Chapter 2.Litho
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“Everything that we do in life, including love, is done in an express train travelling towards death. To smoke opium is to leave the train while it is in motion; it is to be interested in something other than life and death” (Jean Cocteau, painter and writer) D continuing use will also vary from drug to drug Interpersonal factors; Social-environmental and and from user to user. These are sometimes cultural factors. Those categories may well overlap. described in terms of positive reinforcement – whereby the individual finds the first-time experi- ence rewarding and seeks to reinforce the effect by 2.1. CONSTITUTIONAL/ continuing; and negative reinforcement, whereby PERSONAL FACTORS it is the sense of deprivation or discomfort felt at the lack of the drug which causes the user to Discoveries in neurobiology have shown that the continue. human brain releases substances similar to psychoactive substances: for example, exogenous Psychoactive drug consumption is derived from opiates (those produced outside the body) such four forms of use: ritual/cultural – (discussed as heroin correspond to endogenous opiates in Part 1, Box 1A); medical/therapeutic; social/ (produced inside the body) known as endorphins. Endogenous receptor systems have been A distinction must be made between discovered for opiates, stimulants, hallu- cinogens and cannabis. Research into the causal and correlative factors. anatomic pathways of primary drug rein- forcement, or reward – namely how and recreational; and occupational/functional. The where addictive drugs act on the brain – has led relationship between the different categories and to speculation over a possible link between drug the status of use may fluctuate – consumption of dependency and genetic predisposition. This stimulants or of tranquillizers may begin legally theory suggests that in the same way as the with a medical prescription for a precise condition diabetic is deficient in insulin, there may exist and then be continued illegally with a forged biological or genetic weaknesses which may be prescription or by buying on the black market. compensated for by the administration of specific Whether licit or illicit, functional drug use orig- psychoactive drugs. Goldstein3 has noted that the inates with a specific and (in the original intention state of anhedonia – the inability to experience of the user) temporary purpose but may slide into life’s normal pleasures and satisfactions – is one a continuing and more problematic form of use. commonly associated with opiate addiction, but This was the case with amphetamine use in many was unable to establish whether this was South-East Asian cities at the end of the 1960s and antecedent to or a result of the dependency. beginning of the 1970s, when stimulants were Gerra4 endorses the theory that certain individ- popular and easily available to students who uals may lack neurotransmitters (chemicals) such wished to stay awake for long hours of study; more as serotonin or dopamine, and sees similarities recently they have been widely abused by long- between psychoactive drug dependency and distance truck drivers, and appear in increasing other forms of compulsive behaviour such as quantities on the illicit market.2 gambling, alcoholism and eating disorders such as anorexia and bulimia. Motivations for illicit drug use can be separated according to the source of the predominent The impact of heredity is considered to be a possible influence. These are summarized in three principal risk factor that may predispose an individual to categories: Constitutional/personal factors; problematic drug use. Genetic predisposition 46 hypochondria. It should be stressed, however, that the relationship between these attributes and psychoactive drug use is far from clear. Several researchers have made an association between different types of drug use and the personality or emotional needs of the consumer. This type of theory can be explained in psycho- analytical terms: “… the drug of choice of a user is not arbitrary but dependent on the developmental state to which the user wishes to regress. When an individual finds an agent that chemically facilitates his pre-existing preferential mode of conflict solu- The brain holds some clues to addiction. Photo courtesy of 6 National Institutes of Health, USA, Brain Imaging Section. tion it becomes the drug of choice.” does seem to have been proved for alcoholism, Other research suggests that the principal differ- such that a child born of alcoholic parentage ence between stimulants and narcotics users adopted from birth by a normal family has a much consists in the more passive qualities of the latter: greater chance of becoming an alcoholic than “Both groups have ego-weaknesses, but the specific his or her stepbrothers and, conversely, a child drug of choice reflects specific ego needs: persons of normal parentage raised by alcoholics is much who respond to stress passively and through avoid- less likely to become alcoholic than his step- ance use opiates because their effects reinforce brothers.5 withdrawal, while those who