Drugs in American Society
Erich Goode
Ninth Edition
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Chapter 7
Theories of Drug Use
Outline
Biological Theories
Psychological Theories
Sociological Theories
Theory
Theory = an explanation, whether confirmed or unconfirmed,
of a general class or category of phenomena; a theory of drug
use would attempt to explain why people, or some people use
or abuse psychoactive substances
Nearly all theories are partial in scope – select one or a limited
number of factors that are believed to cause drug use and
abuse
Most (not all) theories cover different aspects of the same
phenomenon; regarded as complimentary rather than
contradictory
Biological Theories
Biological theories (of drug use) = based on physical causes,
such a genes, hormones, neurological factors, etc.
Postulate that specific physical mechanisms in individuals
impel or influence them either to experiment w/ drugs or
to abuse them once they are exposed to them
2 such theories:
1. Genetic theories
2. Metabolic imbalance
1. Genetic Theories
Genetic theories (of drug use) = rely on chromosomal
differences in the population which influence the
predisposition to take or abuse psychoactive substances
Gene or combination of genes influence biological
mechanisms relevant to substance abuse:
Being able to achieve a certain level of intoxication
Lowering/not lowering anxiety levels when under influence
Capacity to metabolize chemical substances
2. Metabolic Imbalance
Metabolic imbalance = theory focuses specifically on narcotic
addiction; proposes that opiate addiction is caused by an
incomplete biochemical makeup, which narcotic drugs
completes
Once persons with a metabolic imbalance begin using
narcotics, a biochemical process kicks in to make their bodies
crave opiate drugs and render them prone to becoming
addicts
No biological mechanism corresponding to metabolic
imbalance has ever been found
Psychological Theories
Psychological theories (of drug use) = based either on
reinforcement, whether positive or negative, or personality
type
Reinforcement theories suggest individuals continue drug
use because they have a past history of being rewarded for
doing them
Personality theories suggest individuals have a type of
personality that compels them to use/abuse drugs
Psychological Theories
Psychological theories focus on 3 factors:
1.
2.
3.
Positive and/or negative reinforcement
Inadequate personality
Problem behavior-proneness
1. Reinforcement
Reinforcement theories (of drug use) = based on the idea that
drug use is caused by the reinforcing effects of psychoactive
drugs
Positive reinforcement = motivation to continue using drug
because of positive sensations
Negative reinforcement = motivation to continue using drug
to avoid withdrawal symptoms
2. Inadequate Personality
Inadequate personality theories (of drug use) = based on the
notion that young people who lack self-esteem, are unable to
cope with life, who are failures, turn to drugs to drown out the
feelings of failure
Drugs use masks some of life’s problems
The more inadequate the personality, the greater the likelihood
of becoming highly involved in drug use
For the weak, drug use is a kind of crutch
Drug use also viewed as defense mechanism
2. Inadequate Personality
Self esteem/Self-derogation theory (one type/category of
inadequate personality theory):
Drug use/abuse, like deviant/criminal behavior, are
responses to low self-esteem and self-rejecting attitudes
For some, normatively approved activities and group
memberships are sources of painful experiences;
deviant/disapproved activities and memberships act as
effective sources of self-enhancement; drug use provides
this type of deviant activity and group membership
3. Problem-Behavior
Proneness
Problem-behavior proneness theory (of drug use) = argues
that drug use is simply one specific manifestation of a wide
range of problematic behaviors, such as early sex, juvenile
delinquency, conflict with alienation from parents, and
impulsivity
Drug users more unconventional and risk taking than
nonusers
The more unconventional the youth, the greater the
likelihood he/she will use drugs; the more unconventional,
the more serious the drug involvement
Sociological Theories
Sociological theories (of drug use) = make use of broader,
structural, cultural, or institutional factors and variables
1.
2.
3.
4.
5.
Anomie Theory
Social Control and Self-Control Theory
Social Learning and Subculture Theory
Selective Interaction/Socialization Theory
Conflict Theory
What are the parts of a
Theory?
Theory of the person
Theory of the social
Theory of the classification of what is to be explained
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or
distribution without the prior written consent of McGraw-Hill Education.
1. Anomie Theory
Anomie theory = argues that nonconforming behavior is the
product of a malintegrated society whose culture
encourages material achievement but whose social
structure and economic structure denies that same
achievement to most members, thus leading to strain, which
results in deviant adaptations, including retreatism (such as
drug addiction and alcoholism) and innovation (such as
drug dealing)
Innovators = accept society’s goals, but reject means
Retreatists = reject society’s goals (can’t make it), reject
means (why try?)
What are the parts of Anomie
Theory?
