SOCIAL CONTEXT AND HUMAN MEANINGWhat can a sociologist tell us about drug use that we do not already know? If there is anything particularly distinctive about the sociologist's view, it is his emphasis on social context. It might appear that this concept seeped into the public consciousness long ago, that it is a banality. But if this were so, the stupendous blunders committed every day by drug researchers and commentators would not occur. If the concept were really understood, a large part of the drug problem would also be understood.
The social context of drug use powerfully influencesindeed, it might almost be said determinesat least four central aspects of the drug reality, aspects that traditionally have been presumed to grow directly out of the chemical and pharmacological properties of drugs themselves, independent of human intervention. These four aspects are drug definitions, drug effects, drug-related behavior, and the drug experience. The sociological perspective stands in direct opposition to what might be called the chemicalistic fallacythe view that drug A causes behavior X, that what we see as behavior and effects associated with a given drug are solely (or even mainly) a function of the biochemical properties of that drug, of the drug plus the human animal, or even of the drug plus a human organism with a certain character structure. Drug effects and drug-related behavior are enormously complicated, highly variable, and contingent on many things. And the most important of these things are social and contextual in nature. In the animal world, it is quite a bit easier to predict what drugs will do. But experiments with rats do not tell us very much about human behavior. This is why social context is so important.
One of the central dimensions of all human experience is meaning. No object or event has meaning in the abstract, in a natural state. Rather meaning is imposed, socially fabricatedin short, symbolic. Meaning has two features: it is both internal and external. Meaning is assigned externally to objects or behavior in the process of human collaboration or interaction. But it also resides within the individual: it is arrived at as a result of a private act of choosing on the individual's part. In order for an observer to grasp that internal meaning, he must view the world from the subject's perspective, which inevitably involves empathy.
The same behavior, the same phenomenon, the same material reality, can mean completely different things to different people or to the same person in different contexts. Meaning is an ascription. It is superimposed on a phenomenon, a reality. It does not arise naturally. Anything may have multiple meanings, depending on one's point of view. Human action is suffused with meaningjust about everything we do is evaluated, thought about, mulled over, judged, interpreted.
Take anythingan object, an act, a thought. Put into two different settings, it will mean radically different things to usperhaps, contradictory thingssimply because of our variability in interpretations. It is not the thing, the act, the thought, we are reacting to. The same thing quite simply "means" different things; the thing does not generate the meaningwe put it there. Consider two scenes: one the boudoir, man and wife alone, engaging in foreplay; the other the examining room of a gynecologist's office, the physician, a man, examining a patient for breast cancer. In both cases, a woman's breasts are being felt. But in one, the behavior is linked with a "script" we refer to as "lovemaking." In the second, it is linked with a different script: a medical examination (Gagnon and Simon 1972). Though the specific acts involved are almost identical in a sheerly physical sense, they "mean" radically different things, and the participants act and react, think and feel, differently as a consequence. Thus they are in fact totally different acts, not because they differ externally but because different interpretations have been brought to them.
A large proportion of all assertions about social reality are ideologically imperialistic in naturethat is, an external meaning is imposed on a reality that should be investigated from an internal perspective. For example, many people equate long hair on men with feminization, without first asking what long hair actually means to the person growing it. Rather their point of view is that of an external observer who thinks that long hair should mean something definite and unvarying. A few generations ago anthropologists, armed with psychoanalytic insights, invaded non-Western civilizations and imposed their interpretations on what they saw. Snakes were interpreted as phallic symbols, regardless of what snakes actually meant to the particular cultures involved. Nakedness was given a sexual meaning, in spite of fact that in some societies nakedness has the overwhelming meaning of poverty, and not at all of sexuality. Today many of these ideological biases have been eliminated from most analyses of other civilizations, but they are depressingly routine when it comes to our own.
And drugs. How do social definitions, interpretations, and meaning impinge on drugs, drug effects, and drug-related behavior? Are the same drug realities defined and interpreted in vastly different ways? How do contextual features change the relevant characteristics of drug use? An example. Peyote taken by American Indians in a ceremony participated in by adherents of the Native American Church is legal and legitimateeven holy. Yet the same substance, taken by college studentseven for the same purposesis suddenly, magically, labeled a dangerous drug, debilitating and damaging to the user and a threat to societyand quite illegal. Another example: heroin and morphine. These two drugs are not very different pharmacologically and biochemically, except that pure heroin is several times as potent as morphine. (In fact, the morphine administered for therapeutic purposes in hospitals is stronger than the heroin sold on the street, since black market heroin is considerably diluted.) An experienced drug addict would probably not be able to discern the difference between comparable doses of heroin and morphine, and a pharmacologist would have to look very, very closely to distinguish the laboratory effects of the two drugs. In short, by "objective" standards they are very nearly the same drug; they do more or less the same things to the tissues of the body. Nonetheless, heroin is declared to have no medical uses whatsoever. It is considered a menace, a killer. Morphine, on the other hand, is regarded as a boon to mankind. It has the stamp of approval from the medical fraternity; it is a valuable therapeutic tool. And yet the roles and medical functions of the two drugs, and hence their social meanings, could easily be reversed. It is not the characteristics of drugs themselves, their pharmacological actions, that generate such contrasting interpretations; rather it is the meanings that have been more or less arbitrarily assigned to them.