seek to reinforce their ability to confront, compete and accomplish will Just as physical and psychological drug depen- tend to use stimulants.”7 dence are now viewed as lying along a con- tinuum, the disease model and moral weakness O’Connor et al.8 examined the personalities and drug model – or the relative influence of biological preferences of 125 recovering drug users, divided functioning and personality variables – cannot according to drug preference, but found no signif- properly be separated. In psychoanalytical terms, icant distinctions between users, either in psycho- the elaboration of drug dependency theories pathological terms or in non-pathological character raises questions of an addiction-prone person- traits, although opiate users showed a higher ality and of defective or dysfunctional character formation. It has been argued The human brain produces opiates similar that because of their rapid action on the brain, psychoactive drugs attract those to those derived from the opium poppy. who seek or need instant reward and gratification; a ‘short circuiting of the pleasure- susceptibility to boredom. They concluded that drug pain principle’. In Freudian terms this ‘deficient research based on psychopathology may be compro- ego functioning’ permits the user to revert to a mised by the social and economic forces which state of instant infantile gratification and thus to impinge on illicit drug use. delay or avoid the challenges of a mature adult role. Such a theory allows that dependence in The idea of the heroin addict as someone who is itself can be a character trait in certain individ- weak, passive and ‘can’t cope’ is firmly rejected in uals who feel the need to be protected from life a classic 1969 study of heroin users in New York in general. Other attributes with which drug abuse City by Preble and Casey.9 The authors conclude has been associated include low self-esteem and that the heroin addict is attempting to escape – confidence, low satisfaction, high anxiety, low not from life, but from the monotony of existence assertiveness, impulsivity, rebelliousness, low – through an aggressively-pursued career which is personal control and a tendency towards “exacting, challenging, adventurous and rewarding”. 47 The particular significance of the heroin user’s life application by others of the rules and sanctions to is derived less from the actual effects of the drug an ‘offender’.” His concept of the “deviant career” on body and mind than from the activities has some of the characteristics of the conven- involved in “taking care of business” – the daily tional career, including chance influential factors hustling involved in obtaining supplies of the or “career contingencies”. This might determine for drug, staying out of the hands of the police and example how and when an individual comes into from the “gratification of accomplishing a series contact with an illicit-drug using circle and which of challenging, exciting tasks every day of drugs may be available. As the deviant career the week”. progresses, a perceptual shift takes place, whereby the individual comes to view the non-deviants as Clearly the drug of choice may not necessarily be outsiders, and “… comes to regard conventional the drug always used – there are other important conceptions of it (cannabis) as the uninformed variables such as availability and price, and the fact views of outsiders and replaces those conceptions that some individuals use the contrasting effects of with the ‘inside’ view he has acquired through his one drug to offset the extreme highs or lows of experience of the drug in the company of other another. users”. Howard Becker, an influential theorist of social On this basis, behaviour which is illegal, such as behaviour, rejects the notion of pre-disposing char- cannabis smoking, can be perceived as perfectly acter traits, and sees drug use as a socially learned normal when it becomes adopted on a regular basis process by which consumption – in his example, of by a specific social group or, alternatively, if it is cannabis – is a function of the individual’s con- perceived as being particularly widespread. ception of the drug and of its social usefulness.10 From interviews with 50 cannabis smokers Becker Becker’s theories have found particular favour with concludes that the desirable effects of this the group of social scientists of the ‘rational choice’ school, which assumes that individuals “The drug of choice is not arbitrary”. rationally select those actions which will maximize their expected utility. The indiv- idual who perceives utility in drug-taking substance do not occur spontaneously, but have activities can be said to have an ‘optimistic bias’ to be learned and appreciated through group with regard to his/her actions. This may be the interaction; acquiring the habit is simultaneously result of misinformation, self-delusion, or the learning to be part of a group. The user, he denial or postponement of negative perceptions in suggests, goes through three stages: first he has to the presence of an immediately gratifiying sensory be taught how to get ‘high’, then how to enjoy the experience.