friendships may be both appropriate and effective if they can be permanently established. Motivation for the nonsocialized user to continue drug use can be decreased if other methods of meeting the needs of novelty and sensation seeking are found.

latrogenic users will continue with drug use if the physical pain or mental anguish recurs and another mode of resolving the problems is not available. This would seem, therefore, to be an effective group for traditional medical and psychotherapeutic treatment to provide other sources of help to resolve their problems.

The usefulness of these interventions for cessation of continued drug use with nonsocialized or iatrogenic users depends upon their remaining within their distinctive pathways. If it is only possible to obtain the drug through participating in a distinctive drug subculture, then these individuals may well shift to the prodrug socialization model. A person shifting to this model would be identified by positive past experiences with drugs--which by themselves could produce prodrug socialization--and by their involvements with others in the drug subcul

ture.

It is the prodrug socialized group for which continued use is theoretically most likely. Internal processes and social support systems encourage some use of illicit drugs. The individual's commitment to the drugs means that he or she is more likely to seek out a drug if it is not readily available than someone who is functioning under another model. Further, active countersocialization probably needs to exist in the environment for cessation to occur.

Since the models for psychological and physiological dependence are relatively undeveloped because of a very limited research base, cessation processes for addicts are also relatively unknown. But if addiction were purely physiological, then the medical detoxification techniques should work reasonably well. Psychological dependence would be expected to develop from a long history of reinforcements and would need to be offset by a long series of counterreinforcements. A new subculture may be necessary for most addicts.

Extensive and thorough analysis of the effects of contemporary treatment programs by Sells and his associates (e.g., Sells and Simpson in press) is in keeping with the model. They found that using only detoxification as a cessation technique was relatively ineffectual. This would be expected since contemporary street addicts are psychologically as well as physiologically addicted. (But it should be noted that detoxification techniques are widely accepted in the medical world as effective for individuals who are only physiologically addicted as a result of medical treatment and not psychologically dependent.) Psychological dependence upon drugs necessitates treatment for that dependence as well as for the physiological component. Sells and Simpson (in press) have found that methadone maintenance, therapeutic communities, and drug-free treatments are all effective, but that the former two are most effective for addicts and the latter for nonaddicted continual users. Though they both disrupt the psychological dependence on illicit drugs, methadone maintenance provides an alternative drug, and therapeutic communities control access and provide countersocialization. In methadone maintenance, the prodrug community is no longer needed because the methadone is supplied through legal channels, and the therapeutic community effectively controls the individual's

environment to prevent such involvements. Drug-free treatment is less successful with addicts because the addict remains in the environment and continues to have both access to the drugs and, probably, social support for their use.

The current models suggest that for the nonsocialized user methadone maintenance is most favorable from a long-term perspective. The therapeutic community can be expected to be more effective for the prodrug socialized user since it offers the greater possibility for resocialization. The drug-free approaches are primarily oriented toward psychological dependence. This means that they will be more effective with continual use, but because they have problems with the physiological addiction that accompanies daily use, drug-free treatment approaches will be less effective when both physiological and psychological dependence occurs.

EXISTENTIAL THEORY (p. 24)
Greaves

Cessation can be brought about in only three major ways: by controlling the availability of abused substances (source factors), by creating an environment in which the secondary gain from drug use is made excessively painful (social factors), or by volition (personal factors). The first two are seen as transient and artificial in the case of individuals with severely disturbed personalities, who will simply relapse once the external conditions are removed, but may be of benefit in terms of bringing about and sustaining a detoxified state in more healthy abusers. In any event, voluntary cessation is the only form of cessation which holds forth any promise of sustained cessation. Voluntary cessation can occur under either of two nonexclusive conditions: (1) through insightful realization that drugs are positively destructive to the individual and through resolve to avoid their use whatever the emotional cost, and (2) through treating and training the individual to secure emotional and phenomenal states that are pleasant and substitutive for ongoing drug-induced states.

The problem with insight and resolve is that the drive for the drug of choice remains, much energy is expended in mere coping, and the opportunity for relapse is high. The problem with treating the personality disorder which gives rise to drug abusing behavior is that very few therapists are trained in dealing with problems of dysphoria and existential ennui, prime "illnesses of the spirit" which contribute to drug dependence.

ADAPTATIONAL THEORY (p. 195)

Hendin

Drug abusers who stop often say they became repelled by their own confused functioning. "I would dial telephone numbers and actually forget whom I was calling" said one young man in describing his

decision to discontinue two years of daily marijuana abuse that kept him in a semiclouded state. He was able to come to this conclusion only after he had resolved a difficult emotional situation involving his school work and his family.

Since stress is a major part of the pattern of use, a diminution of stress can cause the drug pattern to markedly abate or stop. Youngsters who abuse marijuana as part of a maladaptation to school frequently stop when they stop going to school, particularly if their families have learned to accept reduced expectations for academic achievement. Those whose parents continue to treat them with disapproval or contempt are more likely to continue their drug abuse (Hendin et al., in press).

Young people who abuse marijuana to deal with problems related to competition and aggression may cease to do so if they manage to structure their lives so as to ease the pressure on them (Hendin 1973a; Hendin et al., in press). Young women who push themselves into an unwanted pursuit of achievement with amphetamines will usually stop if they alter their goals (Hendin 1974b). Young men who need heroin to function in relationships with women often stop when they are no longer in the relationship (Hendin 1974a).