The sociologist's view of drugs and drug use goes a good deal further than merely recognizing that there are variable interpretations of similar drug realities and drug-related situations. It also emphasizes that the drug experience and drug effects will vary when different meanings are brought into the drug-taking situation. The one-dimensional, chemicalistic view of drug taking is that humans are basically passive receptors for drug actions, and that when a certain drug is administered a certain effect, or standard set of effects, takes place. This view has been discredited as a general model, but the comments of many drug experts indicate that it is still operative. It is not uncommon to encounter analyses that utilize such concepts as the "complete marihuana intoxication syndrome" (Wikler 1970, p. 324), as if the effects of marijuana were a clinical entity with distinct configurations analogous to an H2O molecule or a cumulus cloud; or the notion that drug users are part of "an abnormal subculture" (Willis 1969, p. 34), as if this could be determined by means of objective, scientific examination.
Naturally, some drug effects will be fairly distinct and will not vary a great deal, and there will be widespread agreement on their occurrence. In almost every case the whites of a person's eyes will become bloodshot after he has smoked a sizable quantity of marijuana. A person with a.2 percent blood-alcohol concentration in his bloodstream will not be able to operate a complex piece of machinery as well as he could when sober. Nearly everyone will go through some sort of withdrawal distress after long-term administration of a gram a day of barbiturates. But drug effects with such narrow variability are themselves limited in number; drug effects that are highly sensitive to external conditions and about which interpretations vary enormously are far more common, as well as far more important and interesting to most observers.
It is crucial to distinguish between drug effects and the drug experience. What happens in one's mind subsequent to taking a given drug is the outcome of many different factors, not solely a function of specific biochemical reactions. A number of changes take place in the body when a chemical is ingested, and not all these changes are automatically noticed and classified. The subject must be attuned to certain drug effects to be able to interpret and categorize them and thus place them within his experiential and conceptual realms. Otherwise, the effect of a drug may simply be sensed as a vague, unsettling, dizzyish sort of experience. A drug effect has to be interpreted and categorized in order to "happen" internally, in order to be part of one's experiencing of it. Out of many potential "effects" of drugs individuals and drug subcultures (as well as the general society) select several to pay special attention to. Very few hospital patients who are administered morphine experience it as euphoric or pleasurable, yet the illegal street user of morphine experiences euphoria and pleasure from it. Psychedelic drugs taken for religious purposes, after spiritual preparation and training, are typically felt as having a religious impact, yet people who take hallucinogenic drugs simply to get high do not usually report anything like a religious or mystical experience. Drugs only potentiate certain kinds of experiencesthey do not produce them. It is the situation, the social definition surrounding usenot simply the drug's "objective" biochemical effectsthat determines the experiential dimension.
Societies define not only the meaning of drugs but also the meaning of the drug experience; these definitions differ radically among different societies and among subgroups and subsultures within the same society. Social groups and cultures define what kind of drug taking is appropriate. They define which drugs are acceptable and which are not. They define who takes drugs and why. They decide what amounts of each drug are socially acceptable. They spell out which social situations are approved for drug use and which are not. They define what drugs do, what their actions and effects on people will be. Right or wrong, each of these social definitions and descriptions will have some degree of impact on actual people in actual drug-taking situations. Each will exert a powerful influence on what drugs actually do. The fact that heroin is attributed with a fantastic power to enslave actually helps to give heroin the power to enslave; the "effect" does not rest completely within the biochemical properties of the drug (Young 1971, p. 43). The effective role of placebos in medical therapy has been underscored in numerous discussions and research. (As one psychopharmacologist wryly remarked: "The lethal dosage of placebo is unknown" [Claridge 1970, p. 26].) The fact that marijuana tends to have a negative and inhibitory effect on the sexual activity of caged rats and a positive and disinhibitory impact on sex in humans indicates the overwhelming role played by social expectations and definitions.
IDEOLOGY AND CULTUREBecause the sociologist studies cultures and societies, ideology and morality, as artificially fabricated productsnot as "natural" and inevitable givens in the universehe is a little more detached from his society's values than are most other members of the society. The sociologist is therefore a little quicker to point out the hidden moral and ideological assumptions behind supposedly "objective" descriptions. What seems to most people to be "reasonable" and "natural" nearly always turns out to be that which is socially approved. If something is condemned as "irresponsible" or "unnatural," this can usually be translated as "potentially disruptive of existing social arrangements and privileges." The way that dominant members of society look at things is supposedly the way things "actually" are. In reality, the dominant view on a given subject (as with nearly every view) is typically shot through with value judgments, with ideological and moralistic assumptions that bear no necessary relationship to the phenomenon in question. Yet such views hide behind a mask of objectivity.
This is true even of the views of scientists engaged in research on the effects of drugs. It is true of "experts" who write books and articles on drugs. And it is especially true of medical men who inform the public about the dangerous practice of drug "abuse." Morality and ideology are labeled "science" if two conditions hold: (1) the propounder of a given viewpoint has scientific credentials in the public eye, and (2) the view presented is in line with dominant opinion. Writings on drugs contain innumerable biases, some hidden, many not so hidden. But incredibly enough few readers ever question these biases; rather they assume them to be true and self-evident, a reflection of the "real" world. The dense involvement of all of us in our culture is indicated by our almost blind and uncritical acceptance of these views.
Dip into any book on drugs. Glance over the concepts, the definitions, the assertions made. Consider such terms as "unreal sensations," "moral judgment of right and wrong,' "withdraw from reality" (Houser 1969, pp. 15, 43, 12), "demoralizing effect," "good judgment," "bad attitudes," "the needs of... law and society," "detrimental to the individual and society" (Jones, Shainberg, and Byer 1969, pp. 36, 16, 85, 9), "poorly adjusted," "the true meaning of anything," "wholesome family situation," "totally unresponsive to education about the hazards of drugs," "well-adjusted young people" (Byrd 1970, pp. 94, 154, 212). These terms were culled from recent drug texts published by prominent publishing houses and widely read. They all contain moral assumptions about what is right and wrong; and they all reflect the ideological bias that the phenomena so described have fixed meanings in the real world, independent of what anyone thinks of them. But in fact every one of these terms is an expression of prejudices on the authors' part; not one has any meaning in a strictly scientific sense. Naturally, some readers will share these prejudicesbut some will not. What is a "bad attitude"? Something the author doesn't like? Something generally condemned by conventional members of society? Can a "bad attitude" be tested empirically?
