Children’s earliest interactions occur in the family; sometimes family situations heighten a child’s risk for later drug abuse, i.e., when there is: 

• a lack of attachment & nurturing by parents or caregivers
• ineffective parenting 
• a caregiver who abuses drugs

But families can provide protection from later drug abuse when there is: 

• a strong bond between children & parents 
• parental involvement in the child’s life 
• clear limits
• consistent enforcement of discipline

Interactions outside the family can involve risks for both children & adolescents, such as: 

• poor classroom behavior or social skills 
• academic failure 
• association w/drug abusing peers

Association w/drug-abusing peers is often the most immediate risk for exposing adolescents to drug abuse & delinquent behavior. Other factors, such as drug availability, trafficking patterns & beliefs that drug abuse is generally tolerated, are risks that can influence young people to start abusing drugs.

When & how does drug abuse start & progress?

Studies such as the National Survey on Drug Use & Health, formally called the National Household Survey on Drug Abuse, reported by the Substance Abuse & Mental Health Services Administration, indicate that some children are already abusing drugs at age 12 or 13, which likely means that some begin even earlier.

Early abuse often includes such substances as:

• tobacco
• alcohol
• inhalants
• marijuana
• prescription drugs such as sleeping pills & anti-anxiety medicines

If drug abuse persists into later adolescence, abusers typically become more heavily involved w/marijuana & then advance to other drugs, while continuing their abuse of tobacco & alcohol.

Studies have also shown that abuse of drugs in late childhood & early adolescence is associated w/greater drug involvement. It's important to note that most youth, however, don't progress to abusing other drugs.

Scientists have proposed various explanations of why some individuals become involved w/drugs & then escalate to abuse. One explanation points to a biological cause, such as having a family history of drug or alcohol abuse.

The drug war's littlest victims
Measures to put drug abusers in rehab instead of jail could rescue their kids from the cycle of addiction, foster care & crime.

Oct. 30, 2002  |  The last time Tracy Carter, a longtime drug user, was sent to the county jail, she ran into her mother. Neither woman was surprised. Carter's parents are both longtime heroin addicts. Her sister is a heroin addict. Carter says she herself was born a heroin addict. So were most of her 7 children.

Carter (not her real name), 38, has been in & out of jail throughout her long career as an addict, mostly for violating her probation. She has come out each time - homeless, jobless & full of good intentions - & started using again within a matter of weeks or months.

This grim routine has left her children trapped in a grueling cycle themselves: bouncing from one home to another; vacillating between faith & despair as their mother makes & breaks promise after promise & as they grow up without her, drifting into depression, delinquency & addictions of their own.

In November 2000, California voters decided it was time for Tracy Carter & drug users like her, to try something different. With 61% of the vote, they passed Proposition 36, a measure that sends most nonviolent drug offenders into treatment rather than to jail.

2 years later, similar initiatives are on the ballot in Ohio & the District of Columbia; several more states have implemented or are working on legislative fixes to tough drug laws & more than 70% of Americans are telling pollsters they'd like to see the government ease up on addicts.

This new climate may be based in pragmatism as much as in compassion. The number of drug offenders in state & federal prisons has increased more than tenfold over the past decade, from 40,000 to nearly 500,000.

Incarcerating them costs 5 billion dollars a year. With a faltering economy draining government coffers - & the war on terrorism competing for dollars formerly reserved for the war on drugs - the price tag for being the world's largest jailer is starting to look a little steep.

A national shift from incarceration to treatment has the potential to save much more than dollars. More than 8 million of America's 75 million children have a parent or parents addicted to drugs or alcohol.

Parental drug addiction fuels the foster care system; it feeds the juvenile justice system. It affects welfare caseloads, school performance & child health. And parental addiction is self-perpetuating: Up to 70% of the children of addicts become addicted to drugs themselves.

Might drug treatment slow the staggering growth in the nation's foster care system, which has more than doubled in the past 15 years, to over half a million children?

Child welfare workers think so. In a 1997 survey by the Child Welfare League, child welfare workers estimated that 67% of the parents they dealt with needed treatment, but only 31% got it.  

According to researchers at the National Center on Addiction & Substance Abuse at Columbia Univ. (CASA), parental substance abuse is implicated in 7 of 10 cases of child abuse & neglect & is responsible for $10 billion of the $14 billion spent nationally each year on child welfare costs.

Nationwide, according to the Office of National Drug Control Policy, 5 million Americans need drug treatment but only 2 million receive it. 

Might treatment stem the tide of juvenile incarceration, which has left 125,000 adolescents behind bars at last count - many of whom have experienced parental drug addiction & incarceration?

Might it aid those hardest cases that stymie welfare reformers - the families that lose their benefits to time limits before they manage to find another means of support, many of whom are thought to have drug problems?

If these are questions we're only just beginning to ask; the children of drug-addicted parents are well ahead of us.

In 1999, in researching a report on foster care, I interviewed & surveyed in writing more than 150 current & former foster youth in California & New York. When I asked the question, "What might have kept your family together?" one answer came up over & over: Help with a parent's drug problem.

"My father was into drugs instead of me," one teenager wrote. "That's why I'm in the system."

"If there wasn't drugs," wrote another, "I probably wouldn't know what a system is."

Our response to these children has to date lacked imagination: We incarcerate addicted parents & place their children in foster care, or leave them to fend for themselves. CASA researchers spent 3 years scrutinizing state budgets in an effort to figure out the dollar cost of this approach.

In 1998, they determined, the states spent $81.3 billion dealing with drug abuse & its consequences, but of each dollar spent, only 4 cents went to prevention & treatment. This imbalance, they found, had a particularly powerful impact on the young: The states spent $5.3 billion addressing cases of child abuse & neglect, 79 % of which could be traced to parental drug or alcohol abuse.