Theory of the person :
Theory of the social:
reflective entity that considers opportunity and likelihood of outcomes
a larger framework of values and distribution of material and symbolic
“goods”
Theory of the classification of what is to be explained
People who do not seem to adhere to norms and reject social “goods”
2. Social Control and
Self-Control Theory
Social control theory = argues that violations of the norms,
particularly juvenile delinquency, take place to the extent that
bonds to conventional others, conventional beliefs, and
conventional activities are weak or absent
Self-control theory = explanation that argues that deviant, criminal,
and delinquent behavior – including recreational drug use – are
caused by low self-control which, in turn, is caused by poor,
inadequate parenting
Routine activities theory = explanation that argues that deviance
and crime will take place to the extent that three factors are
present: a motivated offender, a suitable target, and lack of a
capable guardian
What are the parts of Social
Control Theory?
Theory of the person
Theory of the social
People are largely a bundle of desires and are largely egoistic
Other people who recognize that egoism on the part of one harms the
opportunities for ego satisfaction of the rest
Theory of the classification of what is to be explained
People who regularly put individual egoism ahead of group rules about
limits to egoism
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or
distribution without the prior written consent of McGraw-Hill Education.
3. Social Learning and
Subculture Theory
Social learning theory = theory of deviance which argues that
deviant, criminal, and delinquent behavior are learned in a
more-or-less straightforward manner, as a result of exposure to
social circles whose members define engaging in
nonnormative activity in positive terms
Subcultural theories = explanations of use, abuse, or addiction
based on the notion that group-based norms, values, beliefs,
and behavior influence drug taking
What are the parts of Social
Learning Theory?
Theory of the person
People are largely value free and tend to absorb the ideas and
behaviors of those around them
Theory of the social
Other people who have done the same already
Theory of the classification of what is to be explained
Clusters of people who differ from other clusters
What are the parts of
Subculture Theory?
Theory of the person
Theory of the social
People have culture—interconnected sets of learned values that are
mutually reinforcing
Clusters of people who share a culture or subculture (where some
values are shared with the larger society and some are not
Theory of the classification of what is to be explained
The existence of subcutlures themselves
4. Selective Interaction/
Socialization Theory
Selective interaction = drug users do not randomly fall into
social circles of users; attracted to those they are compatible
with
Selective interaction/socialization theory = argues that young
people use recreational drugs because, first, they gravitate
toward social circles whose members are compatible in a
range of ways, drug use included, and second, because these
circles further socialize them into the desirability of using
drugs; the theory further argues that different factors are more
influential at different stages of the young person’s life, that is,
as he or she moves from younger to older adolescence into
young adulthood
What are the parts of
Selective Interaction Theory?
Theory of the person
Theory of the social
People have tendencies that are somewhat learned but not simply
imitated, and which cause them to gravitate to others like themselves
The larger body of individuals and groups that clustering in loose
formations of like-minded individuals
Theory of the classification of what is to be explained
Why not everyone conforms to the groups where they start out, and why
clusters of like-minded people occur
5. Conflict Theory
Conflict theory = argues that social behavior is the outcome of
differences among groups and categories in the population in
power, wealth and resources; drug abuse and drug selling
tends to be more entrenched in poorer, more disorganized
neighborhoods because viable economic options for residents
are limited and community members find it difficult to combat
the power of drug dealers
Represents a macro level explanation of drug use
What are the parts of Conflict
Theory?
Theory of the person
Theory of the social
People have interests based largely on their inherited material
circumstances
A collection of groups of like-minded folks who differ by their place in
the overall material distribution of a place
Theory of the classification of what is to be explained
Distinct sets of values in different groups that coincide with differences
in material well being of the group members.
1. Based on the readings from
the first half of the course, do
you believe that drug use would
increase or decrease if it were
legalized? Would drug-related
problems such as crime and
addiction worsen? Explain your
answers using the materials,
theories, and evidence from the
course readings thus far. Your
grade will be determined by how
well you justify your answer
using course material.
2. Is drug addiction sufficient
reason to remove a person’s
civil rights? Explain your
answers using the materials,
theories, and evidence from the
course readings thus far. Your
grade will be determined by how
well you justify your answer
using course material.
3. The US bases it
categorization (and legal
standing) of drugs based on a
scale of medical utility and
potential for abuse. Propose an
alternative means for
categorizing psycho active
substances that could determine
legal and illegal status.
Explain your answers using the
materials, theories, and
evidence from the course
readings thus far. Your grade
will be determined by how well
you justify your answer using
course material.
4. Should alcohol be treated
considered a schedule 1 drug?
Explain your answers using the
materials, theories, and
evidence from the course
readings thus far. Your grade
will be determined by how well
you justify your answer using
course material.
