Psychology Of Drug Use And Abuse Research Paper

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The use of psychoactive drugs has existed among various human cultures through the millennia. The abuse of many such drugs has been an important though socially defined, adverse consequence of their use.

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1. Psychoactive Drugs

The term ‘drugs’ as commonly used today is a shorthand for ‘psychoactive drugs’—compounds or substances which alter the neurological functioning and/or structure of the organism in such a way as to directly influence perception, mood, consciousness, and/or energy levels. There are many compounds that have such effects, ranging from those occurring naturally in plants (e.g., cocaine, caffeine, nicotine, cannabis, opium, psilocybin) and natural process (fermentation of fruit and other plant products containing carbohydrates, yielding alcohol) to compounds that are synthesized (e.g., amphetamines, LSD, ‘ecstasy,’ and PCP).

2. Distinguishing Characteristics Of Drug-Using Behaviors

There is one central characteristic that distinguishes psychoactive drug use from most other classes of behavior. Drugs influence the neurological system directly and provide pleasure or other forms of reinforcement (Koob and Nestler 1997). This reinforcement occurs without any of the intervening ‘adaptive behaviors’ which normally would be associated with such reinforcement because, in evolutionary terms, those behaviors that were adaptive evolved as having reinforcing effects due to their importance in the survival of the species. In essence, drug use involves a shortcut to the pleasure centers of the brain—a bypassing of adaptive behavior. Two other characteristics, which derive from this central one, also characterize this domain of behavior. First, because of this shortcut, drug-using behavior can come to interfere with, or displace, many behaviors that are adaptive such as eating, forming appropriate bonds to family and community, working, or performing well academically. Put another way, it can come to assume a higher position in the hierarchy of needs. It can also disrupt fundamental psychological processes essential to performing a wide range of other behaviors or tasks by altering or impeding perception, memory, decision making, motivation, and energy levels. Second, the direct reinforcing properties of psychoactive drugs on the neurotransmitters in the brain can alter the structure and function of the neurological system itself, such that a need is created for the drug in order for the individual to attain what had previously been a normal level of neurological functioning. In other words, the user can become dependent on or addicted to the drug; thus, the underlying motivation for using a drug can shift quite dramatically from what might have motivated use at earlier stages of involvement.

3. Illicit vs. Licit Drug Use

There are many psychosocial determinants of the use of psychoactive substances, two of the most important of which are the legal and normative status of particular substance-using behaviors in the society. The primary focus in this research paper will be on psychoactive substances, the use of which is considered illicit in most societies. Tobacco and alcohol are generally licit to use and legal to possess; but because they are dealt with at some length in other entries, they will receive only very general treatment here. It should be noted, however, that even the use of alcohol and tobacco by people under certain ages is considered illegal and illicit. Three general social classifications of psychoactive drugs will be distinguished, and the importance of their classification considered: psychotherapeutic drugs, legal drugs, and illegal drugs.

3.1 Psychotherapeutic Drugs

Certain drugs can be either licit or illicit to use, depending on the conditions under which use occurs; and they can be legal or illegal to possess, depending on how they have been obtained. A number of psychoactive drugs—the so-called psychotherapeutic drugs—have medical applications, so their use is considered as legitimate for the medically supervised therapeutic treatment of particular conditions. These drugs include tranquilizers (most of which are benzodiazepines, used to alleviate anxiety), sedatives (most of which are barbiturates, used to induce sleep), amphetamines (used to treat hyperactivity disorders), and various opium derivatives and their synthetic analogues (used to control pain, coughing, and diarrhea). All of these drugs have regulated access, through the requirements of a doctor’s prescription and pharmacy dispensation. However, the sale, possession, or use of these substances outside of prescribed medical regimen is considered illicit and illegal, in part because all of these drugs have the potential to produce dependence in the user; and dependence is presumed to be more likely to develop under conditions of unsupervised use.

3.2 The Legal Drugs

Certain psychoactive substances have emerged as legitimate to use in most societies outside of any medical regimen and without any therapeutic purpose, usually because at the time of their emergence, they are presumed to be safe. These include alcohol, nicotine, and caffeine. All of these substances have been in fairly widespread use for some centuries in different cultures. Although there have been some concerns in the past about the health and societal consequences of alcohol and tobacco, such concerns increased considerably over the course of the twentieth century, leading to increased stigmatization of their use and legal controls on their sale and distribution.

3.3 The Illegal Drugs

In the twentieth century most other psychoactive substances have been deemed illegal and illicit to use, possess, or sell in most societies. This illegal status is based largely on their presumed negative impact on the functioning of the individual, family, and/or larger society. Various international treaties have had the effect of making the legal status of various of these drugs (plus most of the psychotherapeutic drugs) fairly homogenous throughout the world, sometimes changing traditional and accepted drug using behaviors in certain societies into illegal and illicit ones (United Nations 1971, 1972). The potential beneficial uses of these drugs, if any, generally are considered to be outweighed by potential negative consequences. Among them are marijuana and hashish, various hallucinogenic drugs, including LSD and PCP, cocaine powder and crack cocaine, methamphetamine, opium and heroin.

