Socio-Cultural Context of Substance Use and Abuse Research Paper

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The use of alcohol and drugs is an ancient and widespread custom among human beings throughout the world. Although some such usage is commonplace, specific beliefs and practices vary markedly from one population to another, and significant changes have occurred over time within many societies (Blum et al., 1974). Far from being aberrant or isolated acts, alcohol and drug use are often highly valued and integrated with other aspects of the culture. This often involves important linkages between such use and religion, economics, diet, health beliefs and practices, social organization, literature and the arts, or other features of daily life, as well as with exceptional concerns. At the same time, it is important to acknowledge that alcohol and other drugs can be harmful to the user or others. They can be toxic, can greatly increase the risk of accidents, and can even cause physiological damage to various organs and social, psychological, and other disruptions. Dependence (often called addiction) is uncommon but is a major interference with a user’s social obligations and expectations, which partly explains why abuse has been the subject of scientific study more than moderate use, which is much more common. In view of humankind’s long ambivalence, a wide range of such sociocultural influences, in combination with the biophysiological impacts that alcohol and drugs have on the human organism, and a variety of psychological causes and effects, are all important for understanding the association between such usages and public health.

Alcohol/Drug Use In Evolutionary Perspective

There has been little systematic attention paid to alcohol or drug use by non-human animals, although Siegel (1989) reviewed the literature and described intoxication among various birds, fish, insects, mammals, and reptiles. Altered behavior after the ingestion of diverse substances was so commonplace that he characterized the quest for intoxication as a primary motivational force, the fourth drive (on a par with hunger, thirst, and sex).

As far as origins of alcohol/drug use are concerned, there is little in the way of empirical evidence, although myths, folktales, and popular beliefs abound, usually with respect to whatever substance is most favored locally. Given the present state of archaeological technology, there is little opportunity to know with confidence many details about alcohol/drug use by prehominid or ancient human beings. Speculation tends to emphasize either accidental discovery or imitation based on the observations of animals’ reactions to naturally occurring substances.

In other instances, supernatural beings were said to have given alcohol or drugs to humankind. Dionysus was both the god and origin of wine for ancient Greeks; Bacchus was his counterpart for Romans. Similarly, Egyptians supposedly learned about beer (which they called liquid bread) from the god Osiris; in the Americas, Aztecs claimed to have got pulque from Mayahuel, a goddess with forty breasts.

Although alcohol/drug use are widespread phenomena in human cultures, they have not evolved in any discernible sequence overall, nor do they evidence similar or even analogous patterns over time in most parts of the world.

The earliest archaeological evidence of both beer and wine appears in the Near East about 7000 years ago. Beer rapidly diffused as a staple food, whereas wine was long a luxury product, although its popularity also spread both east and west. Drinking and drunkenness were both much appreciated, until Islam spread through much of the same area after 700 AD, and most interpreted Koranic injunctions as prohibiting the use of alcohol.

It remains a mystery why most of North America and the islands of the Pacific did not have alcoholic beverages until the arrival of Europeans. When such drinks were introduced, some peoples rejected them and others embraced them. The homebrewed beers of sub-Saharan Africa and what is now Latin America have tended to persist in both alimentary and ritual roles, even while industrial beers are gaining.

Distillation was probably invented by Arabs in North Africa and diffused to Western alchemists a couple of centuries before it became popular around 1200 AD. Opium, smoked or eaten, was highly esteemed as a tranquilizer throughout much of Asia, and derivatives of it served as such and as analgesics throughout Europe and North America in the nineteenth century. Heroin was originally hailed as a cure for opium addiction in much the same manner that cocaine was initially embraced as both mentally and physically therapeutic. Heroin and cocaine in various forms have enjoyed popularity in recent decades and are the basis of a vast international trade, much of which is illicit. Although caffeine is the active ingredient in coffee, tea, and chocolate, each of these beverages has its distinct history. Coffee spread from eastern Africa and the Near East, and, in the early years, was often suspected of eroding the moral values of those who drank it. Various governments banned it and closed coffeehouses as supposed hotbeds of immorality, sedition, and even revolution. But such prohibitions tended to be short-lived, and coffee is now extremely popular, with or without food, and is rarely even considered to be a drug. Although tea originated in Asia, it spread rapidly over the British Empire and is now a popular staple, similarly no longer viewed as a drug. Chocolate, having originated in pre-Columbian Mexico, underwent a similar dispersion linked with a similar trajectory from popularity to suspicion and on to acceptance as benign. Tobacco contains nicotine and other psychoactive substances; it similarly spread rapidly (from the Caribbean) to circle the globe in a few years, sometimes embraced and sometimes reviled, whether smoked, sniffed, or chewed. Recent health concerns have diminished its use in the developed world, although its popularity is still increasing in many poorer regions. Also during the past century, ether drinking has been replaced by solvent sniffing, and a variety of synthesized drugs now offer central nervous system (CNS) stimulation, relief from pain, or escape to bored or harried urbanites throughout the world system.

