Posts Tagged ‘addiction culture drugs alcohol’

Introduction:

To answer the above question, I am first going to briefly examine what is meant by the terms substance use problem, Criminal Justice Intervention, Public Health Intervention and Harm Reduction. I am going to examine what is meant by contemporary society by the phrase substance use problem, how this concept then defines and drives what are the current thoughts around Criminal Justice Interventions, and public health interventions, and then I will examine what is meant by Harm reduction and how this may or may not compliment public health and criminal justice interventions.

What are Substance Use problems?

The common  contemporary concept of substance use being a social evil, is relatively new, and if you examine social history, and read commentators such as ( Anderson & Berridge 2000),(Barclay et al  2000 ) & (Gossop 2007)  you can see from their research and resultant books, that substance use has been a integral part of society from early times. In many historical pieces, many academics discuss how substances such as cocaine, opium , and alcohol were all used in various commercially available products without any recourse prior to 1820(Anderson & Berridge 2000).

With the advent of the pharmacology act of 1820, the rise of professionalism amongst the new scientific professions such as medicine and pharmacology, the adoption of a new “Medical Model “of viewing substance use issues, or addiction and the rise of temperance, due to the public and social drive against drunkenness and all of its resultant evils, the common concept of what a substance use problem were, gradually began to perfuse into societies psyche. Over the various decades, more prohibitive laws have been passed, each time the laws becoming more prohibitive, until after world war two, the modern landscape of prohibitive legislation was finally developed and ratified by several global position statements by the United Nations. First the 1961 Declaration on narcotics,(UNODC 1961) which ratified the concept of all member nations being drug free, and basing their drug policies on evidence,  and the 1971 convention on Psychotropic  Substances, which called for psychotropic substances to be placed into Schedule one or two dependant on Harm, and banning all use except for medical and research practice. (UN 1971) These two documents also reinforced the concept of the “drugs war”, which had began with the branching out of the enforcement authorities into enforcing social and racial stereotypes based on cultural use of alien substances by ethnic and disenfranchised groups(ref)  which  with the repeal of the Volstead act, which  was the catalyst for the prohibition years from 1920-1932, enabled  the law enforcement apparatus originally set up to enforce prohibition enact a new role as guardians of society  against the insidious march of deviant and immoral drug use as alcohol became a legal substance once more. This new role brought with it the need for a more robust legislative and social framework to control these “immoral substances” and as such a new paradigm acceptable to the public to allow the enforcement and development of new legislation.

This was achieved by not only classifying the sale and use of these substances as illegal acts out with medical and scientific use, but was also fuelled by the development of the scientific model of addiction as a “disease of the will”, an idea first vocalised as early as the 1600’s by men like Trotter, Rush, Levine, & Huss, who all initially discussed alcohol, but the ideas of this “disease model” were quickly applied to all substances. With the advent of the 12 step model, which was “scientifically” endorsed via research and study by E.M Jellinek .published in 1960?

The decision of the United Nations both in 1961, and later in 1971, to endorse these concepts within their individual conventions, introduced this concept of drug use as a form of criminal behaviour perpetrated by criminals to supply clients with substances to ensnare them in a disease process, which then drove them to more crime to facilitate their ever increasing craving for their substance of choice.

Therefore substance use problems can be seen as criminal behaviour caused by the use of illegal substances which by their very nature have medically related problems, such as mental health issues, and physical health issues which are in the long run detrimental to the drug user’s health and social wellbeing.