But as the nation tentatively embarks on a new way of doing things, early indications are promising. In California, the Dept. of Corrections has reported a 20% drop in the number of drug offenders in its custody since Proposition 36 was implemented & a 10% drop in women inmates overall.

As the measure is fully implemented, the state Legislative Analyst's Office estimates, it'll save between $100 & $150 million each year in prison costs.

When parents do get treatment, the federal Center for Substance Abuse Treatment has found, kids come home & taxpayers save even more money. In a Florida pilot program, for example, 180 women treated in a single residential program regained custody of 580 children who had previously been in the care of the state.

Charles (not his real name), 18, grew up in Northern California under the old drug enforcement regime. He spent his childhood & adolescence in a series of foster homes & juvenile halls while his crack-addicted mother cycled in & out of jail & prison.

When Charles was 16, his mother put herself in rehab. Today, she works at a church & has her own 2 bedroom apartment. She hasn't used drugs in 2 years.

"It feels good," says Charles. "That little piece that's lost -- it's filled the gap there. At first I used to think my mom would be dead, but now I know she's going to see my kids. She'll see me graduate from high school, go on to college. I used to pray at night for a new mommy & daddy. Now I'm getting my mama back."

Does large-scale treatment work as an approach to drug addiction? We don't know, because we've never tried it. But as the casualties of our decades-long war on drugs continue to fill not only our nation's prisons but its foster homes, group homes & juvenile halls, there's plenty of evidence that the alternative has failed the children it was meant to serve.

Despite years of disappointment & betrayal, children of addicts will likely tell you they're willing to give their parents another chance. 3 decades into a failed war on drugs, voters may finally be ready to do the same.  

Addicts, like all people, act to maximize the rewards they perceive are available to them, however much they hurt & hobble themselves in the process.

Early Childhood Antisocial Behavioral Factors which predict Conduct Disorder & Substance Dependence in adolescence:

helpful hints for high school teachers/counselors.

Ais K.W. Murray, M.S. Health Administration, B.S. Psychobiology

summary

Simply discovering that a drug or alcohol or an activity accomplishes something for a person who has emotional problems or a particularly susceptible personality doesn't mean that this individual will be addicted.

Indeed, most people in any such category aren't addicts or alcoholics.

Addicts must indulge in their addictions with efficient abandon to achieve the addicted state. In doing so, they place less value on social proprieties or on their health or on their families & other considerations that normally hold people's behavior in check.

Think of addictions such as overeating, compulsive gambling & shopping & unrestrained sexual appetites & who gamble away their families' food budgets or who spend more money.

Those who overeat - spend more than they earn on clothes & cars or who endlessly pursue sexual liaisons don't necessarily have stronger urges to do these things than everyone else, so much as they display less self-restraint in giving into these urges.

I always think in this connection of the Rumanian saying my in-laws use when they see an extremely obese person:

"So, you ate what you wanted."

It takes more than understanding what a particular drug does for a person to explain why some individuals become addicted to so many things.

If alcoholics are born addicted to booze, why do over 90% of alcoholics also smoke?

Why are compulsive gamblers also frequently heavy drinkers?

Why do so many women alcoholics also abuse tranquilizers?

Tranquilizers & alcohol have totally different molecular properties, as do cigarettes & alcohol. No biological characteristic can explain why a person uses more than one of these substances excessively at the same time.

And certainly no biological theory can explain why heavy gambling & heavy drinking are associated.[3]

The Experience

People become addicted to drugs & alcohol because they welcome the sensations that alcohol & drug intoxication provides for them.

Other involvements to which people become addicted share certain traits with powerful drug experiences, they're all-encompassing, quick & powerful in onset & they make people less aware of & less able to respond to outside stimuli, people & activities.

In addition, experiences that facilitate addiction offer people a sense of power or control, of security or calm, of intimacy or of being valued by others; on the other hand, such experiences succeed in blocking out sensations of pain, discomfort or other negative sensations.

Life Phases

Everyone knows people who drink or take drugs too much during a bad phase in their lives; i.e., after a divorce or when their careers have taken a bad turn or some other time when they seem to be without moorings. The life phase in which people most commonly are rudderless & willing to try anything is when they're young.

For some groups of adolescents & young adults, drug or alcohol abuse is almost an obligatory rite of passage. But in most cases, no matter how bad the addiction seems at the time, people recover from such a phase without mishap when they move on to the next stage in their lives.

It's customary for those in the addiction treatment industry to say that such individuals weren't really alcoholics or chemically dependent. Nonetheless, any AA group or treatment center would have accepted these people as addicts or alcoholics had they enrolled during their peak period of substance abuse.

The Situation or Environment

Life stages, like adolescence, are part of a broader category in the addictive matrix; the situation or environment the individual faces. One of the most remarkable illustrations of the dynamics of addiction is the Vietnam war, an illustration to which I'll return throughout this chapter.

American soldiers in Vietnam frequently took narcotics & nearly all who did became addicted. A group of medical epidemiologists studied these soldiers & followed them up after they came home.

The researchers found that most of the soldiers gave up their drug addiction when they returned to the States. However, about 1/2 of those addicted in Vietnam did use heroin at home.

Yet only a small percentage of these former addicts became readdicted. Thus, Vietnam epitomizes the kind of barren, stressful & out-of-control situation that encourages addiction.

At the same time, the fact that some soldiers became addicted in the US after being addicted in Asia while most didn't indicates how important individual personalities are in addiction.

The Vietnam experience also shows that narcotics, such as heroin, produce experiences that serve to create addictions only under specific conditions.

The Social & Cultural Milieu

We must also consider the enormous social-class differences in addiction rates. That is, the farther down the social & economic scale a person is, the more likely the person is to become addicted to alcohol, drugs or cigarettes, to be obese or to be a victim or perpetrator of family or sexual abuse.

How does it come to be that addiction is a "disease" rooted in certain social experiences & why in particular are drug addiction & alcoholism associated primarily with certain groups?

