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SHAME

As a consequence of the predominance of narcissistic concerns and vulnerability, shame and the compulsive provocation of humiliations and putdowns assume particular prominence. Shame is the experience of being exposed as weak, a failure, as not living up to an image that one wishes to have of oneself. With strongly grandiose self-images, coupled with exaggerated expectations of what others could and should do, there is a continued proneness to massive disappointments, to "narcissistic crises."

THEORIES ON

One's

Relationship

to Others

Psychological, Social, and
Epidemiological Factors in
Juvenile Drug Use

Isidor Chein, Ph.D.

OVERVIEW

Over the last several decades, the use of narcotics by juveniles has reached "epidemic" proportions. When this phenomenon became widely publicized, not a great deal was known about its meaning, origin, or the dangers implicit in it. Although this may not have been the first such flareup of drug use in this country, and although it was "viewed with alarm" when it came to public attention, no valid and systematic studies of the problem had been made (Lindesmith 1947; Dai 1937; Terry and Pellens 1928). Thanks to the intervention of the National Institute of Mental Health (United States Public Health Service), however, the wave of juvenile drug use which occurred in the early 1950s became the subject of relatively intensive study. We are now in possession of a wealth of information, collected systematically and with a view to testing specific hunches and hypotheses.

This paper, prepared by Jean B. Wilson and reviewed by Harold B. Gerard, Ph.D., is based largely on findings originally presented in "Juvenile Narcotics Use," by I. Chein and E. Rosenfeld, reprinted from a symposium entitled NARCOTICS, appearing in Law and Contemporary Problems, volume 22 (no. 1, Winter 1957):52-68, published by Duke University School of Law, Durham, North Carolina, copyright 1957 by Duke University. It also includes findings highlighted in "Psychological, Social and Epidemiological Factors in Drug Addiction," published in 1966. The reader who is interested in pursuing Dr. Chein's work further is referred to his 1965 article, "The Use of Narcotics as a Personal and Social Problem," and to The Road to H (1964), coauthored with D.L. Gerard, R.S. Lee, and E. Rosenfeld. Dr. Chein particularly urges the reader to refer to his article titled "Psychological Functions of Drug Use," in Scientific Basis of Drug Dependence: A Symposium, edited by H. Steinberg (London: Churchill), 1969.

What, then, do we know about the juvenile drug user and the path he followed to addiction?'

SOME BASIC FACTS

Every year, several hundred new cases of young men (aged 16 to 20, inclusive) who are involved with narcotics become known in New York to the city courts, the Probation Department, city hospitals, and the Youth Council Bureau. The majority of these cases are users of heroin; only a few are nonusing sellers of heroin or are involved exclusively with marijuana. These figures, however, give only a minimal estimate of the true incidence of drug involvement. Drug use among juveniles flourishes in the most deprived areas of the city. The incidence of illicit narcotics use on the contemporary urban scene is associated with the distribution of conditions of human misery, in almost any way that you might define the latter. It is overwhelmingly, though not exclusively, concentrated in areas of the city that are underprivileged in virtually every aspect of life that could possibly be relevant and on which there are data from which to derive indexes. These areas are also obviously underprivileged in ways that we do not index, e.g., with respect to quality of housing and of educational facilities.

The chronic users come not only from the worst neighborhoods, but from homes where family life is most disrupted, where the population is of the lowest socioeconomic status, and where there are highly concentrated ethnic groups who are often discriminated against. Despite efforts to discover concentrations of young users from less deprived areas, all available evidence pinpoints drug use among juveniles as a type of behavior characteristically associated with neighborhoods of gross socioeconomic deprivation.

Drug use leads to a criminal way of life. The illegality of purchase and possession of opiates and similar drugs makes the drug user a delinquent ipso facto. The high cost of heroin, the drug generally used by juvenile users, also forces specific delinquency against property, for cash returns. The average addicted youngster is too young and too unskilled to be able to support his habit by his earnings. Not only have many users freely admitted having committed crimes like burglary, but there is also independent evidence that in those areas of the city where drug rates have gone up, the proportion of juvenile delinquencies likely to result in cash income has also gone up, while the proportion of delinquencies which are primarily behavior disturbances (rape, assault, auto theft, disorderly conduct) has gone down (Research Center for Human Relations 1954b). Available knowledge about the behavior of drug users in juvenile gangs also indicates that they show a preference for income-producing crimes, as against participation in gang warfare, vandalism, and general hell-raising (Research Center for Human Relations 1954c). It takes most youngsters who

'All but one of our studies were focused on males. However, what we have had to say about the personality problems of drug users and what is needed for their cure and rehabilitation may well be equally applicable to users of both sexes and varying ages.

eventually become addicted several months, sometimes a year or more, to change from the status of an occasional weekend user to that of a habitual user who needs two, three, or even more doses a day (Research Center for Human Relations 1957a). Many occasional users never take the crucial step to addiction, with its physiological manifestations of dependence, increasing tolerance, and withdrawal symptoms. Thus, we must distinguish between experimentation and habitual use, and, correspondingly, between factors conducive to experimentation and factors conducive to habituation and addiction.

Youngsters who experiment with drugs know that what they are doing is both illicit and dangerous. While they may not be fully aware of all facts about addiction, they are likely to have seen addicts and certainly have heard about addicts being jailed, about the pains of withdrawal, and about the high cost of drugs. One would expect, therefore, that willingness to experiment with an illegal and dangerous activity presupposes a certain attitude toward one's self, one's future, and the society. And indeed we find that chronic addicts, as people, tend to be characterized by certain personality deficiences and by hostility to society. They suffer from exceptionally low panic and frustration thresholds when confronted by the demands implicit in enduring intimate relationships or, for that matter, in any time-consuming responsible activity, or even when confronted by the likelihood of such demands. They are afflicted by a profound distrust of their fellow human beings, comprehending interpersonal relationships exclusively in terms of conning, manipulating, and pushing other people around. Among the things these young addicts want "much more than almost anything else in the world" is "to be able to get other people to do what you want," and "to enjoy life by having lots of thrills and taking chances." Their characteristic mood is suffused by a sense of futility, expectation of failure, and general depression.

What are the factors involved in the generation and perpetuation of the kind of person represented by the typical young addict? If you think of the including society, the ethnic group, the neighborhood, the family, the school, the person as he goes through his various developmental phases, and if you consider almost any pair of these, you find a vicious cycle generating the personality type or the conditions that breed the type. There are, of course, many instances in which particular circumstances break the cycle or even generate a contrary, beneficent cycle. We will discuss these circumstances later in this paper. But first let us examine the situations which are likely to lead to adolescent drug addiction.

Conditions within the family, the lifestyles of his peers, and the school he attends all influence the young urban male and make it probable or improbable that he will become a drug addict.

It is not surprising that the urban slum is a particularly good breeding place for families in which the parents, assuming that this basic family unit has managed to remain intact, are so preoccupied and fatigued by their struggles to keep their own heads above water that they have little time, patience, or perspective to deal with their children as human beings rather than as instrumentalities and sources of frustration; in which fathers have been so emasculated by their own incompetencies and dearth of opportunity as to be unable to set an appropriate model of the male role; in which momentary moods rather than stable patterns of personal relationships govern the application of reward and

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