Whether or not one believes in God, Christ, Buddha, or any other formal deity or doctrine is not felt to be as significant as the fact that a spiritual philosophy has been personally derived. As Alexander and Adlerstein (1959) noted in their study, death anxiety was not that different between religious and nonreligious groups. This leads to the postulate that belief in any system--deism, atheism, etc.--is in itself a resolution and represents a philosophical-religious construct regarding life and the meaning derived from one's life experiences. The lack of such a system is then similar to being noncommitted, which can lead to feeling helpless, powerless, and frustrated. If the loss of a significant loved one results in a sense of loss of a viable self as well as the loss of belief in a viable other, including God and/or spiritual faith, then it is logical to assume that there may be a loss of total meaning to one's existence, so that drugs may represent a search for and a defense against one's own mortality.

Certainly one's value system and one's religious orientation evolve from within the family system. In order to understand how families respond to death and loss, the family value system regarding the philosophy of life needs exploration.

SPECIAL POPULATIONS

The extension of the incomplete loss theory to other populations gains support from a national drug abuse survey (Coleman 1976; Coleman and Davis 1978), where separation and loss were reported as relevant issues in many families. Further comparison of characteristics of drug abusers from multiethnic families suggests that a common element is that of loss and separation due to divorce, marital breakup, or death. One of the most striking types of loss exists among the Navajo, who are in danger of losing their religious rituals to the new revivalist sects. One sensitive worker has said, "Unless the Indian can keep his rituals, he will most assuredly die" (Coleman 1979b). A dispute with the Hopi also threatens them with a severe land loss and concomitant deprivation of large numbers of livestock. Navajo counselors feel that the stripping of cultural needs exacerbates and contributes to addiction.

SUMMARY

In summary, this theory is based on the premise that death, separation, and loss are significant etiological factors in heroin-addict families. The death and death-related variables are integral parts of a homeostatic pattern that keeps the drug-abusing member helpless and dependent on staying at home with the family. Within the complex set of feedback mechanisms involved in the drug-taking process lies an overall sense of family hopelessness and lack of purpose or meaning in life which accompanies the repetitive drug-sustaining cycle of family interactions.

The Social Deviant and
Initial Addiction to
Narcotics and Alcohol

Harris E. Hill, Ph.D.

Generally research on the addictions has been concerned with various phases of chronic intoxication and relapse, or with behavioral changes that accompany these phases of addiction. The present suggestions, on the contrary, are mainly directed toward study of the development of initial addiction and the possible significance of social deviance and the psychopathic personality in this process. Definite evidence of social pathology in all preaddiction personalities is lacking. There is now good reason to believe, however, that in the United States all alcoholic and narcotic addicts studied as groups show social deviance as the only common characteristic, and that this characteristic existed prior to addiction.

For the present discussion it will be assumed, in contrast to views such as those stated by Lindesmith (1947), that alcoholics and narcotic addicts in general are social deviants prior to the initial addiction. This does not imply that all such individuals are aggressive and antisocial. In this respect it is perhaps unfortunate that "psychopathic deviate" was used as a label for this scale of the MMPI which differentiates at a high level between individuals who are fairly well adjusted in our society and those who exhibit a diverse array of social pathology. It may be that a generic term, such as "conduct disorder," would be more appropriate (Hill et al. 1960; Meehle 1956). Cameron and Magaret (1951) cogently state that although some social deviants are aggressively antisocial, many are simply "inept" or "inadequate" personalities.

This paper, prepared by Jack E. Nelson and reviewed by Harris E. Hill, is based largely on an earlier publication written by Dr. Hill, titled "The Social Deviant and Initial Addiction to Narcotics and Alcohol." It is reprinted by permission from Quarterly Journal of Studies on Alcohol, vol. 23, pp. 562-582, 1962. Copyright by Journal of Studies on Alcohol, Inc., New Brunswick, New Jersey 08903.

