Addiction

Different cultures view substances in different ways. This difference in perception influences the use of, and the reaction to the substance that in turn encourages or discourages the likelihood of addiction. The presence of a substance in one culture may lead to addiction, but in another follow no abuse pattern. The introduction of a substance into a culture that does not have a social mechanism for regulating its use already established is a common historical theme. There are several historical examples. In India, the use of opium was never considered a dangerous substance. Indeed, it was grown and used in a social context but was not considered an addictive substance. When introduced to China by the British, opium quickly become a major social problem. Prior to the coming of the Spanish, the Hopi Indians drank alcohol in a ritualistic fashion. Following the Spanish arrival, however, alcoholism became prevalent among the same group of Indians. The introduction of a substance into two cultures simultaneously can lead to different outcomes. Heroin was introduced to the United States and Europe at the same time. In the U.S. heroin, addiction was a social catastrophe, while in Europe, the addiction was considered an American disease.

By looking at cultural perspectives, it is evident that the amount of substance in use at any given time or place does not account for addictive potential. Rather, the effects of alcohol and its presence within a culture correlate more closely with addiction. During the colonial period in America, alcohol consumption was higher than it is today, but the level of alcoholism was far less. Eastern Europeans and Russians are known for consuming large amounts of alcohol, and they have a high rate of alcoholism. In these cultures, and others where alcoholism is rampant (such as among American Indians, Eskimos, and Scandinavians) the display of antisocial aggression and loss of control while intoxicated is excused. These behaviors, the hallmarks of alcoholism, are neither as prevalent or as widely displayed in other cultures that also consume large amounts of alcohol (such as Greeks, Italians) but where alcoholism is low. Clearly, cultural factors influence the nature of addiction. The exact mechanisms of how they do this are not so easily studied and therefore continue to be poorly understood.

Behavior is closely tied to the social and peer groups to which a person belongs. Peer pressure exerts a powerful influence over adolescents and to a lesser, but not trivial, degree over adults. Individuals can easily be coerced into initiating and continuing behaviors such as drug use when surrounded by influential peers. Types of behaviors or drug use are not the only things that are influenced by peer pressure, though. Styles can also be changed. How much an individual will drink or smoke, or what kind of alcohol or cigarettes are consumed, the peer group will, often determine. In addition, peer groups can affect patterns of usage as well as the way the drug is experienced. Individuals seek to cognitively define the internal states that are a direct result of drug effects by noting the reactions of others.

The influence of peer group pressure on drug experiences is best noted with marijuana. The use of this substance is a social learning process and involves the peer group as "teachers" in many aspects of its use. In its early introduction, this drug has to be taught how to be smoked effectively. Users will educate the new user how to recognize and anticipate its effects. The peer group helps the novice define why the altered state is a desirable one. Such social learning is present in all types of drug use as well as other behaviors that often lead to addiction.

An individual's desire for a drug cannot be separated from the situation that surrounds the person taking the drug. Studies by Falk et al. (1983) showed that animals that were addicted to alcohol through an intermittent feeding schedule reduced their alcohol intake when their feeding schedules were normalized. In addition, in the absence of alternatives, the animal is more apt to overindulge. In humans, plausible alternatives will often redirect behavior away from drug use despite the positive mood changes associated with it. Servicemen returning from Vietnam who had been drug addicted during the war often did not become readdicted when they used the same drugs on the home front.

Another important element of addiction is ritual. As simple, as eliminating the rituals that accompany the addiction can be enough to cause the addiction to lose appeal. Powerful aspects of the addiction are obtained from the ritual itself, such that without it, the behavior or substance no longer is accompanied by euphoria. Heroin is a good example. The ritual of injecting heroin and the lifestyle involved in the pursuit and use of the drug is a part of the addiction. Taking away these components, as is done in methadone clinics, often reforms addicts on these bases alone.