The term ‘presumed’ is used throughout this discussion to describe both the negative effects and the benefits of these drugs, because the presumptions sometimes turn out to be quite erroneous. This was true of the presumed safety of tobacco products and of cocaine, to take but two examples. Also, there remains considerable controversy, and incomplete scientific knowledge, about the consequences of various of the psychoactive substances in use today, particularly the newer ones.

The boundaries of social legitimacy and illegality of the use of various psychoactive substances are themselves subject to change, as knowledge accumulates about the effects of the drugs and also about the effects of the control mechanisms intended to control their use. In fact, there has been a vigorous policy debate over whether reclassifying a previously illegal drug, like marijuana, as a psychotherapeutic drug might also affect the extent to which that drug is used in society outside of its newly legitimated medical regimen. Some argue that such a reclassification would destigmatize the drug and make its use seem less dangerous—both important psychosocial determinants of use, as will be discussed further below.

4. Religious And Cultural Constraints

The fact that many drugs are taken for reasons other than instrumental ones—that is, their use does not have accepted therapeutic purposes and does not facilitate task performance—but rather for pleasure (or other directly reinforcing properties of the drugs) itself stigmatizes their use for many people. Against the Protestant work ethic, such behavior can be seen as slothful, self-indulgent, hedonistic, and therefore inherently immoral. In the Mormon religion alcohol use is explicitly prohibited, and in the Islamic religion the use of alcohol and most other psychoactive substances is banned.

On occasion the use of illegal drugs may take on symbolic meanings that change their acceptability within the society, or at least within certain sectors of society. A dramatic instance of this occurred in the United States during the Vietnam War era, when the use of marijuana and LSD, in particular, came to be associated with being a part of the counterculture and the antiwar movements of the time (Zinburg and Robertson 1972). Within the context of a major generational division over values, use of these drugs became legitimate, and even positively valued, within a large sector of the youth generation. Use of these drugs at once symbolized defiance of adult norms and a statement of solidarity with those social movements. During that period of generational rift, the normative constraints among youth on the use of these drugs eroded considerably, and thus came to diverge from the prevailing norms in adult society. It was just a few years after this historical period that illicit drug use among adolescents and young adults reached its pinnacle in the country. In the years since, these symbolic meanings have virtually disappeared as the movements themselves have become part of history; and youth norms against use strengthened considerably. Not coincidentally, illicit drug use among young people declined quite substantially between the late 1970s and the early 1990s.

In sum, religious and other cultural considerations, as well as more practical concerns about the costs and benefits of use, and the costs and benefits of various control mechanisms, weigh heavily in determining the legality and social acceptability of using various psychoactive compounds. Legal status and social acceptability, in turn, are among the most powerful psychosocial determinants of use, as is evidenced by the fact that the psychoactive substances that are considered legal and socially acceptable—including alcohol, nicotine, and caffeine—have by far the greatest prevalence of use.

Use of these drugs is widespread not only because their use is legally and normatively accepted, however, but also because their legal status allows those who sell them to engage in massive advertising and promotional campaigns aimed at encouraging and facilitating consumption of the drug. One of the major reasons given by those who oppose the legalization of marijuana or other illegal drugs is that legalizing these drugs would unleash just such powerful marketing forces, which could further dramatically increase use (Inciardi and McBride 1991).

5. Research Traditions

Many subareas of research on psychoactive drugs have evolved, particularly in the past forty to fifty years. These include etiology, epidemiology, neurology, psychopharmacology, molecular biology, prevention, and treatment. The psychiatric tradition in epidemiology and treatment has emphasized accurately diagnosing and effectively assigning treatment regimens to individual cases. The other social sciences have looked more at drug use in the normal population, with an emphasis on causes, correlates, and consequences. There have emerged a few large, ongoing epidemiological survey studies of national populations that have as their primary focus the tracking and studying of drug use in the normal population. Two are in the United States: the National Household Survey of Drug Abuse (SAMHSA 2000) and the Monitoring the Future study (Johnston et al. 2000) that began in 1971 and 1975, respectively. More recently a coordinated series of national school surveys, modeled largely after Monitoring the Future, has been launched in more than two dozen countries in Europe under the auspices of the Council of Europe and the government of Sweden (Hibell et al. 2000).

The fact that addiction has long been conceptualized as a disease within certain scientific circles has led to terminology that is medical in nature in defining the subfields of research (e.g., epidemiology, etiology, prevention, treatment). In fact, Alan Leshner, the current director of the National Institute on Drug Abuse, has asserted that drug addiction is a disease of the brain, evidenced by lasting structural and functional changes in the brain induced by drug use, but that drug use short of addiction is a preventable behavior (Leshner 1999).

