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Lastly, the theory suggests methods for prevention—reductions in both availability and proneness. lt is likely that governments can reduce only availability over the short run (through laws, enforcement, etc.) and that reductions in proneness (reorganizing society?) will be much more difficult.


The major weaknesses of the theory appear to be the following:

1. The theory is essentially a post hoc analysis and integration of ideas and research findings. lt has not received an independent empirical validation for most of its propositions.

2. The major concepts of "availability" and "proneness" are not very specific, but they are global concepts with a variety of possible meanings. ln any one empirical test they would require clear, unambiguous definition.

3. There is a physical analogy that can be made about the theory— that of a hydraulic pump: Where availability is high, proneness need not be and vice-versa. lt remains to be seen whether this is an adequate representation of reality.

4. There are several situations in which availability is high but drug use is low—e.g., Turkish and Mexican farmers who grow opium do not appear to use it. lt is difficult to believe that proneness is zero in those areas, and other explanatory variables are perhaps required.

5. The relative weight to be given to availability and proneness factors in a given situation can be expressed only in general terms. Further detailed or mathematical expressions of the contribution of each are required.

6. Special problems exist with the concept of availability in that the actual availability is almost never known for individual drugs. lt may be surmised, but research will often be done with perceived availability or with one single aspect of actual availability.

Perceived Effects of
Substance Use

A General Theory

Gene M. Smith, Ph.D.

The theory is referred to as being "general" because it attempts to identify common processes and mechanisms that might be involved in the use of a wide variety of substances: caffeine; cigarettes; alcohol; marijuana and hashish; LSD and similar hallucinogens; sedatives, such as barbiturates and tranquilizers; stimulants, such as amphetamines and cocaine; heroin and other opiates. The term "substance" is employed rather than "drug" to avoid an unprofitable debate over the appropriateness of using the term "drug" to refer to certain substances just listed. Our focus is on the effects of substance use as perceived by the user, whether or not those perceptions accord with other evidence.

This chapter specifies assumptions and speculates about mechanisms that might advance the understanding of the complex and often perplexing processes that range from initiation to compulsive substance use. The perspective presented here has been helpful to the author. Obviously, however, it is only one of many ways to conceptualize the processes under discussion.


We assume that most acts are intended to benefit the actor; to promote his or her self-protection and self-enhancement; to produce gratification; and to reduce frustration, boredom, depression, anxiety, guilt, and other forms of psychic distress. The fact that substance use is often in direct conflict with those objectives raises important theoretical questions regarding the dynamics underlying such use. lt is not enough simply to observe that conscious and/or unconscious motives often lead to behavior that is irrational and self-defeating, and that compulsive substance use is merely one instance of such irrationality. Although true, that statement does not clarify the genesis of compulsive substance use' or help identify the mechanisms that permit such use to progress to levels of severe self-destructiveness.

First, we must acknowledge that substance use often is not selfdestructive. lndeed, recognizing the satisfying and self-enhancing nature of substance use is essential to understanding the processes of initiation, continuation of use, escalation, cessation, and relapse. When and how is substance use satisfying and/or self-enhancing? What mechanisms enable use to continue and escalate even after its disadvantages have become substantially greater than its advantages? The topics discussed below present observations and assumptions bearing on those and related questions.


Consequences of substance use reported by the subject can of course be highly biased. Some consequences may be grossly misperceived. Some may not be recognized at all. However, if perceived consequences reflect the subject's estimate of the costs and benefits of his or her use, they can provide valuable information regarding the reinforcement contingencies that facilitate or inhibit the continuation of substance use. Paradoxically, information concerning perceived consequences of substance use might be more useful in clarifying the causes of use than in identifying its true consequences. We assume that the user's perceptions of the costs and benefits of his or her substance use are critically important in determining continuation or cessation of use— however erroneous those perceptions might be.

Although the process of evaluation need not be deliberative (or even conscious), we assume that substance use will continue as long as the perceived aggregate benefits are valued more highly by the user than the perceived aggregate costs. This cost-benefit relationship depends on many variables, such as which substance is used, its strength, the frequency of its use, the immediacy and intensity of its perceived effects, the needs the substance is perceived to satisfy and frustrate, the intensity of those needs, their importance and centrality in the user's life, and the effects use has on the user's concepts of Self and ldeal Self.