The essential role of ritual has been well studied in narcotic addicts by Light and Torrance (1929). They reported that narcotic addicts could have their withdrawal symptoms relieved by a single prick of a needle, or an injection of sterile water. They postulated that the greater the addiction, the more likely to obtain temporary relief from the ritual of injection without the chemical support. Since then similar studies have looked at smoking. Nicotine administered directly by ingestion or injection does not have nearly the same affect that inhaled nicotine does for smoking addicts. Along the same thread, smokers will continue to smoke long after the level of nicotine to achieve the desired affect is reached. Clearly the ritual of injection and inhalation in the case of narcotic addiction and smoking, respectively, play an important, even an essential, role in the addiction.

As people advance through life, their reactions, need for, and style of drug use change. The classic form of this phenomenon, originally hypothesized by Winick (1962), is termed maturing out. As they accept adult responsibilities and assume adult roles, the majority of young addicts will leave their chemical addictions behind. The more readily available the substance, however, the less chance that this will occur. Alcohol is much more readily available than heroin, and, although it also shows a tendency to mature out, it does so less dramatically. Those addictions, such as smoking, that are easily incorporated into one's lifestyle do not commonly have a tendency to mature out. In fact, as individuals with these addictions age, the habitual nature of the addiction makes it even more difficult to stop the addictive behavior.

Before the 1920's, people were convinced that opiate use caused personality defects. At that time, investigators began to challenge this notion and concluded that these defective personality traits actually preceded the drug use. It was ascertained that to neurotic and psychopathic people opiates offered an escape from the realities of life that did not bother psychologically fit individuals. Thus, the drug use was an answer to their pathology, not a cause for it. A study done by Chein et al (1964) drove this point home. They noted that low self-esteem, learned incompetence, passivity, a negative outlook, and a history of dependent relationships characterized ghetto adolescent addicts: clearly individuals with an already burdened outlook on life.

There is no doubt that individuals are predisposed towards some types of addiction based on their personality. Some have tried to predict addictive behaviors based on personality traits. Efforts to unveil an overall addictive personality type have failed, but there are clearly some similarities. Addicted individuals often do not value achievement, they desire instant gratification and they complain of higher than normal levels of stress. The argument that an individual has an addictive personality is strengthened, though, when one considers that the same individuals become addicted to many things, whether simultaneously or sequentially. Furthermore, it is commonly seen that an individual addicted to one depressant is also addicted to another, or will subsequently become addicted. For example, individuals often leave behind a narcotic addiction in favor of an addiction to alcohol. Lastly, the notion that addiction is personality driven is solidified when one considers the habits of reformed addicts. Strong compulsions towards eating, prayer, and other non-drug involvements are classically seen among reformed heroin addicts.

An individual's reaction to drugs is strongly influenced by many things. Expectations, beliefs, and behavior of surrounding people that affect the individual's mental set all contribute. These factors can be so imposing that they can overcome the pharmacological properties of the drugs. The efficacy of placebo demonstrates how cognitive bias can create expected drug effects. In some individuals, placebos can be as powerful as painkillers such as morphine. Cigarette smokers claim that smoking relaxes them, despite the fact that nicotine is a stimulant. In a study done by Zinberg (1974), subjects given nicotine infusions did not become addicted once released from the hospital because they did not believe themselves to be addicts.

There have been several studies that have further substantiated the role cognitive bias plays in addiction. Male subjects who believed they were drinking alcohol, when in fact they were not, became sexually aroused and aggressive. When they were unknowingly given actual alcohol, the same subjects did not display either of these behaviors. Similarly, alcoholic subjects lose control of their drinking when they believe they are drinking alcohol, but not when they are actually drinking alcohol. An individual's belief in his or her status as an alcoholic will better predict the likelihood of relapse than previous drinking patterns and the degree of alcohol dependence. Cognitive and emotional factors are among the most important predictors of relapse in narcotic addiction, alcoholism, smoking, over-eating, and gambling.