Alcohol/Drug Use Among Humankind Today

There is so much variation among the substances that are used by human beings even now that it is not easy to provide just an illustrative sampling. More importantly, the social and cultural meanings, patterns of usage, values, and associated attitudes are yet more varied in ways that are important but rarely recognized. One convenient way of ordering such data is geographically, with a brief survey of influential drugs and outstanding uses as encountered in major world areas. This is not an arbitrary convention inasmuch as the natural environment comprises a complex interrelated system of soil, flora, fauna, climate, and other factors that can be viewed as the context for all human behaviors. With respect to alcohol, for example, the sugar content of plants affects their aptness for fermentation, and a shortage of fuel may preclude distillation. The molecular composition of a leaf or vine may harbor psychoactive potential, but it is moot unless ingested.

Biologists and ethnopharmacologists do not yet know why the Western Hemisphere is home to many times more psychoactive plants than the Eastern. Neither do historians or anthropologists understand how people came to use such plants, a tantalizing mystery in part because so many require elaborate processing and are highly toxic at various stages in their preparation.

Part of the ecological richness of what is now Latin America is a wealth of plants that have psychoactive properties and that have been used by native peoples in various ways. Coca grows throughout the area but is most potent at about 2000 m elevation in the Andes. The Incas and their descendants traded it far and wide; farmers still chronically chew it to relieve hunger, thirst, and cold, and shamans use it for divination, diagnosis, and other ritual purposes. Simple processing of it yields an addictive paste, and more sophisticated refinement yields powdered cocaine hydrochloride, which is widely used worldwide. Nowadays, it tends to be sniffed by wealthy users who find small quantities exciting but not interfering with the rest of their lives. The same drug tends to be taken by injection by a small group of poor and compulsive users who must often resort to crime or prostitution to feed their dependency.

Forested lowland areas of Latin America yield many snuffs, cactus fruits, and mushrooms that are still used by native peoples for myriad purposes. One of the most famous is ayahuasca, long a medication and inducer of visions that would be helpful to the community; it has recently become popular among outsiders who are seeking shortcuts to divine revelation or direct contact with what they interpret as primal forces of nature. Peyote, rich in LSD, was and is a sacrament to Huichol Indians in Mexico and to members of the Native American Church in North America. When chewed, it induces visual hallucinations that a believer interprets as directives for proper living, and it has diffused little beyond that religious context.

Snuffs and drinks made from a variety of plants are common throughout Latin America, but usually their magical powers are monopolized by a few specialists who provide services to the community. Drug-induced visions often allow practitioners to learn about enemies, the dead, or others, and have been reported in considerable detail. Ethnobotany and ethnopharmacology have become big business, and traditional native knowledge is being actively sought by international pharmaceutical companies. Drug tourism has recently become a small source of income in some regions, as is the quest for shamanic and ecstatic experiences.

The islands of the Pacific generally lacked alcoholic beverages before the arrival of Europeans. Kava is a mild stimulant that was often mistaken for a fermented drink. Traditionally, it played an important ceremonial role in maintaining social hierarchy, but has gradually become secularized and popular. Its recent combination with alcohol often results in aggression, in contrast with its tranquilizing and sociable effects in traditional use. Although some populations in Oceania have not accepted alcohol, others have been transformed by it, especially as young men who lack meaningful social roles drink heavily and act out in boisterous ways. Similar problems often occur among aboriginal Australians, who are stereotyped as chronic drunkards although their average per capita consumption is lower than that of white Australians. The traditional native drug, pituri, is little used nowadays, but the sniffing of gasoline and other volatile substances is highly visible among the poorest of the aboriginal population.

Different drugs have long been favored in various parts of Asia. In the southeast, betel is still habitually chewed, even though many consider it unsightly. Opium derived from poppies is often smoked, eaten or sold to outsiders as a major commodity in trade. Those who become dependent in opium-producing regions tend to be the aged, for whom it serves as self-medication; despite easy availability, growers and traders rarely use it.