Criminal justice Interventions:

Within the substance misuse arena, the term Criminal Justice Intervention refers to any of the interventions delivered due to a service user breaking the relevant part of the legislation.  The whole idea of drug interdiction and the reduction of supply all of which are parts of the criminal justice system, as noted above, come from the moral model of addiction, which is based on the belief that the use of drugs and alcohol is morally wrong, and that by preventing use you prevent substance mis use. The most effective example of this was as discussed the Volstead act which ushered in the era of prohibition within the US, strongly supported by the temperance movement, this however is also held up as an example of how the criminal justice approach can cause a rise in criminality, and offers an environment for organised crime to flourish. (Buchanan & Young 2000)

Within the UK we have also had our criminal justice system influenced by this movement, one of the many legislative bills which can be traced to these movements, especially here in Scotland was the 1913 Temperance Act (Scotland) which was an attempt to control licensing, this is sometimes over looked by all of the prohibitions passed with the defence of the realm act, which was intended to control substances, specifically alcohol, and the access troops had to it.

 

The main legislation in respect to this in the United Kingdom is the misuse of drugs act 1971, which has tariffs attached to various acts involved in drug use, and has also a classification system based on how harmful the drug is, and each drug is categorised as A, B or C dependant on perceived harm. (http://www.legislation.gov.uk/ukpga/1971/38/contents)

This legislation also gives courts and enforcement agencies the power to hand out custodial sentences, the tariff for which depending on the class of drug, and the part of the legislation the offence is committed under.
In Scotland at this point in time, there are several  criminal justice interventions utilised which can also be linked to Public Health Interventions which are prison based  opiate replacement therapies, Drug Treatment and Testing orders. There are also others, e.g. Probation and community service orders, which may also have public health elements within them.

Within this essay, we are going to focus on two of these interventions, prison based opiate replacement programmes, and drug treatment and testing orders, due to the way they can be linked to public health through the blood borne virus and sexual health framework.

Public Health Intervention

Public health interventions are interventions which look at the health of the general population initially, then specific groups deemed to be vulnerable or at risk specifically within that general population.

As with Criminal Justice Interventions, as outlined above, Public Health Interventions have their  core concepts based within a model of addiction. The model of addiction that public health takes its main concepts and schemas from is the medical model, as briefly discussed previously. This model suggests that addiction is the result of a disease process, and as a result the various issues that are associated to this disease concept such as the cravings, and associated medical problems such as liver damage, blood borne virus and the social issues such as crime and some degree poverty can be abated by people “just saying no” or by facilitating people who use drugs into treatment. The public health model also looks at abstinence, as does the moral model, as the ideal, and to this end most interventions are geared towards a drug free life(Scottish Government 2008,).

Public health interventions rely more on policy than legislation, to guide and facilitate their delivery, and examples of this for substance use  directly related to our two interventions would be the Road to Recovery (Scottish Government 2008) the sexual health & blood borne virus framework (Scottish Government 2011) , both of which discuss in detail substance use/misuse and the governments expectations of what services should offer.

Public Health interventions, especially around blood borne viruses and their prevention, tend to be delivered alongside harm reduction techniques, which are the polar opposite to the models discussed as the focus tends to be on the reduction of harm with abstinence being of secondary concern, this often causes tension between drug services and public health services, as drug services are being seen to condone drug use (Lloyd & Hunt 2007). On the other hand drug services tend to look at harm reduction as one of the many tools on a continuum towards abstinence, but another difference is that drug services are also pragmatic and realise that the concept of abstinence is not suitable for everyone, and with most harm reduction services the role is completed with some clients by just ensuring someone turns up at the clinic is using the correct injecting technique and knows how to react in an overdose situation.

Harm Reduction Approach:

As outlined above, Harm reduction approaches focus on reducing harm, this approach is more centered on thebehaviour change model as described by Prochaska & DiClemente in 1980, but also uses elements from Bandura’s theories around learned behavior, and also to some extent Skinner’s work around operant conditioning. (Ghodse 1995, Rasool 2009)

Harm reductionists believe in facilitating change, by providing choice, and by influencing factors such as mentorship and peer concepts, and this can be seen actively at work in the various peer support models used throughout the current drug services. This idea is at odds with the interventions based on the more traditional viewpoints as outlined previously. These concepts focus on facilitating the service user to enter into treatment and then whilst in treatment, maintain their sobriety, with the ultimate aim to be to facilitate and maintain abstinence. The tension arises with the way that this is done, and how the problems are perceived.