A smaller range of addiction & behavioral problems are associated with the middle & upper social classes. These associations must also be explained. Some addictions, like shopping, are obviously connected with the middle class.

Bulimia & exercise addiction are also primarily middle-class addictions.

Finally, we must explore why addictions of one kind or another appear on our social landscape all of sudden, almost as though floodgates were released.

i.e., alcoholism was unknown to most colonial Americans & to most Americans earlier in this century; now it dominates public attention. This isn't due to greater consumption, since we're actually drinking less alcohol than the colonists did.

Bulimia, PMS, shopping addiction & exercise addiction are wholly new inventions. Not that it isn't possible to go back in time to find examples of things that appear to conform to these new diseases.

Yet their widespread, almost commonplace, presence in today's society must be explained, especially when the disease, like alcoholism, is supposedly biologically inbred.

The Addiction Experience

Consider one strange aspect of the field of pharmacology, the search for a nonaddictive analgesic (painkiller).[4] Since the turn of this century, American pharmacologists have declared the need to develop a chemical that would relieve pain but that wouldn't create addiction.

Consider how desperate this search has been: heroin was originally marketed in this country by the Bayer company of Germany as a nonaddictive substitute for morphine!

Cocaine was also used to cure morphine (& later heroin) addiction & many physicians (including Freud) recommended it widely for this purpose.

Indeed, every new pharmaceutical substance that has reduced anxiety or pain or had other major psychoactive effects has been promoted as offering feelings of relief without having addictive side effects.

And in every case, this claim has been proved wrong. Heroin & cocaine are only 2 obvious examples. A host of other drugs, the barbiturates, artificially synthesized narcotics (Demerol), tranquilizers (Valium) & on & on, were welcomed initially, only to have been found eventually to cause addiction in many people.

What this tells us is that addiction isn't a chemical side effect of a drug. Rather, addiction is a direct result of the psychoactive effects of a substance, of the way it changes our sensations. The experience itself is what the person becomes addicted to.

In other words, when narcotics relieve pain or when cocaine produces a feeling of exhilaration or when alcohol or gambling creates a sense of power or when shopping or eating indicates to people that they're being cared for, it's the feeling to which the person becomes addicted.

No other explanation, about supposed chemical bondings or inbred biological deficiencies is required. And none of these other theories comes close to making sense of the most obvious aspects of addiction.

One of the key dynamics in the alcoholism or addiction cycle is the repeated failure of the alcoholic or addict to gain exactly the state he or she seeks, while still persisting in the addicted behavior.

i.e., alcoholics (in research, these are frequently street inebriates) report that they anticipate alcohol to be calming & yet when they drink they become increasingly agitated & depressed.[5]

The process whereby people desperately pursue some feeling that becomes more elusive the harder they pursue it is a common one & appears among compulsive gamblers, shoppers, overeaters, love addicts & the like.

It's this cycle of desperate search, temporary or inadequate satisfaction & renewed desperation that most characterizes addiction.

How do people become addicted to powerful experiences such as gambling?

Actually, gambling may be far more addictive than heroin. More people who gamble have a sense of loss of control than have this feeling with narcotics: very few people who receive morphine after an operation in the hospital have even the slightest desire to prolong this experience.

It's the total nature of the gambling experience (as practiced in Atlantic City casinos, e.g.) that promotes this sense of addictive involvement. The complete focusing of attention, the overriding excitement of risk & the exhilaration of immediate success or usually, the negative sensations of loss, make this experience overwhelming for even the strongest among us.

Any experience this potent, alluring & at the same time holding out the possibility of serious disturbance to one's life, has great addictive potential. Gambling uplifts one & then can make one miserable.

The temptation is to escape the misery by returning to the ecstasy. People for whom gambling serves as a major source of feelings of importance & power are quite likely to become addicted to gambling, at least for a time.

When thinking of who becomes addicted to gambling, we should also keep in mind that heavy gamblers are frequently also heavy drinkers. In other words, those who seek power & excitement in the "easy," socially destructive form of gambling are very often those prone to seek such feelings in alcohol.[6]

Many of us, on the other hand, have had addictive gambling experiences. We did so when we were young & went to a local carnival for the promise of easy & exciting money. Plopping down our quarters at the booth where the man spun the wheel, we became increasingly distressed as our anticipated winnings didn't materialize.

Sometimes we ran home to get more of our savings, perhaps stealing from our parents to get money. But this feeling rarely continued after the carnival departed. Indeed, when we got older & gambled in a small-stakes pinochle or poker game with friends, we simply didn't have the same desperate experience that gambling had led us to under different circumstances at a different time in our lives.

Just because people have had acute, even addictive, experiences with something by no means guarantees that they'll always be addicted to this activity or substance. Even when they're addicted, by no means is every episode of the experience an out-of-control one.

Two questions then are "Why do some people become addicted at some times to some things?" & "Why do some of these people persevere at the addiction thru all the facets of their lives?"

The study we previewed of U.S. soldiers' drug use in Vietnam & after they returned home gives us good answers to both these questions.

This study, based on the largest group of untreated heroin users ever identified, has such major ramifications for what we know about addiction that it could revolutionize our concepts & treatment for addiction - if only people, particularly scientists, could come to grips w/its results.

i.e., Lee Robins & Richard Helzer, the principal investigators in this research, were shocked when they made the following discovery about veterans' drug use after leaving Asia:

"Heroin purchased on the streets in the US... didn't lead [more] rapidly to daily or compulsive use... than did use of amphetamines or marijuana."[7]

What does it prove that people are no more likely to use heroin compulsively than marijuana? It tells us that the sources of addiction lie more in people than in drugs. To call certain drugs addictive misses the point entirely.

Richard Clayton, a sociologist studying adolescent drug abuse, has pointed out that the best predictors of involvement with cocaine among high school students are, first, use of marijuana & third, smoking cigarettes. Adolescents who smoke the most marijuana & cigarettes use the most cocaine.