Drugs in American Society
Erich Goode
Ninth Edition
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Outline
Social research on Drug Use
Rates of Drug Use
Arrestee Drug Abuse
Monitoring (ADAM) Program
Drug Abuse Warning
Network (DAWN)
Monitoring the Future (MTF)
National Survey on Drug Use
and Health (NSDUH)
There are lots of data
sources on drug use; each
has its own strengths and
limitations
Triangulation = examining
a phenomenon by using
two or more independent
data sources
Multiple Confirmation =
verifying that a given
proposition is true through
the use of two or more data
sources
Researchers hoping to learn
about illicit drug use rely
heavily on self report surveys
Research tells us that most
respondents tell the
approximate truth (to the best
of their ability) if they believe
they will remain anonymous
In short, picture we get from
surveys is roughly accurate –
good enough to give us fairly
good idea of what’s going on
and provide us with enough
information to make
generalizations and predictions
Sampling = systematically
selecting a subset of a
population that looks like or
represents that population
with respect to important
characteristics
The way a sample is drawn is
extremely important
Biased sample = a subset of
a population that was
selected by researchers in
such a way that each
member of the population
did not have an equal chance
of appearing in the sample
Descriptive statistics =
numbers or figures that
depict the basic
characteristics of
phenomenon – totals, %s,
rates
Inferential statistics =
numbers or figures that
help uncover the causeand-effect relationships
between two or more
variables
Inferential statistics attempt
to weed out, control, or hold
constant all the other factors
that are related to the ones in
which we are interested
Social scientists want to
know who use drugs, why,
with what frequency, and
with what consequences
4 main sources of
information on drug
use/abuse:
1. ADAM
2. DAWN
3. MTF
4. National Survey on Drug Use
and Health
5th source of information
on drug use/abuse is
Pulse Check
Arrestee Drug Abuse
Monitoring Program (ADAM)
= a federally sponsored,
ongoing data-collection
program that drug tests
(urine sample) and
interviews a sample of
persons arrested in jails
located in metropolitan
areas; high response rate –
no legal consequences of
testing positive or admitting
use
Established in 1987 by NIJ originally called Drug Use
Forecasting (DUF); name
changed to ADAM in 1997
ADAM gets at populations
that are inaccessible by
means of more conventional
research methods, such as
surveys; may not live in
conventional households
What does ADAM data tell
us?
Compared with cross-section of
population at large – most of
whom are not criminal –
arrestees (criminal offenders)
are more likely to use
psychoactive drugs
Limitations of ADAM?
Drug Abuse Warning Network
(DAWN) = an ongoing, federally
sponsored data collection
program that tabulates the
number of drug-related
admissions to emergency
departments (ED reports), as
reported by metropolitan
hospitals and clinics, and the
number of drug-related deaths,
as reported by metropolitan
medical examiners (ME reports)
ED episode = a specific incident
reported to the DAWN of an
untoward, drug-related
experience that results in the
user presenting him/herself to
metropolitan clinics and hospitals
for medical or psychiatric
treatment
ED mention = the mention of
a specific drug in a specific
incident reported to the
DAWN program
ED report = reports issued
by DAWN emergency
departments on drug
episodes
ME episode = a specific
incident reported to DAWN
of a drug-related death
ME mention = the mention of
a specific drug in a specific
incident reported to DAWN
of a drug-related death
ME reports = reports issued
by medical examiners on the
number of drug-related
deaths that took place in a
given metropolitan area
DAWN reports not
standardized; becoming
more so in recent years
DAWN tabulates only acute
drug reactions; does not tally
chronic effects of drugs
3 drugs appear consistently
in both ED and ME figures;
DAWN’s Big Three = cocaine,
heroin, and alcohol-incombination
Monitoring the Future (MTF)
Survey = an ongoing, federally
sponsored data collection
program that entails
administering questionnaires
on drug use to high school
seniors (since 1975), young
adults not in college (since
1977), college students (since
1980), and eighth and tenth
graders (since 1980); measures
use of and attitudes toward
legal/illegal drugs
Conducted by University of
Michigan’s Institute for Social
Research
Surveys
conducted in
classrooms; self-
administered
questionnaires
For each drug, 4 levels of
use surveyed: lifetime
prevalence (ever used),
annual prevalence (past
year), 30-day prevalence
(past month), daily use (20
or more days in past
month)
MTF
data doesn’t include
absentees from school and
dropouts
MTF samples are huge and
reasonably representative
of target population
National Survey on Drug Use and
Health (NSDUH) = an ongoing,
federally sponsored door-to-door
or telephone interview and
questionnaire study on drug use
of a representative sample of the
American population ages 12 and
older
Sponsored by the Substance
Abuse and Mental Health Services
Administration (SAMHSA)
Provides national estimates of the
rates of use, number of users, and
other measures related to the use
of illicit drugs, alcohol, cigarettes,
and other tobacco products
Like MTF, NSDUH asks about
lifetime prevalence, annual
prevalence, 30-day
prevalence, daily use;
divides sample into 3 groups:
youths ages 12 to 17, young
adults ages 18 to 25, older
adults ages 26 and older
Sample large enough to
provide reliable estimates of
drug use in each state
NSDUH is less useful for
subsamples in the population
of drug users that are
statistically rare
Emerging differences in
use patterns can be
missed…
Social Influence is difficult
to measure via self-reports
Anonymity doesn’t
guarantee truthfulness or
lack of stigma (guilt)
Respondent Driven
Sampling
Homophily in social networks can
be measured…how much, and
what kinds of similarity matter?