The present discussion of the social deviant is an attempt to discover more fully the behavioral characteristics which make him uniquely susceptible to the effects of narcotics and alcohol. Identification and classification of deviant attitudes and overt responses appears to be the most critical and the most difficult task to accomplish in research on the psychopath. If this could be done with even a fair degree of success, criteria might be available for the study of antecedents, for the prediction of behavioral trends which result from particular antecedents, and for the prediction of specific drug effects which are acceptable and desirable to particular personalities.

There appear to be several powerful interacting factors which determine the vulnerability of the social deviant to initial addiction. The first, which has been discussed at some length by others, is that such behavioral equipment is found most frequently in the underprivileged and slum areas in which opiates and other drug supplies have "high" availability (Chein and Rosenfeld 1957; Cohen 1955; Clausen 1957) and in which both narcotic addiction and alcoholism are common. The environmental conditions which produce the deviant in these areas also provide more ready access to opiates than in the larger society, and with regard to both opiates and alcohol, provide a greater degree of exposure to models of excessive use. But, to a more limited degree, this would appear to hold also for the social deviant in all societal strata. Secondly, lack of social controls (shared responses) appears to determine the degree of acceptability, to the deviant, of experimentation with drugs as well as with other forms of unusual behavior (Chein and Rosenfeld 1957). Although a certain degree of privation and social isolation in the "fringe" areas are contributing factors to social deviance as well as to addiction, they appear to be neither necessary nor sufficient causal antecedents of such behavior. The descriptions given by Chein and Rosenfeld (1957) and by Clausen (1957) of nondelinquent nonaddict adolescents and their families resident in deprived areas suggest that familial discipline, and inculcation of other shared responses, such as a variety of interests and activities, provide deterrents to the use of drugs and other deviant behavior. In contrast, but in keeping with the psychopath of the deprived areas, the social deviant of the middle class, while not deprived ecologically, usually has a family background which provides inconsistent or unrealistic discipline and little consistent warm guidance in developing interests. Thus when adolescence and, finally, adulthood arrive, individuals have not developed behavior which is appropriate for either their status or their age, and could not be expected to exhibit social controls which they have not acquired.

It seems reasonable to assume that the degree of social deviance exhibited by an individual is a measure of the effectiveness of his social controls, and that the degree of such effectiveness is determined by the development of preferences and inhibitions which are held in common by the larger society. The social deviant is deficient in reactions of self-criticism, counteranxiety, or "guilt" which might deter unusual behavior. Since the social deviant is deficient in these social values or shared responses of the larger society, counteranxiety is low and retrial or continuance of the use of drugs is acceptable.

In addition to being deficient in social controls, the deviant appears to be more accepting of short-term satisfactions, or at least less able to defer short-term gains for long-range satisfaction. Few experimental but many clinical data indicate in this regard that the social deviant does not gain the degree of satisfaction (reinforcement) from daily

pursuits that the "normal" individual does (Chein and Rosenfeld 1957; Cohen 1955; Clausen 1957). Stable interests which provide continued reinforcement were found to be present in general in teenage nondelinquents who were not drug "users" but who lived in "high use" areas, whereas there was a paucity of such interests in comparable teenage addicts. The deviant thus appears to be more vulnerable to repetition and continuance of unusual activities that provide even temporary satisfactions. With fewer social deterrents to drug use, and concomitantly fewer satisfying daily pursuits, it would be predicted that drug-produced euphoria is more acceptable to and more easily induced in the deviant.

Euphoria as an acceptable drug effect is, clearly, not exclusively associated with social deviance--the functions of the cocktail party are not directed entirely toward business or political ends. At present, although few have difficulty in accepting clinical definitions and selfreport, "euphoria" has no precise, scientific referent.

A considerable number of narcotic addicts state that their initial trial of opiates was extremely pleasant. Although an estimate of the proportion cannot be made at present, some of these individuals used opiates first to alleviate alcohol withdrawal symptoms. Other addicts maintain that their initial use of opiates was very unpleasant, but that through repeated trials the effects became very desirable. Continued use even makes vomiting a "good sick." It thus seems reasonable to assume that social deviants attain euphoria more easily than normal persons, since they find experimentation with drugs acceptable, and since acceptability, desirability, and euphoria are closely allied.

