A Sociological Perspective on Drugs and Drug Use
Erich Goode, Professor of Sociology at SUNY Stony Brook
From: Drugs in American Society, First Edition, Chapter 1
©1972 Alfred A. Knopf, Inc. ISBN 0-394-31323-2
SOCIAL CONTEXT AND HUMAN MEANING
What can a sociologist tell us about drug use that we do not already
know? If there is anything particularly distinctive about the
sociologist's view, it is his emphasis on social context. It
might appear that this concept seeped into the public consciousness
long ago, that it is a banality. But if this were so, the stupendous
blunders committed every day by drug researchers and commentators
would not occur. If the concept were really understood, a large
part of the drug problem would also be understood.
The social context of drug use powerfully influencesindeed,
it might almost be said determinesat least four central aspects
of the drug reality, aspects that traditionally have been presumed
to grow directly out of the chemical and pharmacological properties
of drugs themselves, independent of human intervention. These
four aspects are drug definitions, drug effects, drug-related
behavior, and the drug experience. The sociological
perspective stands in direct opposition to what might be called
the chemicalistic fallacythe view that drug A causes
behavior X, that what we see as behavior and effects associated
with a given drug are solely (or even mainly) a function of the
biochemical properties of that drug, of the drug plus the human
animal, or even of the drug plus a human organism with a certain
character structure. Drug effects and drug-related behavior are
enormously complicated, highly variable, and contingent on many
things. And the most important of these things are social and
contextual in nature. In the animal world, it is quite a bit easier
to predict what drugs will do. But experiments with rats do not
tell us very much about human behavior. This is why social context
is so important.
One of the central dimensions of all human experience is meaning.
No object or event has meaning in the abstract, in a natural
state. Rather meaning is imposed, socially fabricatedin short,
symbolic. Meaning has two features: it is both internal and external.
Meaning is assigned externally to objects or behavior in the process
of human collaboration or interaction. But it also resides within
the individual: it is arrived at as a result of a private act
of choosing on the individual's part. In order for an observer
to grasp that internal meaning, he must view the world from the
subject's perspective, which inevitably involves empathy.
The same behavior, the same phenomenon, the same material reality,
can mean completely different things to different people or to
the same person in different contexts. Meaning is an ascription.
It is superimposed on a phenomenon, a reality. It does not arise
naturally. Anything may have multiple meanings, depending on one's
point of view. Human action is suffused with meaningjust about
everything we do is evaluated, thought about, mulled over, judged,
Take anythingan object, an act, a thought. Put into two different
settings, it will mean radically different things to usperhaps,
contradictory thingssimply because of our variability in interpretations.
It is not the thing, the act, the thought, we are reacting to.
The same thing quite simply "means" different things;
the thing does not generate the meaningwe put it there. Consider
two scenes: one the boudoir, man and wife alone, engaging in foreplay;
the other the examining room of a gynecologist's office, the physician,
a man, examining a patient for breast cancer. In both cases, a
woman's breasts are being felt. But in one, the behavior is linked
with a "script" we refer to as "lovemaking."
In the second, it is linked with a different script: a medical
examination (Gagnon and Simon 1972). Though the specific acts
involved are almost identical in a sheerly physical sense, they
"mean" radically different things, and the participants
act and react, think and feel, differently as a consequence. Thus
they are in fact totally different acts, not because they differ
externally but because different interpretations have been brought
A large proportion of all assertions about social reality are
ideologically imperialistic in naturethat is, an external meaning
is imposed on a reality that should be investigated from an internal
perspective. For example, many people equate long hair on men
with feminization, without first asking what long hair actually
means to the person growing it. Rather their point of view is
that of an external observer who thinks that long hair should
mean something definite and unvarying. A few generations ago anthropologists,
armed with psychoanalytic insights, invaded non-Western civilizations
and imposed their interpretations on what they saw. Snakes were
interpreted as phallic symbols, regardless of what snakes actually
meant to the particular cultures involved. Nakedness was given
a sexual meaning, in spite of fact that in some societies nakedness
has the overwhelming meaning of poverty, and not at all of sexuality.