As previously stated, Harm reduction is about choice, with the emphasis being put on personal responsibility, the other two models are about removing choice, the disease model could be said to absolve personal responsibility due to the concrete belief that addiction is a disease, therefore any “addict” or “alcoholic” is at the behest of a disease process which causes the sufferer to have cravings, and ensures that once they use their substance of choice they continue to use until they are intoxicated or causing physical/psychological harm to themselves. Within the Criminal Justice Model, again choice is removed from the service user, as they are either incarcerated, in which case they are removed from their supply, or through DTTO’ given a tariff that also involves forced treatment options on the pain of imprisonment when and if they do not comply(Rasool 2009) there is also the issues around the harm reduction agency facilitating an illegal act by facilitating the use of illegal substances, this argument can be seen in the various papers surrounding the setting up and running of “drug consumption rooms” and introducing needle exchange in a prison environment.

Do the two models compliment a harm reduction approach ?:

On initial examination the two models would seem to be at odds to a harm reduction approach, but to answer this question, we need to examine in more depth areas where all three of these concepts intersect, and the easiest topic to do this with is the current delivery of Blood Borne Virus Services within an addiction related context.

Blood Borne Viruses especially Hepatitis C and HIV have been an issue within the drug taking communities and the prisons that are more often than not a main fixture within their existence since the 1980’s.

The topic has been and continues to be an area of  research within academia, and in her book “ Aids in the UK : The making of policy 1981-1994: Virginia Berridge discusses how the issues around this encouraged the prisons within the UK to adopt  Opiate Replacement Therapy as a main tool to fight infection and reduce high risk behavior within the prison system in the 1980’s and 90’s, and the text from this era also indicates that injecting practice, and other high risk behavior was prevalent, which increased the risk of cross infection within the prison estate, with some of the respondents admitting in open questionnaires that they had indulged in risk behaviours whilst incarcerated. (Berridge 1996, WHO,1998).

This research and further discussions with the prison authorities led to Opiate Replacement Therapy being chosen as the main intervention to reduce these risk behaviours.

As with Prisons, and those incarcerated, HCV has also been an issue within the community with the incidence of HCV on the increase, especially within the drug using population. This issue has been deemed a priority by the Scottish Government who have produced two strategies to develop services Hepatitis C Action Plan (Scottish government 2006) which then developed into the Sexual Health and Blood Borne Virus Framework (Scottish Government 2011), which looked at all of the actions needed to deliver containment of what is a growing public health problem (Scottish Government 2006, 2011), inclusive of a section that was specific about Prevention,. In this section, it specifically looked at expectations around provision of services, and the expectation that services should complement each other.

The main thrust of these documents was to decrease risk behaviour in the community and increase access to preventative strategies including needle exchange and related therapies such as Opiate replacement therapy.

To achieve this various strategies were developed, which included the re-orientation of needle exchange to incorporate easier access to sterile equipment, more accessible testing processes, education about the issue and one of the few interventions that has spanned across all three areas without much disagreement has been that of using peers to deliver health, and harm reduction related messages, as well as Opiate replacement therapy.

Recent research has now highlighted that the combination of targeted prevention messages, and information on testing, has reduced transmission rates, and Peer education initiatives (Dolan et al 2004, Allman et al, 2006, Fisher et al, 2013, Moro et al 2013, Lianping et al 2013Weeks et al 2006), has been successful in delivering the relevant messages to target populations and reduced risk behaviour. Opiate Replacement Therapy has also been highlighted as an intervention, with roots in Harm reduction philosophy that has had a major impact on clients in both Public Health, and Criminal Justice environments, as it allows the service users to reduce risk by changing behavior around that risk, e.g.  sharing non-sterile equipment, by eliminating the risk taking.