And the terms "adjusted," "poorly adjusted," and "maladjusted." "Adjusted" to what? It is possible to be "adjusted" to Nazism, or to the grosser injustices of our own society. What about "irresponsible"? "Irresponsible" in what sense? And to whom? In an article published in a major medical journal a world-renowned laboratory and clinical scientist and physician noted in appropriately solemn tones that the effects of marijuana are "very, very bad," but that the effects of alcohol are "just bad" (Wikler 1970, p. 324). How fortunate we are to receive such valuable esoteric scientific information!
Such terms and expressions assume the abstract correctness of the social system in which we live. Deviations from the system are declared to be scientific errors. These declarations represent what might be called pseudosciencemoral and ideological judgments being represented as science. The strange thing is that this tendency is the rule rather than the exception in the drug field. In the debate over drug use and drug effects, smuggled-in value judgments are extremely common, and they shore up many an otherwise persuasive argument. They are used continually as rhetorical and propaganda devices, to win arguments. Assigning something to the status of that which is natural, reasonable, inevitable, rational, and scientifically true not only serves a propaganda purpose but a repressive function as well. If something is rooted in the natural order, is self-evidently true in a scientific sense, how is it possible to question it? However, if we are to be successful at understanding the nature of the drug reality, it is essential to remain sensitive to this ideological sleight of hand.
THE POLITICS OF REALITYThe word "politics" has become attached to a variety of phenomena that were previously thought to be unrelated to the arena of politicsthe "politics of experience," "the politics of consciousness expansion," "the politics of therapy." Implied in any such term is the notion that what becomes taken for granted in any society is, in fact, arbitrary and problematic. We think that, for example, the psychiatrist-patient relationship and interaction is a technical and medical matter in toto, whereas recent thinking in this area has come to the conclusion that ideological, moral, and political considerations are densely woven into the therapeutic process. In a sense, psychiatry becomes a means of upholding one particular ideological view, and repressing others, rather than simply helping to make a patient healthy. Likewise, with scientific definitions of reality we can look at science as an institution which has as its task the verification of a special world-view. The rules of science can be looked at as forensic strategies; facts become wielded as ideological weapons. This view holds that science is deeply involved with ideology, and that the classical view of scientific "objectivity" is completely mythical.
The concept of "the politics of reality" is especially important in areas of controversy. An extremely naive and outmoded "rationalist" position on facts is that man is essentially reasonable, and that the truth will win out simply because it is the truth. This point of view assumes that reality has a kind of brute hardness to it. The sociological position is that, more important than simply what is true (whatever this might mean), is what is thought to be true. One of the more fascinating processes to be observed in society is the way in which certain assertions come to be regarded as true. Obviously, different individuals and social groups have different stakes, both ideological and material, in certain definitions of what is true. Thus gaining acceptance of one's own view of reality, of what is true, is an ideological and political victory. Science has become the basic arbiter of reality. Almost no one aside from the scientistand even then usually only the specialist within a given fieldhas any direct contact with the empirical phenomena scientists describe. The fact that the earth revolves about the sun "makes sense" only when interpreted through specialists; almost no one who believes it has ever tested it for himself. In this sense, scientific truth is not very different from religious truth: we accept it as an act of faith.
In any dispute, we not only want to be morally right, whatever that might entail; we also want to be empirically and scientifically correct. Nothing has greater discrediting power than the assertion that a certain statement has been "scientifically disproven." Generally we search-about for evidence to "prove" our value judgments. If we believe marijuana use to be morally reprehensible, we want to back up our position with "objective" facts to show that we are also empirically correcthence the claim that marijuana is physically or psychologically damaging. Almost no one who believes that marijuana use is immoral also believes that it is harmless; almost no one who views marijuana use with moral indifference regards marijuana as damaging (though many feign moral indifference, simply to make their empirical view more credible). We shop around for evidence in much the same way that we trundle through a supermarket, selecting here and there. Facts are manipulated, wielded as bludgeons, employed as rhetorical devices. Presenting facts in the drug area is more like making a case than searching objectively for evidence.
Any phenomenon is far more complicated than it appears at first blush. We have been taught to perceive only a small portion of the almost infinite number of experiences taking place before us. Philosophers call this process of selective perception attending. We attend to certain kinds of facts and ignore others. "Seeing" is also "not seeing." Whenever a certain observation is made, a sociologically relevant question would be not only "Is it true?" but also "Why stress this observation rather than another equally valid one?" Thus almost any conceivable discussion of the harmfulness or relative harmlessness of marijuana could be presented validly, with extensive documentation, simply by attending to one segment of the marijuana reality and ignoring others. In medical terms marijuana is harmfuldamaging and dangerousto some people under certain circumstances, according to some definitions of harm, at certain dosage levels, in some moods and psychological states. But marijuana is also relatively harmless medicallyfor most people, most of the time, at the potency levels generally available, and so on.
There is enormous leeway, then, in presenting different views of a phenomenon, especially one as controversial as drug use. We are ultimately interested not in highly concrete facts but in generalizations from the facts. ("Is marijuana harmful?" "Does marijuana lead to heroin?" "Does marijuana debilitate driving skills?") Since so many different things can and do happen to so many different individuals, the gates are open to pick and choose those facts that are compatible with our own views. One of the central concerns of this book will be an exploration of the politics of reality in the area of drug use.