Today many of these ideological biases have been eliminated
from most analyses of other civilizations, but they are depressingly
routine when it comes to our own.
And drugs. How do social definitions, interpretations, and meaning
impinge on drugs, drug effects, and drug-related behavior? Are
the same drug realities defined and interpreted in vastly different
ways? How do contextual features change the relevant characteristics
of drug use? An example. Peyote taken by American Indians in a
ceremony participated in by adherents of the Native American Church
is legal and legitimateeven holy. Yet the same substance, taken
by college studentseven for the same purposesis suddenly,
magically, labeled a dangerous drug, debilitating and damaging
to the user and a threat to societyand quite illegal. Another
example: heroin and morphine. These two drugs are not very
different pharmacologically and biochemically, except that
pure heroin is several times as potent as morphine. (In fact,
the morphine administered for therapeutic purposes in hospitals
is stronger than the heroin sold on the street, since black market
heroin is considerably diluted.) An experienced drug addict would
probably not be able to discern the difference between comparable
doses of heroin and morphine, and a pharmacologist would have
to look very, very closely to distinguish the laboratory effects
of the two drugs. In short, by "objective" standards
they are very nearly the same drug; they do more or less the same
things to the tissues of the body. Nonetheless, heroin is declared
to have no medical uses whatsoever. It is considered a menace,
a killer. Morphine, on the other hand, is regarded as a boon to
mankind. It has the stamp of approval from the medical fraternity;
it is a valuable therapeutic tool. And yet the roles and medical
functions of the two drugs, and hence their social meanings, could
easily be reversed. It is not the characteristics of drugs themselves,
their pharmacological actions, that generate such contrasting
interpretations; rather it is the meanings that have been more
or less arbitrarily assigned to them.
The sociologist's view of drugs and drug use goes a good deal
further than merely recognizing that there are variable interpretations
of similar drug realities and drug-related situations. It also
emphasizes that the drug experience and drug effects will vary
when different meanings are brought into the drug-taking situation.
The one-dimensional, chemicalistic view of drug taking is that
humans are basically passive receptors for drug actions, and that
when a certain drug is administered a certain effect, or standard
set of effects, takes place. This view has been discredited as
a general model, but the comments of many drug experts indicate
that it is still operative. It is not uncommon to encounter analyses
that utilize such concepts as the "complete marihuana intoxication
syndrome" (Wikler 1970, p. 324), as if the effects of marijuana
were a clinical entity with distinct configurations analogous
to an H2O molecule or a cumulus cloud; or the notion that drug
users are part of "an abnormal subculture" (Willis 1969,
p. 34), as if this could be determined by means of objective,
Naturally, some drug effects will be fairly distinct and will
not vary a great deal, and there will be widespread agreement
on their occurrence. In almost every case the whites of a person's
eyes will become bloodshot after he has smoked a sizable quantity
of marijuana. A person with a.2 percent blood-alcohol concentration
in his bloodstream will not be able to operate a complex piece
of machinery as well as he could when sober. Nearly everyone will
go through some sort of withdrawal distress after long-term administration
of a gram a day of barbiturates. But drug effects with such narrow
variability are themselves limited in number; drug effects that
are highly sensitive to external conditions and about which interpretations
vary enormously are far more common, as well as far more important
and interesting to most observers.
It is crucial to distinguish between drug effects and the drug
experience. What happens in one's mind subsequent to taking
a given drug is the outcome of many different factors, not solely
a function of specific biochemical reactions. A number of changes
take place in the body when a chemical is ingested, and not all
these changes are automatically noticed and classified. The subject
must be attuned to certain drug effects to be able to interpret
and categorize them and thus place them within his experiential
and conceptual realms. Otherwise, the effect of a drug may simply
be sensed as a vague, unsettling, dizzyish sort of experience.
