Cultures of Addiction

How much do I take? When can I use again? What happens if a bruise develops at the injection site? The person also learns to experience the effects of the drug. The initial effects of even heroin can be very subtle and the person may need to be taught by others how to recognise and enjoy the drug effects. They will also be helped to understand and deal with the negative effects of early heroin use.

At a practical level, the culture of addiction provides knowledge and skills on how to use, how to minimise risks, and how and where to access the drug. For example, once the person is unable to afford to purchase the amount of heroin they require to stave off withdrawal, they may decide to resort to criminal activities such as shop-lifting to accumulate the necessary funds. Other heroin users will introduce them to the things they need to know to shop-lift successfully.

As the person moves from initial experimentation to dependent use, the search for supports that sustain and justify their use is intensified. The negative effects of using become more evident and the person needs something to counter these effects and the resulting reductions in their self-esteem. In relation to the latter, the user may rationalise that these negative effects of drug use are a small price to pay for the drug and group helping them to deal with past physical or sexual abuse. This helps them refuse to acknowledge that they have a problem, thereby helping sustain their addiction.

The ability of a culture to offer identity and membership is a strong attraction to people who have felt excluded from normal society. Adopting the identity of a user is an important transition into the world of heroin or other drug addiction, and for many people this identity meets more needs than does the actual use of heroin.

As with other cultures, drug cultures are localized to some extent. For example, people who use methamphetamines in Hawaii and Missouri could share certain attitudes, but they will also exhibit regional differences. The text boxes in this chapter offer examples of the distinct values, languages, rituals, and types of artistic expression associated with particular drug cultures.

Addiction And Sociological Influences: Culture And Ethnicity

Many subcultures exist outside mainstream society and thus are prone to fragmentation. A single subculture can split into three or four related subcultures over time. This is especially true of drug cultures, in which people use different substances, are from different locales, or have different socioeconomic statuses; they may also have very different cultural attitudes related to the use of substances.

Bourgois and Schonberg described how ethnic and racial differences can affect the drug cultures of users of the same drugs to the point that even such things as injection practices can differ between Black and White heroin users in the same city. Exhibit lists of some of the ways in which drug cultures can differ from one another.

How Drug Cultures Differ. There is overlap among members, but drug cultures differ based on substance used—even among people from similar ethnic and socioeconomic backgrounds. The drug culture of heroin use McCoy et al. Differences in the physiological and psychological effects of drugs account for some differences among drug cultures. For example, the drug culture of people who use heroin is typically less frenetic than the drug culture involving methamphetamine use.

However, other differences seem to be more clearly related to the historical development of the culture itself or to the effects of larger social forces. Cultural and socioeconomic components contributed to the rise in methamphetamine use among gay men on the West Coast Reback and among Whites of lower socioeconomic status in rural Missouri Topolski and Anderson-Harper However, in these two cases, the details of those change factors are quite different. In Missouri, the low cost and easy production of the drug influenced development of a methamphetamine drug culture.

Missouri leads the nation in the number of methamphetamine labs seized by police; a disproportionately large number of seizures occur in rural areas Carbone-Lopez et al. The popularity of the drug among Whites could be linked to the historical development of the methamphetamine trade by White motorcycle gangs Morgan and Beck On the other hand, most gay men who use the drug report having first used it at parties with the expectation of involvement in sexual activity Hunt et al.

In studies of gay men who used methamphetamine, the main reason for use was to heighten sexual experience Halkitis et al. Morgan and Beck found that increased sexual activity was one reason why certain women and heterosexual men used methamphetamine, but it was not as important a reason as it was for gay men. Counselors and clinical supervisors must acquire knowledge about drug cultures represented within the client population. Drug cultures can change rapidly and vary across racial and ethnic groups, geographic areas, socioeconomic levels, and generations, so staying informed is challenging.

Besides needing an understanding of current drug cultures to help prevent infiltration of related behaviors and attitudes within the treatment environment , counselors also need to help clients understand how such cultures support use and pose dynamic relapse risks. Counselors can use this exercise to begin to educate clients about the influence of drug cultures and help them identify the specific behaviors, values, and attitudes that constitute their experience of using alcohol and drugs.

It can be a helpful tool in improving clients' understanding of the reinforcing aspects of alcohol and drug use beyond physiological effects. In addition, this exercise can be used as a training tool in clinical supervision to help counselors understand the influence and potential reinforcing qualities of a drug culture among clients and within the treatment milieu.