THE HIERARCHY OF CREDIBILITYThe concept of "the hierarchy of credibility" (Becker 1967a) is especially important in any area of human behavior where "experts" abound. It refers to the fact that some people especially those in socially responsible positionshave more power to define what is true than others do. Yet some of the most prestigious, well-known, and credible drug "experts" have never done any research on the subject, and their pronouncements make it clear that they are ignorant of the latest research. Legitimacy and credibility bear a scant relationship to actual expertise, if that is defined by participation in firsthand research or by a detailed and up-to-date knowledge of that research.
From time to time the American Medical Association has issued statements purporting to describe to physicians, as well as to the public at large, the dangers of marijuana use. These statements have been construed by both groups as crystallizations of scientific and expert truth, solidly based on hard evidence. They have been labeled "studies" and "reports," yet they are not based on any research that members of the AMA might have clone, or on research that the AMA might have commissioned, or indeed on any research at all. The American Medical Association's articles on "Marihuana and Society" (American Medical Association 1968) and "Dependence on Cannabis (Marihuana)" (American Medical Association l968) have been cited in thousands of anti-marijuana tracts as definitive proof of the drug's harmfulness, yet they contain little more than a mixture of quite outdated assertions and blatantly biased value judgments.
Inevitably, in any controversy we run into the problem of whose word to accept as valid. It is possible in any debate to attack the credentials of anyone with whom we disagree and to accept those of someone we agree with. Through this winnowing process, an artillery of authorities can be assembled to make it appear that we are "right" about our views. But credentials can be weighed in very different ways. To the public a hospital administrator, the head of a government agency, or a member of a national medical committee has better "credentials" than an independent medical or scientific researcher whose work may be known only to a few thousand specialists. To these specialists the hospital administrator may be an ignoramus. It usually turns out that those in positions of social responsibility, those who have credibility and legitimacy, can also be counted on to say something relatively safe and essentially protective. They as well as the public see their role as that of upholding dominant ideological views. They act as a kind of filtering device for the findings of various independent researchers, accepting those findings that fit in with dominant views and ignoring or attacking those that do not. For instance, the fact that a clear majority of all scientific researchers favor some form of legalization of marijuana is unknown to the publicbut the fact that officials of the AMA, the federal government, and the World Health Organization would oppose such a move probably is known to the public and is considered proof that it would be unwise.
The concept of "the hierarchy of credibility" becomes crucial when we consider that credible spokesmen have been known upon occasion to proclaim utter nonsense, yet their statements are taken seriously by a large proportion of the public. On March 6, 1971, Dr. Wesley Hall, the newly elected president of the American Medical Association, was quoted by United Press International as saying that a study completed by the AMA left "very little doubt" that marijuana caused a considerable reduction in sex drive. Dr. Hall noted that a thirty-five-year-old man might find his sex drive diminished to that of a seventy-year-old man if he used marijuana, and he hinted that certain evidence demonstrated that marijuana caused birth defects. (This was an extremely clever statement, incidentally, containing as it does what is probably the most dreaded fear of man and woman respectively.) Dr. Hall also suggested that forthcoming findings would help to reduce the level of marijuana use in the country (Drugs and Drug Abuse Education Newsletter 1971). His statement received considerable coverage by the media and was quickly broadcast across the country.
About three weeks after the statement was made, Dr. Hall said that he had been misquoted, but he added, in an interview:I don't mind... if this can do some good in waking people up to the fact that, by jingo, whether we like to face it or not, our campuses are going to pot, both literally and figuratively.... If we don't wake up in this country to the fact that every college campus and high school has a problem with drug addiction, we're going down the drain not only with respect to morality, but. .. the type of system we're going to have (Drugs and Drug Abuse Education Newsletter 1971, pp. 6, 7).
Dr. Hall said that he was "deeply concerned with the fact that kids 18 years old are going to have the vote," because they are "in favor of legalization of marijuana and even ... the harder drugs." In relation to drug use in Las Vegas, he commented: "They have 7,000 kids there on drugs.... Somebody better wake up and do something about it instead of talking about the authenticity of a final report which might or might not be out yet." Attacking NIMH's report on marijuana, Dr. Hall said: "Some people are a little bit hesitant to stick out their neck until they have proof positive." Commenting on his own role, he explained: "The AMA states that marijuana is a dangerous drug, that it should not be legalized, and that every physician should do everything in his power to alert the folks to the dangers of marijuana, and this is one thing I'm trying to do." When asked whether misleading statements such as his own might damage the credibility of the AMA, Dr. Hall said: "I'm tired of these phrases about the credibility gap. We're talking about the morality of the country... and respect for authority and decency" (Drugs and Drug Abuse Education Newsletter 1971, p. 7).
The entire episode bears crystal-clear testimony to most of the sociological concepts discussed in this chapter. It is readily apparent that Dr. Hall does not like marijuana use; as he sees his job, he must assemble a damaging argument to convince the public of what he wants it to believe. And given the AMA's legitimacy in most Americans' eyes, it is entirely possible to perform this feat. It is also clear that Dr. Hall is untroubled by such technicalities as evidence, facts, and datawhat he wants is good, solid propaganda, regardless of what the facts say. The truly amazing thing is that the AMA can continue to be believed after such an episode. But such is the power of the hierarchy of credibility; in fact, the AMA is and will continue to be taken seriously by most Americans.