A drug effect has to be interpreted and categorized in order to
"happen" internally, in order to be part of one's experiencing
of it. Out of many potential "effects" of drugs individuals
and drug subcultures (as well as the general society) select several
to pay special attention to. Very few hospital patients who are
administered morphine experience it as euphoric or pleasurable,
yet the illegal street user of morphine experiences euphoria and
pleasure from it. Psychedelic drugs taken for religious purposes,
after spiritual preparation and training, are typically felt as
having a religious impact, yet people who take hallucinogenic
drugs simply to get high do not usually report anything like a
religious or mystical experience. Drugs only potentiate certain
kinds of experiencesthey do not produce them. It is the situation,
the social definition surrounding usenot simply the drug's
"objective" biochemical effectsthat determines the
Societies define not only the meaning of drugs but also the meaning
of the drug experience; these definitions differ radically among
different societies and among subgroups and subsultures within
the same society. Social groups and cultures define what kind
of drug taking is appropriate. They define which drugs are acceptable
and which are not. They define who takes drugs and why. They decide
what amounts of each drug are socially acceptable. They spell
out which social situations are approved for drug use and which
are not. They define what drugs do, what their actions and effects
on people will be. Right or wrong, each of these social definitions
and descriptions will have some degree of impact on actual people
in actual drug-taking situations. Each will exert a powerful
influence on what drugs actually do. The fact that heroin is attributed
with a fantastic power to enslave actually helps to give heroin
the power to enslave; the "effect" does not rest completely
within the biochemical properties of the drug (Young 1971, p.
43). The effective role of placebos in medical therapy has been
underscored in numerous discussions and research. (As one psychopharmacologist
wryly remarked: "The lethal dosage of placebo is unknown"
[Claridge 1970, p. 26].) The fact that marijuana tends to have
a negative and inhibitory effect on the sexual activity of caged
rats and a positive and disinhibitory impact on sex in humans
indicates the overwhelming role played by social expectations
IDEOLOGY AND CULTURE
Because the sociologist studies cultures and societies, ideology
and morality, as artificially fabricated productsnot
as "natural" and inevitable givens in the universehe
is a little more detached from his society's values than are most
other members of the society. The sociologist is therefore a little
quicker to point out the hidden moral and ideological assumptions
behind supposedly "objective" descriptions. What seems
to most people to be "reasonable" and "natural"
nearly always turns out to be that which is socially approved.
If something is condemned as "irresponsible" or
"unnatural," this can usually be translated as "potentially
disruptive of existing social arrangements and privileges."
The way that dominant members of society look at things is supposedly
the way things "actually" are. In reality, the dominant
view on a given subject (as with nearly every view) is typically
shot through with value judgments, with ideological and moralistic
assumptions that bear no necessary relationship to the phenomenon
in question. Yet such views hide behind a mask of objectivity.
This is true even of the views of scientists engaged in research
on the effects of drugs. It is true of "experts" who
write books and articles on drugs. And it is especially true of
medical men who inform the public about the dangerous practice
of drug "abuse." Morality and ideology are labeled "science"
if two conditions hold: (1) the propounder of a given viewpoint
has scientific credentials in the public eye, and (2) the view
presented is in line with dominant opinion. Writings on drugs
contain innumerable biases, some hidden, many not so hidden. But
incredibly enough few readers ever question these biases; rather
they assume them to be true and self-evident, a reflection of
the "real" world. The dense involvement of all of us
in our culture is indicated by our almost blind and uncritical
acceptance of these views.
Dip into any book on drugs. Glance over the concepts, the definitions,
the assertions made. Consider such terms as "unreal sensations,"
"moral judgment of right and wrong,' "withdraw from
reality" (Houser 1969, pp. 15, 43, 12), "demoralizing
effect," "good judgment," "bad attitudes,"
"the needs of... law and society," "detrimental
to the individual and society" (Jones, Shainberg, and Byer
1969, pp. 36, 16, 85, 9), "poorly adjusted," "the
true meaning of anything," "wholesome family situation,"
"totally unresponsive to education about the hazards of drugs,"
"well-adjusted young people" (Byrd 1970, pp. 94, 154,
212). These terms were culled from recent drug texts published
by prominent publishing houses and widely read. They all contain
moral assumptions about what is right and wrong; and they all
reflect the ideological bias that the phenomena so described have
fixed meanings in the real world, independent of what anyone thinks
of them. But in fact every one of these terms is an expression
of prejudices on the authors' part; not one has any meaning in
a strictly scientific sense. Naturally, some readers will share
these prejudicesbut some will not. What is a "bad attitude"?