The above appear to be the chief factors which produce the special vulnerability of social deviants to addiction. They are deficient in daily pursuits which are reinforced by and bring satisfaction to the larger society; they are not deterred from unusual behavior by counteranxiety, which in the "mature" adult can be partially identified as inhibitions; because of these deficiencies they are especially susceptible to short-term satisfactions, and if drugs are available they can themselves rapidly manipulate their personal state.

If these views have only partial validity the devising of such an ideal learning situation in the laboratory would be difficult. It must be considered, also, that both opioids and alcohol produce many effects, in addition to those mentioned, which may be desirable to social deviants but which do not seem to be peculiar to them.

The lowering of social controls and the production of euphoria by drugs has received little attention in the literature, compared to drugproduced alteration in pain and discomfort, anxiety and depression, and conflict and aggression. Since these latter effects presumably can be attained in the nondeviant individual (and the nonaddict), such effects per se do not appear to be the critical elements in the process of initial addiction. But an individual so unfortunate as to be socially deviant and at the same time either neurotic or schizoid is doubly vulnerable to addiction, since some indications of these tendencies can

be altered by drugs (Haertzen and Hill 1959).' Unfavorable conditions are still further compounded when withdrawal symptoms appear which can be alleviated by continued drug use. With these additional factors, it would appear that no investigator, even in the most euphoric moments, has even approximated the devising of such optimal conditions for learning. With such an array of behavioral determinants, any learning theoretician could find support for whatever systematic position he or she wished to assume. It may well be that this concentration of reinforcements on one form of behavior--drug use--is partially explanatory of the strength of both alcoholism and opioid addiction, "loss of control" with respect to these substances, and the resistance of the addictions to therapy.

One of the most difficult problems in the etiology of the addictions, and one which apparently has a direct connection with specific effects of drugs, is concerned with the use of a particular agent when others are equally available. Alcohol and opiates, although having some effects in common, perhaps even some common effects on conflict and anxiety, frequently produce diametrically oppposite actions. Although no study is available which compares the initial use of alcohol and opiates in naive subjects, a not insignificant number of narcotic addicts report previous alcoholism. It is known also that initially the very great majority of narcotic addicts have experimented with alcohol and that it is as available to them, or more so, than are narcotics. Frequently they maintain that they become aggressive and assaultive, or comatose, under alcohol. To them, these effects are opposite to the preferred actions of the opiates. Especially in the social deviant alcohol may produce euphoria, reduce conflict, and make possible the occurrence of behavior which was inhibited by either conflict or counteranxiety. It thus seems apparent that alcohol and opiates differentially but specifically alter the probability of occurrence of particular classes of responses.

Briefly, in this connection, it is assumed for the general case that the behavioral equipment of the individual is composed of specific responses or response patterns which have certain probabilities of occurrence (strength) in any given situation. Since different responses of the individual differ in strength, they form a response hierarchy for a given situation ranging from the response which is most likely to that which is least likely to occur (Hull 1934; Miller and Dollard 1941). As an organizing principle in research on psychopharmacology, and for its applicability to the addictions, it is here hypothesized that drugs rearrange the individual's response hierarchy in ways which are specific for particular drug and for a given situation. (Conger [1956] presented a somewhat similar formulation for some of the actions of alcohol.)

Psychodynamic mechanisms by which desirability (to the user) of drug effects are determined have been proposed by many, but few have focused on social deviance in this process. However, since deviants must live in a society to which they are not well adapted, they not only face the difficulties encountered by the average individual but

'Probably both neurotic and schizoid tendencies involve anxiety and counteranxiety, but it appears evident that when these reactions are combined with social deviance, the inhibiting effects of counteranxiety are not as effective as are the reinforcing effects of the drug.