4 The Origins of Drug Use
QUESTIONS WHICH A THEORY OF DRUGTAKING MUST ANSWER
We have seen that the absolutists' theories of drugtaking focus entirely on the drug used without considering its cultural meaning, take social reaction against the drugtaker for granted without attempting to explain it, picture themselves as having the objectivity of physical scientists by ignoring the fact that they view reality from the perspective of their own values and that their pronouncements often — if they possess power in the world — effect the 'reality' which they are studying.
What is needed is a theory of drugtaking which will take into account all the above mentioned factors, which will provide an explanatory framework in which to analyse any type of drugtaking, legal or illegal, `soft' or `hard', but which will at the same time be based on the cultures to which the particular group of drugtakers being investigated belong. There are to my mind eight basic questions that must be answered in order to understand the life history of a particular type of drugtaker. I will detail both the questions and the way in which I feel they can best be answered.
I. Immediate Origins of Drugtaking
Society consists of a large number of groups of people with their own norms and values. Now, each of these subcultures consists of solutions to the problems experienced by people in their own part of the social structure; that is, they represent desired ends and approved means of achieving them. Old people, young people, working class, middle class, West Indian, Irish, criminals and doctors all face their own particular set of problems and all evolve cultures with which to solve them. Moreover, certain of these problems are solvable in terms of the use of psychotropic or consciousness-altering drugs. That is, the effects of the drugs are compatible with the problems faced by the individual or group concerned. A complication arises at this point in that, as explained earlier, the effects of drugs are also partially controlled by the culture itself. But only partially so; for certain drugs are more pharmacologically suited for aiding certain activities than others. Amphetamines, for instance, are, because of their stimulant effect, a much more feasible solution to the problem of a high work load (e.g., in the case of a physician or student) than would be the depressant alcohol. The use of a specific drug is therefore hit upon because of its availability and pharmacological suitability, but after that its effects are restructured and given meaning by the subculture concerned.
The psychotropic drugs, alcohol, nicotine and caffeine are freely available in our society, as — to a slightly less extent — are prescribed barbiturates, amphetamines and tranquillizers. Their widespread use indicates that they provide a most important solution to the problems of a vast number of individuals. The extent and nature of their use is not, however, uniform but varies with the particular subculture which we refer to; to take alcohol, for example, there are wide differences between the drinking habits and ritual of merchant seamen and businessmen, between Frenchmen and Englishmen, between Italians and orthodox Jews. Each subgroup of society will have a conception of what is the appropriate situation to have a drink (what are the cues?), what are the permissible and desirable effects of alcohol, how much it is necessary to drink to achieve this desired state, what meanings are associated with the drunken state (e.g., feelings of masculinity), what is normal and deviant drinking behaviour. They will have a definition of the social drinker but they will also have a notion of the alcoholic; for instance, the phrase 'It is enough to turn a man to drink' indicates that there are definite theories as to the inception of alcoholism and there are in addition undoubtedly notions of how an alcoholic typically acts. Thus the social drinker in our society is commonly seen as someone who holds his drink and enjoys himself whilst the alcoholic is seen as someone who is sick: he is determined and controlled by the drug alcohol. Now, as we have argued, the effects of drugs are related to the conceptions people have of them. We may note that although alcohol is physiologically addictive, the ease with which one is able to cure oneself of this addiction, the speed at which one becomes addicted and the type of behaviour -displayed during addiction will be at least partially related to the social pressures and beliefs surrounding alcoholism. Both the roles 'social drinker' and 'alcoholic' are, I suggest, culturally defined solutions to particular problems. That is, the person who needs to relax and enjoy himself will find himself attracted to social drinking, and the individual who feels that it would be preferable to exist in a state where he is 'out of control' (i.e., where he is determined) will be recruited readily to the role 'alcoholic'.
In the latter instance, our definition of the alcoholic as the determined person will attract those who wish to opt out of particular social situations and be able to say, it's not me who is doing this it's the 'liquor' or the 'booze'. Similarly, the definitions and roles held by a subgroup of society as regards the typical marihuana smoker or heroin addict will attract certain individuals and, obversely, of course, repel others. That is, the way we define the type of person who takes a certain drug and its likely effects controls to some extent the people who take a specific type of drug. Society to some extent creates a series of psychotropic boxes into which the right individuals jump, and of which inappropriate individuals steer clear. For instance, the alcohol molecule per se does not contain a solution to a man's problems; rather, the culture he belongs to defines the problem, states if alcohol is relevant to its solution, and programmes and structures the administration of alcohol so as to provide an array of possible and permissible effects. In short, the psychotropic box erected around alcohol in the particular subculture to which the individual belongs may or may not be capable of containing the problem which he faces.