Recent research suggests that ORT has been so successful in preventing onwards transmission of BBV within the prison environment that in the reports conclusion it suggests that there may be no need for needle exchange programs within Scottish prisons, it also suggests that this result is also due to other harm reduction strategies. (Taylor et al 2013). This trend of ORT and other Harm reduction strategies reducing ongoing transmission through high risk behaviours has also been witnessed in the general community, the NESI study & others indicated that a similar trend in the community of injecting drug users, suggested that ORT was one of the main contributors along with other strategies. (NESI 2012, Turner et al 2011).

Summary:

The question that was to be considered was Do criminal justice and/or public health interventions compliment a harm reduction approach to substance use and problems, and in order to do this we had to examine how and why we as a society view substance use the way we do, how this ultimately affected how we saw the problem , and as a result how this was developed into the conceptual ideas of the moral model and medical model to describe why people with substance use issues behaved in a certain way. We then examined how historically these concepts or models influenced the development of not only two distinct models, the disease model, and the moral model, but also how these models began to influence not only social concepts of addiction/ substance use, but also informed political and policy development in the western world. We then looked at how these historical ideals through globalisation led to the world acceptance of these concepts, and how this acceptance through the United nations conventions and declarations led to not only a prohibitive form on control through the development of legislation like our own Misuse of drugs Act 1971, but also how this “war on drugs” also led to, supported and normalised the continued medicalisation of drug use issues which has led to abstinence based policy statements like the road to recovery(Scottish Government 2008).

The next step of our exploration of the question examined how these two models viewed the harm reduction approach, and this concept and what it means in relation to the prohibitive and moral stance point of the medical and moral models, we also looked at how their is inherent tension between the traditional models and harm reduction due to the focus of harm reduction being on and this was explored looking at the issue of blood borne viruses, and how certain harm reduction approaches have been identified and utilised to control the spread of this condition, within the paradigms of the two traditional models, and their related interventions. We also briefly examined the research that has suggested that these identified harm reduction approaches, namely Opiate replacement therapy, and targeted prevention education utilising peer educators, has been seen to be as effective inside the criminal justice intervention that is incarceration, and also within public health where they are targeting substance use sub populations to facilitate total abstinence.

Conclusion:

Therefore when considering the question Do criminal justice and/or public health interventions compliment a harm reduction approach to substance use and problems, we have to suggest that in some cases these two  forms of intervention can complement the harm reduction approach, as outlined above, however we also have to concede that the two approaches that advocate criminal justice interventions and public health interventions i.e. the medical model and moral model, although fundamentally trying to do the same thing as harm reduction approaches, that is to protect the population from harm, are fundamentally different in outlook and design. We also have to concede that the two abstinence based models also in their own ways remove responsibility from people who use drug, and therefore by default remove ownership and responsibility for actions and behaviours as well. This again is a major difference that can only add to the tensions previously discussed, and this is evident when you examine the current debates around the introduction of drug consumption rooms in the community,( Lloyd & Godfrey 2010,Lloyd & Hunt 2007, Patel, 2007, McKeagney 2006, Rhodes et al 2006) or needle exchange programs within the prison (Taylor et al 2013). Therefore in conclusion it can be strongly suggested that some harm reduction approaches are complimented by Criminal Justice and Public Health Interventions, with the caveat that these harm reduction approaches can be effectively said to be within the letter of the law, i.e. are not encouraging the illicit injecting of illegal substances, or are not condoning use of illegal substances.

This discourse is well represented in research literature, (Lloyd & Godfrey 2010, Lloyd & Hunt 2007, Patel, 2007, McKeagney 2006, Rhodes et al 2006) and most famously was commented on by the Joseph rowntree trust in their 2006   paper “The Report of the Independent Working Group on Drug Consumption Rooms”

References

Anderson S. and Berridge V. (2000): Opium in 20th Century Britain: Pharmacist’s regulation & the people, Addiction Vol.95 (1)

Barclay et al, Royal College of Surgeons ( 2000) Drugs, Dilemmas and Choices, London Gaskell

 

Berridge V (1996) Aids in the UK: The Making of policy 1981-1994: Oxford University Press

 

Bloor M and Wood F. (1998) Addictions and Problem Drug Use: Issues in Behaviour, Policy and Practice,  London, Jessica Kingsley Publishers.