'The categorical terms "use" and "abuse" are convenient for distinguishing well-regulated (and often beneficial) substance ingestion from unregulated, compulsive, and clearly detrimental ingestion. Unfortunately, when the term "abuse" is used, the nature and degree of abuse is rarely specified. The boundaries that separate use from abuse are ambiguous and debatable; and those boundaries vary from substance to substance and from user to user. ln addition, the categorical nature of the terms "use" and "abuse" tend to obscure the continuous process by which substance use shades into substance abuse, and it diverts attention from the fact that the transition is a multivariate process that occurs concurrently along numerous dimensions which themselves are apt to be continuously distributed processes. For these reasons, we will not use the term "abuse" but rather will speak of use that is, or is not, compulsive.

We assume that any single act of substance use produces numerous and varied positive and negative effects. Some effects are perceived with greater accuracy than others; some with greater clarity and certitude than others. Some effects are not perceived at all, and some that are perceived are accorded little or no significance. We assume that dimly perceived substance effects, and even some effects that are beyond conscious awareness altogether, can influence future use; but that, in general, influence varies directly with the clarity and certitude of the perception of each effect and with the significance attributed to it by the user.


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 use, and the earlier it is likely to begin.

ln the manner that caffeine is usually consumed, most users perceive the beneficial effects (mood elevation, increased alertness, and improved mental and physical performance) as easily outweighing the costs. Alcohol, in small amounts, is widely perceived as promoting conviviality, enhancing the pleasure of social interaction, and reducing unwanted inhibitions. Marijuana is perceived to produce euphoria and enhance enjoyment of food, sex, art, music, and hobbies for many users. Amphetamines and cocaine can produce mood elevation and perceived enhancement of performance. Barbiturates and tranquilizers can diminish psychic and physical discomfort; so can opiates.

Prior to compulsive use, the perception that the benefits outweigh the costs may indeed be valid, but as escalation proceeds, the actual aggregate net effects can become damagingly negative. One rarely (if ever) becomes a compulsive user without a considerable amount of previous noncompulsive use. The preponderance of perceived positive effects over perceived negative effects during the early stages of substance use can be the seductive bait that ultimately leads the user into the trap of addiction.


ln the preceding section we emphasized that well-regulated, noncompulsive substance use can be satisfying and rewarding. Yet, type and amount of substance use vary dramatically from person to person. For any particular substance, some individuals begin using as children, some begin later, and some avoid use altogether. At the adolescent and preadolescent age levels, what accounts for these differences? Relevant factors include (a) substance availability, (b) type and

amount of substance use by members of friendship groups, role models, and other significant persons, (c) demographic variables, (d) genetic variables, (e) beliefs regarding the risks and benefits of substance use, and (f) attitudes, values, and behavioral propensities that comprise what is referred to here as "personality." Space limitations preclude discussion of all such potential determinants of use. We will comment only on the possible separate and interactive effects of substance availability, friendship groups, and personality.

Although illicit substances can be purchased at most schools, they 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. lf friendship groups include users, availability is greater, and the likelihood of use is increased; so is the likelihood of very early initiation of 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. lf 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.

The longitudinal evidence now available indicates that nonusing adolescents who are most likely to use marijuana and/or hard drugs during later adolescence tend to be more rebellious and deviance prone; more alienated from parents; more critical of society; more impulsive; more emotional; more pessimistic and sad; more adventuresome and thrillseeking; more sociable and extroverted; less traditional and conservative regarding values; less oriented toward religion; less orderly, diligent, and effective in work and study habits; less intellectually curious and interested; less determined, persistent, and motivated toward achievement; less likely to feel valued and accepted by others; less trustworthy and responsible; less tender and considerate of others; and less self-controlled. Moreover, many of those same personality characteristics differentiate early initiates from later initiates and, in addition, predict subsequent degrees of drug involvement (Jessor 1976; Mellinger et al. 1975; Segal 1975; Smith and Fogg 1977, 1978).

The results just mentioned reflect statistical regularities that apply to large groups of individuals. There are, of course, many exceptions at the individual level of analysis. For example, Smith and Fogg (1978) studied attitude and personality variables in a group of 651 students, all of whom reported being nonusers of marijuana when tested as seventh or eighth graders. When studied subsequently, 206 students reported that they had remained nonusers for the full five-year period of the longitudinal study; 128 reported one or more instances of marijuana use before completing the ninth grade; and 317 reported using marijuana during their high school years. A multiple discriminant function analysis involving five predictor variables3 enabled the continuing nonusers to be discriminated from the early initiates with 80 percent accuracy. That classification analysis focused on the two most distinctly different groups among the three groups studied; but, even so, 80 percent is a very high degree of classification accuracy—especially

2The five predictor variables were obedience as measured by a selfreport scale, obedience as measured by peer ratings, sociability as measured by peer ratings, and two self-report measures of attitudes toward cigarette smoking.

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