The culture of addiction: Part 1

384985_10150365241281765_1866835833_nThis is the first of two blogs on the culture of addiction. I will later look at the culture of recovery, and after that consider how we can help people move from the culture of addiction to the culture of recovery.

These articles are based on the seminal writings of William L White, in particular from his book Pathways from the Culture of Addiction to the Culture of Recovery. In this book, Bill provides key insights into how we can help people move cultures – essential in their journey along the path to recovery.

‘Culture’ generally refers to patterns of human activity and the symbolic structures that give such activities significance and importance. Wikipedia

Drug users often seek out and build relationships with other people whose drug use is similar to their own. They become part of small groups within which they can nurture the rituals of drug use. These groups interact with other drug-using groups, ultimately forming a broader network of users who share common goals and attributes. These social networks constitute a fully organised culture, one that has an existence and power that transcends individual membership.

In his classic book Pathways from the Culture of Addiction to the Culture of Recovery, William L White emphasises the importance of understanding the culture of addiction. He emphasises that many addicts find it easier to break their physiological relationship with the drug than to break their relationship with the culture in which they use the drug.

Clearly, one needs to understand how to move someone from the culture of addiction to the culture of recovery. White’s book is essential reading!

Bill White describes the culture of addiction in the following way:

  • The culture of addiction is an informed social network in which group norms (prescribed patterns of perceiving, thinking, feeling, and behaving) promote excessive drug use.
  • The culture of addiction is a way of life, a means of organising one’s daily existence, and a way of viewing people and events in the outside world.
  • The culture of addiction encompasses values, artefacts, places, rituals, relationships, symbols, music and art, all of which reinforce one’s involvement in excessive drug consumption.
  • The culture of addiction can play a role in the early stages of substance use and misuse, as well as in sustaining addiction.

The culture of addiction and early drug use
When people first use, it is not just the pleasurable effects of the substance being consumed that are likely to lead to further use, but also the social experiences and rewards derived from participation in substance-using rituals. The culture of addiction, and drug-specific subcultures, offer the opportunity for a person to identify with other people, lifestyles, symbols and rituals that meet their own personal needs.

The heroin user who has been traumatised by sexual or physical abuse as a child will not only feel the powerful ‘analgesic’ effects of the drug – helping them to deal with their psychological pain – but may also benefit from relationships and experiences within the social setting in which they take heroin. The people who they take the drug with may have experienced similar abuse in their youth, or may know others with similar problems, and are therefore more likely to be understanding and comforting.

A young person who has rebelled against their family and friends may feel they fit in better with the heroin (or other drug) scene they have encountered. Becoming part of the heroin scene – which is demonised by society – can be viewed by some young people as being an effective form of rebellion against the comfort of living with wealthy parents who are viewed as not understanding the person’s desires and needs.

The addiction culture provides a place where neophytes (new users) learn how to use drugs. When a person starts to use they are confronted with a variety of knowledge and skill demands, which they learn from other users in their group.

How do they snort or inject the drug? What equipment is needed? How much do I take? How do I know the drug’s purity? When can I use again? What happens if a bruise develops at the injection site? And so forth.

The person also learns to experience the effects of the drug. The initial effects of even heroin can be very subtle and the person may need to be taught by others how to recognise and enjoy the drug effects. They will also be helped to understand and deal with the negative effects of early heroin use.

The culture of addiction and maintaining addiction
Whilst the culture of addiction may not have influenced the development of a person’s addiction, it may play an important role in maintaining their addiction.

At a practical level, the culture of addiction provides knowledge and skills on how to use, how to minimise risks, and how and where to access the drug. For example, once the person is unable to afford to purchase the amount of heroin they require to stave off withdrawal, they may decide to resort to criminal activities such as shop-lifting to accumulate the necessary funds. Other heroin users will introduce them to the things they need to know to shop-lift successfully.

As the person moves from initial experimentation to dependent use, the search for supports that sustain and justify their use is intensified. The negative effects of using become more evident and the person needs something to counter these effects and the resulting reductions in their self-esteem.

The addiction culture can support self-esteem by ‘nurturing’ one’s specialness of being an addict, by denying addiction exists, or by meeting other unmet needs. In relation to the latter, the user may rationalise that these negative effects of drug use are a small price to pay for the drug and group helping them to deal with past physical or sexual abuse.

By mixing with other addicted individuals, the person can maintain the illusion that their use and problems are no worse than anyone else’s – or in fact, less than those of particular people. This helps them refuse to acknowledge that they have a problem, thereby helping sustain their addiction.

The ability of a culture to offer identity and membership is a strong attraction to people who have felt excluded from normal society.

Adopting the identity of a user is an important transition into the world of heroin (or other drug) addiction, and for many people this identity meets more needs than does the actual use of heroin. Whilst a user may be stigmatised in the ‘outside’ world, they can see themselves as part of a special group, a group in which they gain status as a participant and later as a teacher to new users.

“… members are bound to a group through which significant personal needs can be met on a daily basis. A major need for all members is to sustain an identity that provides a sense of both social and personal value. The fact that addiction inevitably eats away at self-esteem suggests that these cultures must provide elaborate mechanisms to sustain the identity of their members.” William White

White makes the very important point that if treatment cannot provide an alternate identity and alternative mechanisms to maintain self-esteem, or help the person regain self-esteem, then it will not help a person move from the culture of addiction to the culture of recovery.