Variables
Edges
Transitive
closure
-7.583
Age homophily
θ
Error
p-value
3.592
0.020
***
“
0.367
0.115
**
Gender
homophily
“
0.058
0.102
0.566
Race /
Ethnicity
homophily
“
1.205
0.098
***
Injection
Partner
homophily
“
0.460
0.104
***
Medical Marijuana: A
debate
Soc 309 Dombrowski
Fall 2014
Is the use of medical marijuana a problem today?
A.
Yes
B.
No
C.
Unsure
Is medical marijuana legal in Nebraska?
A.
Yes
B.
No
C.
Unsure
For fun
Current users (last 30 days): How do
you use marijuana?
For medical reasons
For fun and medical reasons
Marijuana Today
• Marijuana is the most commonly used illicit drug in the U.S.
• Any use among general population age 12+ in past month:
• 2011: 7%
• 2008: 5.8%
• Use is most common among people age 18-25 (19% of population)
• 48% of adults in the US report having used marijuana at some time in
their life
Marijuana Medicine?
• Botanical cannabis (plant): “Medical Marijuana”
• Synthetic THC medications available in U.S. for nausea/appetite
stimulation:
• Dronabinol (Marinol®) (FDA approved for HIV)
• Nabilone (Cesamet®) (FDA approved for cancer; HIV off-label)
• Other medications not available in U.S.:
• Nabiximols (Sativex®) THC/cannabidiol mouth spray for pain relief, muscle
spasms; currently being investigated by FDA
• Rimonabant (Accomplia®, Zimulti®) for treatment of obesity and nicotine
dependence
(selective cannabinoid receptor-1 blocker)
Current Medical Marijuana Status in US
California Dreaming
• Medical marijuana
dispensaries developed as a
means to cultivate and
distribute medical
marijuana
• In 2007, the City of Los
Angeles capped the number
of licensed dispensaries at
187
• Thousands of unregulated
dispensaries still operate
• Because of conflicts over
land use and zoning,
marijuana delivery services
have developed
How does state regulation work? And what’s
the problem?
• Most drug arrests are made by local/state law enforcement, who enforce state
laws
• Local/state law enforcement in CA operates under Compassionate Use Act (allows for
medical marijuana)
• Federal law enforcement operates under Controlled Substances Act (does not allow for
medical marijuana)
• Federal law enforcement of marijuana laws is rare, varies depending on political
climate
• Federal authorities have been shutting down dispensaries they believe are “profit-making”
enterprises
• Supreme Court ruled that federal marijuana laws have precedence over state law
(2005)
• Can be charged with federal marijuana violations even if obeying state regulations
• Case would have to be brought by federal authorities
• Rare, but can/does happen
• Supreme Court ruled that federal government cannot investigate physicians just
because they recommend marijuana (2002)
Federal Law is a different Story
• Controlled Substances Act (1970)
• Marijuana is a Schedule I drug: “No currently accepted medical use”
• No legal distinction between medical and recreational use
• Up to 1 year in federal prison, $100,000 fine for first possession
offense
• Up to 5 years in federal prison, $250,000 fine for first manufacturing
offense
• Supreme Court ruled that medical necessity is no excuse to break
federal law (2001)
• FDA affirmed smoked marijuana is not considered medicine (2006)
A moving target?
• Investigational New Drug Program
•
•
•
•
•
Individuals could apply for marijuana from the federal government
Under 100 patients given marijuana in program
Large numbers of people with HIV/AIDS applied
Program shut to new enrollees in 1992 due to high demand
Handful of people still getting drug through program today
• Dronabinol (Marinol®) approved by FDA for cancer chemotherapy
(1985) and HIV/AIDS (1992)
• Nabilone (Cesamet®) approved by FDA 1985, became available for
cancer chemotherapy in 2006
How does marijuana work?
• Contains over 60 cannabinoids: main active
chemical is ∆-9-tetrahydrocannabinol (THC)
• Stimulates “high” by triggering receptors in
parts of brain that influence pleasure,
memory, thinking, concentration,
coordination
• THC’s molecular structure is similar to that of
neurotransmitters that affect cannabinoid
receptors (affect pain, appetite, vomiting
reflex)
• Effects generally last 1-4 hours
Cannabis (sativa, indica, ruderalis)
•
•
•
•
•
•
•
•
•
•
•
Plant-derived cannabinoids
∆9 -tetrahydrocannabinol (9) - THC
∆9 -tetrahydrocannabivarin - THCV
Cannabidiol (7) - CBD
Cannabigerol (6)
Cannabichromene (5)
Cannabicyclol (3)
Cannabielsoin (5)
Cannbitriol (9)
Cannabinol
Miscellaneous (11)
Distribution of CB1 and CB2 receptors in the
body….