Something the author doesn't like? Something generally condemned
by conventional members of society? Can a "bad attitude"
be tested empirically?
And the terms "adjusted," "poorly adjusted,"
and "maladjusted." "Adjusted" to what? It
is possible to be "adjusted" to Nazism, or to the grosser
injustices of our own society. What about "irresponsible"?
"Irresponsible" in what sense? And to whom? In an article
published in a major medical journal a world-renowned laboratory
and clinical scientist and physician noted in appropriately solemn
tones that the effects of marijuana are "very, very bad,"
but that the effects of alcohol are "just bad" (Wikler
1970, p. 324). How fortunate we are to receive such valuable esoteric
Such terms and expressions assume the abstract correctness of
the social system in which we live. Deviations from the system
are declared to be scientific errors. These declarations represent
what might be called pseudosciencemoral and ideological
judgments being represented as science. The strange thing is that
this tendency is the rule rather than the exception in the drug
field. In the debate over drug use and drug effects, smuggled-in
value judgments are extremely common, and they shore up many an
otherwise persuasive argument. They are used continually as rhetorical
and propaganda devices, to win arguments. Assigning something
to the status of that which is natural, reasonable, inevitable,
rational, and scientifically true not only serves a propaganda
purpose but a repressive function as well. If something is rooted
in the natural order, is self-evidently true in a scientific sense,
how is it possible to question it? However, if we are to be successful
at understanding the nature of the drug reality, it is essential
to remain sensitive to this ideological sleight of hand.
THE POLITICS OF REALITY
The word "politics" has become attached to a variety
of phenomena that were previously thought to be unrelated to the
arena of politicsthe "politics of experience," "the
politics of consciousness expansion," "the politics
of therapy." Implied in any such term is the notion that
what becomes taken for granted in any society is, in fact, arbitrary
and problematic. We think that, for example, the psychiatrist-patient
relationship and interaction is a technical and medical matter
in toto, whereas recent thinking in this area has come
to the conclusion that ideological, moral, and political considerations
are densely woven into the therapeutic process. In a sense, psychiatry
becomes a means of upholding one particular ideological view,
and repressing others, rather than simply helping to make a patient
healthy. Likewise, with scientific definitions of reality we can
look at science as an institution which has as its task the verification
of a special world-view. The rules of science can be looked at
as forensic strategies; facts become wielded as ideological weapons.
This view holds that science is deeply involved with ideology,
and that the classical view of scientific "objectivity"
is completely mythical.
The concept of "the politics of reality" is especially
important in areas of controversy. An extremely naive and outmoded
"rationalist" position on facts is that man is essentially
reasonable, and that the truth will win out simply because it
is the truth. This point of view assumes that reality has a kind
of brute hardness to it. The sociological position is that, more
important than simply what is true (whatever this might mean),
is what is thought to be true. One of the more fascinating processes
to be observed in society is the way in which certain assertions
come to be regarded as true. Obviously, different individuals
and social groups have different stakes, both ideological
and material, in certain definitions of what is true. Thus gaining
acceptance of one's own view of reality, of what is true, is an
ideological and political victory. Science has become the basic
arbiter of reality. Almost no one aside from the scientistand
even then usually only the specialist within a given fieldhas
any direct contact with the empirical phenomena scientists describe.
The fact that the earth revolves about the sun "makes sense"
only when interpreted through specialists; almost no one who believes
it has ever tested it for himself. In this sense, scientific truth
is not very different from religious truth: we accept it as an
act of faith.
In any dispute, we not only want to be morally right, whatever
that might entail; we also want to be empirically and scientifically
correct. Nothing has greater discrediting power than the assertion
that a certain statement has been "scientifically disproven."
