Love and Addiction - 2. What Addiction Is, and What It Has to Do with Drugs - What Addiction Is, and What It Has to Do with Drugs

Written by Stanton Peele

Social and Cultural Variations in Drug Effects

If many drugs can addict, and if not everyone gets addicted to any particular drug, then there can be no single physiological mechanism which explains addiction. Something else has to account for the variety of reactions people have when different chemicals are introduced into their bodies. The signs which are taken as indicators of addiction, withdrawal and tolerance, are affected by a host of situational and personal variables. The way people respond to a drug depends on how they view the drug—that is, what they expect from it—which is called their "set," and on the influences they feel from their surroundings, which comprise the setting. Set and setting are in turn shaped by the underlying dimensions of culture and social structure.

Lasagna's placebo experiment demonstrated that people's reactions to a drug are determined as much by what they think the drug is as by what it actually is. An important study that showed people's expectations working in combination with pressures from the social environment was conducted by Stanley Schachter and Jerome Singer. In it, individuals who were given a shot of adrenalin responded to the drug in entirely different ways, depending on whether they knew ahead of time to anticipate the effects of the stimulant, and on what mood they observed being acted out by someone else in the same situation. When they weren't sure what they were getting in the injection, they looked to see how the other person was acting in order to know how they should feel (see Appendix C). On a larger scale, this is how drugs are defined as being addictive or nonaddictive. People model their response to a given drug on the way they see other people responding, either in their social group or in the society as a whole.

A striking example of this social learning is provided by Howard Becker's study (in his book Outsiders) of the initiation of novice marijuana smokers into groups of experienced smokers. The novice has to be taught first that feeling certain sensations means that he is high, and then that these sensations are pleasurable. Similarly, groups of people who took LSD together in the 1960s were often known as tribes. These groups had widely differing experiences with the drug, and people who joined a tribe quickly learned to experience whatever it was that the rest of the group encountered in a trip. In the case of heroin, Norman Zinberg reports in his December, 1971, New York Times Magazine article, "G.I.'s and O.J.'s in Vietnam," that army units each developed their own specific withdrawal symptoms. The symptoms tended to be uniform within a unit, but varied greatly among units. In Drugs and the Public, Zinberg and John Robertson also note that withdrawal was consistently milder at the Daytop Village addiction treatment center than it was, for the same addicts, in jail. The difference was that the social atmosphere at Daytop did not allow severe withdrawal symptoms to appear because they could not be used as an excuse for not doing one's work.

Whole societies, too, teach specific lessons about drugs in line with their attitudes toward them. Historically, the drugs which other cultures have considered dangerous often have not been the same ones that we, in our culture, think of in such a light. In The Soul of the Ape, for example, Eugene Marais describes the devastating effects of our ordinary smoking tobacco on the Bushmen and Hottentots of nineteenth-century South Africa, who were familiar and moderate users of dagga (marijuana). Opium, which has been taken as a pain-killer since antiquity, was not regarded as a special drug menace before the late nineteenth century, and it was only then, according to Glenn Sonnedecker, that the term "addiction" began to be applied to this drug alone with its present meaning. Previously, the negative side effects of opium were lumped together with those of coffee, tobacco and alcohol, which, according to the data compiled by Richard Blum in Society and Drugs, were often objects of greater concern. China banned tobacco-smoking a century before it prohibited opium in 1729. Persia, Russia, parts of Germany, and Turkey all at some time made the production or use of tobacco a capital offense. Coffee was outlawed in the Arab world around 1300 and in Germany in the 1500s.

Consider the following description of drug dependence: "The sufferer is tremulous and loses his self-command; he is subject to fits of agitation and depression. He has a haggard appearance.... As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery." The drug in question is coffee (caffeine), as seen by the turn-of-the-century British pharmacologists Allbutt and Dixon. Here is their view of tea: "An hour or two after breakfast at which tea has been taken . . . a grievous sinking . . . may seize upon a sufferer, so that to speak is an effort. ... The speech may become weak and vague.... By miseries such as these, the best years of life may be spoilt."

What seems dangerous and uncontrollable at one time or in one place becomes natural and comfortable to deal with in another setting. Although tobacco has been proved to be injurious to health in any number of ways, and recent investigations suggest that coffee may be equally harmful, Americans do not, by and large, strongly mistrust either substance (see Appendix D). The ease we feel in handling the two drugs has led us to underestimate or disregard their chemical potency. Our sense of being psychologically secure with tobacco and coffee stems, in turn, from the fact that energizing, stimulant drugs closely fit the ethos of American and other Western cultures.

A culture's reaction to a drug is conditioned by its image of that drug. If the drug is seen as mysterious and uncontrollable, or if it stands for escape and oblivion, then it will be widely misused. This usually happens when a drug is newly introduced to a culture on a large scale. Where people can readily accept a drug, then dramatic personal deterioration and social disruption will not result from its use. This is usually the case when a drug is well-integrated into life in a culture. For instance, studies by Giorgio Lolli and Richard Jessor have shown that Italians, who have a long and settled experience with liquor, do not think of alcohol as possessing the same potent ability to console that Americans ascribe to it. As a result, Italians manifest less alcoholism, and the personality traits which are associated with alcoholism among Americans are not related to drinking patterns among Italians.

Based on Richard Blum's analysis of alcohol, we can develop a set of criteria for whether a drug will be used addictively or nonaddictively by a particular culture. If the drug is consumed in connection with prescribed patterns of behavior and traditional social customs and regulations, it is not likely to cause major problems. If, on the other hand, either the use or control of the drug is introduced without respect to existing institutions and cultural practices, and is associated either with political repression or with rebellion, excessive or asocial usage patterns will be present. Blum contrasts the American Indians, in whom chronic alcoholism developed in the wake of the white man's disruption of their cultures, with three rural Greek villages where drinking is so fully integrated into a traditional way of life that alcoholism as a social problem is not even conceived of.