CB1
CB2
•
•
immunologic cells
(modulation cell
migration)
microglia
(possible role in
Alzheimer’s?)
Hypothesized effects on brain activity
DA: reward and
motivation
Glu: learning and
memory
GABA: inhibition
of neuronal
activity
Pharmacokinetic properties of smoked THC
Smoking:
• Bioavailability: 10-25%
50% of the THC content is
delivered into smoke
50% of smoke is exhaled again
60% of inhaled smoke may be
metabolized in the lung
• Peak concentrations are high and
reached within minutes
• t½ distribution 0.5 hr,
t½ for elimination 30 hr
Pharmacokinetics of Oral THC
Oral:
•Bioavailability: 5-20%
Often considered 1/3 that of
smoked due to gastric
degradation and extensive firstpass effects
High intra-patient variability!
•Multiple peak concentrations
are low and reached in 1-3 hr
•t½ absorption 0.8 hr,
t½ distribution 3.8 hr
t½ for elimination 25 hr
Medical Uses: Chronic Pain
For Multiple Schlerosis
In AIDS patients, marijuana is better at fighting
“wasting” than other non-marijuana medicines?
A.
True
B.
False
C.
Unclear
Answer :
C
For appetite loss in chemotherapy
Reasons for having the “real deal”?
• THC medications still have psychoactive effects (make you high)
• There are chemicals in medical marijuana that moderate THC’s
psychoactive effects
• These chemicals are not present in medications
• Medical marijuana is cheaper
• Not made/patented by pharmaceutical industry
• Smoked medical marijuana takes effect in minutes; THC medications take
over an hour
• Instant feedback allows users to take more if needed for relief
• Due to rapid relief, may consume less if smoked
• When swallowed, THC absorption is more erratic, and less concentrated
• THC effects more unpredictable and variable, possibly less effective
But…
Medical Marijuana is not FDA approved
• FDA approval assures that medications are effective, safe, and properly labeled
• FDA cannot evaluate medical marijuana as a drug since it is a plant, not a
standardized medical formulation
• Medical marijuana is different everywhere, depending on how it is bred, under
what conditions it is grown, etc.
• No way to know if medical marijuana is pure. Can be contaminated by pesticides,
mold, fungus.
Difficult to approve something that is smoked as “medicine”
• Negative effects of smoking
• Depending on type of marijuana, can undergo different types of chemical
changes when burned
• No standard measurement of dosage (inhalations vary by the individual, unlike
pills)
Advantages of
Medical Marijuana
Advantages of
THC Medications
Chemicals that moderate THCs psychoactive
effects
FDA approved
Less expensive
Standardized medical formulation
More immediate relief
Purity
Instant feedback allows for moderation,
possibly less consumption
Not smoked
Less erratic absorption than THC medications
Standardized dosing
Smoking marijuana while pregnant has been
shown to harm fetuses?
A.
True
B.
False
Answer :
A
Health effects of smoking marijuana
Is it addictive?
The Gateway Hypothesis
The drug is changing too….
Toxicity (lethal dose/effective dose)
Refer Madness?
The real issue?
• Marijuana use is more common in
states that have medical marijuana
laws
• It is unclear if higher rates of use are
cause or effect of medical marijuana laws
• Rates of marijuana abuse and
dependence are higher in states that
have medical marijuana laws
• Higher rates of abuse/dependence due to
increased rates of use
• No increase in rate of dependence among
users
A spectre is haunting America?
Or excuse?
Other thoughts…
• https://www.youtube.com/watch?v=oxrKyjeClTk
Is Drug Addiction a Brain
Disease?
Kirk Dombrowski
Soc 309 (Drugs and Society)
Fall 2014
Yes or No?
• The answer matters:
•
•
•
•
•
Stigma
Medical insurance liability
Treatment research
Punishment for harms and accountability
Expenditure of public funds
• Concept of Medicalization
• Power/control exercised by medical profession
• Profit motive and drug industry
• Ignores social conditions that produce distribution
• Empirical Evidence?
A World Problem
• The ability to solve a world problem is directly proportional to our
ability to define it.
• Are we dealing with a problem or a disease?
• (Guess what? It doesn’t have to be one or the other. It could be
BOTH!)
How do we define addiction?
• some people think it’s based upon problems
people have when they are addicted
• I have problems with my mother-in-law. Am I
addicted to my mother-in-law?
How do we define addiction?
• some people think it’s based upon how much
and how often the drug (activity) is carried out
• university students drink a great amount of alcohol,
usually many days a week. Are they all addicted to
alcohol?
How do we define addiction?
• some people think it’s based upon a person’s
personality or lack of will power
• many addicts are high functioning, intelligent people
with no other psychopathology
• does any of this make sense?
How do we define addiction?
• Many would argue that “addiction” is not a
useful scientific term
• Chocolate addiction?
• Television addiction?
• Exercise addiction?
• Is heroin addiction similar to exercise
addiction? (Probably not..)
