Chapter 2:

Theories of Drug Use and Abuse

A Sociological Perspective

Introduction to Theories of Drug Use

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• Multiple theories explain drug use and abuse from different perspectives (biological, psychological, sociological)

• Sociological theories are unique in that they emphasize the role of environmental and social factors

Nature Theories

• Overview: Drug use is an expression of an innate and universal drive to alter consciousness

• Proponent: Andrew Weil (1986)

- Drug use is one of many ways to alter consciousness (e.g., rocking, spinning in children)

- Supporting Evidence: Psychoactive substance use is ubiquitous across cultures

• Limitations: Lack of empirical testing; more philosophical than scientific

Other Nondrug ways of altering consciousness…

• Meditation;
• Intense physical activity (e.g., runners report being “addicted” to the high associated with exercise);
• Risk-taking behaviors such as skydiving or dangerous driving;
• Fasting from food or water
• Self-inflicted pain

The Altered Consciousness of Pain

Genetic/Biological Theories

• Overview: Drug use and addiction are influenced by inherited genetic traits

• Example:

• The flushing response genetic response mainly in Asian ancestry (about one third) and more than 540 million people globally.
• Facial flushing, sweating, nausea, and sometimes tachycardia (Chan, 2018).
• Negative reaction to alcohol dehydrogenase.

Genetic/Biological Theories

• Sensitization Theory:
• Neuroadaptations: Repeated exposure to drugs causes changes in the brain's reward system, making it more sensitive to drugs.
• Incentive salience�The brain's reward system becomes hypersensitive to drugs, which can cause a person to "want" the drug even after they stop using it.
• Craving�The theory suggests that addiction is caused by intense cravings, which can be conscious or unconscious.
• Individual differences�Some people are more likely to become sensitized to drugs than others.

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Sensitization Theory

• Over time the motivation for taking the drug becomes increasingly associated with avoiding the discomfort associated with the aftereffects of the drug (e.g., depression, restlessness) and less and less associated with the “reward” of the high.
• Explains why people often “chase” the same level of euphoria they experienced when they initiated the use of a drug, and why they continue to use the drug even after they no longer experience it as enjoyable.
• Criticism: Genetic factors alone cannot explain drug use; environmental factors are important
• “Sensitization theory is a unique type of neurobiological theory of addiction, as it is distinct in the sense that a behavioral pattern, chronic substance use, places the individual at elevated risk for drug use, relapse, and craving via a biological process.” (Mosher & Akins, 2021)

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Susan’s Brain

Disease Model of Addiction

• Overview: Substance abuse is a medical disease; addiction is an illness beyond individual control
• Key Points:
• Proponent: Elvin Jellinek (1960)
• 1784: Dr. Benjamin Rush called alcoholism an “odious disease”
• Alcoholism is seen as an incurable, degenerative disease
• Heavy problem drinkers show a single distinct pattern of ever greater alcohol use leading to greater bodily, mental, and social deterioration.
• The condition, once it appears, persists involuntarily: The craving is irresistible and the drinking is uncontrollable once it has begun.
• Medical expertise is needed to understand and relieve the condition (“cure the disease”) or at least ameliorate its symptoms.

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Source

Disease Model of Addiction

• Criticism: The disease model over-simplifies addiction, lacks empirical support, supports profits over actual solutions.
• The truth lies somewhere in between.
• 1935 creation of AA: Emphasizes complete abstinence and sees alcoholism as a ‘sickness’

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Psychological Theories

• Self-Derogation Theory:
• Drug use results from low self-esteem and self-rejection
• The more negative a person’s experience with conventional others, the more likely deviant behavior such as drug use becomes to seek validation
• Example: emergence of drug “subcultures”

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Psychological Theories

• Problem Behavior Theory:
• Drug use is part of a broader personality type characterized by risk-taking and unconventionality and a tendency to engage in behaviors that society has deemed unacceptable.
• A drive for independence, not following the rules, rush of adrenaline, etc.
• Criticism: Fails to explain why some people with similar traits don't engage in drug use

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Psychological Theories

Source: Mosher, C. J., & Akins, S. M. (2020). Drugs and drug policy: The control of consciousness alteration (3rd ed.). SAGE Publications, Inc.

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Sociological Theories: Learning Theories

• Differential Association Theory:
• Drug use is learned through interactions with others who value deviant behavior
• Key Idea: People who associate with drug users are more likely to adopt drug-using behaviors
• Social Learning Theory:
• Expands differential association by including reinforcement (both positive and negative) in the learning process
• Key Concept: Drug use is reinforced socially (peer approval) and physiologically (drug-induced pleasure or relief)
• Main influencers: parents and peers

Sociological Theories: Social Control and Bonding

• Social Bonding Theory: Drug use is more likely when an individual's bond to conventional society is weak or broken. Four concepts:
• Attachment: how much a person cares about others’ opinions of him or her and thus how constraining these opinions are. When attachment is low, the opinions of others are much less effective at preventing people from engaging in behavior such as drug use.
• Commitment: extent to which a person is invested in society in terms of educational attainment, occupational advancement, wealth, and the like. As commitment increases, a person has more to lose from engaging in deviant acts.
• Involvement: the amount of time a person spends engaged in conventional activities (e.g., after-school sports). The more time that is spent engaged in conventional activities, the less time there is available for engaging in unconventional activities such as drug use.
• Belief: the extent to which a person holds and endorses conventional rules and norms in society.
• Each of these elements of the social bond is related to the other, so it is probable that the strengthening of one bond (e.g., commitment in the form of a new job) will result in strengthening of the other (e.g., involvement in the form of more time spent in work as a result of the new job) and vice versa.

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Sociological Theories: Social Control and Bonding

• Interactional Theory: Combines social control and learning theories, focusing on how weak bonds and delinquent peers contribute to drug use
• Youth not bonded with parents experience→ weakened bonds at school (and vice versa)→association with delinquent peers and antisocial attitudes and behavior→increased likelihood of weak conventional attachments later in life and deviant behaviors such as illegal drug use and crime.

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Sociological Theories: Social Control and Bonding

Age-Graded Theory

Trajectories and turning points:

Sociological Theories: Strain and Conflict Theories

• Strain Theory (Merton, Agnew): Drug use can be a response to societal pressures, such as economic inequality
• General Strain Theory: Focuses on negative emotions like anger and frustration leading to drug use. Conventional healthy alternatives (sports, etc) have to be available but are not to everyone.
• This also includes access to:
• recreation and entertainment options (e.g., shopping malls, rec centers, sports clubs, movie theaters, and libraries);
• coping and treatment resources (e.g., medical care, professional counseling, and substance treatment centers);
• access to institutions that make psychological coping more easy

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Sociological Theories: Strain and Conflict Theories

• Conflict Theory: societal resources limited, opposing groups struggle over resources, some groups inevitably mariginalized. Therefore:
• Drug laws reflect societal power struggles, benefiting the powerful while marginalizing the poor
• Example: Minorities are disproportionately punished for drug use despite similar usage patterns among all groups

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Key Takeaways

• No single theory can fully explain drug use; a combination of biological, psychological, and sociological factors influences addiction
• Sociological theories emphasize the importance of social structure, peer groups, and environmental factors in understanding substance use
• Strain, conflict, and bonding theories are particularly valuable for explaining how societal factors affect drug use and abuse