The Drug User: Personality Issues, Factors, and Theories An Annotated Bibliography

212 Pages·1983·7.23 MB·English

by  Stanley Einstein (auth.)

THE
PersonalITY Issues,
Factors, and Theories
An Annotated Bibliography
THE
Personality Issues,
Factors, and Theories
An Annotated Bibliography
Stanley Einstein
Institute for th~ Study of Drug Misuse
New York, New York
PLENUM PRESS· NEW YORK AND WNDON
Ubrary of Congress Cataloging in Publication Data
Einstein, Stanley.
The Drug user.
Bibliography: p.
1. Drug abuse-Etiology. 2. Drug abuse-Bibliography. I. TiUe. [DNLM: 1. Substance
dependence-Psychology. 2. Substance abuse-Psychology. WM 270 D7952]
RC564.E381983 616.86'3071 82-18905
ISBN-13:978-146844147-5 e-ISBN-13:978-1-46844145-1
DOl: 10.1007/978-14684-4145-1
© 1983 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1983
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
CONTENTS
INTRODUCTION 1
Classification Systems 17
Drug User Personality Theories and Interventions 19
Factors Initiating Treatment 23
The Screening Process 24
Treatment Goals 26
BIBLIOGRAPHY 43
Articles in Books, Books, Dissertations 156
Presentations 202
v
INTRODUCTION
The personality of the individuals who use a variety of sub
stances, singly or in combination, which are legal or illegal in
status, for non-medical reasons, has been of interest and concern
to a variety of intervention agents and groups for many decades.
Indeed, a review of the literature leads to the conclusion that this
interest has in no way waned. More and more articles and books are
written, and more and more research is planned and carried out,
which are designed to describe the personality of the knOWll-yisible
drug user(s). If anything this interest has broadened to include the
spouse of the drug user, his or her parents, and at times the child
of the drug user.
In simplistic terms the thesis is posited or hinted at, that a
specific type of individual will use "drugs" in a socio-cultural un
acceptable manner. And the critical factor which is pinpointed to
explain this type of drug use is the personality/character-traits of
the individual, alone or in combination with other factors. These
latter factors can include, among others, the primary and secondary
effects of drugs, the meaning attributed to the manner of using
drugs (oral, intravenous, intramuscular, sniffing, smoking, etc.,)
as well as to the drug experience, the external environment, gen
etics, drug availability, individual and group coping skills; as
well as socio-political-economic factors.
In a sense the data which has been collected, and the theories
which grow out of them, ask us to consider and believe that they
offer us the key to understanding the etiology of drug use, and by
implication the etiology of abstinence. And once this key is in our
hands effective intetvention, whatever its scope and depth, is
simply a matter of appropriate decision making, suitable choice of
policies and their implementation, time, technology, reasonable
intervention planning and the appropriate budgeting of manpower and
money.
2 INTRODUCTION
The apparent certainty that personality - however this concept
is defined and whatever its structure - is a critical factor in ex
plaining drug use, has often served to minimize our interest and
needed concern in a number of significant issues. These issues in
clude, among others:
1. There is a significant difference between etiology of and
reasons for drug use. Notwithstanding the obvious fact that
the former is derived from the latter, the former is our best
interpretation(s) - hopefully - of the most reliable and consis
tent meaning of the latter given to us by the drug user or those
who claim to know him. The drug user tells us in the best way
which s/he knows why his or her drug use is currently active, re
sorts to his or her memory to explain the conditions and circum
stances associated with initial drug use, and cognitively - emo
tionally anticipates their future drug use behavior - career. In
brief these are the conscious reasons explaining drug use, on the
part of the drug user. A critical issue, often overlooked, is the
assumption that the drug user "knows" the reasons for his drug use
behavior. Whereas there is lit~oubt that he knows and feels
that he has to tell the interviewer something, it is indeed ques
tionable that he knows the relevant complex interacting factors
which theoretically are the basis of his drug use. There is a
gap, broad and narrow, between knowing, sensing, being aware of
and being able to explain! This may be all the more evident when
one considers issues such as communication skills, circumstances
surrounding the interview, interview techniques used, background
of the interviewer, theoretical orientation of the interviewer,
type and quality of the relationship between the drug user or
other sources of information, and the interviewer, amount of time
for the interview, the data collection system, etc. For those who
believe that we inevitably know why we do whatever we do, these
aforementioned issues and factors will be meaningless. And right
fully so. But, for those who question whether any individual, or
man as a species, can ever fully know, these issues should begin
to raise questions about the relationship between communicated
reasons for and the etiology of drug use. Ironically, what is
often overlooked is the assumption made by many intervention
agents that the drug user, as part of or because of his ailment -
behavior - condition cannot be believed. And yet it is the mat
erial given to us by the drug user which is the basis of etiolog
ical theories.