 

Buchanan J and Young L ( 2000): The War on Drugs-A war on drug users?. Drugs :education, prevention & policy Vol.7 No4

Department of Health(England) and The Devolved Administrations(2007):Drug Misuse and dependence: UK Guidelines on Clinical Management London: The Department of Health (England),the Scottish Government, Welsh Assembly Government, and Northern Ireland Executive.

Ghodse H.  (1995): Drugs and Addictive Behaviour : A guide to treatment  2nd  Edition London Blackwell Science Ltd

Gossop  M. (2007): Living with Drugs 6th EditionAldershot, : Ashgate Publishing Ltd.

Hunt N. And Stevens A. (2004): Who’s Harm? Harm Reduction and the Shift to Coercion in UK Drug Policy, Social Policy & Society Vol 3 . (4) pp333-342

Independent Working Group (2006) : Drug Consumption Rooms, summary report of the Independent Working Group, Joseph Rowntree Foundation

Jellinek, E. M. (1960). The disease concept of alcoholism. New Brunswick, NJ: Hillhouse Press

King R.S and Mauer M. (2006): The war on marijuana: The transformation of the war on drugs in the 1990’s: Harm Reduction Journal Vol 3 (6)

Lloyd C, Godfrey C (2010): Commentary on Pinkerton(2010): Drug consumption rooms-time to accept their worth: Addiction, 105 p1437-1438

Lloyd c, Hunt N, (2007)  : Drug consumption rooms: An overdue extension to harm reduction policy in the UK?: International Journal of Drug Policy  18  p 5-9

McKeganey N, (2006): Safe Injecting rooms and evidence based drug policy: Drugs: education, prevention, and  policy   Vol.13,No1, P1-3

Patel K, (2007): Research note: Drug Consumption Rooms and Needle and Syringe  Exchange programs: Journal of Drugs Issues 37: 737

Rhodes T, Kimber J, Small W, Fitzgerald J, Kerr T, Hickman M, Holloway G, (2006): Public Injecting and the need for “safer environment interventions” in reduction of drug-related harm: Addiction 101, 1384-1393

Runciman R,  Lloyd C, Hunt N, Fortson R, Green K, Hayman A, McKeganey N, Stimson G, Strang J, Wright N, (2006): The Report of the Independent Working Group on Drug Consumption Rooms: Joseph Rowntree Foundation

Rassool G.H., (2009): Alcohol & Drug Misuse: A handbook for Students and Health

Professionals,  Abingdon: Routledge

Scottish Government (2008) The Road to Recovery: A new Approach to tackling Scotland’s Drug Problem, The Scottish Government Edinburgh

Stimson G, Des Jarlais D.C, Ball A (editors) (1998): Drug Injecting and HIV Infection: World Health Organisation UCL Press London.

Turner, K et al. (2011) The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction, 106, 1978-88

University West of Scotland et al. (2012) Needle Exchange Surveillance Initiative (NESI): prevalence of HCV and injecting risk behaviours among people who inject drugs attending injecting equipment provision services in Scotland, 2008/2009 & 2010.

United Nations : Convention on Psychotropic Substances1971, United Nations New York.

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http://www.legislation.gov.uk/ukpga/1971/38/contents  Accessed on  8th May 2014 @ 20.13

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Here is an essay i wrote as part of my course work, please feel free to leave any comments or thoughts you have about this subject.

The Essay

This essay will explore the concepts that influence and dictate how we as a society have been influenced by cultural factors which colour our view with regards to alcohol/substance use, and the problems which rightly or wrongly are associated with the use of these substances.