Generally we search-about for evidence to "prove" our
value judgments. If we believe marijuana use to be morally reprehensible,
we want to back up our position with "objective" facts
to show that we are also empirically correcthence the claim
that marijuana is physically or psychologically damaging. Almost
no one who believes that marijuana use is immoral also believes
that it is harmless; almost no one who views marijuana use with
moral indifference regards marijuana as damaging (though many
feign moral indifference, simply to make their empirical view
more credible). We shop around for evidence in much the same way
that we trundle through a supermarket, selecting here and there.
Facts are manipulated, wielded as bludgeons, employed as rhetorical
devices. Presenting facts in the drug area is more like making
a case than searching objectively for evidence.
Any phenomenon is far more complicated than it appears at first
blush. We have been taught to perceive only a small portion of
the almost infinite number of experiences taking place before
us. Philosophers call this process of selective perception attending.
We attend to certain kinds of facts and ignore others. "Seeing"
is also "not seeing." Whenever a certain observation
is made, a sociologically relevant question would be not only
"Is it true?" but also "Why stress this observation
rather than another equally valid one?" Thus almost any conceivable
discussion of the harmfulness or relative harmlessness of marijuana
could be presented validly, with extensive documentation, simply
by attending to one segment of the marijuana reality and ignoring
others. In medical terms marijuana is harmfuldamaging and dangerousto
some people under certain circumstances, according to some definitions
of harm, at certain dosage levels, in some moods and psychological
states. But marijuana is also relatively harmless medicallyfor
most people, most of the time, at the potency levels generally
available, and so on.
There is enormous leeway, then, in presenting different views
of a phenomenon, especially one as controversial as drug use.
We are ultimately interested not in highly concrete facts but
in generalizations from the facts. ("Is marijuana harmful?"
"Does marijuana lead to heroin?" "Does marijuana
debilitate driving skills?") Since so many different things
can and do happen to so many different individuals, the gates
are open to pick and choose those facts that are compatible with
our own views. One of the central concerns of this book will be
an exploration of the politics of reality in the area of drug
THE HIERARCHY OF CREDIBILITY
The concept of "the hierarchy of credibility" (Becker
1967a) is especially important in any area of human behavior where
"experts" abound. It refers to the fact that some people
especially those in socially responsible positionshave more
power to define what is true than others do. Yet some of
the most prestigious, well-known, and credible drug "experts"
have never done any research on the subject, and their pronouncements
make it clear that they are ignorant of the latest research. Legitimacy
and credibility bear a scant relationship to actual expertise,
if that is defined by participation in firsthand research or by
a detailed and up-to-date knowledge of that research.
From time to time the American Medical Association has issued
statements purporting to describe to physicians, as well as to
the public at large, the dangers of marijuana use. These statements
have been construed by both groups as crystallizations of scientific
and expert truth, solidly based on hard evidence. They have been
labeled "studies" and "reports," yet they
are not based on any research that members of the AMA might have
clone, or on research that the AMA might have commissioned, or
indeed on any research at all. The American Medical Association's
articles on "Marihuana and Society" (American Medical
Association 1968) and "Dependence on Cannabis (Marihuana)"
(American Medical Association l968) have been cited in thousands
of anti-marijuana tracts as definitive proof of the drug's harmfulness,
yet they contain little more than a mixture of quite outdated
assertions and blatantly biased value judgments.
Inevitably, in any controversy we run into the problem of whose
word to accept as valid. It is possible in any debate to attack
the credentials of anyone with whom we disagree and to accept
those of someone we agree with. Through this winnowing process,
an artillery of authorities can be assembled to make it appear
that we are "right" about our views. But credentials
can be weighed in very different ways. To the public a hospital
administrator, the head of a government agency, or a member of
a national medical committee has better "credentials"
than an independent medical or scientific researcher whose work
may be known only to a few thousand specialists. To these specialists
the hospital administrator may be an ignoramus. It usually turns
out that those in positions of social responsibility, those who
have credibility and legitimacy, can also be counted on to say
something relatively safe and essentially protective. They as
well as the public see their role as that of upholding dominant
ideological views. They act as a kind of filtering device for
the findings of various independent researchers, accepting those
findings that fit in with dominant views and ignoring or attacking
those that do not. For instance, the fact that a clear majority
of all scientific researchers favor some form of legalization
of marijuana is unknown to the publicbut the fact that officials
of the AMA, the federal government, and the World Health Organization
would oppose such a move probably is known to the public and is
considered proof that it would be unwise.