View in own window. This chapter aims to explain that people who use drugs participate in a drug culture , and further, that they value this participation. However, not all people who abuse substances are part of a drug culture. Although drug cultures typically play a greater role in the lives of people who use illicit drugs, people who use legal substances—such as alcohol—are also likely to participate in such a culture Gordon et al.

Drinking cultures can develop among heavy drinkers at a bar or a college fraternity or sorority house that works to encourage new people to use, supports high levels of continued or binge use, reinforces denial, and develops rituals and customary behaviors surrounding drinking. In this chapter, drug culture refers to cultures that evolve from drug and alcohol use. To some extent, subcultures define themselves in opposition to the mainstream culture. Subcultures may reject some, if not all, of the values and beliefs of the mainstream culture in favor of their own, and they will often adapt some elements of that culture in ways quite different from those originally intended Hebdige ; Issitt ; Exhibit Individuals often identify with subcultures—such as drug cultures—because they feel excluded from or unable to participate in mainstream society.

The subculture provides an alternative source of social support and cultural activities, but those activities can run counter to the best interests of the individual. Many subcultures are neither harmful nor antisocial, but their focus is on the substance s of abuse, not on the people who participate in the culture or their well-being.

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The Language of a Drug Culture. One of the defining features of any culture is the language it uses; this need not be an entire language, and may simply comprise certain jargon or slang and a particular style of communication. The use of slang regarding more Mainstream culture in the United States has historically frowned on most substance use and certainly substance abuse Corrigan et al.

This can extend to legal substances such as alcohol or tobacco including, in recent years, the increased prohibition against cigarette smoking in public spaces and its growing social unacceptability in private spaces. As a result, mainstream culture does not—for the most part—have an accepted role for most types of substance use, unlike many older cultures, which may accept use, for example, as part of specific religious rituals. Thus, people who experiment with drugs in the United States usually do so in highly marginalized social settings, which can contribute to the development of substance use disorders Wilcox Individuals who are curious about substance use, particularly young people, are therefore more likely to become involved in a drug culture that encourages excessive use and experimentation with other, often stronger, substances for a review of intervention strategies to reduce discrimination related to substance use disorders, see Livingston et al.

When people who abuse substances are marginalized, they tend not to seek access to mainstream institutions that typically provide sociocultural support Myers et al. This can result in even stronger bonding with the drug culture. A marginalized person's behavior is seen as abnormal even if he or she attempts to act differently, thus further reducing the chances of any attempt to change behavior Cohen The drug culture enables its members to view substance use disorders as normal or even as status symbols.

The disorder becomes a source of pride, and people may celebrate their drug-related identity with other members of the culture Pearson and Bourgois ; White Social stigma also aids in the formation of oppositional values and beliefs that can promote unity among members of the drug culture Exhibit The Values and Beliefs of a Heroin Culture. Many core values of illicit drug cultures involve rejecting mainstream society and its cultural values. Stephens analyzed value statements from people addicted to heroin and extracted the core tenets more When people with substance use disorders experience discrimination, they are likely to delay entering treatment and can have less positive treatment outcomes Fortney et al.

Discrimination can also increase denial and step up the individual's attempts to hide substance use Mateu-Gelabert et al. The immorality that mainstream society attaches to substance use and abuse can unintentionally serve to strengthen individuals' ties with the drug culture and decrease the likelihood that they will seek treatment.

The relationship between the drug and mainstream cultures is not unidirectional. Since the beginning of a definable drug culture , that culture has had an effect on mainstream cultural institutions, particularly through music Exhibit , art, and literature. These connections can add significantly to the attraction a drug culture holds for some individuals especially the young and those who pride themselves on being nonconformists and create a greater risk for substance use escalating to abuse and relapse.

The culture of addiction: Part 1 — Recovery Stories

Music and Drug Cultures. Since the s, when marijuana use became associated with jazz musicians, there has been a connection between certain music subcultures and particular types of substance use Blake ; Gahlinger As Blackman notes, more To understand what an individual gains from participating in a drug culture , it is important first to examine some of the factors involved in substance use and the development of substance use disorders.

Despite having differing theories about the root causes of substance use disorders, most researchers would agree that substance abuse is, to some extent, a learned behavior. Beginning with Becker's seminal work, research has shown that many commonly abused substances are not automatically experienced as pleasurable by people who use them for the first time Fekjaer For instance, many people find the taste of alcoholic beverages disagreeable during their first experience with them, and they only learn to experience these effects as pleasurable over time.

