Addiction: The Analgesic Experience - Cultures Differ Entirely in their Styles of Drinking

Written by Stanton Peele

Cultures also differ entirely in their styles of drinking. In some Mediterranean areas, such as rural Greece and Italy, where great quantities of alcohol are consumed, alcoholism is rarely a social problem. This cultural variation enables us to test the notion that addictive susceptibility is genetically determined, by examining two groups that are genetically similar but culturally different. Richard Jessor, a psychologist at the University of Colorado, and his colleagues studied Italian youths in Italy and in Boston who had four grandparents born in southern Italy. Although the Italian youths began to drink alcohol at an earlier age, and although overall consumption of alcohol in the two groups was the same, instances of intoxication and the likelihood of frequent intoxication were higher among the Americans at a .001 level of significance. Jessor's data show that to the extent that a group is assimilated from a low-alcoholism culture to a culture with a high alcoholism rate, that group will appear intermediate in its alcoholism rate.

We need not compare whole cultures to show that individuals do not have a consistent tendency to become addicted. Addiction varies with life stages and situational stresses. Charles Winick, a psychologist dealing with public-health problems, established the phenomenon of "maturing out" in the early 1960s when he examined the rolls of the Federal Bureau of Narcotics. Winick found that one quarter of the heroin addicts on the rolls ceased to be active by the age of 26, and three quarters by the time they reached 36. A later study by J. C. Ball in a different culture (Puerto Rican), which was based on direct follow-through with addicts, found that one third of the addicts matured out. Winick's explanation is that the peak period for addiction—late adolescence—is a time when the addict is overwhelmed by the responsibilities of adulthood. Addiction may prolong adolescence until a person matures sufficiently to feel capable of handling adult responsibilities. At the other extreme, the addict may become dependent on institutions, such as prisons and hospitals, that supplant drug dependence.

It is unlikely that we shall ever again have the kind of large-scale field study of narcotics use that was provided by the Vietnam War. According to then Assistant Secretary of Defense for Health and Environment Richard Wilbur, a physician, what we found there disproved anything taught about narcotics in medical school. Over 90 percent of those soldiers in whom heroin use was detected were able to give up their habits without undue discomfort. The stress produced by danger, unpleasantness, and uncertainty in Vietnam, where heroin was plentiful and cheap, may have made the addictive experience alluring for many soldiers. Back in the United States, however, removed from the pressures of war and once again in the presence of family and friends and opportunities for constructive activity, these men felt no need for heroin.

In the years since American troops have returned from Asia, Lee Robins of Washington University and her colleagues in the department of psychiatry have found that of those soldiers who tested positive in Vietnam for the presence of narcotics in their systems, 75 percent reported that they were addicted while serving there. But most of these men did not return to narcotics use in the United States (many shifted to amphetamines). One third continued to use narcotics (generally heroin) at home, and only 7 percent showed signs of dependence. "The results," Robins writes, "indicate that, contrary to conventional belief, the occasional use of narcotics without becoming addicted appears possible even for men who have previously been dependent on narcotics."

Several other factors play a part in addiction, including personal values. For example, a willingness to accept magical solutions that are not based on reason or individual efforts seems to increase the probability of addiction. On the other hand, attitudes favoring self-reliance, abstinence, and maintaining health seem to decrease this probability. Such values are transmitted at cultural, group, and individual levels. Broader conditions in a society also affect its members' need and willingness to resort to addictive escape. These conditions include levels of stress and anxieties brought on by discrepancies in the society's values and by lack of opportunities for self-direction.

Of course, pharmacological effects also play a part in addiction. These include the gross pharmacological action of drugs and differences in the way people metabolize chemicals. Individual reactions to a given drug can be described by a normal curve. At one end are hyperreactors and at the other end are nonreactors. Some people have reported day-long "trips" from smoking marijuana; some find no relief from pain after receiving concentrated doses of morphine. But no matter what the physiological reaction to a drug, it alone does not determine whether a person will become addicted. As an illustration of the interaction between the chemical action of a drug and other addiction-determining variables, consider cigarette addiction.

Nicotine, like caffeine and the amphetamines, is a central-nervous-system stimulant. Schachter has shown that depleting the level of nicotine in the smoker's blood plasma causes an increase in smoking. This finding encouraged some theorists in the belief that there must be an essentially physiological explanation for cigarette addiction. But as always, physiology is only one dimension of the problem. Murray Jarvik, a psychopharmacologist at UCLA, has found that smokers respond more to nicotine inhaled while smoking than to nicotine introduced through other oral means or by injection. This and related findings point to the role in cigarette addiction of ritual, alleviation of boredom, social influence, and other contextual factors—all of which are crucial to heroin addiction.