• Has this dichotomy caused a problem in
getting support for treatment, research, &
education?
The Facts……
DSM and ICD: two drug problems
• abuse: caused by rebellion, money,
boredom, experimentation, thrill-seeking,
desperation, self-medication
• dependence: caused by genetics, brain
chemistry sensitivity, with input from the
environment
We have medical and social criteria mixed
together….
Social
Impact
New technology makes new research possible
Areas of the brain
activated by presence
of cocaine (Fowler et
al, Syanapse 1989)
NIDA’s Model
Drugs mimic brain chemicals
Similar form leads
to disruption of
normal functioning
Drugs Associated wth Neurotransmitters
Why do people have “drugs of choice”?
•
•
•
•
•
•
Dopamine - amphets, cocaine, ETOH
Serotonin - LSD, ETOH
Endorphins - opioids, ETOH
GABA - benzos, ETOH
Glutamate -ETOH
Acetylcholine - nicotine, ETOH
Movement
Motivation
Dopamine
Addiction
Reward & well-being
The Neuron: How the Brain’s
Messaging System Works
Dendrites
Axon
Cell body
(the cell’s life
support
center)
Terminal
branches of
axon
Neuronal Impulse
Myelin
sheath
Donald Bliss, MAPB, Medical Illustration
dopamine
transporters
Effects of
some
popular
drugs on
sustained
dopamine
levels
Long Term
Effects on
number of
dopamine
receptors
Cocaine
Meth
Alcohol
Heroin
Effects of Age of Onset
Rat selfadministration
shows
significant
differences
when age of
onset is tracked
Other differences
High
reception
Influences the
experience of
the drug
Low
reception
However, other factors affect DA D2 levels
Becomes Dominant
No longer stressed
Chronic Stress can lead to
different responses. Rats
that become dominant
show lower cocaine selfadministration, and
higher numbers of long
term DA D2 Receptor
levels.
Becomes Subordinate
Stress remains
Typology of Theories of Drug Use & Addiction
THEORY
INITIAL DRUG USE or
INVOLVEMENT
Nature
Weil
Biological
DRUG ADDICTION
Biogenetic
Neurological/ “brain plasticity”
Psychological
Psychoanalytic
Personality
Psychoanalytic
Personality
Behavioral
Sociological
Differential Association
Differential Reinforcement
Becker’s Learning Theory
Social Control Theory
Strain Theory
Conflict Theory
Dislocation Theory
Differential Reinforcement
Becker’s Learning Theory
Integrated Theory
Strain Theory
Cultural Deviance Theory
Labeling Theory
Conflict Theory
Dislocation Theory
Adapted from Faupel, Sociology of American Drug Use
Emotional / Contextual Factors
Other factors predict just as well or better
than brain functions….
PSYCHOLOGICAL THEORIES
• Psychoanalytic – Drugs are used to alleviate
frustrations over the inability to adjust to normal
routines of adult life
• Personality – Drugs are used by individuals with
“addictive personalities.”
• Behavioral – Operant conditioning - Behavior is
reinforced when rewarded. Addiction results when
drug becomes positive reinforcement (inducing
pleasure) or a negative reinforcement (alleviating
unpleasant withdrawal)
http://www.youtube.com/watch?v=I_ctJqjlrHA
SOCIAL LEARNING THEORIES
• Alfred Lindesmith: Basis of sociology of addiction. Addiction
results only when there is a cognitive connection that drugs
alleviate withdrawal
• Drug users become drug users through socialization-- learning
through interaction with others. 3 Variants:
• Becker’s Learning Theory: Individuals learn to become drug
users through watching others administer the drug properly,
and by learning to associate the effects with pleasure.
• Differential Association – Edwin Sutherland – We learn
behavior from people who have influence in our lives.
• Differential Reinforcement – Ron Akers – Our behavior is
reinforced through the rewards we get from our primary
social group of interaction. Law-abiding groups are likely to
discourage illicit drug use.
SOCIAL CONTROL THEORY
• People naturally want to “act deviant” or pursue
their desires– Social control theory explains why they
don’t.
• Hirschi – Behavior defined as problematic can be
avoided through the attachments or bonds that
people have to conventional society
• Attachment, Commitment, Involvement, Belief
SOCIAL STRAIN THEORY
• Attempts to explain higher drug use rates among
different segments of the population
• “Anomie theory”
• Approved social goals/ends (getting a college
degree) do not always match available means (lack
of educational funding)
• Result = Feeling of normlessness and
disillusionment, or “strain,” that can lead one to
reject conventional standards
CULTURAL DEVIANCE THEORY
• Criminalization of drug use results in the creation of
distinct “drug subcultures”
• Charles Winick’s Integrated Structural Theory (combines
cultural deviance theory and strain theory):
• Access to drugs increases, more embedded in
subculture of use
• Disengagement from normative attitudes on drugs–
create new beliefs and values
• “Role strain” and “role deprivation”
LABELING THEORY
• Focus on social reaction to drug use
• Drug “problems” are constructed – Example:
construction of binge drinking
• Why are some behaviors defined as deviant?
