as witnessed by their expressed desire for opiates and their disposition to relapse, and in those medical patients who become physiologically dependent without knowing it but who remain indifferent because they have not developed a strong psychological attachment to opiates. (See Lindesmith 1947 for examples.) Our theory implies that singling out any particular point in a reinforcement history as the stage of "addiction" is more or less arbitrary. We recognize, however, that there are advantages associated with employing physical dependence as a tacit operational criterion of "addiction." Because the withdrawal syndrome (1) is a salient phenomenon that usually implies a substantial history of prior reinforcement, (2) introduces a potent new reinforcer, and (3) sets a new lower bound on the rate of continued use, the point at which physical dependence appears serves as a useful peg on which to hang a definition of "addict" that signals important changes in lifestyle. This highly visible point divides opiate users into those with and without such major lifestyle changes with great efficiency (i.e., low false-positive and false-negative rates). Indeed some addicts date their being "hooked" from the time they recognized major changes in their lifestyle, such as intense craving, getting fired from their job, or realizing that they preferred heroin to sex (Hendler and Stephens 1977, p. 41).

Convenient though it may be, there are important disadvantages associated with equating addiction with physical dependence as laymen do, or with making it a necessary but not sufficient condition of addiction in a theory of opiate use (Lindesmith 1947). By encouraging the notion that physical dependence is necessary in order for addiction to be present, one also encourages the seriously misleading impression-according to our theory--that a user is relatively safe as long as physical dependence is avoided. This conception opens neophytes to

the insidious features of onset underscored by the reinforcement perspective, according to which predependence use is more dangerous than seems apparent because the actual onset accrues gradually with each reinforcement.

COPING THEORY (p. 38)

Milkman/Frosch

Isolation of the transition from use to abuse is evasive because drug involvement is viewed in the larger context of addictive processes. The transition to abuse is interpreted as that period in which the individual begins the "progressive or repetitious patterns of socioculturally and/or psychophysically determined seductive behaviors, detrimental to the individual, the society, or both" (Milkman 1979). According to this conceptual model, the individual may embark on an abusive style of living prior to, during, or after involvement with substances.

To be sure, continued use of psychoactive substances often culminates in marked deterioration of systems vital to the individual's adaptive community functioning. In the case of heroin, for example, prolonged use may coincide with decrements in adaptive functions of the ego. Psychological deterioration combined with the pressures of physiological dependency sets the groundwork for a vicious cycle. The heroin user must rely increasingly on a relatively intact ego to procure drugs and attain satiation. Ultimately she or he is driven to withdrawal from heroin by the discrepancy between intrapsychic needs and external demands. Hospitalization, incarceration, or self-imposed abstinence subserve the user's need to resolve growing conflicts with reality.

As in the case of heroin, the alterations induced by amphetamine are initially harmonious with the user's characteristic modes of adaptation. Continued failure, however, to achieve overinflated self-expectations leads to growing conflicts with reality. Increasingly large and frequent pharmacologic supports are called upon to bolster failing ego defense mechanisms. The recurrent disintegration of mental and physical functioning is a dramatic manisfestation of the amphetamine syndrome.

ACHIEVEMENT-ANXIETY THEORY (p. 212)

Misra

Initially, drugs are used to seek relief from the pressures of achievement (Misra 1976). Using drugs is relaxing; they provide a quick "chemical vacation" from the stresses and strains of living (Lawson and Winstead 1978). Over a period of time, however, the increase in physical tolerance, on the one hand, and the desire for controlling one's periods of relaxation, on the other, tend to reduce the distance between the work life and the leisure-time activities. Achieving and maintaining a feeling of freedom--of nonachievement or, perhaps, antiachievement-becomes a crucial goal in life. It is at this point that drug use becomes drug abuse. The goal is no longer freedom from the pressures of achievement. Rather, it is to have a feeling of nonachievement. the work ethic reversed: a thrill in not achieving.

It is

Drug abuse is, in a sense, a silent protest against the achieving society. It protects us from a sense of failure: I may not be achieving what my neighbors and colleagues are, but I do attain a unique feeling of relaxed carelessness. Addiction forms the nucleus of a subculture of people who all have the same feeling of nonachievement, and friendships and groups evolve around this theme as efforts are made to create and maintain fellowship among the addicts.

ADDICTIVE EXPERIENCES THEORY

Peele

(p. 142)

Addiction occurs along a continuum, so that it is impossible to designate an exact point at which a drug habit becomes an addiction. Viewing addiction as an extreme at one end of this continuum, we can say drug abuse is any use which tends to move the individual in this direction along the continuum.