The second best predictor of which kids will become cocaine abusers doesn't involve drug use. This factor is truancy: adolescents who cut school frequently are more likely to become heavily involved with drugs.[8]

Of course, truant kids have more time on their hands to use drugs. At the same time, psychologists Richard & Shirley Jessor found, adolescents who use drugs have a series of problem behaviors, place less value on achievement & are more alienated from ordinary institutions such as school & organized recreational activities.[9]

Do some people have addictive personalities? What might make us think so is that some people do many, many things excessively. The carryover from one addiction to another for the same people is often substantial. Nearly every study has found that overwhelming majorities (90% & more) of alcoholics smoke.[10]

When Robins & her colleagues examined Vietnam veterans who used heroin & other illicit drugs in American cities following the war, they found:

The typical pattern of the heroin user seems to be to use a wide variety of drugs plus alcohol. The stereotype of the heroin addict as someone with a monomaniacal craving for a single drug seems hardly to exist in this sample.

Heroin addicts use many other drugs & not only casually or in desperation.

In other words, people who become heroin addicts take a lot of drugs, just as kids who use cocaine are more likely to smoke cigarettes & use marijuana heavily.

Some people seem to behave excessively in all areas of life, including using drugs heavily. This even extends into legal drug use.

i.e., those who smoke also drink more coffee. But this tendency to do unhealthy or antisocial things extends beyond the simple use of drugs. Illicit drug users have more accidents even when not using drugs.[11]

Those arrested for drunk driving frequently also have arrest records for traffic violations when they aren't drunk.[12] In other words, people who get drunk & go out on the road are frequently the same people who drive recklessly when they're sober.

In the same way, smokers have the highest rates of car accidents & traffic violations & are more likely to drink when they drive.[13] That people misuse many drugs at once & engage in other risky & antisocial behaviors at the same time suggests that these are people who don't especially value their bodies & health or the health of the people around them.

If, as Lee Robins makes clear, heroin addicts use a range of other drugs, then why do they use heroin? After all, heavy drug users are equally willing to abuse cocaine, amphetamines, barbiturates & marijuana (& certainly alcohol).

Who are these people who somehow settle on heroin as their favorite drug? The heroin users & addicts among the returned veterans Robins studied came from worse social backgrounds & had had more social problems before going to Vietnam & being introduced to the drug.

In the words of Robins & her colleagues:

People who use heroin are highly disposed to having serious social problems even before they touch heroin. Heroin probably accounts for some of the problems they have if they use it regularly, but heroin is "worse" than amphetamines or barbiturates only because "worse" people use it.

The film Sid and Nancy describes the short life of Sid Vicious of the British punk rock group The Sex Pistols. All in this group came from the underclass of British society, a group for whom hopelessness was a way of life.

Vicious was the most self-destructive & alcoholic of the group. When he first met his girlfriend, Nancy, an American without any moorings, her main appeal was that she could introduce Sid to heroin, which Nancy already used.

Vicious took to the drug like a duck to water. It seemed the logical extension of all he was & all he was to become, which included his & Nancy's self & mutual absorption, their loss of careers & contact with the outside world & their ultimate deaths.

The development of an addictive lifestyle is an accumulation of patterns in people's lives of which drug use is neither a result nor a cause but another example. Sid Vicious was the consummate drug addict, an exception even among heroin users.

Nonetheless, we need to understand the extremes to gain a sense of the shape of the entire phenomenon of addiction. Vicious, rather than being a passive victim of drugs, seemed intent on being & remaining addicted. He avoided opportunities to escape & turned every aspect of his life toward his addictions - booze, Nancy, drugs - while sacrificing anything that might have rescued him - music, business interests, family, friendships, survival instincts.

Vicious was pathetic; in a sense, he was a victim of his own life. But his addiction, like his life, was more an active expression of his pathos than a passive victimization.

Addiction theories have been created because it stuns us that people would hurt - perhaps destroy - themselves through drugs, drinking, sex, gambling & so on. While people get caught up in an addictive dynamic over which they don't have full control, it's at least as accurate to say that people consciously select an addiction as it is to say an addiction has a person under its control.

And this is why addiction is so hard to ferret out of the person's life - because it fits the person. The bulimic woman who has found that self-induced vomiting helps her to control her weight & who feels more attractive after throwing up is a hard person to persuade to give up her habit voluntarily.

Consider the homeless man who refused to go to one of Mayor Koch's New York City shelters because he couldn't easily drink there and who said, "I don't want to give up drinking; it's the only thing I've got."

The researcher who has done the most to explore the personalities of alcoholics and drug addicts is psychologist Craig MacAndrew. MacAndrew developed the MAC scale, selected from items on the MMPI (a personality scale) that distinguish clinical alcoholics and drug abusers from normal subjects and from other psychiatric patients.

This scale identifies antisocial impulsiveness and acting out: "an assertive, aggressive, pleasure-seeking character," in terms of which alcoholics and drug abusers closely "resemble criminals and delinquents."[16] These characteristics are not the results of substance abuse. Several studies have measured these traits in young men prior to becoming alcoholics and in young drug and alcohol abusers.[17] This same kind of antisocial thrill-seeking characterizes most women who become alcoholic. Such women more often have disciplinary problems at school, react to boredom by "stirring up some kind of excitement," engage in more disapproved sexual practices, and have more trouble with the law.[18]

The typical alcoholic, then, fulfills antisocial drives and pursues immediate, sensual, and aggressive rewards while having underdeveloped inhibitions. MacAndrew also found that another, smaller group comprising both men and women alcoholics—but more often women—drank to alleviate internal conflicts and feelings like depression. This group of alcoholics viewed the world, in MacAndrew's words, "primarily in terms of its potentially punishing character." For them, "alcohol functions as a palliation for a chronically fearful, distressful internal state of affairs." While these drinkers also sought specific rewards in drinking, these rewards were defined more by internal states than by external behaviors. Nonetheless, we can see that this group too did not consider normal social strictures in pursuing feelings they desperately desired.