The importance of the disease concept, for which there is increasing neurological evidence, is that it implies that drug dependence should be responded to as more than just a moral failing. It implies that dependent users have important changes in their neurotransmitter systems that reduce to a considerable degree the extent to which they have reasonable control over their drug-using behavior.

6. Use vs. Abuse

One important distinction in psychosocial aspects of drugs has been between use and abuse, though it is a distinction less discussed in the literature today than it was early in the epidemic of illicit drug use. In theory, the distinction lies in whether the drug-using behavior has reached the stage at which it is adversely affecting the normal functioning and well-being of the individual and, therefore, has become ‘abuse.’ Is the individual’s drug use disrupting normal emotional, cognitive, social, or work functioning, including school performance for those in school, or is it endangering physical health? Is it interfering with the user’s functioning in key social roles such as spouse, parent, child, friend, student, worker, and citizen? As may be obvious, such a distinction is easier to conceptualize than to operationalize. Beliefs about the adverse effects of drugs influence not only the larger society’s view of, and constraints on drug use, but the likelihood that a given individual will engage in using drugs—a point to which we will return below. Because many of the dangers of a particular drug are not well documented in the early years after it comes onto the scene—witness cocaine use in the late 1970s—‘correctly judging whether there are serious health or addiction hazards, say, and therefore whether use constitutes ‘abuse,’ is not at all straightforward.

Some research on the reasons adolescents give for using various drugs may help to elucidate the theoretical distinction between use and abuse (Johnston and O’Malley 1986). Young people who have used a drug only once or twice usually give as their primary reason curiosity, ‘to see what it was like.’ Those who have used only a reasonably limited number of occasions, but have gone beyond experimentation, most often mention reasons such as ‘to feel good or get high’ or ‘to have a good time with my friends’—what might be called social and recreational reasons for use. However, those who have used a drug with some frequency start to mention what might be called psychological-coping motives for their use—‘to get through the day,’ ‘to get away from my problems,’ ‘because of anger or frustration,’ ‘to relax or relieve tension.’ That is not to say, necessarily, that using drugs created these psychological coping needs, although drug use may well contribute to them. More likely it means that youngsters who are having trouble coping, or are dysphoric for whatever reason, receive more relief and, therefore, reinforcement from using the drug. These most likely are the individuals at greatest risk of progressing to abuse or even dependence. Needless to say, the drugs usually offer a false promise of helping them cope with the vicissitudes of life.

7. Stages Of Involvement

The research literature on substance use has distinguished a number of stages of involvement with a drug (Clayton 1992). In general, the stages of use of a drug can be described as abstention, initiation, continuation, progression, dependence, and relapse. In addition, cessation of use can occur after initiation, progression, dependence, or relapse. Psychiatric researchers have been most concerned with defining, understanding, and intervening in the later stages of this continuum.

Explaining progression in the earlier stages of the continuum of involvement, and trying to intervene in that progression, has fallen largely to the social sciences. Though many social scientists who work in this field are informally called epidemiologists or etiologists, in fact they have tended to come mostly from psychology (including social, clinical, counseling, and community psychology), sociology, social work, anthropology, and, more recently, public health and economics. Two very general fields have evolved here—first, the study of the natural phenomena and second, the development of interventions (e.g., education, prevention, persuasive communication). Because prevention is the subject of another article, it is mentioned here only to note that the scientists and program developers in prevention tend to have quite similar disciplinary backgrounds and theoretical underpinnings as those who work on the etiology and epidemiology of substance use. Social learning theory has been widely adopted in all of these subareas, for instance.

The notion of a continuum of involvement applies not only to individual drugs, but also across drugs. The use of certain substances tends to precede the use of other ones with a high degree of regularity (Kandel 1975, Kandel et al. 1992). Marijuana use, for example, is usually preceded by the initiation of cigarette smoking, and the two behaviors remain highly correlated at later ages. Alcohol use also tends to precede the use of marijuana; and marijuana use, in turn, usually precedes use of most of the so-called ‘hard’ drugs like stimulants, opiates, and hallucinogens. The regularity of this pattern of progressive involvement has led to work aimed at predicting specific details of these transitions.

8. Attitudes And Beliefs About Drugs

8.1 Social Connotations Of Use

One of the many influences on substance use is the symbolic meaning the individual sees it as having within society at large or within various social circles. It is obvious that cigarettes and alcohol have acquired certain associations in peoples’ minds as a result of intentional manipulation through advertising. Less obvious perhaps is the fact that even unadvertised substances acquire social connotations, and that these may change considerably over time. The high degree of association of marijuana and LSD came to have with the counterculture already has been mentioned. When cocaine use first started to grow in the late seventies, it was very expensive and thus was used disproportionately by the rich and sometimes famous. As a result it acquired a certain cache that made its use more desirable to many, whereas a number of other drugs, like heroin, were more associated with marginal groups and the less affluent. It seems likely that adolescents come to see inhalants as ‘kids’ drug’ as they get older, and that their use declines as a result.