In northern Asia, the fly agaric mushroom is so esteemed as a hallucinogen that men drink urine to get a second-hand or prolonged dose of the active agent. China’s many nationalities use alcohol in many different ways, often significantly embedded in social rituals, and the Russians’ love of vodka is increasingly cited as a major cause of short life expectancy.

Across most of Europe, alcohol is widely known and enjoyed, although in very different ways. Cultures in the southern band of countries in Europe are often called ‘wine cultures’; wine is common as an adjunct to meals, and average per capita alcohol consumption is exceptionally high. A middle band of so-called ‘beer cultures’ tend to favor beers and ales, whereas ‘spirits cultures’ line the north, with infrequent but heavy drinking of distillates. Recent decades have seen a remarkable trend toward homogeneity, with almost every country drinking less of its traditionally dominant beverage and more of others.

Throughout much of Africa, native beers are common- place, often as the primary beverage and nutritionally important in the diet. The base varies, with barley, millet, honey, dates, maize, and palm nuts the most common. Apart from their value as food and refreshments, such beers have traditionally played important roles in gifting, purifying, signaling friendship, hospitality, or other symbolizing. Factory-made beer is gaining popularity in recent years, although many of the traditional uses continue. Drug use for psychoactive effects is relatively rare in most of Africa. In the sub-Saharan region, tobacco is commonly used as a relaxant but it lacks the special religious, judicial, and other symbolism that alcohol has. In the north, tea and coffee tend to be important as adjuncts to food and as hospitality, but few other drugs have much importance.

Sociocultural Influences In Alcohol/ Drug Use

Anthropologists often define culture as the system of patterns of belief and behavior that shape the worldview of a given population, and society as the array of statuses and role relationships that describe the composition and organization of a population. By eliding the concepts, it is both convenient and revealing to attend to a variety of factors, social and cultural or sociocultural, that are important to human beings in their quotidian lives but that are rarely identified or measured in other terms or by other methods.

The conceptual linkage of ‘alcohol and drugs’ is also a fairly recent convention and one that has not yet gained general acceptance. In broad terms, it stands for a huge variety of substances that are psychoactive or mind altering when ingested. By changing the internal chemistry of the body, especially the transmission of messages across nerve cells in the brain, alcohol and drugs have various effects that are regulated in large part by their composition and dosage.

However, we have already seen that alcohol/drug use is far more complex than would be implied by the direct action of a chemical agent upon a host body; an enormous third class of variables is often referred to simply as the environment. For those reasons, alcohol/drug use is often characterized as a biopsychosocial phenomenon that cannot be understood unless all those several and diverse types of variables are taken into consideration.

In the simplest terms, there is no single meaning, use, or function that is assigned to alcohol or any drug in a universal manner. On the contrary, they are often evaluated in diametrically contrasting ways such that, for example, sometimes they are viewed as sacred and sometimes as sacrilegious, alternatively healthful and harmful, inspiring or repugnant, relaxing or stimulating, liberating or enslaving, and so forth. Because the scope of sociocultural influences on alcohol/drug use is so large, the following discussion is divided into sections that focus on patterns of use, associated attitudes, a variety of problems that are said to be linked with them, some benefits, and notes on prevention and treatment of problems.

Patterns Of Alcohol/Drug Use

One need not seek out isolated or exotic populations in order to find significant differences in terms of alcohol/drug use. Within the United States, there are some Protestant groups for whom avoidance of coffee, tea, and alcohol are issues of faith, whereas others use wine in a key sacramental ritual. Switzerland and The Netherlands have become venues for drug tourism because their emphasis on harm-avoidance as crucial in public health policy is associated with more liberal treatment of drug selling and drug taking. So-called ‘wet cultures’ in southern Europe have relatively high rates of per capita alcohol consumption based on frequent drinking of small quantities, whereas so-called ‘dry countries’ in northern Europe have relatively low rates of consumption based on infrequent drinking but in large quantities.

Chinese and Arab attitudes about alcohol are of special interest because both groups long praised drinking and drunkenness as not only permissible and enjoyable, but even as desirable and commendable. Songs, poetry, paintings, and inscriptions on a variety of fine objects attest to these positive values in ancient times. Religious and political changes in both cultural systems have resulted in more negative views of alcohol, including episodic prohibition under various emperors of China and lasting prohibition under Shariah, the Islamic legal code enforced in some countries.

In the various areas where prohibition for secular reasons has been attempted, it has rarely endured long in the face of widespread criminality, corruption, and disregard for the law. Informal social controls often carry more weight than laws, however, so we often find that young people are not allowed to drink; females, if they drink, are often discouraged from having as much as males, and those in critical or liminal statuses (such as menstruation, initiation, pregnancy, devotion, to name a few) may find themselves hedged about with specific restrictions.