MacAndrew's approach in this research was to identify particular personality types identified by the experiences they looked to alcohol to provide. But even for alcoholics or addicts without such distinct personalities, the purposeful dynamic is at play. For example, in The Lives of John Lennon, Albert Goldman describes how Lennon—who was addicted over his career to a host of drugs—would get drunk when he went out to dinner with Yoko Ono so that he could spill out his resentments of her. In many families, drinking allows alcoholics to express emotions that they are otherwise unable to express. The entire panoply of feelings and behaviors that alcohol may bring about for individual drinkers thus can be motivations for chronic intoxication. While some desire power from drinking, others seek to escape in alcohol; for some drinking is the route to excitement, while others welcome its calming effects.

Alcoholics or addicts may have more emotional problems or more deprived backgrounds than others, but probably they are best characterized as feeling powerless to bring about the feelings they want or to accomplish their goals without drugs, alcohol, or some other involvement. Their sense of powerlessness then translates into the belief that the drug or alcohol is extremely powerful. They see in the substance the ability to accomplish what they need or want but can't do on their own. The double edge to this sword is that the person is easily convinced that he or she cannot function without the substance or addiction, that he or she requires it to survive. This sense of personal powerlessness, on the one hand, and of the extreme power of an involvement or substance, on the other, readily translates into addiction.[19]

People don't manage to become alcoholics over years of drinking simply because their bodies are playing tricks on them—say, by allowing them to imbibe more than is good for them without realizing it until they become dependent on booze. Alcoholics' long drinking careers are motivated by their search for essential experiences they cannot gain in other ways. The odd thing is that—despite a constant parade of newspaper and magazine articles and TV programs trying to convince us otherwise—most people recognize that alcoholics drink for specific purposes. Even alcoholics, however much they spout the party line, know this about themselves. Consider, for example, the quote at the beginning of chapter 4 in which Monica Wright, the head of a New York City treatment center, describes how she drank over the twenty years of her alcoholic marriage to cope with her insecurity and with her inability to deal with her husband and children. It is impossible to find an alcoholic who does not express similar reasons for his or her drinking, once the disease dogma is peeled away.

Social Groups & Addiction

In the study of bulimia among college-age and working women, we saw that while many reported binge eating, few feared loss of control and fewer still self-induced vomiting.[20] However, twice as many of the college students as working women feared loss of control, while five times as many college women (although still only 5 percent of this group) reported purging with laxatives or through vomiting. Something about the intense collective life of women on campus exacerbates some women's insecurities into full-scale bulimia, while college life also creates a larger, additional group that has unhealthy eating habits that fall short of full-scale bulimia. Groups have powerful influences on people, as this study showed. Their power is a large part of the story of addiction. In the case of college women, the tensions of school and dating are combined with an intensely held social value toward thinness that many are not able to attain.

Groups certainly affect drinking and drug abuse. Young drug abusers associate primarily with drug abusers, as Eugene Oetting has clearly discerned in a decade's work with a wide range of adolescents. Indeed, he traces drug use and abuse primarily to what he calls "peer-group clusters" of like-minded kids. Naturally, we wonder why adolescents gravitate to such groups in the first place rather than joining, say, the school band or newspaper. But undoubtedly, informal social groups support and sustain much teen behavior. And some of these peer groups tend to be involved in a variety of antisocial activities, including criminal misbehavior and failure at school, as well as encouraging substance abuse.

One of the burdens of the disease movement is to indicate that it doesn't matter what social class one comes from—drug abuse and alcoholism are equally likely to befall you. Oetting disagrees strongly with this position. His opinion matters because he has studied fifteen thousand minority young people, including a great number of Hispanic and Native American youths. This is in addition to some ten thousand nonminority young people. Commenting on research that claims that socioeconomic status does not influence drug use, Oetting notes: "These studies, however, focus on middle and upper class levels of socioeconomic status and disadvantaged populations are underrepresented. Where research is conducted specifically among disadvantaged youth, particularly minority youth, higher rates of drug use are found."[21] These differences extend as well to legal drugs—18 percent of college graduates smoke, compared with 34 percent of those who never went to college.[22]

Middle-class groups certainly drink, and some quite heavily. Yet the consistent formula discovered in surveys of drinking is that the higher a person's social class, the more likely the person is both to drink and to drink without problems. Those in lower socioeconomic groups are more likely to abstain, and yet are much more often problem drinkers. What about drugs? Middle-class people have certainly developed broad experience with drugs in the last three decades. At the same time, when they do use drugs, they are more likely to do so occasionally, intermittently, or in a controlled manner. As a result, when warnings against cocaine became commonplace in the 1980s, cocaine use shrank among the middle class, while cocaine use intensified in ghetto areas, where extremely disruptive and violent drug use has become a major feature of life.

Those with Better Things to Do Are Protected from Addiction

My point of view, however logical, goes so much against standard antidrug crusade wisdom that I hasten to defend my assertion about controlled drug users. It is not that there is any question that the data I cite are correct. Rather, I have to explain why so much of the information presented to the public is misinformation. For example, we hear constantly that the 800-Cocaine hotline reveals great numbers of middle-class addicts. In fact, examining the rolls of facilities for cocaine addicts reveals everything we have already reviewed—that nearly all cocaine addicts are multiple-substance users with long histories of drug abuse. Whatever greater rates of middle-class "stockbroker" addicts there are now, these are dwarfed by the typical cocaine abusers, who resemble other contemporary and historical drug abusers by being more often unemployed and socially dislocated in a number of ways.

