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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