These young people manage more than a change in the external environment. Many use drugs to strengthen psychological defenses and ways of adapting, and they then learn to maintain these without the drug (Hendin 1975). For example, young people who use psychedelics to fragment experience and detach themselves in ways that make them feel safer may stop when they have achieved a detachment and fragmentation that they can maintain without the help of the drug. Their mood without drugs has come closer to their mood with drugs and made drugs less necessary.

BIOLOGICAL RHYTHM THEORY (p. 262)

Hochhauser

Drug use may cease when it no longer serves to provide internal control for the individual. The acquisition of alternative (nondrug) ways of coping may result in the cessation of drug use, or the continued use of drugs may disrupt the chronobiological rhythms so much that the cessation of drugs is necessary to bring the rhythms back under internal control. That is, some addicts may find that narcotics serve to regulate their chronobiological rhythms; others may observe that narcotics disrupt such rhythms, depending on dosage, time (in the rhythmic cycle) of administration, etc. Finally, not using drugs may provide the addict with a greater sense of internal control over perceptions of helplessness.

INTERACTIVE FRAMEWORK (p. 95)

Huba/Wingard/Bentler

We believe that the cessation of drug use is a less homogeneous process than the initiation of use because there seem to be groups of individuals for whom different influences are important. Nonetheless, these different groups of individuals may all be considered within the general framework of our theory and many different systems must be simultaneously studied.

One group of individuals seems to cease taking drugs because of behavioral pressure from the intimate support system. For this group, the major reason for ceasing to use drugs is that use fails to be valued within that set of individuals defined as important sources of modeling and reinforcement. A second group of individuals is perhaps more likely to quit of their own volition as a result of realizing undesirable changes in their psychological or organismic status. A third group of individuals may change their drug-taking behavior as a function of some intervention by the sociocultural influence system, usually arrest or forced treatment. This process may operate in part because of product unavailability. Finally, some small group of individuals may cease taking a drug because of limited economic resources.

DRUG SUBCULTURES THEORY (p. 110)
Johnson

Drug subcultures theory hypothesizes that drug use and abuse may diminish or cease if and when commitments to subcultural values, norms, and rituals decline or terminate for any combination of reasons. Such diminution in use may be due to reducing interaction or terminating friendships with drug-using peer groups or associates. Peer groups and individuals may switch preferences in drug use because of changing drug fads, declines in availability of a substance, or an increase in availability of another drug. Individuals may switch reference groups and orient themselves toward nondrug activities and associates. Nonusing friends (or those who are moderate users), parents, spouse, or legal authorities may exert direct pressure to reduce or terminate use. For the heaviest drug users--who are frequently sellers--a decision to stop dealing or to sell only to close friends may reduce the amount of drugs consumed.

Critical changes in the life cycle appear to be associated with long-term diminution and almost complete cessation of involvement in drug subcultures and drug use. Evidence from national surveys (Abelson et al. 1972, 1973, 1977; Abelson and Atkinson 1975; Abelson and Fishburne 1976; O'Donnell et al. 1976; Johnson 1978) and local surveys (Kandel 1978b; Brown et al. 1974; Division of Substance Abuse Services 1978; Johnson and Uppal, in press) indicates that the assumption of adult roles significantly decreases participation in the drug subculture for large segments of the regularly using population. Particularly important to diminishing use are marriage, parenthood, full-time employment, and associated changes in friends and peer groups (Brown et al. 1974). Involvement in these adult roles occupies major proportions of the

working day, as well as leisure time activities. Little or no effort is expended to seek drug supplies or associates with whom to use drugs. If, however, such persons attend social functions where drugs, especially marijuana, are being used, they may be influenced by the subcultural conduct norms of that peer group to use again. But these will be isolated episodes, which will not occur until another similar social occasion arises.

SELF-DEROGATION THEORY (p. 128)

Kaplan

Cessation of the drug abuse (or other deviant pattern) would be likely to occur if and when self-devaluing outcomes outweigh self-enhancing outcomes. In that case the subject would be likely to experiment with alternative modes of deviance, since normative patterns would continue to be motivationally unacceptable as long as they were subjectively and in fact associated with self-devaluing experiences. But insofar as individual maturation and correlated changes in socioenvironmental experiences (including social support systems) reduce the likelihood of self-devaluing experiences, offer new opportunities for self-enhancement, and provide the person with effective coping mechanisms and a correlated realistic sense of control over the environment, the illicit drug use is likely to cease in favor of normative response patterns.

EGO/SELF THEORY (p. 29)

Khantzian

The addict's relationship with and dependence on a substance are the result of failures to find more ordinary solutions to human problems of coping with emotional distress and seeking satisfaction for one's needs and wants. Drugs have been substituted as an extraordinary solution for a range of problems, but particularly as a means to cope with major ego and self disturbances. However, the drug "solutions" are at best short term and tenuous, and the long-term dependence on drugs has serious, maladaptive aspects and consequences. As a result, addicts understandably are very often ambivalent about their substances. Often consequences such as legal, medical, and interpersonal crises that result from long-term drug use break down the rationalizations and denial that have supported continuing drug use and dependency. At these times, alternative solutions and satisfactions become possible and realizable and may, for the first time in some and once again in others, make possible the replacement of drugs with human involvements such as alternative compulsive (but benign) activities, religious immersion, relationships, and becoming the treator (versus the treated). This may occur with or without treatment interventions or relationships.