What about the masses of cocaine users who appeared in the 1980s? The Michigan group studying student drug use found that high school grads in the early 1980s had a 40 percent chance of using the drug by their twenty-seventh birthday. Yet, most middle-class users use the drug only a few times; most regular users do not show negative effects and only a few become addicted; and most who have experienced negative effects, including problems of controlling their use, quit or cut back without treatment. These simple facts—which run so counter to everything we hear—have not been disputed by any investigation of cocaine use in the field. Ronald Siegel followed a group of cocaine users from the time they began use in college. Of the 50 regular users Siegel tracked for nearly a decade, five became compulsive users and another four developed intensified daily usage patterns. Even the compulsive users, however, only "experienced crisis reactions in approximately 10 percent of their intoxications."[23]

A more recent study was published by a distinguished group of Canadian researchers at the Addiction Research Foundation (ARF) of Ontario—Canada's premier drug addiction center. This study amplified Siegel's U.S. findings. To compensate for the overemphasis on the small minority of cocaine users in treatment, this study chose middle-class users through newspaper ads and by referrals from colleagues. Regular cocaine users reported a range of symptoms, most often acute insomnia and nasal disorders. However, only twenty percent reported frequently experiencing uncontrollable urges to continue use. Yet even in the case of the users who developed the worst problems, the typical response of the problem user was to quit or cut back without undergoing treatment for cocaine addiction![24] How different this seems from the advertisements, sponsored by the government and private treatment facilities, that emphasize the incurable, irresistible addictiveness of cocaine.

Where do these media images come from? They come from some extremely self-dramatizing addicts who report for treatment, and who in turn are extremely attractive to the media. If, instead, we examine college-student drug use, we find (in 1985—a peak year for cocaine use) that 17 percent of college students used cocaine. However, only one in 170 college-student users took the drug on as many as twenty of the previous thirty days.[25] Why don't all the other occasional users become addicted? Two researchers administered amphetamines to students and former students living in a university community (the University of Chicago).[26] These young people reported enjoying the effects of the drug; yet they used less of the drug each time they returned to the experimental situation. Why? Simple: they had too much in their lives that was more important to them than taking more drugs, even if they enjoyed them. In the words of a past president of the American Psychological Association Division of Psychopharmacology, John Falk, these subjects rejected the positive mood effects of the amphetamines,

probably because during the period of drug action these subjects were continuing their normal, daily activities. The drug state may have been incompatible either with the customary pursuit of these activities or the usual effects of engaging in these activities. The point is that in their natural habitats these subjects showed that they were uninterested in continuing to savor the mood effects [of the drugs].[27]

Going to college, reading books, and striving to get ahead make it less likely that people will become heavy or addicted drug users or alcoholics. Having a good-paying job and a good social position makes it more likely that people can quit drugs or drinking or cut back when these produce bad effects. No data dispute these facts, even among those claiming that alcoholism and addiction are medical diseases that occur independent of people's social status. George Vaillant, for example, found his inner-city sample of white ethnic groups were three to four times more likely to become alcoholic than were the college students his research tracked over forty years.

The truth of the commonsense notion that people who are better off are less likely to become addicted, even after using a powerful psychoactive substance, is amply demonstrated by the fate of the cocaine "epidemic." In 1987, epidemiological data indicated, "The nation's cocaine epidemic appears to have peaked. Yet within the broad trend runs a worrisome countertrend." Although American cocaine use has stabilized or diminished, small groups within the larger group seem to have intensified their use. What is more, "cocaine use is moving down the social ladder." David Musto, a Yale psychiatrist, analyzed the situation:

We are dealing with two different worlds here. The question we must be asking now is not why people take drugs, but why do people stop. In the inner city, the factors that counterbalance drug use—family, employment, status within the community—often are not there.[28]

Overall, systematic research finds cocaine to be about as addictive as alcohol and less addictive than cigarettes. About ten to twenty percent of middle-class repeated cocaine users experience control problems, and perhaps five percent develop a full-scale addiction which they cannot arrest or reverse on their own. As for the newest crisis drug, crack, a front-page New York Times story (August 24, 1989) carried the subtitle "Importance of users' environment is stressed over the drug's attributes." Jack Henningfield of the National Institute on Drug Abuse indicated in the article that one in six crack users becomes addicted, while several studies have shown that addicts find it easier to quit cocaine—"either injected, sniffed or smoked"—than to stop smoking or drinking. Those who become addicted to cocaine have generally abused other drugs and alcohol and are usually socially and economically disadvantaged. Certainly some middle-class users become addicts, even some with good jobs, but the percentage is relatively small and nearly all have important psychological, job, and family problems that precede addiction.

Values

Although addicts are often impulsive or nervous or depressed & find that drugs relieve their emotional burdens, this doesn't mean that all people with these traits are addicts. Why not? Primarily because so many people, whether nervous or impulsive or not, refuse to use a lot of drugs or otherwise succumb to addiction.

Consider a worried father who gets drunk at a party & feels tremendous relief from his tension. Will he start getting drunk after work? Far from it; when he comes home from the party, he sees his daughter sleeping, immediately sobers up & plans to go to work the next morning so as to maintain the path he has selected as a family man, father, husband & solid citizen.

The role of people's value-driven choices is ignored in descriptions of addiction. In the disease way of thinking, no human being is protected against the effects of drugs & alcohol - anybody is susceptible to addiction. But we find that practically all college students are disinclined to continue using amphetamines or cocaine or anything that gets in the way of their college careers. And hospital patients almost never use narcotics once they leave the hospital.

The reasons that these & other people don't become drug addicts are all values issues - the people don't see themselves as addicts, don't wish to spend their lives pursuing & savoring the effects of drugs & refuse to engage in certain behaviors that might endanger their family lives or careers. Without question, values are crucial in determining who becomes & remains addicted or who chooses not to do so.

Actually, most college students indicate that they find amphetamines & cocaine only mildly alluring in the first place, while patients often dislike the effects of the powerful narcotics they receive in the hospital. Really, many more people find eating, shopping, gambling & sex to be extremely appealing than find drugs so. Yet although more people respond with intense pleasure to hot fudge sundaes & orgasms than to drinking or drug taking, only a small number of people pursue these activities without restraint.