Historical Context of Cultural Influence on Substance misuse,

It has long been assumed that the act of using substances is “inherent” ( Barclay et al, 2000) within the human make up, and that human beings have for centuries attempted to alter their perceptions of the world around them for various reasons, linked in to local socio–religious practice with societies becoming increasingly drug focused as they develop. (Ghodse H.    1995).  There is also good evidence by looking at anthropological studies that the use of substances within “primitive cultures” is not automatically associated with negative outcomes, which suggests that  the effects of substance are cultural specific.  (MacAndrew & Edgerton 1969)

More recently within our own History of the Post Industrial Revolution, Hogarth’s Etchings of alcohol use and misuse in Beer Street & Gin Lane, highlight that there were issues developing around substance misuse, and societies perceptions of this and  as early as 1729 the government, backed by religious leaders, began to tax gin.  Coming up to date to the here and now, the rise of new psycho stimulant substances reinforces this concept that human beings are always on the lookout for ways to alter their perception.

 Hogarth published his images of what were then contemporary scenes of life within London, or indeed any city of the time.  His now famous Gin Lane and Beer Street pieces highlighted the social differences between those who drank the cheap and readily available gin, and those who drank the more upmarket beer. Within these images, specifically Gin Lane, you can see the traces of the moral model , which suggested  that  those who were addicted to alcohol, especially spirits, were ethically and morally weak, a concept reinforced by the anti social behaviour recorded in the image, the main object being the intoxicated women letting her baby fall, as she reaches for a substance from the tin in her hand, and this image is compounded by the fact that she has bare breasts ,which would be not only a social taboo in what was a deeply conservative society, but could also indicate a woman of loose virtue and morals.  This has striking similarities , to the way contemporary society views female intravenous drug users who are mothers, and prostitute themselves to fund their addiction.

 The advent of control of substances, indicated another more sublime factor now emerging in the politics, and social world, that of the control of populations sanctioned by professionals, the Gin Act for example was forwarded by the political & religious establishment of the time, as a way to prevent Laziness and Criminal behaviour, ( Barclay et al,2000) within the growing masses of people now flocking to the cities for work in the new industrial complex which was growing rapidly.  Again if we look at the moral model, both laziness and criminality are moral weaknesses, therefore the control of the substance that caused these weakness was the logical step to “protecting “the population.  This gradually permeated throughout the next century with various acts being passed. the 1862 Pharmacy act to control the availability of opium, the 1912 Hague Convention, the Harrison Act of 1914 all related to control of opium, alcohol was also beginning to be controlled, with the Defence of the Realm Act in 1915, and previously on a more localised basis the Temperance Act Scotland 1913, which aimed to control the sale of alcohol, thus limiting its effect on the war effort and laterally the society in general. In more recent times, it could be argued that the introduction of the Misuse Of Drugs Act in 1971, which made injecting any substance, or the preparation of any substance for injection illegal, among other things, and classified certain substances, and attached specified legal tariffs for possession of these was a another move down this route.

 All introduced at a time when the disposable syringe, a relatively new development (1968), was becoming common place, and injecting practice was a common route for utilising drugs for recreational purposes.

 Social context of Cultural Influence on Substance misuse

 As Noted previously, mankind has had a long if not chequered history with substances, utilising their psychoactive elements to alter perception.

The human being is also the only animal that actually seeks these substances for this particular effect, “mankind is the only species that actively seek out and ingests the psychoactive substance in its environment.” (, Barclay et al, p.24 2000), and this behaviour has led to a whole collective of different concepts of what a culturally acceptable substance is. 