Expectations can also be important among people who use drugs; those who have greater expectancies of pleasure typically have a more intense and pleasurable experience. These expectancies may play a part in the development of substance use disorders Fekjaer ; Leventhal and Schmitz Additionally, drug-seeking and other behaviors associated with substance use have a reinforcing effect beyond that of the actual drugs.

Activities such as rituals of use Exhibit , which make up part of the drug culture , provide a focus for those who use drugs when the drugs themselves are unavailable and help them shift attention away from problems they might otherwise need to face Lende The Rituals of Drug Cultures. Several authors have noted that illicit drug use and alcohol use typically involve ritualized behaviors Alverson ; Carlson ; Carnes et al. The rituals of substance use affect where, more Drug cultures serve as an initiating force as well as a sustaining force for substance use and abuse White As an initiating force, the culture provides a way for people new to drug use to learn what to expect and how to appreciate the experience of getting high.

There are also practical matters involved in using substances e. The skills needed to use some drugs can be quite complicated, as shown in Exhibit If first use is by snorting, how is it done assuming the person has never taken a drug intranasally? Is there a special technique for using heroin this way?

If first use is by injection, more The drug culture has an appeal all its own that promotes initiation into drug use. Stephens uses examples from a number of ethnographic studies to show how people can be as taken by the excitement of the drug culture as they are by the drug itself.

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Media portrayals, along with singer or music group autobiographies, that glamorize the drug lifestyle may increase its lure Manning ; Oksanen In buying and perhaps selling drugs, individuals can find excitement that is missing in their lives. They can likewise find a sense of purpose they otherwise lack in the daily need to seek out and acquire drugs.

In successfully navigating the difficulties of living as a person who uses drugs, they can gain approval from peers who use drugs and a feeling that they are successful at something. In some communities, participation in the drug trade—an aspect of a drug culture —is simply one of the few economic opportunities available and is a means of gaining the admiration and respect of peers Bourgois ; Simon and Burns However, drug dealing as a source of status is not limited to economically deprived communities.

In studying drug dealing among relatively affluent college students at a private college, Mohamed and Fritsvold found that the most important motives for dealing were ego gratification, status, and the desire to assume an outlaw image. Marginalized adolescents and young adults find drug cultures particularly appealing. Many individual, family, and social risk factors associated with adolescent substance abuse are also risk factors for youth involvement with a drug culture. It's a bad habit" Sonnedecker, p. The modern form of the concept of addiction as an uncontrollable disease did not appear originally with narcotics, however, but with alcohol.

Levine 9 has described "The Discovery of Addiction" in his article of that title: Previously, in colonial America and before, habitual drunkenness was considered a vice or moral failing or lack of self-control. Only very near the end of the eighteenth century was alcohol first recognized, even by drunkards themselves, as having the power to cause people to drink uncontrollably. In the nineteenth century the temperance movement argued that alcohol inevitably provoked loss of control. That is, the nineteenth-century view of alcohol addiction is exactly that which in the twentieth century has been connected to narcotics: This idea of progressive, irreversible, inevitable exacerbation of the habit, causing loss of control of personal behavior and of the ability to make moral discriminations, actually retains strong elements of both colonial and temperance moralism.

It is therefore not correct to say simply that modern disease notions have replaced outdated "moral" models of drug use. Rather, relabeling misbehavior as a medical consequence of drug use locates the source of evil in the drug and dictates that the addict's moral responsibility is to avoid the substance entirely--that is, to abstain. Essential redefinitions of both alcohol and narcotic addiction occurred at the turn of the twentieth century.

The term "alcoholic" was accepted as a popular designation for the chronic inebriate only in this century, after the founding of Alcoholics Anonymous. Before that time, "drunkard" was the standard designation and "dipsomaniac" was for a long term the preferred psychiatric term. After World War I, Dr. William Silkworth became the first to treat alcoholics based on the idea that they suffered from an inbred allergy to alcohol that caused them to lose control of their drinking. One of his patients, William Wilson, cofounded Alcoholics Anonymous in This modern version of the disease theory of alcoholism thus conceived of alcoholism as a danger for only a small group of afflicted, biologically predestined individuals.

Only this group had to abstain, or else they would progress to the same self-destruction that the temperance movement had outlined for all drinkers. Such a revised disease theory was required after Prohibition was repealed in to fit a world in which drinking was ubiquitous, popular, and largely benign. Changes in views of drug addiction were in almost an exactly opposite direction. In the case of narcotics and, along with it, cocaine , the entire thrust was to redefine previously accepted substances as dangerous and to proscribe their use for ordinary, law-abiding citizens. The campaign against narcotics under the leadership of Harry Anslinger founder of the Federal Bureau of Narcotics began by imposing increasingly stern legislation on labeling, importation, and administration of the opiates.