The power of the hierarchy of credibility is also demonstrated in an anti-marijuana tract distributed recently by the Ambassador College Press. The pamphlet, entitled "New Facts About Marijuana," claims that marijuana is more dangerous and damaging than any other drug, and that it is the "number one narcotic drug" because "the effect on chromosomal organization... from its first use posits permanent effects through generations.... Very few fatal diseases are ever transmitted to subsequent generations as both dominant and recessive. They are either one or the other. But marijuana addiction is transmitted to subsequent generations in both ways, dominant and recessive." These statements were made by a Dr. Louis Sousa of St. Ditmas Hospital in Paterson, New Jersey, and were supposedly presented at a conference of geneticists at Oxford University. Several interested observers (Fiedler 1971; Wittman 1971) checked on the validity of these facts. They discovered that (1) Louis Sousa was not a physician but a laboratory technician; (2) the paper in question was never delivered at a conference of geneticists at Oxford; (3) Sousa was discharged from St. Ditmas about five or six years before the pamphlet was distributed; (4) Sousa has subsequently left the country, under indictment for perjury on another matter. But notice the manipulation of the symbols of legitimacyattributing Sousa with a medical degree when he has none, invoking the prestige of Oxford Universityin an effort to convince readers of the pamphlet that marijuana must indeed be harmful. If such an impeccable authority claims genetic damage, how could it be false?
WHAT IS A DRUG?After emphasizing the ideological biases hidden in most analyses of the drug reality, it is now possible to attempt several crucial definitions, utilizing these insights as a basis. To be adequate, any definition should perform the following functions: (1) it should group together all the things that share a given relevant trait and (2) it should set apart those things that do not share that trait. What is the defining trait that all drugs share? And what separates a drug from something that we cannot properly call a drug?
Most of us believe that all drugs have some intrinsic property that automatically classifies them as drugs. Even the experts assume that the category "drug" is based on a natural pharmacological realitythat a drug must be something or do something that makes it part of a natural, organic, and chemical entity. Yet any search for a purely pharmacological definition of drugs would be fruitless. No formal, objective characteristic of chemical agents will satisfy both criteria of an adequate definition simultaneously. There is no effect that is common to all "drugs" and that at the same time is not shared by "nondrugs." Some drugs are powerful psychoactive agentsthey influence how the mind works; others have little or no impact on mental processes. Some drugs have medicinal properties; others have no medical value at all. Some drugs are toxicthey require very small amounts to kill living beings; the toxicity of other drugs is extremely low. Some drugs build tolerance very rapidlyincreasingly higher doses are required to achieve a constant effect; others do so slowly or not at all. Some drugs are "addicting"they produce a physical dependence; others are not. There is no conceivable characteristic that applies to all substances considered drugs. The classic definition of a drug to be found in nearly every introduction to pharmacology is "any chemical substance that affects living protoplasm." Unfortunately this widely adopted definition is far too broad to be of real usea glass of water fits the definition, as does a bullet fired from a gun, a cold shower, a meal, a cup of coffee, aspirin tablets, or even this book.
When we turn to the social definition, we find that the concept "drug" is a cultural artifact, a social fabrication. A drug is something that has been arbitrarily defined by certain segments of society as a drug. Although all substances called drugs do not share certain pharmacological traits that set them apart from other, nondrug substances, they do share the trait of being labeled drugs by members of society. What this means is that the effects of different drugs have relatively little to do with the way they are conceptualized, defined, and classified. The classification is an artificial one; it resides in the mind, not in the substances themselves. But it is no less real because it is arbitrary. Society defines what a drug is, and the social definition shapes our attitudes toward the class of substances so described. The statement "He uses drugs" calls to mind only certain kinds of drugs. If what is meant by that statement is "He smokes cigarettes and drinks beer," we are chagrined, since cigarettes and beer are not part of our stereotype of what a drug is, even though nicotine and alcohol are certainly drugs by at least one criterionthey are both psychoactive.
Thus there is a popular conception of drugs (mainly illegal drugs) and a psychopharmacological definition (psychoactive drugs) that are somewhat independent of one another. A given chemical substance may be a drug within one definition or sphere of interest but not another. Substances such as primaquine, primadone, prinadol, priodox, priscoline, and privine have important medical uses and are described in reference works on therapeutics. Yet it would not occur to the man on the street that any of these substances were drugs. Other substances such as peyote, kava-kava, betel nuts, coca leaves, and Amanita muscaria are used by certain tribal peoples, but they would not appear anywhere in a work on therapeutic medicine. Penicillin has been one of the most valuable drugs in medical therapy in human history, but it is not used illicitly on the street. Alcohol is a drug in a psychoactive sense, but not if we were to adopt conventional society's definition: a man who drinks liquor does not think of himself as a drug user, and he would rarely be so defined even by nondrinkers. Nothing is a drug according to some abstract formal definition, but only within certain behavioral and social contexts. Which substances we elect to examine in any discussion of drugs is always arbitrary and depends entirely on our purposes.
Therefore when anyone speaks or writes of drugs, whether layman or professional, physician, sociologist, journalist, or politician, he is referring to a social and linguistic category of entities, not to a natural or pharmacological category. Thus the claim that the "willingness of a person to take drugs may represent a defect of superego functioning in itself" (Fink, Goldman, and Lyons 1967, p. 150) means simply that individuals who ingest substances that society has arbitrarily chosen to label "drugs" supposedly share certain neurotic personality traits, traits not generally shared by those who ingest substances to which society does not assign the label "drugs." This distinction is crucial, and cannot be ignored.
One discussion points out that "nothing is a drug but naming makes it so" (Barber 1967, p. 166). Common substances such as ink, soap, gauze bandages, iron, and salt are considered drugs within certain medical contextsthat is, they are considered to have therapeutic utility and are used to heal, or for diagnostic purposes.... almost anything can be called a "drug." There is nothing intrinsic to any physical or biological substance that makes it a drug or does not. The same substance can be called a "drug" in one social context and called something else in another. For example, the ink that is used in fountain pens is not a drug when used in that way, but it may legally be defined as a drug if it is used as a diagnostic agent in connection with anti-fungal materials which are also defined as drugs.... When we look at drugs in a generalized and comprehensive way, what we see is that it is not so much the substance of a material that makes it a drug, but rather some particular social definition (Barber 1967, p. 2).