Cannabis nicely illustrates both cultural differences and rapid changes in drug use and associated symbols. There are communities in India where high-caste Hindus indulge in cannabis tea while low-caste members of the same village drink a locally made liqueur. Each group speaks lavishly about the benefits of its drink, and each deplores the other’s. Closer to home, cannabis was long viewed in the United States as an unfortunate weakness of a few jazz musicians, blacks, or Hispanics, but not a threat to the white middle class. That abruptly changed when reefer madness was publicized as turning innocent young people into murderous or rapacious monsters after smoking a single cigarette. At the same time that laborers in Jamaica and Costa Rica were heavily smoking cannabis as an energizer, and finding that they could do more work, earn more, buy better houses, and educate their children, students there and elsewhere were finding relaxation and indifference in smaller doses of the same drug. Popular resentment against disproportionate punishment for cannabis use and in favor of the medical relief that it appears to provide for AIDS, glaucoma, chemotherapy, and other ills has resulted in a few states’ recently opposing the federal ban on that drug in the United States.

Demography is far removed from pharmacology in anyone’s view of the world, and yet it is a sociocultural influence that was crucial in shaping one form of drug use. Middle-aged men from several Levantine countries thoroughly enjoyed daily sessions in which they chewed qat leaves and quietly talked with male friends, but had to forgo such use when they went to work in Britain. When the expatriate colony there grew large enough to warrant it, an enterprising merchant was quick to fly in fresh qat so that stylized daily use could be resumed.

The imagery of opium as luxurious in oriental settings, nefarious when used to recruit Western women as sex slaves, inspiring for bohemian artists, analgesic in the hands of a physician, or addicting when offered by a pusher on the street all relate to the same substance and reflect changing ideological emphases and contexts.

Smoking tobacco was a concrete way of symbolizing the links between human beings and both natural and supernatural forces for many tribes of North American Indians. Cigarettes were thought feminine at the start of the twentieth century and masculine after World War I. Health warnings and the assertion of nonsmokers’ rights have resulted in rapid reduction of smoking in many areas that are economically and politically dominant, while there has been a similarly abrupt rise in smoking in developing regions.

Modern technology and the global economy have facilitated the spread of alcohol and drugs, to the point where some would say that there is now a multisocietal and transcultural pattern. To the extent that such a pattern is meaningful, it could probably be described as consisting of name-branded beers, relatively expensive wines, and Scotch whisky as drinks that signal wealth and associated power or prestige. Industrially produced drugs tend to have a similar cachet, although cocaine, heroin, cannabis, and their derivatives have a truly global market, despite stringent legal and other restrictions. Such drugs are often used excessively by addicts for whom drug use has become a preoccupation that overwhelms concerns for health, family, or other workaday relationships. Although such usage is too often misinterpreted as typical and causes a variety of lamentable problems, it is rare in epidemiological terms.

In fact, there are few societies in which drugs are used more often than weekly, and fewer in which usage is casual and dissociated from connotations of the sacred or powerful. Tobacco, coffee, tea, and chocolate are rare exceptions to that generalization, although each of them also has its own kind of symbolic importance in various social and cultural contexts.

Special Attitudes About Alcohol/Drug Use

Alcohol and drug use are behaviors that are often the focus of considerable affect and emotion, whether in favor or in opposition. Different populations show a broad range of affect and emotion, from frequent and ostentatious use and praise to prohibition and vehement condemnation of the substances, their use, and the outcomes of such use. Popular attitudes are often significantly different with respect to different substances, or they may differ for different categories of users or different contexts and purposes of use. It is commonplace that popular attitudes differ from official attitudes as expressed by authorities and as codified in laws and regulations, which tend to be more restrictive although not always diligently enforced.

Many observers have remarked on the frequency with which such attitudes reflect a profound ambivalence, combining recognition of the inherent risk that excessive use may result in problems affecting not only the user but also others with appreciation of various short-term benefits that accrue to those who use such substances in moderate or sensible ways.