2. The relationship between the etiologicai factors associated
with and/or attributed to the drug use by the "special/unique"
drug user, and the theorist/researcher are not a chance phenomena.
More often than not the focus of the clinical description or the
empirical study is designed to prove or disprove a specific thesis
held by the writer rather therl to understand a simple or complex
INTRODUCTION 3
phenomena. This "research" process generally occurs within a spe
cific reality which has a significant affect on research design
and implementation. Public funds, the primary source for study
ind drug use, is not simply available to study what one would like
to study at any given period of time. In a sense, the drug users
so called need for instant chemical gratification is matched by
our need for immediate closure and/or publicat.ion.
3. There is an implicit assumption made by many writers that
drug use is a unitary event. The reality is that this perception
of drug use is one of the many myths surrounding this stigmatized
field. Any type of understanding of drug use must be based upon
a phase or continuum approach to drug use. This should include
as a minimum:
3.1 Initiation - factors effecting the initial use of a specific
drug or combination of drugs.
3.2 Maintenance - factors affecting the continued use of a spe
cific drug or combination.
3.3 Drug Use Pattern Changes - factors effecting changes in drug
use patterns. These include among others, after initial use and
maintenance have occurred, the selection and use of "new" sub
stances, changes in manner of drug use, changes in escalation;
types of drug use patterns (i.e. escalation (drug abuse), con
trolled use, etc.).
3.4 Cessation - factors affecting short term or total abstinence
from drug use, from specific drugs, from specific ways of using
drugs (i.e. orally, intravenous, etc.), as well as changes re
sulting in the cessation of the use of illegal substances and the
use and/or increased use of socially acceptable substances (i.e.
alcohol, coffee, tobacco, etc.).
3.5 Reinitiation - factors affecting the use of specific drugs,
patterns of use, manner of use, when such behavior has been
absent from the individuals functioning for shorter or longer
periods of time. This issue includes behavior as disparate as
the reinitiation of drug use after many years of abstinence, as
well as the smoking behavior of an orthodox Jew, who may be a
"chain smoker" and begins smoking every Saturday night after ab
staining for 24 hours, the Sabbath, for every week of his smok
ing career.
3.6 Drug Use/Abstinence Meaning - the meaning attributed to drug
use/abstinence, during each phase, as well as the entire process,
by the drug user, the drug user(s) "culture", the intervention
4 INTRODUCTION
system and its agents as well as society at large.
The reader can argue with the types of categories or phases
which should be included in the drug use continuum, the relative
importance of each one, and the meaning of each phase. Indeed
the reader is invited to develop other continuum schema. But
what is of critical importance is the acknowledgment that the
use of and reliance upon a personality orientation to understand
ing drug use and drug abstinence must be related to the variety
of possible stages and phases which make up this complex behavior
and life style. To do otherwise is in essence to believe that the
concepts of both personality as well as drug use are static phe
nomena. And there is little hard evidence to SUbstantiate such
a view.
4. There is an apparent lag between the development of a spe
cific personality theory of drug use and the changes in the pro
cess of and possible meanings of drug use, over time, for spe
cific populations, the availability of "old" as well as new types
of drugs, and situational factors which mayor do effect such
behavior.
A selected number of examples should suffice to help the reader
analyze various articles included in the bibliography in a more
critical manner.
4.1 Theories developed prior to the advent of poly-drug use im
plicity or explicity assumed that drug use per se, and/or the
selection of a specific drug was in part related to the predic
table sought after effects of the drug. But the combination of
central nervous system depressing, stimulating, and "confusing"
drugs cannot lead to predictable effects. This is all the more
so when the substances which are ingested are of a street vari
ety; their pharmaceutical purity being in doubt. When one adds
to this such empirically demonstrated concepts as set and setting
theorists and theories are severely challanged to adequately ex
plain and not describe drug use.
4.2 During the last two decades, there has been a marked increase
in the use and misuse of substances such as barbiturates, tran
quilizers and a variety of psychedelics. These substances and
their known as well as assumed effects were unknown to theorists
in the past.