Now and then, however, certain individuals or groups will question the 'taken-for-granted' effects of specific drugs and will utilize these drugs to obtain different results than defined by those people from their culture of origin. For instance, the college student in his drinking group may begin to define the consumption of an amount of alcohol his temperate parents would associate with alcoholism as merely having a good night out. He will learn to control his intoxication. Or bohemians may define the effects of marihuana as expressive and facilitative of aesthetic experience rather than as inducing libidinousness and aggression of an essentially amoral nature. Or, again, a group may appropriate a synthetic drug such as LSD and erect a cult of initiates around it. Why do these changes in definition occur? I suggest that this occurs when the culture to which a group belongs becomes inadequate for solving their particular desires and problems. People have certain aspirations from the social world: sexual, economic, expressive, etc. Their culture attempts to provide solutions to these particular problems and when there is a disparity between people's aspirations and their means of achieving them a situation occurs which sociologists term anomie. In face of this contingency, people tend to create new means of achieving their aspirations or will alter their desires to achievable ends. For instance, a group of boys may find that the working-class culture of the area in which they live does not provide them with solutions to the particular problems they experience. They may crave a measure of excitement and fun in their lives but find their work repetitious and boring, and the leisure activities available in their area staid and uninteresting. As a result, in certain circumstances, they may develop a subculture which involves delinquency and vandalism. That is, they create their excitement in illicit ways.
Now as psychotropic drugs are used in nearly all societies we would expect them to have the role of solving certain problems and realizing aspirations inherent in these cultures. Their effecis become valued as a means of relaxation, enjoyment, to forget one's workaday worries, etc. New subcultures, however, will have different conceptions of what is desirable and how to achieve it. For instance, the delinquent subculture we referred to may lay a particularly important stress on extreme hedonism; it may value kicks and thrill-seeking behaviour. Drugs — alcohol, marihuana or even perhaps heroin — may be used to achieve these euds.. The important fact to note, however, is that such groups would redefine the nature of these drugs and often radically restructure their possible effects. To explain then the use of a new drug such as LSD or the new use of an accepted drug such as alcohol we must first explain the rise of a subculture of people who are using this drug. And to explain the rise of subcultures the most potent concept is that of anomie. Once again our focus must not be the drug per se but the culture within which it is used and within which its use becomes intelligible.
2. Structural Origins
It is necessary to go beyond the immediate origins of drug use and try to explain why the immediate origins themselves occur in terms of wider processes occurring within society. For instance, it is not sufficient to say that the bohemian student faces at college a state of anomie because his aspirations for an interesting and meaningful course are not met, and that this gives rise to a culture of bohemianism within which drug use becomes a means of obtaining the desired goals of the new subculture. We must also explain why it is that the course is unable to meet the demands of the students and what determines the specific terms in which the student's demands are couched. This brings us to the consideration of the educational system, and the relationship of the latter to the economy, in short for us to view the anomie and drug use of bohemian students in the context of the total society.
3. Individual versus Collective Solutions
The problems faced by an individual may well be solved by the normal behaviour suggested by his culture. In terms of drugs, the man who feels it difficult to relax after work will find that there is a programmed psychotropic drug, alcohol, available and centred around the approved role `social drinker' which will solve his problem. But what of those for whom the culture provides no normal solutions? The individual who faces a particular strain can either solve his problem in isolation or join with like-suffering others to create a collective solution. Taking the individual solution first: a person facing severe strain, yet unaware that there are others who feel likewise, will probably interpret his troubles in terms of self-blame and personal inadequacy rather than as a result of stresses commonplace in society. He will take recourse to the pervasive absolutist explanations of deviancy which are commonly held legitimate in our society. He will individuality his problem and will fail to see himself — or indeed be seen by others — as a man whose troubles are explicable in terms of the wider social context. In such a fashion the deviant is scalpeled off from society, he exists and is understandable only within the narrow limits of his personal pathology, his behaviour is circumscribed within a medical metaphor.
The individual with such a definition of his problems may well find that there are roles associated with certain types of drug use and effects which are appropriate to him. The chief `pathologically caused' psychotropic box which we have in our society is, of course, that of the isolated alcoholic, but subgroups within our society often have conceptions of the heroin addict which are very similar. Thus, for the adult middle-class Briton the social drinker is the normal role for drinking alcohol, whilst the alcoholic is the deviant role. For his bohemian son on the other hand marihuana smoking may be the normal psychotropic activity with heroin use as a deviant role. That is, both `straight' and `hip' cultures have a concept of the `sick' drug user. Into such a role individuals in the particular cultures involved would slot, taking drugs in response to what they and others perceive as the ineluctable disposition of their personalities. The individual is thus playing a pathological role defined for him by his group and heavily underwritten with absolutist premises.
