It’s Not Just About the Drug, Part 1

In a previous blog, I’ve described how the National Institute of Drug Abuse (NIDA) in the USA has described addiction as a brain disorder. They have frequently described drugs as ‘hijacking’ the brain. I pointed out that drugs do not have the power in themselves to ‘hijack’ anything.

Many of society’s reactions to the so-called ‘drug problem’ are based on the premise that the problems faced by individuals and communities are caused by the drug. However, contrary to what is commonly assumed, psychoactive drugs do not produce fixed and predictable psychological effects that are dependent purely on their chemical properties. Moreover, drugs themselves do not produce societal problems.

In fact, the way that a drug affects a person (and a society) depends on two additional factors to the biochemical actions of the substance. Firstly, the ‘person’, or ‘set’, a variety of individual characteristics such as a person’s personality, their expectancies of how the drug will affect them, and their emotional state.  Secondly, the ‘social context’, or ‘setting’, the influence of the physical and social setting within which drug use occurs.

There is a seminal book entitled Drug, Set, and Setting: The Basis for Controlled Intoxicant Use, written by Norman E. Zinberg M.D. and published in 1984, that focuses on the present issue. The book seems to be ignored by those people claiming that drugs cause a brain disorder.

This is the first of three blogs where I consider different aspects of drug, set and setting.

The drug experience
Few people have difficulty in understanding that different individuals in the same social setting react in different ways to alcohol. Individual differences are also observed when people first take drugs. In one research study, a number of people were all given a fixed dose of amphetamine for the first time in the same laboratory, but only a proportion of people experienced pleasurable effects of the drug: a significant remainder experienced anxiety.

Anecdotal reports reveal marked variations in the subjective experiences of people who use heroin for the first time, which cannot be readily explained by differences in the amount used or variations in drug purity.

The effects of a drug are partly dependant on the personality of the person. For example, extraverts succumb much more readily than introverts to the intoxicating effects of alcohol. The user’s beliefs (or expectancies) about drugs are also an important determinant of the drug effect.

In one research study, a group of subjects was given a sleeping tablet and told by the experimenter that it would make them sleepy. Another group was given the same tablet and told that they did not know what effect it would have, whilst a third group was given a placebo and told it would make them feel sleepy. Those subjects who were given the active drug and told that it would make them sleepy showed the greatest drowsiness. The other two groups showed the same level of drowsiness. Thus, in this study, the experimenter’s suggestions were as effective as the drug.

The importance of factors such as beliefs, attitudes and expectancies is also illustrated by the classical research of Howard Becker with cannabis users. The majority of people who first try cannabis do not get high. They may feel a little strange, but they are not sure how to interpret the changes they are experiencing. They may even feel sick or become concerned about how they feel.

When they converse with others about what they experiencing, they may be told about specific details of the cannabis experience they had not noticed before, or had noticed but not realised were part of being high or stoned. The next time they smoke the drug they are better prepared to know that they are stoned.

This learning of the drug experience is also apparent with other drugs. Young people who try their first cigarette or their first drink of alcohol rarely find the experience enjoyable, but they later begin to enjoy the experience. Many heroin users spend an initial period learning to interpret the effects of the drug.

Moreover, variations in social setting can lead to differences in the observed effects of people drinking alcohol. Someone who is drinking alcohol in a loud, raucous setting comprising many people drinking excessively is much more likely to feel and act drunk than someone who is drinking the same amount of alcohol amongst a similar-sized group all sitting down quietly drinking alcohol.

> It’s Not Just About the Drug, Part 2

The photograph used in this blog post is by Efren Barahona and has come from Unsplash, a great resource of free high resolution photographs.