The crucial role of sociocultural influences on such use and special attitudes about use is evident in the fact that both use and attitudes have often varied significantly with respect to the same substance from time to time, often reversing within just a few years. A dramatic illustration is the United States, where the 1960s saw widespread alcohol/drug use as part of a movement toward greater independence and freedom from responsibility for individuals. In subsequent decades, an extreme negative connotation has been given to drugs, so strong that the very word is often interpreted as implying harm, risk, and illegality. Corporations that used to offer proudly a wide range of preventive or curative ‘drugs’ now deal in ‘pharmaceuticals,’ and some who favor abstinence from alcohol are quick to insist that it be treated like ‘other drugs.’ Such negative emotional loading is commonplace, regardless of legality or popularity of use. A fad for zero-tolerance has resulted in schools’ disciplining students for sharing candies, individuals’ having their vital medications taken from them, and so forth.

Problems Associated With Alcohol/Drug Use

A large part of what is written about alcohol/drug use in recent years has a distinctly negative bias, presuming that all use is abuse, so that vague but alarming statements are made about rapidly accelerating consumption around the world. Linked with consumption are a host of problems, some physical, others psychological, and still others social, that often affect nonusers as well as users. Such problems are quite variable, ranging from liver cirrhosis to absence from school or work, from spouse abuse to dependence or addiction, and from illegal trafficking to personal embarrassment. Those who have a primary concern with public health or law enforcement tend to emphasize different problems within their areas of responsibility, and the data are generally poor. Nevertheless, a closer look at their own numbers shows that fewer than 1 in 10 of those who admit to habitually using either drugs or alcohol experience any such problems in association with such use (Walton, 2002).

In most societies, about 90% of those who use alcohol do so without suffering any of the so-called alcohol-related problems that tend to be the focus of concern in public safety and health. It is generally estimated that roughly the same proportions hold among drug users. It is also common that those 10% of users who suffer various problems are responsible for at least 80% of overall consumption. With few exceptions, therefore, it can be said that alcohol/drug use is most often unproblematic except in the case of exceptionally heavy or excessive use, which is often referred to as abuse. Nevertheless, the reality and importance of alcohol/drug use and of related problems is such a preoccupation that it warrants our paying attention to at least five broad areas: economic, political, legal, health, and social welfare.

Economic

At the beginning of the twenty-first century, alcohol and drugs must be recognized as together comprising one of the major businesses in many parts of the world in terms of foreign currency although rarely in terms of employment. Statistics are lacking because most of the commerce is surreptitious and untaxed. Where governments actively try to control drug traffic, the direct costs are enormous and indirect costs are also substantial, including an illicit network of distribution, intense competition at every level of the market, and high costs to consumers, some of whom must rely on criminal activity to support their use of drugs.

Where alcohol/drugs are legal, they tend to provide at least some income from taxation; users are spared the extra burden of criminality for their habits, and the general crime rate tends to be lower. Where they are positively approved, few economic costs are evident.

In many frontier areas, alcohol was often used as a crucial commodity in trade. It combined high value in small volume and was produced by a technology that native people did not readily master. As such, it served as a tool of colonialism and even today is still used as part of wages in some developing regions. Growers, refiners, and major traffickers rarely use such products enough to become dependent on them, but it is not unusual to find that those who do the most lowly work in such a network receive partial payment in drugs and often become dependent.

Legality is not the only consideration, however; spouses or companions often complain that too much is spent on alcohol/drugs, leaving too little in the budget for other needs. In extreme cases, this can result in spouse or child abuse or neglect, although wealthy users can often spend huge amounts without suffering financially.

Compulsive use of alcohol/drugs can interfere with an individual’s ability to take part in the labor market, as it does with other social relationships. In general, alcohol/ drug use tends to occur in inverse proportion to income, education, and status, and the testimony of the heaviest users suggests that it is at least as often a symptom as it is a cause of their poverty. A quest for excitement, good feelings, or respites from daily tedium or frustrations has prompted many of those who could least afford it to turn to alcohol/drugs.

Political

As with any behavior, the degree of social acceptance, indifference, or rejection of alcohol/drug use is important in determining who does it, where, when, how, and with what consequences. Correlatively, alcohol/drug use is often cited as an important characteristic of particular individuals or categories of people, explaining or justifying their treatment by others in the society.

The significant profit margin that is involved in alcohol/ drug traffic generates considerable wealth and correlatively, power and politics are involved even – or especially – in instances where the traffic is illegal. The problem of political influences associated with alcohol/drug use is aggravated where national boundaries are crossed and differing laws, policies, and groups of officials must be dealt with.

Where official policies fit well with popular beliefs and practices, alcohol/drug use tend to be unremarkable, often integrated with workaday activities and the pace of life. Where they are discrepant, alcohol/drug use can be a focus of social and cultural strains, defiance of the law, dissatisfaction, and prejudicial treatment of users.