4.3 The outcome (upon behavior and functioning) of the deviant
label attributed to the known visable drug user has over time
been in a constant state of change. In a sense doors have been
open, partly open, closed and locked to individuals and/or groups
of drug users in an unpredictable way. The junky, the addict,
the drug user, the drug abuser, the recreationar-user, the speed
INTRODUCTION 5
freak, the acid head have been responded to in differential ways
~by intervention agents as well as society at large, It is
legitimate to assume that in part, the behavior and functioning
of the drug user, is effected by the consequences of the labels
given to him as well as the drug users identification with these
labels. This is so if for no other reason than the reality that
each label offers available as well as unavailable options for
life styles - in our eyes as well as in the eyes of the catego
rized drug user. To complicate this issue even more is the
available evidence that general cultural standards, which define
deviance and the labeling process, don't necessarily parallel sub
cultural standards. Thus, that which may be unacceptable to us,
and negatively valued by us, may and all too often is quite ac
ceptable, "normative", valued and sought after by them. In a
sense, personality theories by definition, are anchored to our
cultural conceptualization(s) and categories and not to their
life spaces and culture. This issue may be difficult if not
impossible to bridge. By and large the negative personality
characteristics attributed to drug use/the drug user presume in
herent difficulties for the drug user being able to function and
adapt in our "normal and healthy" world within the life style
options available for us. Rarely if ever are positive personality
characteristics attributed to the drug user or to his style of
life and his social-cultural frame of reference. Such a theo
retical myopia does not permit us to acknowledge that by and
large we don't want the stigmatIZed drug user to live in and
function in our life space. And secondly, that those charac
teristics which we attribute to his personality, were we to be
able to remove their "inherent" negative valences, may be crucial
for the drug users survival in his life space.
4.4 The impact of the stylishness of drug use is often overlooked
in drug use personality theories, or quite simply cannot be ad
equately integrated by specific theories.
Iatrogenic Addiction may be interpreted in various ways by dif
ferent personality t~orists. But what are the theoretical options
for explaining the use of single or multiple drugs in such tempo
rarily fixed mass-rituals as the rock festivals of the 1970's, or
in combination with political activities, revolutionary fervor,
or "dropping out" during this same period? By the time the behav
ior was observed, the data collected and interpreted, the specific
behavior and its context had all but disappeared.
5. Another key factor which surely effects the validity, the
reliability, and ultimatelyithe effective utilization of drug use
personality theories are the sources of the theories' data. And
over time these sources have differed in terms of types of drug
users, numbers of drug users investigated, the sites in which the
research took place, the techniques used, as well as the native
6 INTRODUCTION
and trained-in abilities of the investigator to adequately gather
the "raw data" and then to meaningfully interpret them.
5.1 A variety of typologies have been developed to date by which
we can categorize various types of drug users. Some of the ty
pologies used are more emotionally laden; some less so. I am
not about to argue with the criteria used in the development of
any of the publicized typologies. I do feel justified in rais
ing some issues for the critical consideration of the readers.
At the time that the drug user was being interviewed, tested or
observed, what role(s) was he engaged in - by choice or by lack
of choice. Some of the obvious roles include patient, prisoner,
research subject, student, neighbor, etc. I suggest that one
can legitimately assume that there is some relationship and effect
between the developed typology and the drug users' role at the
time that the raw data was collected. In addition, one should
consider the possibility that most of the roles engaged in by the
drug users who were "researched" by personality theorists were
limited by definition. Captive audiences, the source of much of
our current raw data, can in no way cover the broad spectrum of
drug users. Indeed, the concept of the hidden or invisible drug
user/addict attests to this. The reader is asked to consider
what is entailed in becoming a known-visible and interviewed drug
user, versus those factors, including--potential personality factors
which permit the drug user to remain hidden and unknown.
5.2 It would appear that with the advent of small group statistics,
the number of drug users upon which theories are built is almost
irrelevant. We are fully aware that numbers by themselves do not
make up for the quality of an investigation, its meaning or its
utilization. What is being suggested however is that numerous
theories, based upon rarified numbers of drug users, make gener
alizations which are meant to be relevant to masses of other drug
users, both on a local level as well as in other countries and
cultures. The concept of the needle freak is one such example.
The theory derived from the use of drugs by urban delinquents
adolescents, during a particular period of community and street
life in New York City during the 1950's is another example. The
descriptions, based upon limited types of data and numbers of drug
users in urban centers in the nSA during the 19th century is yet
another example. Indeed at times it even seems that the data may
even be an afterthought for the theory. Theoretically the situa
tion existed, and potentially exists today, for tens of thousands
of drug users of a specific type - the Viet Nam soldier - to be
investigated in depth in order to better comprehend the person
ality issues associated with the various phases of ~rug use as
well as abstinence. No doubt there are many reasons as to why
this has not been done on an ongoing basis. Whatever these rea
sons are and whatever their merit, the reader is asked to consider
that a multitude of smaller studies, using public funds, continue