WHAT IS A NARCOTIC?The term "narcotic" has been used in two radically different ways in our society. The popular and legal definition has been "any illegal drug." When a drug seizure is made by the police, newspapers will proclaim: "Police Confiscate Narcotics." Many state statutes define marijuana as a narcotic. Medically, pharmacologically, and scientifically, however, the term "narcotic" means a chemical substance that dulls the body's sensitivity to pain; this function is called "analgesia." Thus narcotics serve an important medical and therapeutic function. But they are also pharmacologically addictingthat is, they produce an actual physical dependency in both animals and man. Within this definition only a very narrow range of drugs may properly be called narcotics, and these are discussed in Chapter 6.
Why should confusion arise between the popular and the medical definitions of narcotics? Why should the law, government figures, and the man in the street think of narcotics as "illegal drugs," while the scientist and the physician define them as "painkilling drugs"? And why should government officials stoutly defend the unscientific definition? Several years ago Donald Miller, chief counsel for the Bureau of Narcotics and Dangerous Drugs, a subunit of the Department of Justice, stated: "So far as I can see, I do not think it is irrational to legally define marihuana as a 'narcotic drug' " (Miller 1968, p. 55). Elaborating on the categorization, Miller noted:Despite some physiological differences in the effects of the drugs in the opium family and marihuana, the inclusion of marihuana in the statutory definition of "narcotic" is not constitutionally improper. The word "narcotic" is commonly used to designate drugs having the consciousness-altering characteristics of marihuana, i.e., stupor, mental lethargy, marked alterations of mood, and possible physiological harm (Miller 1968a, p. 93).
Actually, the defenders of classifying marijuana as a narcotic have an ideological and propagandistic purpose in mind. "Narcotic" has become a kind of code worda discrediting labelfor a drug whose use is (supposedly) "bad" for the user. In the view of the propagandists, attaching such a labeleven if it is absurd from a scientific point of viewmakes it easier to persuade the public that the drug is in fact harmful and dangerous. The scientific definition of a narcotic ("painkiller") is relegated to minor importance, and the moral meaning ("bad") is given a center stage position. Apparently there is a fear on the part of propagandists that removal of the label "narcotic" from marijuana would imply that it is not in fact dangerous. Notice the clear political overtones of this labeling process in the following statementthe reaction of Representative Charles Wiggins, a Congressman, to the statement made by a physician, Sidney Cohen, that marijuana is not medically or pharmacologically a narcotic:You say quite positively marihuana is not a narcotic. It is not, but only because medical science has chosen to define a narcotic in a fairly narrow sort of way. What I am fearful of, Doctor, is that those who listen to the words, "marihuana is not a narcotic" will not be medical doctors at all, but will rather be just ordinary people who will read into that that it is not dangerous. Now you do not mean that, do you? [my emphasis] (Pepper 1970, p. 13)
It is easy to see from this quote the great hold that definitions have on men's minds; it is also clear that our way of defining something has immense ideological implications. Science and politics interpenetrate one another at crucial junctures, and it will be one of the tasks of this book to explore these connections. It should be clear that the popular and legal definition of the term "narcotic" has very little to do with the pharmacological and scientific definition. We will encounter this phenomenon frequently.
DRUG ADDICTION AND DEPENDENCEIn the early 1960s, the World Health Organization, in an effort to devise a new terminology that would apply to the "abuse" of all drugs, not just addicting drugs, adopted the term "drug dependence." According to WHO "drug dependence" is... a state of psychic dependence or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continued basis. The characteristics of such a state will vary with the agent involved, and these characteristics must always be made clear by designating the particular type of drug dependence in each specific case.... All of these drugs have one effect in common: they are capable of creating, in certain individuals, a particular state of mind that is termed "psychic dependence." in this situation, there is a feeling of satisfaction and psychic drive that require periodic or continuous administration of the drug to produce pleasure or to avoid discomfort (Eddy et al. 1965, p. 723).
Under the new terminology, each drug has its own characteristic type of dependence: there is a "drug dependence of the morphine type," a "drug dependence of the cannabis [marijuana] type," a "drug dependence of the alcohol type," and so on. In other words, the new terminology is a definition, or a series of definitions, by enumeration, for it was felt that no single term could possibly cover the diverse actions of the many drugs in use (or "abuse").
In reality, however, the new definition, as well as the accompanying elimination of the term "addiction," is without any utility and confuses more than it clarifies. Its intent is patently ideological in nature: to make sure that a discrediting label is attached to as many widely used (or "abused") drugs as possible. Under the old terminology, it was not possible to label a wide range of drugs as "addicting." As in the "narcotics" controversy, it was necessary to stigmatize such substances as marijuana with a term that sounded very much like "addicting" but that also had a ring of truth to it. In other words, the scientists and physicians who created the new terminology were being employed as propagandists to convince the layman that nonaddicting substances were just as "bad" for him, that he would be just as "dependent" on them as on any truly "addicting" drug, and that the repeated use of both arose out of a compulsion. Under the new terminology, drugs and patterns of drug use that are really radically different are linked together to appear similar in important respects.