One important political aspect of alcohol/drug use is the fiscal implications for the state. At various times, as much as 20% of Russia’s income was derived from distilled spirits; more than half the retail price of beverage alcohol is taxed in several jurisdictions. A state monopoly can give money and power to the state; private enterprise in such commerce can bring significant pressures to bear on officials and legislators.

Even the predominant sociocultural view of morality is intertwined with politics and policies. Where drinkers and drug users are thought to be weak-willed, dissolute, frivolous, or irresponsible, they are often imprisoned or otherwise punished and rarely helped by public institutions. Where they are thought to suffer from a disease, a more philanthropic pattern of harm reduction, treatment, rehabilitation, or social support is often offered.

A striking contrast can be seen between the United States and The Netherlands. In the United States, sentencing for possession of certain drugs has resulted in the imprisonment of millions of individuals, with minorities disproportionately represented, even though studies consistently show those minority populations to be less involved in alcohol/drug use. An explicit emphasis on harm reduction rather than punishment in The Netherlands is reflected in the availability of cannabis in public tea shops, police permissiveness where drug users congregate at certain parks, and publicly sponsored needle exchange, drugs, and treatment for those who want them.

Just as some types of alcohol/drugs tend to be associated with disreputable persons and groups, others are thought to symbolize or demonstrate modernity, sophistication, wealth, or prestige. Those who have paid close attention to alcohol/drug policies cross-culturally and internationally are in broad agreement that scientific knowledge usually plays a smaller role than emotional appeals when it comes to shaping government policies. A costly U.S. war on drugs during recent decades has been declared effective by those who point to burgeoning prison populations and called ineffective by those who point to cheaper and more abundant drugs. Most activities of the war on drugs have been devoted to attempts at diminishing supply rather than reducing demand.

Legal

The majority of alcohol and drug use throughout the world is quite legal and by no means disapproved from the point of view of neighbors or public authorities. This is not to say that it has been ignored by the law.

A major part of the earliest known legal code (Hammurabi’s) was devoted to beer and wine; the primary concern was not with restricting use but rather with protecting users from unscrupulous dealers. Because of its great popularity, alcohol has often been heavily taxed, with accompanying regulations to facilitate the monitoring of production and distribution.

Prohibition for secular purposes has been tried episodically in various areas, generally with mixed results. Sweden tried it for a time, switched to rationing, and settled on a system that combined state monopoly of production and distribution, which has subsequently been liberalized (at the behest of the European Union). Denmark banned beer for some years while allowing easy access to distilled spirits; the situation was reversed for another period of years, and now all alcohol beverages are readily available. Parts of Canada, Mexico, Finland, Honduras, and few other countries have briefly banned alcohol, but no such prohibition has lasted long. Smaller jurisdictions (states, provinces, counties, towns, reserves of Indians or native peoples, etc.) frequently ban sales but also frequently find it difficult to keep people from bringing in alcohol from outside, or producing it clandestinely.

Cycles of strong temperance ideology with associated restrictions have occurred with some regularity throughout the history of the United States, often in association with a bundle of attitudes favoring exercise, fresh air, wholesome foods, and clean living in general.

Many of the substances that are now not only legal but viewed as innocuous were viewed with suspicion earlier. For example, coffee and chocolate were often described in terms very similar to those that opponents now use for cannabis, and both sale and consumption of these items were outlawed in many jurisdictions.

A noteworthy example of rapid sociocultural change is the recent combination of popular concern and legal sanctions against driving while under the influence of alcohol. Within living memory, many countries have enacted laws that specify a certain blood-alcohol concentration as prima facie evidence of drunkenness and what used to be routinely treated as a joke has become a major offense.

The law is not color-blind, and some see racism in the fact that U.S. sanctions against possessing or selling crack (preferred by blacks) are ten times as severe as those for powdered cocaine (mostly used by whites). Many families and communities are deeply affected by alcohol/drug use, enforcement of laws against it, and by economic and other anomalies that are associated with alcohol and drugs.

Health

As with many of the other classes of problems, the most widely discussed negative outcomes for health are generally associated with frequent, heavy, and long-term use rather than with light or moderate use. Alcohol is a good example, about which many physicians approve two or three drinks a day, but warn against more than five or six within a few hours.

For many years, education about alcohol focused on major damage caused to various organ systems that was found only late in the careers of the heaviest drinkers, such as peripheral neuropathy, liver cirrhosis, or pancreatitis. Little recognition was given to the fact that fully 90% of those who drink never encountered any health problem as a result.