Not all isolated drugtakers, however, would view themselves as having pathological personalities. An alternative, and more insidious analysis, would be that although the person is 'normal' the drug to which he has been casually introduced — whether it be alcohol or heroin or tobacco — has such a power to addict that it is impossible to resist its use. That is, both he, and the social commentators who surround him, mystify his relationship with drugs. The dependence is seen as unrelated to his problems; it is an external disease like chicken pox which he has unfortunately 'caught'.
Each way, the individual is seen to be sick: he has either a sick personality which has led him to addiction or has caught the 'sickness' of drug addiction. Such determined- roles, which seemingly rule out any possibility of free choice or voluntarism are — as I have suggested — peculiarly attractive to people who find themselves in impossible and irreconcilable situations. They enable them to continue a particular line of action, for example mainlining heroin, and at the same time to condemn the practice. They make it possible for the drugtaker to deny responsibility for condemned behaviour - which is in the last analysis functional to him. An extreme instance of this is the study by Charles McCaghy 1 of child molesters. Their behaviour was frequently castigated by themselves but was commonly excused by the suggestion that it was the drink which impelled them to act in such a deviant manner. Studies in the sociology of illness have often intimated that the sick role is not always an accidental occurrence. As Aubert and Messinger put it: 'any situation in which an individual stands to gain from withdrawal is such as to render suspect his claim to illness'. 2 Not only, then, are certain drug-taking activities categorized as 'sick' but particular individuals will struggle to achieve this label. For example, in place of the current image of the heroin addict mechanistically propelled against his wishes by his growing physical addiction, I would portray a man who, in the final analysis, is at some stage attracted to the role. What has evolved is a fantasy involving the systematic mystification of his own make-up. Thus, when physical sickness occurs because of withdrawal from heroin he will interpret this as a confirmation of the social or psychological sickness from which he long suspected himself as suffering. He then self-fulfils his predictions about himself by acting upon these false estimations of his own nature. He relaxes his control on his heroin use because he believes that it is useless to resist. His perceptions of the significance and severity of his withdrawal pains will be distorted as he re-evaluates them in the light of his notion of himself as an addict. At no time does he resist this involvement in the vortex of dependency because the benefits of sickness are greater than the pains of freedom. His desire to avoid choice has become translated into a notion of himself as a being unable to make choice. He is ill; and is so obviously really sick because he experiences tangible physical symptoms which informed medical opinion describes as being both painful and tenacious. Not that such a process of self-engulfment in the sick role is realized immediately; rather a spiral of involvement occurs. The greater the physical sickness experienced the more the confirmation that one's self is sick; the more the belief in the inherent sickness of one's position the greater the likelihood both that withdrawal symptoms are perceived as chronic and irresistible and that one will be impotently 'forced' into using a greater dose. Because of this physical dependency will indeed become greater, withdrawal distress increase, and so on.
There is a strong parallel between the world view of the 'sick' drugtaker and the schizophrenic. This is where, as Ronald Laing puts it: 'the central split is between the individual's] own "self" and what he calls his "personality ".... What the individual variously terms his "own", "inner", "trite", "real", self is experienced as divorced from all activity that is observable by another. '3 The schizophrenic sees his actions as determined and beyond the control of his real self: the sick addict sees his actions as determined either by the drug or a weak part of him which he dislikes. Recently Peter Laurie has suggested that perhaps heroin is used as a method of avoiding incipient schizophrenia, and Laing in a letter to him corroborates this suggestion: 'From my own clinical practice, I have had the impression on a number of occasions that the use of heroin might be forestalling a schizophrenic-like psychosis. For some people heroin seems to enable them to step from the whirling periphery of the gyroscope, as it were, nearer to the still centre within themselves.'4
Interestingly, William Burroughs in his novel The Naked Lunch comments: 'I have never seen or heard of a psychotic morphine addict, I mean anyone who showed psychotic symptoms while addicted to an opiate. In fact addicts are drearily sane. Perhaps there is a metabolic incompatibility between schizophrenia and opiate addiction. On the other hand the withdrawal of morphine often precipitates psychotic reactions — usually mild paranoia'.5
This sick role, which involves a split between the patient's 'real' and 'false' self, is corroborated and confirmed by the ideas of addiction held by psychiatrists, and, indeed, as Goffman has so ably indicated, by the profession's attitude to clients as a whole. Thus he writes:
The key view of the patient is: were he 'himself' he would voluntarily seek psychiatric treatment and voluntarily submit to it, and, when ready for discharge, he will avow that his real self was all along being treated as it really wanted to be treated. A variation of the guardian principle is involved. The interesting notion that the psychotic patient has a sick self and, subordinated to this, a relatively 'adult', 'intact', or 'unimpaired' self carries guardianship one step further, finding in the very structure of the ego the split between object and client required to complete the service triad.6
The alternative type of 'sick' addict, where the individual believes himself to be normal yet inflicted with the disease of addiction seen as some external inhuman agent, is in some ways a more successful strategy than the 'sick self' theory. For, in this case, there is no necessity for the individual to bifurcate himself; here, all his weakness is projected outside him on the 'virus' of drug dependency, his self being seen as united and irreproachable in any part.