8.2 Perceived Risk

Whether drugs are seen as dangerous to the user or to others can likewise affect how they are seen more generally. The dramatically lowered social acceptability of tobacco over the past two decades illustrates the point. As smoking came to be seen as carrying high risk of morbidity and mortality, it became a less popular behavior, primarily with adults. And as the evidence grew of the adverse effects on others from their passive exposure to tobacco smoke, smoking in many public places, once an assured right, became a frequently denied privilege. Social norms, as well as regulations and laws, shifted quite dramatically. A not dissimilar thing happened with alcohol, when the many adverse effects of drinking came to be more widely recognized and, in particular, when the consequences of drunk driving were emphasized in the eighties. In that decade drinking and driving declined substantially among adolescents in the United States, and even occasions of heavy drinking declined considerably (O’Malley and Johnston 1999).

A number of the illicit drugs have also had considerable transformations in their social acceptability, as their adverse consequences were documented and made widely known. In the late 1970s, as cocaine use became more widespread, there was little convincing evidence of adverse effects, as ‘experts’ proclaimed that cocaine was neither lethal nor addictive. The evidence eventually cumulated to prove them wrong, but it took some years because there turned out to be a long lag-time on average between the initiation of use and the development of dependency and other serious problems. Researchers at the University of Michigan have demonstrated the importance of perceived risk as a determinant of trends not only in cocaine use, but also in the use of marijuana and other drugs (Bachman et al. 1998, Johnston et al. 2000). Among other things they have shown that a turnaround in the aggregate-level perceived risk associated with a drug by adolescents often presages a turnaround in actual use a year later.

8.3 Disapproval Of Drug Use

As illustrated in the cigarette example above, perceived risk can influence the social acceptability of using a drug, though it is only one such determinant of social acceptance. At both the aggregate and the individual level, personal disapproval of using a drug also has been shown by the Michigan researchers to be an important determinant of use. It is not uncommon for disapproval to show a turnaround a year later than perceived risk, consistent with the notion that risk can influence disapproval.

9. Individual Susceptibility

In addition to attitudes and beliefs about drugs, there are a great many other known individual risk factors for psychoactive drug use (e.g., Clayton et al. 1995, Glantz and Pickens 1992). Some of the strongest among youths and young adults have to do with their degree of attachment to, or integration with, key institutions in society. At the broadest level, deviance from societal norms in general, as reflected by delinquent behavior, is a strong correlate of virtually all forms of illicit drug use (including under-age drinking and smoking). It should not be surprising that one class of illicit behaviors (drug use) correlates strongly with a range of other illicit behaviors. It simply means that people who are willing to violate legal and normative constraints in one domain of behavior are willing to do so in others, as well. One result of this fact is that the correlates and determinants of the various ‘problem behaviors’ among youth tend to be the same. Among them are attachments to various other institutions, but in particular the family, school, and church (Brook et al. 1990).

Young people who have a low degree of attachment or ‘bonding’ to school—meaning that they are not performing well, do not like school, and may frequently be absent or truant—are at particular risk of involvement with illicit drug use. The same may be said of those who are frequently out of the parental home in the evening and/or who are having difficulties with their family, and of young people who are not very religious (regardless of religion or denomination) as reflected in low levels of religious attendance and rated importance of religion in their lives (Petraitis et al. 1995).

10. Future Directions

It has become increasingly clear that both licit and illicit substance use must be viewed in terms of age, period, and cohort effects, since all three different types of change have been observed and documented (Johnson and Gerstein 2000, Johnston et al. 2000). The factors explaining each of these three types of change are likely to be different, as is the timing of their action. The continual emergence of new illicit drugs onto the scene will yield new drug-taking phenomena to be understood and influenced. Undoubtedly more will be learned about the neurological action and effects of the many drugs, which may well change the importance of certain psychosocial factors, such as perceived risk, in determining their use.

The field is extremely multifaceted as has been illustrated here. The number of drugs is large and growing, and they have a wide range of psychological and physical effects. There are many levels of social and psychological determinants of this group of behaviors, ranging from legal, moral, normative, and religious, to neurological, psychological, sociological, political, and economic. (Because drugs are commodities, market considerations also influence use.) Further, drug use is the object of many social interventions, from various forms of education and persuasion to treatment. Thus, despite the considerable resources currently going into research on the determinants of drug use, it is clear that there will remain a great deal to be learned about this unique domain of behavior for some time to come.


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