Ample publicity given to the link between tobacco use and cancer in recent decades has prompted nonsmokers to clamor for increasing smoke-free venues, to the point where a few entire cities have banned smoking in public places. Despite widespread health warnings, often mandated on each package, consumption is increasing among some populations so rapidly that it makes up for decreases among others.

Intravenous drugs are blamed, as is unprotected sex, for much of the rapid spread of hepatitis and HIV/AIDS in many parts of the world. The sharing of needles and other paraphernalia, together with frequent exchanges of sex for drugs, justify such concerns, especially among addicts who often spend considerable time together in crowded and unsanitary conditions.

The monstrous generation of crack babies that were predicted in the 1990s did not materialize, nor did that of fetal alcohol syndrome a decade earlier; evidently only long-term chronic use by the mother is harmful to the fetus. However, both the expense and the distractions of addiction often interfere with the complex sociocultural expectations of mothering in a broad sense, so that poor nutrition, lack of cleanliness, and associated health problems are common among addicts and their families.

For wealthy cosmopolitan individuals, misuse of prescription drugs, anxiolitics, and analgesics is a dangerous trend that is rapidly increasing. A rash of other synthesized drugs can be injurious if used in inappropriate combinations or by naive users. Examples are the so-called date-rape drug that has become a common adjunct to seduction and the drug Ecstasy (MMDA), which causes harmful hyperthermia and dehydration among young people at rave parties. The popular interest in sports is reflected in a preoccupation with steroids and other performance-enhancing drugs, even though their use is limited to a small segment of the population. The well-publicized epidemic of methamfetamine use is unusual for being more rural than urban and for having flourished especially in the midwestern United States, where other drugs have generally been less popular. Cheap and easy to produce, it is a stimulant and produces tolerance, which may be mistaken for instant addiction. Alarmist fears about meth-babies are reminiscent of similar fears about crackbabies a generation earlier.

Social Welfare

Sociocultural attitudes and values play a major role in shaping the nature and extent of problems that people associate with alcohol/drug use and with the public good. Negative labeling that brands a user as degenerate, irresponsible, or criminal carries stigma that sometimes discredits that person as undeserving of help from others. By contrast, identification of the compulsive user as suffering from an illness tends to be associated with a more supportive strategy of harm reduction.

In many urban or cosmopolitan areas, excessive alcohol/drug users constitute an underclass, marginal in economic, political, and other terms. Such marginality is sometimes a cause and sometimes an effect of alcohol/drug use, especially among minority populations who may simultaneously be suffering from cultural deprivation, ethnic prejudice, or related pressures in a society dominated by others with alien ways of thinking and acting.

Well-intentioned but misguided policies sometimes predominate in attempts to foster social welfare. One example is the presumption that using alcohol predisposes a person to use various drugs (the gateway or steppingstone hypothesis), commonly cited as a threat to prevent young people from drinking, but with little evidence to support it.

Benefits Associated With Alcohol/Drug Use

There are many different kinds of benefits that people enjoy from alcohol/drug use, just as there are many different kinds of harm. Not all individuals experience the same benefits, just as not all suffer similar harms. Medicinal or therapeutic use to control or relieve symptoms is an important part of overall use; evidence is also rapidly accumulating about a number of long-term health benefits of moderate drinking, and the social and psychological benefits are so well known as to receive little scientific attention.

Many such benefits and harms have clear bases in physicochemical effects, but often they are also strongly influenced by sociocultural factors. For example, hallucinogens produce visual and other sensory stimuli that are exciting and inspiring for some who are artistically inclined. Drug-induced hallucinations often provide clues to the diagnosis of illness or to foretelling the future, but only among those who are culturally attuned to having such revelatory experiences and know how to interpret the cues.

Similarly, depressants and soporifics provide relaxation, which can be a boon for those for whom it is otherwise difficult to achieve. By contrast, stimulants can be useful to foster action and social interaction.

The symbolism of alcohol in terms of sociability and hospitality makes it sometimes an important part of business or a convenient way of signaling acceptance or approbation. Its widespread use as an adjunct to celebration lends special weight to certain events, and is linked to public demonstrations of approval. In general, those settings in which alcohol/drug use is a communal activity or a ceremonial one that has positive meaning for members of the group tend to be highly approved and rewarded in various sociocultural ways.

Prevention And Treatment Of Alcohol/Drug Problems

Our historical and cross-cultural perspective has already shown that the very idea that certain problems are associated with alcohol/drug use is shaped by sociocultural influences and not merely by the effects that substances have on people. Different and changing views about what constitutes a problem, how alcohol/drug use relates to problems, and how such linkage can be broken are all important with respect to prevention and treatment.