• Why are only some of the people who engage in a
certain behavior defined as deviant?
• What are the personal and social consequences of
being labeled a “deviant?”
CONFLICT THEORIES
• Social inequalities-- racism, poverty, gender violence,
& other forms of discrimination-- all shape
involvement with drugs.
• Why is drug use higher among people living in
concentrated poverty?
• Distribution of social problems creates observed
differences in drug use.
• Lack of economic opportunity
• Living conditions
• More psychic desire to escape pain-Hopelessness
• Addiction is a response to hardship. Drug policy must
address the economic and political sources of
inequality to be truly effective.
ALEXANDER’S DISLOCATION
THEORY OF ADDICTION
• Why are so many people addicted to destructive
habits in the globalizing world?
• Why does addiction extend beyond drugs/alcohol to
include so many other behaviors?
• Why hasn't science been able to solve addiction?
Growth of Free Market Capitalism Changes How We Experience
Social Ties
FAMILY
LEISURE
WORK
The Dislocation Theory: Understanding the
Spread of Addiction
1. Globalization of
Capitalist Free Market
System
2. Decline of PsychoSocial Integration
4. Proliferation of
Addiction
3. Poverty of the Spirit
Drugs in American Society
Erich Goode
Ninth Edition
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Chapter 4
The Sociologist Looks at Drug Use
Outline
What is a drug?
Drug Use and Drug Abuse
Types of Drug Use
Three Eras of Drug Use
Drug Use in the Twenty-First Century
Prescription Drug Use
Defining “Drugs”
Drugs can be defined both materially –by their properties, a more
objective approach- and socially – by the way we and the media
construct them, a subjective approach.
Essentialism = approach to reality that defines phenomena by
objective properties
A drug is any substance with psychoactive effects
Constructionism = approach to reality that defines phenomena
subjectively, that is, by how they are conceptualized, or dealt with by
society
A drug is whatever society or the law define as a drug
Defining “Drugs”
Every phenomenon can be looked at through the lenses of the
two definitions/perspectives just mentioned.
Definitions may be more/less useful according to context.
3 contexts:
Medical utility (less relevant to sociology/criminology)
Psychoactivity (based on an essentialist property)
Illegality (partly a socially constructed property and partly a
consequence of the substances’ effects)
Medical Utility
Medical definition (of a drug) = a substance that is used to by
physicians to treat the body or mind
Objective (essentialist) reality = for a drug to be used
medically, it must act as a healing agent for the body
Subjective (constructionist) reality = drug must be recognized
as therapeutically useful by physicians. There is controversy
over whether some drugs (marijuana, heroin…) are medically
useful.
Medical Utility
Based on a medical definition, heroin would not be
considered a drug in the U.S., while penicillin would.
A medical definition may determine a substance’s legal
status; if not useful, government / individual state more likely
to make sale and possession a crime
Illegality
Illegality context= regards drugs as substances that are illegal to and
possess or sell
Largely a socially constructed definition of what drugs are; different
substances will be defined as drugs in different jurisdictions or time
periods
Legal definitions of drugs may also depend on their physical or
material properties; considered harmful because they are harmful
Definition inadequate if we wish to examine full range of the use of
psychoactive substances, that is, why drugs are used and what
consequences this use has
Legal definition excludes alcohol (sale is authorized and
controlled by the state), a psychoactive substance with strong
connection to both use of illegal drugs and behaviors that illicit
drugs cause/are correlated with
Psychoactivity
Psychoactive = influencing the workings of the mind, cognitive
processes, and consequently, behavior
Any substance, regardless of medical or legal status, that significantly
and pharmacologically alters the workings of the brain is a drug
Pharmacology = the study of the effects of drugs on biological
organisms
Psychopharmacology = the study of the effects of drugs on the mind
Points toward recreational use – the opposite of the medical context
Psychoactivity is a matter of both degree and kind
Pharmacologically speaking, alcohol is a drug in exactly the same
way that cocaine and marijuana, which are illegal, are.