Within Europe, alcohol has been ingrained into our social structure, where alcohol is used to mark almost every landmark within a person’s life, and is utilised in various religious ceremonies.This social acceptance of alcohol, has led to a form of social normalisation around its use, and induction of non-users into the socially accepted patterns of use. 
 If for example a young man is seen to become involved in anti social elements of consuming alcohol,  it is said that he “can’t hold his drink”  and is dismissed as being foolish and immature by our society, possibly receives a police caution, and is seen to “learn from his mistake” (Barclay et al,2000). If however the same young man continues to persist in his anti social behaviour, especially under the influence of alcohol, he becomes more and more isolated, eventually is said to be displaying socially abnormal, or deviant behaviour and is deemed as suffering from Alcohol Dependence Syndrome, or has become an Alcoholic. This behaviour could be seen by society to be non-compliant with the acceptable social norm, therefore this was “deviant” behaviour, and needed some kind of intervention.

This concept highlights a second strand of social normalisation, the reinforcement of culturally acceptable behaviour through the use of behaviour models, namely the disease model, (Jellinek, E. M. 1960), and how this concept can influence how our concepts around alcohol are shaped. 

 The disease concept ,which suggests that a person with an alcohol problem has a disease, also suggests the issue can be treated using a medical intervention, or cured by abstinence,was challenged by MacAndrew & Edgerton (1969), with their research around drunken comportment.
MacAndrew & Edgerton, examined how various primitive societies viewed alcohol within their societies, and discovered that although the universal effects of alcohol, slurring, staggering and sleepiness, affected everybody, the way the culture of the specific tribe reacted to it was different. The studies highlighted that the negative “anti-social effects “noted in the west were often absent.   Out of 46 societies/cultures, studied, a link between alcohol and violence was only found to be present in  one fifth of the societies. (MacAndrew &Edgerton 1969) This suggested that reaction to alcohol was culturally specific.

 One of the other social issues that effects how a society views substance use is the availability of the substance, and what that culture uses as a substance of choice. (Gossop  M. 2007) Many cultures will choose to use a substance that is readily available in their culture, for example in areas of South America, Cocoa is the substance of choice because it is readily available in the surrounding environment, and has historically been used by the indigenous population, and has therefore become that societies drug of choice. It is when these drugs of choice enter a new culture, that they become “Alien Substances” and become viewed with suspicion and become problematic, with any adverse side effects only reinforcing the substances intrinsic dangers. “(Barclay et al 2000).

 This can be illustrated by looking at historical events over 300 years ago, throughout Europe, there was a backlash towards the new drug of the time Tobacco. In Russia, and  the UK ,the ruling classes passed legislation to control the use of the substance . In the UK  King James issued his “counterblast” at Tobacco calling it a “loathsome”, imposing a tax on it,  and  Czar Mikhail Federovitch  executed smokers.  (Barclay et al,2000) . The other way a culture can react to the introduction of an “Alien Substance” is by adopting the social rules and etiquettes around the use of the substance as demonstrated by the introducing culture.  This cultural adaptation or  the Dominant Culture Theory was also discussed by MacAndrew & Edgerton, (1969) who cited the case of the Papago or Tohono O’odham, who eventually adapted the drinking etiquettes of the Anglo American population, mostly  trappers , cowboys and soldiers, who at the time according to historian J.E Levy were the “worst drinkers in the American Nation.”` (Levy J.E.  1996)

 Psychological context of cultural effects on substance use

Different cultures also have different psychological constructs around substances and how the substance is used, and accepted within that society. We have seen how a culture can dominate a lesser culture, and imposes it’s social rituals around the dominant cultures chosen substance on the lesser culture, as it gradually becomes assimilated into the dominant one, but how can a societies psychological reactions differ, how can  one society demonstrate what are deemed to be negative reactions like violence and lack of control, whilst another does not.

The anthropological experiments had suggested that there was more to these reactions than the pharmacological effects of the drug. Marlatt & Rohsenow (1980) designed and conducted an experiment utilising what was described as a Balanced Placebo, which was designed to discover if a subjects behaviour could be manipulated by influencing their expectations with regards to using alcohol. These experiments proved that if people were expecting vodka and tonic, then they would behave in the way society expected them to behave, they also proved that people who were expecting vodka and tonic but received only tonic, still behaved as though they had received alcohol. (Marlatt, G. A., and Rohsenow, D. J. 1980). This experiment indicated that a person’s expectations on how to react with a drug could be learned. This discovery reinforced the idea that a culture/society will reinforce its own normalisation around its chosen substance, by socialisation, and learned behaviour.