Social and cultural variables have significance even at the level of identification and diagnosis of illnesses and disabilities.

In recent decades, WHO (the World Health Organization) has become increasingly aware of differences in the etiology, symptoms, meanings, and attitudes toward psychological states and syndromes. Successive efforts at specifying observable and objective diagnostic criteria and terminology, especially with reference to alcohol/drug use and abuse, have repeatedly and progressively been demonstrated to be widely misunderstood and misapplied, even by professional practitioners who had received advanced training at European or North American institutions and who appear to be skilled in the English language. This should not have surprised the WHO inasmuch as it is a quintessential demonstration of the important impact that sociocultural influences have on alcohol/drug use, not only as it is practiced by peoples throughout the world but even as it is conceived by scientists.

Despite such large and important differences, there is increasing recognition of the abundant evidence that patterns of use tend to be more important than simple quantity and frequency of consumption, which have been the most common measures of use. This accounts for the fact that groups with the highest per capita annual consumption of alcohol (based on frequent moderate ingestion) have fewer problems than groups with much lower consumption (based on episodic excessive drinking).

Risky or harmful levels of use are increasingly targeted for change by those concerned with public health. This involves gradual modification of policies that have emphasized reducing overall consumption (interdiction, taxation, labeling, restrictions of sales, and advertising, etc.) and development of approaches that focus on heavy users. Twelve-step or mutual help groups have enjoyed remarkable success in aiding those who independently choose to stop or lessen alcohol/drug use. A wide range of treatments, ranging from behavior modification to cue recognition and simple counseling have all been found helpful for certain abusers, and growing recognition that occasional relapse is normal rather than a signal of failure has helped even more clients to achieve sobriety. Occasional examples of culturally specific prevention and treatment have been successful. Sweat bath and Sun Dance for Native Americans or vows for Hispanic Catholics are examples, and receptiveness to the interests and attitudes of clients is important, although superficial gestures of supposed cultural appropriateness are not so important as was once believed.

It is crucial to keep in mind that few societies have ever been wholly free of alcohol/drug use and that the reduction of harm is a more realistic goal than universal abstinence.

Bibliography:

Blum RH and Associates (1974) Society and Drugs: Social and Cultural Observations. San Francisco, CA: Jossey Bass.
Siegel RK (1989) Intoxication: Life in Pursuit of Artificial Paradise. New York: Simon and Schuster.
Walton S (2002) Out of It. A Cultural History of Intoxication. New York: Harmony Books.
Coomber R and South N (eds.) (2004) Drug Use and Cultural Context ‘‘Beyond the West’’: Tradition, Change and Post-Colonialism. London: Free Association Books.
Davenport-Hines R (2002) Pursuit of Oblivion: A Global History of Narcotics. New York: Norton.
Grant M and Litvak J (eds.) (1998) Drinking Patterns and their Consequences. Washington, DC: Taylor and Francis.
Heath DB (2000) Drinking Occasions: Comparative Perspectives on Alcohol and Culture. Philadelphia, PA: Brunner/Mazell.
Heath DB (ed.) (1995) International Handbook on Alcohol and Culture. Westport, CT: Greenwood Press.
Jaffe JH (ed.) (1995) Encyclopedia of Drugs and Alcohol, 4 vols. New York: Macmillan Library Reference USA.
Knipe E (1995) Culture, Society and Drugs: The Social Science Approach to Drug Use. Prospect Heights, IL: Waveland Press.
MacCoun RJ and Reuter P (2001) Drug War Heresies: Learning from Other Vices, Times and Places. New York: Cambridge University Press.
McCarthy RG (ed.) (1959) Drinking and Intoxication: Selected Readings in Social Attitudes and Controls. Glencoe, IL: Free Press.
Musto DF (1987) The American Disease: Origins of Narcotic Control, rev. ed. New York: Oxford University Press.
Peele S and Grant M (eds.) (1999) Alcohol and Pleasure: A Health Perspective. Philadelphia, PA: Brunner/Mazell.
Pittman DJ and White HR (eds.) (1991) Society, Culture and Drinking Patterns Reexamined. New Brunswick, NJ: Rutgers Center of Alcohol Studies.
Rudgley R (1993) Essential Substances: A Cultural History of Intoxicants in Society. New York: Kodansha America.
Tracy SW and Acker CJ (eds.) (2004) Altering American Consciousness: The History of Alcohol and Drug Use in the United States, 1800–2000. Amherst, MA: University of Massachusetts Press.