Drug Use & Abuse
Drug use = ingesting a given substance or set of substances in any
quantity with any frequency over any period of time; covers the
entire spectrum of consumption
Since “abuse” is an inexact and loaded term, it should be avoided
except at levels of use that are almost by their nature harmful and
hence, abusive (e.g. drinking a case of beer every day)
Some argue that abuse is the use of psychoactive substance outside a
medical context
Some suggest drug abuse connected to level of use; implies that
certain varieties of use have negative effects of user’s life and/or
lives of persons around the user
Types of Drug Use
LEGAL STATUS
GOAL
Legal
Illegal
Instrumental
Taking Ambien via
prescription to sleep
Using amphetamine to
study all night
Recreational
Drinking alcohol to
feel pleasant
Taking LSD to get high
Legal Instrumental Use
2 principal forms: over-the-counter and pharmaceutical
Prescription drugs are prescribed by physicians to patients
Over-the-counter (OTC) drugs are purchased directly by public on
store shelves without a prescription, though they’re not without their
dangers
Constitute a major source of psychoactive drug use
If a drug is psychoactive, it rarely remains permanently confined to
the context of approved medical usage
Psychoactive drugs once OTC came to be used for the purpose of
getting high
Medical status of a drug may vary over time (medical marijuana)
Legal Recreational Use
Refers to the use of alcohol, tobacco, and caffeine; consumed
for a desired physic state
Coffee drinking can be described as both recreational and
instrumental
Despite mixed motives for taking these drugs, subeuphoric
pleasure cannot be discounted as a major reason for their use
Extent of this type of use immense
Illegal Instrumental Use
Refers to taking drugs without a prescription for some
instrumental purpose of which society approves – driving a
truck, studying for an exam, etc.
Taking drugs illegally but instrumentally connected to other
illegal activities:
Script mill doctors – writing prescription for fee
Illicit, clandestine production – domestically and abroad
Illicit importation – drug smuggling
Illegal Recreational Use
Survey research primary way we learn about illicit
recreational use
As of 2008:
117 million lifetime users
35.5 million users in past year
20 million users in past 30 days
Three Eras of Drug Use
The Natural Era
The Transformative Era
The Synthetic Era
The Natural Era
Began when our ancestors ingested plants that contain
psychoactive ingredients
In ancient times, drug use occurred in the context of either a
religious and ceremonial context, or as medicine.
Included the distillation of alcoholic beverages
The Transformative Era
Began at the dawning of the 19th century with discoveries and
innovations that produced new substances that are more
potent than natural plant products
1803: morphine extracted from opium
1831: codeine was synthesized from opium
1874: diacetylmorphine (heroin) synthesized from coca leaves
The Synthetic Era
Began at the dawn of the 20th century
1903: the first barbiturate, Barbitol synthesized
Scientists began to create drugs entirely from chemicals not
found in nature
1920s: amphetamines synthesized
Spawned a pharmacological revolution that included
recreational use
Sociological Changes
Availability to the young of a disposable income
Recreational drug use rare for adolescents in tribal, agrarian, and early
industrial societies
Globalization—the expansion of the international economic
network, drawing many previously local and national markets
into a single worldwide economy (along with shared
information and media)—has revolutionized the drug trade.
Drug Use in the 21st Century
Tobacco and alcohol remain #1 and #2 in terms of death and disease, killing more
than ½ a million people in the U.S. annually.
Illicit drugs, or the illicit use of prescription drugs, are associated with fewer than
30,000 deaths annually.
Availability of cocaine in the U.S. has decreased by nearly half in recent years,
resulting in significantly diminished cocaine abuse.
Abusive use of cocaine and heroin is most likely to be concentrated in the inner
cities, mainly among racial and ethnic minorities; however, the artificial narcotics,
including oxycodone, fentanyl, hydrocodone, buphrenorphine and the like, tend to be
used in more rural areas.
Marijuana is by far the most commonly used illicit substance, though it is associated
with less crime and psychological/medical pathologies than harder drugs.
In general, users tend to be more loyal to legal drugs—alcohol and tobacco—than to
illegal drugs.
The country’s rate of incarceration drug offenses is the highest in the world, although
treatment is more effect than incarceration for nonviolent users.
Prescription Drug Use
Prescribed by physicians and psychiatrists so that their patients
can be taken out of their pathological or “abnormal” condition
and attain a state of normalcy
The greater the departure from what is considered a “normal”
state of mind that a substance causes, the greater the controls that
governments apply to the distribution of that substance.
Reasons for government control:
To ensure that fewer people are harmed by unauthorized user
Powerful business entities lobby the gov’t to enact or block legislation to protect
corporate interests and intellectual property.
Schedule I Drugs
No medical utility
High potential for abuse
Illegal regardless of purpose for which they are used
Federal law calls for:
A 15-year sentence for manufacture or distribution of narcotics
A 5-year sentence for manufacture and distribution of non-narcotics
A 1-year sentence for simple possession
Marijuana, heroin, Ecstasy (MMDA), LSD, mescaline, peyote,
psilocybin, methaqualone, GHB, and THC
Schedule II Drugs
Some medical utility
High potential for abuse
Most are capable of getting the user high
Morphine, codeine, fentanyl, oxycodone, methadone
Penalties for unauthorized distribution are similar to Schedule
I drugs
Schedule III to V Drugs
Psychotherapeutics:
Antipsychotics--Haldol, Thorazine, Risperdal, and Seroquel
Antidepressants—Zoloft, Prozac, Pristiq, and Effexor
Is virtually no illicit market for these
Sedatives and tranquilizers are used recreationally
https://www.youtube.com/watch?v=kaYvgV1f9bQ
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