The drug-dependent individual then, in both of these modes of adaption, regards his actions as beyond control. He has taken up the sick role available in his culture and perceives himself as a reified 'thing' acting out the pre-determined script which has been allotted to him. But I would argue that this helplessness is fake; it is a mystification because it is a role which is at some point chosen and which is meaning-. ful in terms of its advantages rather than an unavoidable deleterious occurrence. Most appalling of all, it is a myth which by social expectation and confirmation becomes, in part, a reality increasingly difficult for the addict to deny or extricate himself from. It is necessary, therefore, in order to understand the behaviour of this type of alcoholic or heroin addict to — as in the case of schizophrenia — examine the complex of relationships the individual finds himself in primarily at the moment and in his near and relevant past. We must ask: what problems are thrown up by this human matrix, rather than what are the inherent qualities of the drug involved or the essential nature of the man's personality emanating from his far distant childhood experience. And to explain the man's intimate relationships we must then turn our attention to the wider society in which they occur.
There are, however, built-in blocks to the acceptance of such an analysis of this important type of drug dependency. Both society and the individual are unwilling to accept the responsibility which such a demystification would demand. Society will not accept, because it is expedient to lay causal blame on the individual or drug in a vacuum. To suggest that the alcoholic or 'junkie' is grossly dependent on drugs because of his relationship with his family or employer, and that this relationship is a reflection of, for example, the repressive nature of the family and employment in our society, is to make too radical a pronouncement. Such a viewpoint would receive scant support, outside progressive circles, for it involves a culture which questions its own validity. It is likely to demand more change than can be willingly accepted.
Similarly, for the individual to acknowledge that he voluntarily opted for an alienated mode of activity, that he has rejected his own freedom, would undermine the carefully constructed shield that he has evolved to guard him against the encroachments of his fellows. A parallel situation occurs with homosexuals. As Anthony Storr points out: 'all have a vested interest in affirming that their condition is an inborn abnormality rather than the result of circumstances; for any other explanation is bound to imply a criticism- either of themselves or of their families and usually of both'.7
Individuals choose to be determined because it is functional to them, and by defining themselves as such and being labelled by relevant authorities likewise they become determined. Physically addictive drugs merely lend a plausibility
to these determinist notions. Absolutism in social and psychiatric thought, with its implications that human action is determined like that of physical particles, in effect buttresses, sustains and often creates these situations.
We have distinguished two types of drugtaker: those who engage in the normal psychotropic activities of their culture (that is the collective solutions presented to the individual by his group); and those who, facing isolated strain, embark upon individual solutions which are available to them in terms of certain deviant psychotropic roles present in their culture (that is, the collective definitions of permitted deviancy presented to the individual by his group). Thus, either we engage in drugtaking behaviour which is normal for our group, or else we, admitting our own weakness or sickness, act out the role of the deviant drugtaker held by our group. These latter individuals are, so to speak, 'tame' deviants; they admit their failings and interpret their behaviour in - terms of the values of the group to which they belong. They have entered into a contract with society in which they are allowed to act deviantly and opt out of normal adult responsibilities, provided they will admit that this is because of some sickness which impels them to behave in such a fashion despite the inclinations of their own real self. Sometimes, it is true, the alcoholic or heroin addict who adopts such a sick role is condemned as being criminal or voluntarily deviant. But it is the task of the 'enlightened' middle class to defend these underdogs and to explain to those of lesser 'understanding' the true nature of the affliction which they castigate.