How do most people resist the allure of constant snacking & sexual indulgence? They don't want to get fat, die of heart attacks, or make fools of themselves; they do want to maintain their health, their families, their work lives & their self-respect. Values such as these that prevent addiction play the largest role in addictive behaviors or their absence; yet they're almost totally ignored.

For example, a typical New York Times story about the addictive effects of crack describes an adolescent girl who, having run out of money at a crack house, stayed at the house (she didn't go to school or work) having sex with patrons to get more money for drugs. The point of this tale is ostensibly that crack causes people to sacrifice their moral values.

Yet the story doesn't describe the effects of cocaine or crack - for which, after all, most people (including regular users) don't prostitute themselves. This simpleminded mislabeling of the sources of behavior (that taking drugs must be the reason she had sexual intercourse with strangers for money) passes for an analysis of drug effects & addiction in a reputable national news publication.

Similarly, prominent spokespeople lecture us that cocaine is a drug with "neuro-psychological properties" that "lock people into perpetual usage" so that the only way people can stop is when "supplies become unavailable," after which "the user is then driven to obtain additional cocaine without particular regard for social constraints." [30]

What, inadvertently, the New York Times story actually provides is a description of this girl's life & not of cocaine use. Some people do indeed choose to pursue drugs at the cost of other opportunities that don't mean as much to them - in this girl's case, learning, leading an orderly life & self-respect. The absence of such values in people's lives & the conditions that attack these values - especially among young, ghettoized people - may be expanding.

The environments & value options people face do have tremendous implications for drug use & drug addiction, as well as for teen pregnancy & other social disabilities & problems. But we'll never remedy either these conditions or these problems by considering them as the results of drug use or as drug problems.

Life Situations

Although I have presented information that some people form addictive relationships in many different areas of their lives, I don't endorse the idea that people are permanently saddled with addictive personalities. This can never account for the fact that so many people - most people - outgrow their addictions; i.e., problem drinkers as a group are younger drinkers.

That is, the majority of both men & women outgrow their drinking problems as they grow up & become engaged in adult roles & real-world rewards, like job & family. Even most younger adults with antisocial tendencies learn to regulate their lives to bring about some order & security.

No researcher who studies drug use throughout the life span can fail to be impressed that, in the words of one such researcher, "problem drinking tends to be self-correcting & [to] reverse well short of clinical syndromes of alcoholism."[31]

What about those who don't reverse their problem drinking or drug use & who become full-blown alcoholics or addicts?

In the first place, these are most often people with the fewest outside successes & resources for getting better - in the words of George Vaillant, they don't have enough to lose if they don't overcome alcoholism.

For these people, less success at work, family & personal resolutions feeds into greater retreat into alcohol & drugs. Sociologist Denise Kandel, of Columbia Univ., found that young drug abusers who didn't outgrow their problems became more & more absorbed in groups of fellow drug users & further alienated from mainstream institutions like work & school.[32]

Still, even though they're likely to outgrow problematic drug use & drinking, we must consider adolescents & young adults a high-risk group for drug & alcohol abuse. Among other life situations that predispose people to addiction, the most extreme & best documented example is the Vietnam war. A large number of young men used narcotics in Asia.

Of those who used narcotics 5 or more times there, almost 3/4 (73%) became addicted & displayed withdrawal symptoms. American authorities were terrified that this signaled a wholesale outbreak of drug addiction stateside for these returned veterans. In fact, what occurred stunned & baffled authorities. Most of those addicted in Vietnam got over their addictions simply as a result of returning home.

But this isn't the end of this amazing saga. 1/2 of these men who were addicted in Vietnam used heroin when they returned to the US - yet only 1 in 8 (or 12%) became readdicted here. Here's how Lee Robins, Richard Helzer & their colleagues who studied this phenomenon described all this:

It's commonly believed that after recovery from addiction, one must avoid any further contact with heroin. It's thought that trying heroin even once will rapidly lead to re-addiction.

Perhaps an even more surprising finding than the high proportion of men who recovered from addiction after Vietnam was the number who went back to heroin without becoming re-addicted.

1/2 of the men who had been addicted in Vietnam used heroin on their return, but only 1/8 became re-addicted to heroin. Even when heroin was used frequently, that is, more than once a week for a considerable period of time, only 1/2 of those who used it frequently became readdicted.[33]

How to explain this remarkable finding? The answer isn't a lack of availability of the drug in the US, since the men who sought it found heroin to be readily available on their return home. Something about the environment in Vietnam made addiction the norm there.

Thus, the Vietnam experience stands out as an almost laboratorylike demonstration of the kinds of situational, or life-stage, elements that create addiction.

The characteristics of the Vietnam setting that made it a breeding ground for addiction were the discomfort & fear; the absence of positive work, family & other social involvements; the peer group acceptance of drugs & the disinhibition of norms against addiction & the soldiers' inability to control their destinies - including whether they'd live or die.

These elements combined to cause men to welcome the lulling, analgesic - or painkilling - effects of narcotics.

The same men who were addicted in Vietnam, given a more positive environment, didn't find narcosis to be addictively alluring even if they sometimes took the drug at home.

If we can only disregard what we "know" about addiction & its biological properties, we can see how completely logical addictive drug use is.

If someone who knew nothing about addiction were asked to predict how people would react to the availability of a powerful analgesic drug when they were stuck in Vietnam & then whether they would regularly seek out such a debilitating substance when they had the chance to do better things in the US, average, nonexpert people could have predicted the Vietnam addiction scenario.

Yet the leading addiction specialists in America have been perplexed by all this & still can't come to grips with these data.

Cultural Beliefs & the Addiction Splurge

It's truly remarkable how differently people in previous eras reacted to the situations we deal with as diseases as a matter of course today.