If we wish to adopt a less propagandistic stance toward the terms "psychic" or "psychological" dependence, it is necessary to abandon them altogether. The difference between psychic dependence and classic addiction (that is, physical dependence) is the following. If you take or are administered a truly addicting drug such as heroin, morphine, or any of the barbiturates in sufficient doses over a long period of time, you will become addictedthat is, your cells will crave the drug, and if the drug is discontinued, you will undergo withdrawal sickness It does not matter what you think, what ideas and attitudes you have about the use or effects of the drug, your cells will still crave that drug. (Even if you have not been told that you are being given the drug you will experience discomfort, although you will not attribute your discomfort to the drug.) In contrast, if you take or are administered a nonaddicting drug such as marijuana over a period of time, nothing essentially will happen to you when you are "withdrawn" from the drug. It is impossible to induce addiction to marijuana.
Now some individuals do use nonaddicting drugs such as marijuana regularly and frequently. But to say that marijuana "causes" a psychic dependence is meaningless. Medical "authorities" label continued (or even sporadic) marijuana use as "dependence" for the simple reason that they cannot understand why anyone should want to use it at all. It is not the properties of marijuana that "cause" a psychic dependence; rather it is the personality structure of certain individuals who happen to use it frequently. It is the individuals that bear looking into, not the drug. It is illogical to attempt to explain something that is variable (some users smoking marijuana heavily and some infrequently) in terms of something that is constant (the drug supposedly producing a psychic dependence).
Eliot Freidson, a sociologist, has labeled psychic dependence "the overwhelming product of psychiatric scholasticism"; in a letter to the editor of Trans-action magazine, Freidson commented on the "psychic dependence" of marijuana: "What does this phrase mean? It means that the drug is pleasurable, as is wine, smoked sturgeon, poetry, comfortable chairs, and Trans-action. Once people use it, and like it, they will tend to continue to do so if they can. But they can get along without it if they must, which is why it cannot be called physically addictive" (Freidson 1968, p 75). The point is that psychic dependence means the use on a continued basis of anything that certain medical figures disapprove of. The key word here is disapprove, since the use of other substances that these medical figures do not disapprove of is not labeled a dependency.
An addicting drug makes cells dependentit makes them "crave" that drug. When a pharmacologist says that a drug such as morphine or alcohol produces a physical dependence, he means simply that body cells respond in a certain way to continued administration of these drugs. However, it would be completely improper to say that as a direct consequence of this cellular response humans become addicted to the drugs in question. Whether humans do in fact become addicted is dependent largely on social and psychological factors.
Nonaddicting drugs do not produce a biochemical dependence in animal cells. Whether or not they lead to continued use is also a social and psychological matter, but continued administration of a nonaddicting drug cannot be equated with a dependence, physical or psychic. A person who has taken high-quality heroin several times a day over a period of time is un4uestionably physically dependent on heroin. A person who smokes marijuana several times daily is displaying a pattern that is a manifestation of something going on in his mind and in his social milieu, and it has little to do with marijuana as a drug.
It should be clear, then, that there are two quite separable components in the addiction-dependence equation: one is the direct physical action of the drug; the other is how people respond, behaviorally, to the physical action. One component does not translate automatically into the other. The knowledge of what a drug does to the human body does not explain what humans will do in relation to the drug in question.
The basic fallacy of the World Health Organization's new terminology is its reductionismthat is, its assumption that the biochemical properties of a drug determine the behavioral reality in relation to that drug. If the old definition of addiction is understood as a strictly biochemical description, then it contains some validity, although with serious flaws. But the new terminology is completely invalid, because it is trying to deal with the social dimension by absorbing, distorting, and underplaying what is in fact the central feature of drug taking.
DRUG ABUSEPhysicians commonly employ the term "abuse" to refer to the use of a drug outside a medical context; this is the official definition of drug abuse given by the American Medical Association. The term, however, conveys a moral rather than a scientific judgment. Since "abuse" clearly connotes something negative or bad, to employ the term is to discredit and stigmatize drug use rather than to understand or describe it. Those who use the term declare that nonmedical drug use is invariably harmful, without first investigating whether it is in fact so or what constitutes harm in the first place. "Abuse" puts forth the claim that only physicians should be permitted to administer drugs. But since the term "drug" is a social and not a medical concept, such strictly medical claims are inconsistent. One never hears of "medically unsupervised" use (and therefore "abuse") of alcohol, even though alcohol has effects similar in many ways to those substances that physicians feel they ought to control or veto. By the AMA definition, any use of marijuana, regardless of its medical consequences, constitutes abuse, since the drug is not approved for medical purposes by most, and by the most credible, physicians. Purposes such as euphoria, pleasure, relaxation, or mind transformation are considered illegitimate.
As "abuse" is used in context, however, it conveys the distinct impression that something quite measurable is being referred to, something very much like a disease, a medical pathology, a sickness in need of a cure. Thus the term simultaneously serves two functions: it claims clinical objectivity, and it discredits the phenomenon it categorizes. "Abuse" announces to the world that the nonmedical taking of drugsactually, only certain types of drugs, since legal drugs such as alcohol are magically exempt from the definition (and thus the medical definition is a passive and curious reflection of the legal situation)is undesirable, that the benefits obtained from illegal drugs are counterfeit, and that they are in any case outweighed by the hard rock of medical damage. But since the weighing of values is a moral and not a scientific process, we are able to see the ideological assumptions built into the term Furthermore, the linguistic category demands verification. By labeling anything "abuse," it becomes necessary to prove that the label is valid. The term so structures our perceptions of the phenomenon that it is possible to see only "abusive" aspects in it. Therefore data must be collected to "demonstrate" the damages of nonmedical drug use. In such ways do science and medicine become the handmaidens of morality and politics.