But not all drugtakers choose to accept the definitions of drug use taken as given in society. Some come together realizing that they have similar problems, and collectively evolve a new solution. That is, they create a culture where drugs are used, but where the drug use is given a different meaning from that existing previously. First of all, then, a group of people experience anomie: there are no ready solutions to the problems which they experience available in their culture. Then, through communication and interaction they realize that there are others in a like situation, and collectively they create a new culture; innovating solutions to the problems which face them. Such subcultures will involve — if drugs are relevant to their problems — new conceptions of drug use.
It is the use of drugs in radically different ways to achieve ends condemned by powerful groups in society which, as we shall see later, evokes reactions of a substantial and punitive nature.
In evolving new subcultures invoking novel conceptions of drug use social groups will vary with the degree to which they are — so to speak — supervised by the surrounding society. The hallmark, for instance, of delinquent slum areas is the degiee to which adolescents are left unsupervised to seek their own entertainment, usually in and around the streets. Compared to the middle-class child they have a high degree of freedom as far as the development of deviant subcultures is concerned. Similarly, students are often isolated in communities of their peers, unwatched by college authorities. This is not to suggest that social groups which are thus unhampered by control from the outside world will develop deviant norms; merely that the potentiality for such a development exists and will be realized if the group experiences sufficient problems for which there is no ready solution available in their culture of origin.
5. The Immediate Solution
The solution initially devised by an individual or group will be a product of their culture of origin. That is, cultures are transmitted from one generation to the next and then transformed in order to meet the exigencies of the new social situation which their members find themselves in. The old culture is a moral springboard for the emergence of the new.
If the solution to the particular problem faced involved drugs we would expect them: (I) to have properties which are roughly pharmacologically related to the problem; (2) to be accessible; (3) to be in turn shaped to fit these problems by the culture of the group.
Thus, to take the example of the doctor who faces the problem of overwork combined with a painful gastrointestinal disorder. As a member of the subculture of medicine he has a considerable knowledge of drugs, both in terms of their effects and also in terms of their required prescription. He has also high accessibility to a multitude of drugs. Secretly, therefore, he prescribes himself daily shots of morphine. He does not see himself as likely to become addicted, as his expertise in medicine equips him with the belief that he can control its use.8 He will take the opiate in order to pursue ends compatible with his profession (i.e., to continue working) rather than for pleasure as with the lower-class addict. If he becomes, eventually, dependent on morphine the addiction will be shaped, timed, administered and resolved in terms of his culture. All in all, therefore, the solution to his problem is understandable only in terms of the subculture of medicine to which he belongs.
A contrasting example would be that of a group of middle-class students who because of their disillusionment with the rewards of further education drop out and create a bohemian subculture. The values of this emergent culture will be related to the values of their middle-class background. It will be understandable in terms of their culture of origin, changed in order to meet the problem they collectively face. That is, it will be like the culture of the working-class delinquent in that it extols expressivity, hedonism, and spontaneity but will have a middle rather than a lower-working-class orientation. Thus it will value expressivity through non-violent aesthetic pursuits and hedonism through a cool (i.e., controlled) mode of enjoyment rather than a frenzied pursuit of pleasure.
Drug use in this group will involve the smoking of marihuana, which is available in bohemian areas (largely because, in Britain, of the co-presence of immigrant populations), and which has the culturally defined properties of enhancing aesthetic appreciation and bodily enjoyment in a restrained and non-violent manner.
Bohemianism, then — unlike in the case of the physician -- involves the emergence of a new culture which structures and selects the effects and use of the particular drug concerned. Drug use can therefore be part of a newly evolved culture or be contained within the values and restrictions of the old.
1 Charles McCaghy, 'Drinking and Deviance Disavowal: The Case of Child Molesters', Social Problems, no. x6, Summer 1968, pp. 43-9.
2 V. Aubert and S. Messinger, 'The Criminal and The Sick', Inquiry, no. I, pp. 137-60, 1958, p. 142.
3 R. D. Laing, The Divided Self, Penguin, London, 1965, p.73.
4 P. Laurie, Drugs: Medical, Psychological and Social Facts, second edition, Penguin, London, 1969, p. 148.
5 William Burroughs, The Naked Lunch, Corgi, London, 1968, p. 276.
6 E. Coffman, Asylums, Penguin, London, 1968, p. 326.
7 Anthony Storr, Sexual Deviation, Penguin, London, 1964, p. 83.
8 C. Winick, 'Physician Narcotic Addicts', in The Other Side, (ed.) H. Becker, The Free Press, New York, 1964.