When Ulysses S. Grant's periodic drinking binges were described to Abraham Lincoln, Lincoln is reputed to have asked which brand of liquor Grant drank, so that he could send it to his other generals.

Lincoln was apparently untroubled by Grant's drinking, since Grant was successful as a general. He even toasted Grant when they met & watched Grant drink.

What would happen to a general who had drinking binges today? (Grant, incidentally, drank excessively only when he was separated from his wife.)

We'd hospitalize him. Let's not imagine the results of the Civil War if Grant had been removed from service. Of course, Lincoln himself would be disqualified from the presidency on the grounds of what today would be called his manic-depressive disorder.

But now we know that alcoholism is a disease, just as - more recently - we've learned that sexual compulsions & child abuse are diseases that require therapy.

Strangely, these realizations have come at times when we seem to be discovering more & more of each of these - & other - diseases. This brings up another remarkable aspect of alcoholism - the groups with the highest rates of alcoholism, such as the Irish & Native Americans, readily acknowledge that drinking easily becomes uncontrollable.

These groups had the most diseaselike image of alcoholism before the modern disease era commenced. Other groups with abnormally low rates of alcoholism, such as the Jews & Chinese, literally can't fathom the disease notion of alcoholism & hold all drinkers to high standards of self-control & mutual policing of drinking behavior.

Craig MacAndrew & sociologist Robert Edgerton surveyed the drinking practices of societies around the world.[34] They found that people's behavior when they're drunk is socially determined.

Rather than invariably becoming disinhibited, or aggressive, or sexually promiscuous, or sociable when drunk, people behave according to the customs for drunken behavior in their particular cultural group.

Even tribal sexual orgies follow clear-cut prescriptive rules - i.e., tribe members observe incest taboos during orgies, even when the family connection among the people who will not have intercourse is incomprehensible to Western observers.

On the other hand, those behaviors that are permitted during these drunken "time outs" from ordinary social restrictions are almost uniformly present during the orgies. In other words, societies define which kinds of behaviors are the result of getting drunk & these behaviors become typical of drunkenness.

Consider, then, the impact of labeling an activity a disease & convincing people that they can't control these experiences.

Cultural & historical data indicate that believing alcohol has the power to addict a person goes hand in hand with more alcoholism. For this belief convinces susceptible people that alcohol is stronger than are they & that - no matter what they do - they can't escape its grasp.

What people believe about their drinking actually affects bow they react to alcohol. In the words of Peter Nathan, director of the Rutgers Center for Alcohol Studies, "it's become increasingly clear that, in many instances, what alcoholics think the effects of alcohol are on their behavior influences that behavior as much as or more than the pharmacologic effects of the drug."[35]

Alan Marlatt's classic study - in which alcoholics drank more when they believed they were drinking alcohol than when they actually drank alcohol in a disguised form - shows that beliefs are so powerful that they actually can cause the loss of control that defines alcoholism.[36]

Obviously, beliefs affect all the behaviors that we call addictions in the same way that they affect drinking. Charles Winick is the sociologist who first described the phenomenon of "maturing out" - or natural remission - of heroin addiction.

Indeed, Winick discovered, maturing out of addiction is more typical than not even on the harsh streets of New York City. Winick did note, however, that a minority of addicts never outgrow their addictions. These addicts, Winick observed, are those "who decide they're 'hooked,' make no effort to abandon addiction & give in to what they regard as inevitable."[37]

In other words, the readier people are to decide that their behavior is a symptom of an irreversible addictive disease, the more readily they fall into a disease state. i.e., we'll have more bulimia now that bulimia has been discovered, labeled & promulgated as a disease.

Treatment in particular has a powerful influence on people's beliefs about addiction & themselves. And, as we have noted in the case of baseball players & others, this impact isn't invariably positive.

In their study of Vietnam veterans, i.e., Robins & her colleagues offered a surprising glimpse of the world of addicts who didn't seek treatment, including the remarkable ability to resist addiction even after having slipped back to using heroin for a time.

Anxious about what they found, the researchers concluded their report with the following paragraph:

Certainly our results are different from what we expected in a number of ways. It's uncomfortable presenting results that differ so much from clinical experience with addicts in treatment. But one shouldn't too readily assume that differences are entirely due to our special sample. After all, when veterans used heroin in the US 2 to 3 years after Vietnam, only 1 in 6 came to treatment.[38]

If they'd looked only at addicts in treatment, the researchers would have had a very different view of addictive habits and of remission (or cure) than they developed from looking at the large majority who eschewed treatment.

The non-treated even had better outcomes in the Vietnam study:

"Of those men who were addicted in the 1st year back, 1/2 were treated & 1/2 weren't.... Of those treated, 47% were addicted in the 2nd period; of those not treated, 17% were addicted."

Robins & her colleagues pointed out that treatment was sometimes helpful & that the addicts who were treated had usually been addicted longer. "What we can conclude, however, is that treatment is certainly not always necessary for remission."[39]

Although we in the US spend considerable effort in the strange feat of convincing ourselves that we can't control the activities so many of us choose to become involved with, the good news is that very few people accept all of this propaganda.

As yet, apparently, not everyone believes they can't quit smoking or lose weight without a doctor's directions, or that - if they want to revamp their finances - they need to join a group that regards their overspending as an addiction.

The reason disease beliefs aren't more generally held is that so many people have personal experiences that contradict disease claims & people tend to believe their own experience rather than disease advertisements.

i.e., while every public announcement about cocaine, or marijuana, or adolescent drinking is of negative, compulsive, self-destructive behavior, most people control their use of these substances & most of the rest figure out that they need to cut back or quit on their own.

Most of us between the ages of 35 & 45 know scores of people who took a lot of drugs in college or high school but who are now accountants & lawyers & who are worrying about whether they can afford to send their kids to college. Let us now turn to the numerous examples that are avai