DRUG EFFECTS AND THE DRUG EXPERIENCEThe prevalence of ideology in the drug realm is exemplified by the unwillingness of most observers, including physicians and scientists, to attempt a systematic investigation of the reality of drug use from the point of view of the user. This unwillingness is typically verbalized in a rhetoric of objectivitythe user is inevitably biased and hence cannot tell us anything about the phenomenon of drug use. This position confuses "objective" and "subjective" effects, and tends to ignore the drug experience. The fact is that no one except the drug taker is capable of reporting the nature of the drug experience; thus it is absolutely essential to elicit his descriptions. At the same time, we are totally at the mercy of those descriptions. Traditional behaviorists surmount this dilemma by completely ignoring internal states, judging them to be too ephemeral and subject to distortion and error to be reliable. Clinicians, at least of the psychoanalytic school, resolve the dilemma by assuming that overt descriptions and statements by drug users represent some deeper hidden meaning that only the psychoanalyst can understand and interpret. But if we wish to put together a complete picture of the drug reality, we cannot afford to be so restrictive. How can we utilize descriptions by subjects of the drug experience without becoming a victim of such distortions as might obtain from reliance on this type of data?
A few examples will highlight this "objective-subjective" dilemma. Recent laboratory experiments have shown that, contrary to the opinions of most users and nonusers alike, marijuana does not cause dilation of the pupils of the eyes (Weil, Zinberg, and Nelsen 1968). The traditional behavioral scientist will cite this finding as an example of how even experienced users will believe the myths about marijuana, and hence as further proof that it is risky to accept the "subjective" word of drug users about any aspect of the drug reality.
However, there are different levels of the drug reality. The presence or absence of some external drug manifestations (such as pupil dilation) can be verified objectively. Other drug effects are located purely within the subjective realm and are beyond the reach of traditional scientific instruments; in order to explore them we must ask the drug user to re-create the subjective and expressive character of the drug "high." It would be absurd to claim that science can "disprove" the reality of a drug experience as it can the occurrence of a certain physiological effect. Rather the two are in totally different realms. For example, marijuana users often claim that they can hear music more acutely under the influence of the drug (Halikas, Goodwin, and Guze 1971; Tart 1971; Hochman and Brill 1971). However, researchers have been unable to verify this in laboratory experiments: under the influence of marijuana, the activity of perceiving and reporting on auditory stimuli is not significantly different from normal (Caldwell et al. 1969).
The traditional laboratory scientist will feel that this disproves the users' claims, and he will view it as evidence of the distortions inherent in reasoning from subjective reportsas well as evidence for relying exclusively on laboratory findings accumulated by trained scientists. However, to conclude that the drug user is simply an untrustworthy guide through the dark wood of fact would be hasty and simple-minded. To understand the subjective impact of sense stimuli, we have to abandon the strict laboratory approach. Users report overwhelmingly that their identification with, involvement in, appreciation of, and enjoyment of music under the influence of marijuana are heightened, that the experience of listening to music becomes richer and more exciting when they are high. This is not a question of a "misperception"the user's experience is in fact the perception itself, and the perception is the phenomenon to be measured. The subjective grasp of the experience is the very reality itself.
Similar observations may be made with regard to time. Under the influence of marijuana, users commonly report that time appears to pass very slowly, that it is elongated, and they consistently overestimate the amount of time passing (Tart 1971; Goode 1970; Hochman and Brill 1971; Halikas, Goodwin, and Guze 1971). Now there are a number of different ways of approaching time. To the laboratory scientist, time is a fixed quantum that can be divided into infinitely reproducible segments of equal magnitude. Thus the researcher would say that the marijuana user, under the influence of the drug, estimates the passage of time incorrectly. But this conception is not relevant to the dimension of meaning, to the quality of time as experienced. By looking at the marijuana users' experience as a "distortion," the laboratory scientist is imposing his own views on the reality and is attempting to disprove the validity of the perception itself. The fallacy of the strict behaviorist approach is the substitution of the observer's perspectivethat of the scientistfor that of his subjects. It is the failure to take the role of the other, to see the world as the subject sees it.
This discussion should not be construed either as a glorification of what the subject feels to be true or as an affirmation of the position that subjective feelings cannot be studied at all. As David Matza, a sociologist of deviant behavior, has pointed out, attempting to grasp the "subject's definition of the situation ... does not mean the analyst always concurs with the subject's definition of the situation; rather, his aim is to comprehend and illuminate the subject's view and to interpret the world as it appears to him" (Matza 1969, p. 25). The subjective view is not necessarily "right"whatever that might mean regarding one or another propositionbut it does merit understanding on its own ground, and for that purpose its truth or falsity in strictly empirical terms is more or less irrelevant. Because many subjective feelings have no "scientific" or empirical validity, traditional positivistic pharmacology and behaviorist psychology have avoided levels of experience conveyed by the subject through language, through explanations of what he feels. This barrier is now breaking down, and an expanded conception of what science can deal with is emerging. Subjective feelings can be studied "objectively"that is, it is possible to attempt an understanding of the world as it appears to the subject, and to accomplish this "scientifically." There is no contradiction here. What the subject feels and says he feels is a field of data that can be investigated by means of the traditional canons of scientific method. Throughout this book, I will attempt to walk the fine line between these two perspectives. In short, instead of adopting the narrow and arbitrary conventions of traditional behaviorism, ignoring verbal statements and self-descriptions of feelings and experience as irrational or epiphenomenal, I am suggesting that a truly scientific approach toward reality would be to accept them as one dimension of phenomena under study. To exclude subjective states from scientific scrutiny is as arbitrary as thinking of them as the only legitimate version of reality.
NOTES1. In a survey of drug researchers (Clark and Funkhouser 1970), 59 percent favored making marijuana legally as restricted as alcohol; in contrast, only 9 percent felt this way about LSD. (back)
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