Heroin was introduced in the United States in ; by the s it had become the principal object of addiction control efforts, while its use had been relegated to a small group of inner-city addicts. What is most important about these political, economic, medical, and public-relations developments is that narcotics, especially in the form of heroin, came to be seen in American society as the nonpareil drug of addiction--as leading inescapably from even the most casual contact to an intractable depend-ence, withdrawal from which was traumatic and unthinkable for the addict.

That addiction and alcoholism had to be discovered seems bizarre and unnecessary to us, owing to the thoroughness of our indoctrination in the idea that these things are biological entities that have been independently established through clear scientific discovery and practical experience. How, then, have they been missed by so many of the world's cultures for so many centuries?

After all, both alcohol and narcotics have been used widely throughout history. Yet only relatively recently, and then primarily in a few Western societies, did addiction and alcoholism come to be perceived as biological phenomena, a part of the natural landscape. How have so many societies and individuals misunderstood, ignored, or failed to perceive such obvious consequences of alcohol and narcotic consumption? This issue so fundamentally undermines the basis of what we assume today to be objective reality that addictionologists regularly seek to explain away data such as American and British opiate use in the nineteenth century.

For in the last century, opiate and other drug use in the United States and Britain was massive and indiscriminate and yet, only near the very end of this era--paradoxically when both societies had substantially reduced their use of opiates--was addictive symptomatology first recognized as a specific byproduct of narcotics use and the addiction concept invented. Historical works generally maintain that widespread narcotics use failed to create an awareness of addictive symptomatology in nineteenth-century societies because ignorance prevented people from drawing the appropriate connections between usage and addiction symptoms such as withdrawal.

These explanations manage to be at the same time tautologous addiction was not recognized because it was unrecognized and preposterous people far more familiar than we are with self-administration of narcotics were not as aware as we are of their inevitable effects. For example, Lindesmith 11 argued addiction was not common in the last century because addiction can only occur when the narcotics user understands that narcotics produce withdrawal effects and that renewed use relieves withdrawal distress. In other words, for Lindesmith, the genuine addict could only exist in an era that has an understanding of addiction identical to that which currently dominates our society!

Berridge a historian and Edwards a psychiatrist examined the social and medical history of the addiction concept as it developed in England. In one region the Fens , per capita consumption was the equivalent of therapeutic doses of opiates per annum. This commonplace use of narcotics did not arouse special public concern about addiction, and only late in the century did medical authorities label and treat addiction as a specific medical syndrome in connection with the popularity of injectable morphine among the middle classes.

Even at this point, however, the medical image of the specificity and frequency of the narcotic addiction syndrome seems to have been tremendously overstated:. This description actually allows for two separate interpretations both of which these authors make. Either there was a great deal of addiction in the mid-nineteenth century when opiate consumption was greater, but physicians only began to recognize addiction as it actually was on the wane; or else addiction actually did increase at the end of the century, even though consumption was declining, because "the profession, by its enthusiastic advocacy of a new and more 'scientific' remedy and method, had itself contributed to an increase in addiction" p.

In the latter case, the very medical imagery of addiction contributed to compulsive drug use. Berridge and Edwards' potentially radical, revisionist work suggests "Addiction is now defined as an illness because doctors have categorized it thus" p. At exactly this point, the reader is referred to an appendix in which Edwards announces: Edwards is so confident of this assertion that he does not feel an obligation to reference it.

What then are we to make of his own historical analysis with Berridge indicating that addiction has only recently been invented by the medical profession--and that this invention has had counterproductive effects? Apparently, despite their own data, these authors particularly Edwards are absolutely incapable of reconceptualizing addiction as something other than an inevitable physiological consequence of continued narcotics use.

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The cross-cultural literature on drinking styles and the effects of alcohol presents a similar dilemma. In the words of several prominent ethnographers in the alcoholism field: Finally "beverage alcohol usually is not a problem in a society unless. Heath 14 investigated the Bolivian Camba--a group with among the highest recorded rates of alcohol consumption in the world. They only drink at social gatherings, held several times a month, in which all those present over 12 years old drink throughout the day and night. Although these drinkers typically blacked out, Heath observed no cases of antisocial aggression, alcohol withdrawal, or solitary or loss-of-control drinking.