 If for example a societies only expectation of using a substance is positive ,e.g it allows them to communicate with spirits, or allows some positive religious experience ,as is the expectation in primitive cultures then they will react accordingly, if however the society expectations are primed to expect unpredictable behaviour, or negative outcomes, the same will be true. If you then add into the mix, that societies moral attitudes, and beliefs around their chosen substance, and the infiltrating “Alien Substances”, then a cultures influence on substance whether alcohol or other substances can often be mixed, and inconsistent.

 One of the issues that influences society and culture is the concept of deviance in relation to misuse of the chosen substance. Emile Durkheim stated that deviance is an integral part of all societies and serves four functions, (1) affirming cultural values and norms, (2) clarifying moral boundaries, (3) promoting social unity, and (4) encouraging social change, (Thio A. 2004 ) and a societies/ cultures idea of what a social norm is, can be influenced by these factors.  The culture can influence how a substance is used and accepted, it can influence how the substance is morally viewed and accepted and how an individual expects to react when using the substance, and the sanctions which are imposed both socially and personally if the behaviour is out with the accepted norm. Usually this label would be dependent on how the above factors have been integrated into the culture, and how these factors are then used within that cultures mechanisms of social control. A society may demonstrate an intrinsic acceptance to the moral and health issues caused by it’s chosen drug, but act in a totally opposite manner to the alien substance which causes similar issues being suspicious of it, and legislating against it to control these issues. In effect criminalising the Alien Substance “not for risks to health”, but for “moral  degradation, corruption and unbridled sexuality.” (Barclay et al,2000)

 Another major influence is the acceptance of substance misuse within a model designed to explain this behaviour.  These models basically reinforce the concepts of deviant behaviour not being the fault of the person, but indeed being caused, by moral weakness (the Moral Model), or a disease process.(The Disease Model). ( GH Rassool 2009)

These models in turn influence the basic perceptions of society around it’s chosen substance (Gossop 2007) which in the UK  is alcohol. These basic perceptions are also being reinforced by legislation and the highlighting of negative images, that cause moral panic, Hogarth’s images could be cited as historic examples of this, a contemporary example would be the negativity around methadone as often reported in the media.

 The initial question was “Discuss how culture might influence alcohol/drug use and problems.”On examination, culture can have a massive effect on how individuals look at alcohol/drug use.

We have seen how historical concepts can colour how a society looks at substances, and can influence the very learning process, that integrates individuals into a society. This learning process around using substances, can lead to an acceptance of a substance that is culturally specific, and the experiences around this substance can then influence how we view the substance, and in some cases accept its negative aspects. This acceptance of negative and positive aspects, can in turn lead to a cultural expectation of how to act, both in a socially acceptable manner, and in a “deviant manner”, and then influences the social and moral penalties that are utilised to enforce societies sanctions for displaying this behaviour. We have also discussed how these penalties can be applied when a new substance is introduced, to enforce compliance with the social construct developed around the original substance of choice. We have explored how dominant cultures can influence how lesser cultures look at substances and how the expectations of the dominant culture is assimilated by the lesser cultures.

 In conclusion culture has various effects on a societies use of alcohol & drugs, in simple terms this can be summed up in the phrase “I am told therefore I am”. Culture can influence the normalised use of an accepted substance, and also influences the expectations of the reaction to the substance. It also influences various social constructs designed to control the use of substances, and ingrains them into the legal and professional mechanisms to control the general population. This influences the societies views on the use and misuse of substances both accepted and alien. It also influences the beliefs a society has as to the meaning of deviance within this construct, and how this deviance is recognised treated and dealt with.  In other words “I am told therefore I am”

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