Sociocultural Determinants. Integrating the Determinants of Addiction

Societies differ widely in their mores about the use of alcohol and other drugs. Certain societies, for example, tolerate and even encourage consumption of alcohol, whereas others completely prohibit drinking. Some Middle Eastern societies forbid alcohol consumption for religious reasons, yet they do not restrict the use of marijuana and hashish. Alcohol consumption rates in northern European countries and France are high, as is the prevalence of alcohol problems in these countries.

Although alcohol consumption is also relatively high in Italy and Israel, these countries have low rates of alcohol problems. In short, societies differ widely both in the degree to which they encourage drug use and the particular patterns of drug use that they foster. Moreover, the incidence of drug problems in a society is related to the particular drug use practices that that society instills.

How can we account for these wide variations in drug use among different societies? People’s attitudes toward drugs—and the patterns of drug use that correspond to those attitudes—appear to be culturally transmitted through social learning mechanisms. People model their behavior after that of other people and are socially reinforced for doing so.

When, on the other hand, people’s behavior deviates from that of other people around them, they are socially ostracized for not following the established code of conduct. Accordingly, when individuals observe other people in their society using psychoactive drugs to induce pleasurable feelings and to counteract unpleasantness, they are likely to model these socially sanctioned uses of drugs.

The same kinds of differences in drug use that we observe among different societies can also be seen within particular societies. The rates of substance abuse vary significantly among the different subgroups in a given society. For example, as previously discussed, during the late 1960s and early 1970s, a sizable counterculture in the United States used marijuana and hallucinogens extensively, although the majority of society disapproved of this activity.

Within diverse societies such as the United States, different ethnic groups are found to use psychoactive drugs (even generally socially sanctioned ones such as caffeine) at levels significantly different from other segments of the society. These subgroup differences are related to cultural traditions, dietary habits, and religious beliefs. However, regardless of which other practices they are associated with, these differences can again be explained in terms of social learning principles.

That is, people model their behavior after that of the groups to which they belong, such as their family and peers, and are influenced by the models whom they observe in the mass media and through advertising. People are reinforced for patterning their behavior after that of other people but are socially disapproved when their behavior is different from that of other people around them.

Integrating the Determinants of Addiction. Each of the determinants discussed in the preceding sections clearly plays a role in addiction, but none of the determinants taken alone can adequately account for addictive phenomena. How can we bring together the various determinants of addiction into a unifying model of addiction? One possibility for doing so is the Motivational Model—a model that originally was intended to apply to alcohol use, but which can easily be adapted to other forms of drug use and abuse. The model considers each of the variables that are known to affect drug use, looks at ways in which these variables interact with one another, and suggests that the final pathway to drug use is motivational.

The Motivational Model interprets people’s drug use in the context of their general motivational patterns. People are motivated (1) to acquire positive incentives, which will bring them pleasure and (2) to get rid of—or avoid altogether—negative incentives, which cause them discomfort. Thus, in an effort to achieve emotional satisfaction and to avoid discomfort, people organize their lives around striving for goals that will allow them to get, or get rid of, these two kinds of incentives.

People are motivated to use drugs because drug use itself can serve as an incentive (e.g., people seek to find pleasure and avoid discomfort by using drugs). This can occur in one of two ways. First, the drugs that people use can directly change the way they feel, by either enhancing positive feelings or counteracting negative feelings. Second, drug use can change the other incentives in people’s lives. For example, using drugs can cause positive incentives to seem more attractive, or it can cause negative incentives to seem more palatable.

How do the determinants of drug use discussed in the preceding sections figure into the motivational patterns discussed here? Each of the biological, psychological, environmental, and sociocultural determinants discussed earlier helps to define the incentive value of drug use and, in turn, the relative value of obtaining emotional satisfaction chemically and nonchemically.

Thus, to the extent that each category of variable contributes to the positive feelings that a person expects to derive from drug use, the incentive value of using drugs will be enhanced. To the extent that each variable contributes to negative feelings that a person expects to derive from drug use, it will subtract from the incentive value of using drugs.

In short, a person might attempt to derive emotional satisfaction either chemically by using drugs or nonchemically through other life areas. People’s decisions about using or not using drugs is partly a rational process in which they weigh the positive and negative consequences of doing so versus not doing so, and partly an emotional process, based on the degree of emotional satisfaction that they expect to derive from drug use versus other life activities. In the final analysis, people’s decision to use drugs is determined by the balance between the expected emotional satisfaction from using drugs and the expected emotional satisfaction from not doing so.

A major advantage of the Motivational Model is that it offers promise for changing people’s motivation for using drugs. Systematic Motivational Counseling, which is based on the Motivational Model, is designed to change drug abusers’ motivational patterns, maximizing the emotional satisfaction that they derive from their nonchemical incentives, thereby reducing their motivation to seek emotional satisfaction by using drugs and, in turn, their actual drug use. We discuss the Systematic Motivational Counseling technique in the following section.