One such contradictory instance as this is sufficient to disprove any biologically determined formula about the natural relationship between heavy drinking and alcoholism. Although historical and cross-cultural cases reveal that addiction is neither a universal concept nor a universal phenomenon, it is commonly held that a host of solid scientific evidence underlies our beliefs about the special addictiveness of narcotics. This supposed scientific validation allows us to claim most of the world's population has been wrong about narcotics and alcohol, and instead ought to think like we do now about addiction.

Because the United States is the world's leading exporter of scientific ideas, a realignment of attitudes about alcoholism and addiction is occurring in many countries worldwide. Let us outline briefly what type of evidence would either support or disprove the idea that narcotics are drugs of addiction.

If narcotics are addictive, people who take them should be inclined to take them more frequently, compulsively, and unvaryingly than do users of other, nonaddictive drugs, or to have fewer degrees of freedom than people reveal in ordinary that is, nonaddicted habitual behavior. It is perhaps not surprising that research testing these notions has rarely been carried out; after all, we know that narcotics arc addictive. Thousands of people have reported for treatment for such addiction over the decades since the s; laboratory animals can be made to welcome injections of narcotics; and so on.

On the other hand, evidence and unbiased observation regularly find that street narcotics use, even regular use, does not lead to addiction. This evidence is too extensive to review here, beyond a quote from one typical, recent study of black heroin users in four American cities: This lifestyle challenges the current media and popular image of.

The culture of addiction: Part 1

This statement is wrong, however, in limiting mistaken images to the media and popular opinion. These images are accepted and propagated by leading scientific investigators, including those whose results most thoroughly disprove the notions of addiction they defend. One event and the research that accompanied it not only presents conclusive evidence that popular and scientific images of addiction are wrong, but also indicates how mistaken images remain unshaken despite thoroughgoing assaults on their fundamental assumptions.

The research in question is that conducted by Robins, Helzer, and others of the use of narcotics by G. Narcotics users were identified and interviewed on their return home and three years afterwards; the researchers in addition analyzed urine samples from subjects. The most significant aspect of this research was that it identified addicted heroin users in a nonclinical setting. The results of the study, in the words of the investigators, "changed our view of heroin.

Use of heroin purchased on the streets of the United States in did not lead rapidly to daily or compulsive use, no more so than did use of amphetamines or marijuana. Heroin does not seem to supplant the use of other drugs. The stereotype of the heroin addict as someone with a monomaniacal craving for a single drug seems hardly to exist in this sample.

Heroin addicts use many other drugs, and not only casually or in desperation. Of those men who were addicted in the first year back, half were treated and half were not. Of those treated, 47 percent were addicted in the second period; of those not treated, 17 percent were addicted. Treatment is certainly not always necessary for remission. Perhaps an even more surprising finding than the high proportion of men who recovered from addiction after Vietnam was the number who went back to heroin without becoming readdicted.

Half of the men who had been addicted in Vietnam used heroin on their return home, but only one-eighth became readdicted to heroin. Even when heroin was used frequently. That heroin use no more often led to addiction or regular or compulsive use than did amphetamines or marijuana; that those addicted to heroin often used other drugs, sometimes in preference to heroin; that spontaneous recovery was more common than not; and that many of those who gave up their addictions after returning home did not relapse to addiction when they used heroin stateside attack the foundations of the claim that the opiates are, in Edwards' words above, special "drugs of addiction.

Few researchers today would be inclined to challenge the claims Edwards makes which, after all, appeared after the Vietnam data were published.

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Indeed, even the investigators who revealed the startling findings about Vietnam Veterans could not accept the implications of their own research. In their report of their results, these authors remarked that "Heroin is worse than amphetamines or barbiturates only because 'worse' people use it" p. How Our Study Changed Our View of Heroin," indicated amazement that heroin users acted in no more addicted a way than users of other drugs even though "laboratory experiments have shown it to be a highly addicting drug" p.

Typically, this last statement was unreferenced. Actually, according to Charles Schuster 17 currently director of the National Institute on Drug Abuse and a leading animal researcher , compulsive drug-seeking behavior is often attributed to the seductive reinforcing effects of certain insidious drug molecules. Instead, his research indicates, "behavioral variables are as important as pharmacological ones in the development of compulsive drug-seeking behavior" p.

Another behavioral psychopharmacologist concluded after several decades of animal research, "any intrinsic, pharmacological reinforcing functions [of drugs] are altered radically by seemingly small changes in behavioral context" 18 p. These conclusions are based on studies finding that animal drug self- administration requires a specific experimental environment and can be "turned off" by such minor modifications as increasing the amount of bar pressing required to obtain the drug.