The concept of "the hierarchy of credibility" becomes
crucial when we consider that credible spokesmen have been known
upon occasion to proclaim utter nonsense, yet their statements
are taken seriously by a large proportion of the public. On March
6, 1971, Dr. Wesley Hall, the newly elected president of the American
Medical Association, was quoted by United Press International
as saying that a study completed by the AMA left "very little
doubt" that marijuana caused a considerable reduction in
sex drive. Dr. Hall noted that a thirty-five-year-old man might
find his sex drive diminished to that of a seventy-year-old man
if he used marijuana, and he hinted that certain evidence demonstrated
that marijuana caused birth defects. (This was an extremely clever
statement, incidentally, containing as it does what is probably
the most dreaded fear of man and woman respectively.) Dr. Hall
also suggested that forthcoming findings would help to reduce
the level of marijuana use in the country (Drugs and Drug Abuse
Education Newsletter 1971). His statement received considerable
coverage by the media and was quickly broadcast across the country.
About three weeks after the statement was made, Dr. Hall said
that he had been misquoted, but he added, in an interview:
I don't mind... if this can do some good in waking people up
to the fact that, by jingo, whether we like to face it or not,
our campuses are going to pot, both literally and figuratively....
If we don't wake up in this country to the fact that every college
campus and high school has a problem with drug addiction, we're
going down the drain not only with respect to morality, but.
.. the type of system we're going to have (Drugs and Drug Abuse
Education Newsletter 1971, pp. 6, 7).
Dr. Hall said that he was "deeply concerned with the fact
that kids 18 years old are going to have the vote," because
they are "in favor of legalization of marijuana and even
... the harder drugs." In relation to drug use in Las Vegas,
he commented: "They have 7,000 kids there on drugs....
Somebody better wake up and do something about it instead of talking
about the authenticity of a final report which might or might
not be out yet." Attacking NIMH's report on marijuana, Dr.
Hall said: "Some people are a little bit hesitant to stick
out their neck until they have proof positive." Commenting
on his own role, he explained: "The AMA states that marijuana
is a dangerous drug, that it should not be legalized, and that
every physician should do everything in his power to alert the
folks to the dangers of marijuana, and this is one thing I'm trying
to do." When asked whether misleading statements such as
his own might damage the credibility of the AMA, Dr. Hall said:
"I'm tired of these phrases about the credibility gap. We're
talking about the morality of the country... and respect for
authority and decency" (Drugs and Drug Abuse Education
Newsletter 1971, p. 7).
The entire episode bears crystal-clear testimony to most of the
sociological concepts discussed in this chapter. It is readily
apparent that Dr. Hall does not like marijuana use; as
he sees his job, he must assemble a damaging argument to convince
the public of what he wants it to believe. And given the AMA's
legitimacy in most Americans' eyes, it is entirely possible to
perform this feat. It is also clear that Dr. Hall is untroubled
by such technicalities as evidence, facts, and datawhat he
wants is good, solid propaganda, regardless of what the facts
say. The truly amazing thing is that the AMA can continue to be
believed after such an episode. But such is the power of the hierarchy
of credibility; in fact, the AMA is and will continue to be taken
seriously by most Americans.
The power of the hierarchy of credibility is also demonstrated
in an anti-marijuana tract distributed recently by the Ambassador
College Press. The pamphlet, entitled "New Facts About Marijuana,"
claims that marijuana is more dangerous and damaging than any
other drug, and that it is the "number one narcotic drug"
because "the effect on chromosomal organization... from
its first use posits permanent effects through generations....
Very few fatal diseases are ever transmitted to subsequent generations
as both dominant and recessive. They are either one or the other.
But marijuana addiction is transmitted to subsequent generations
in both ways, dominant and recessive." These statements were
made by a Dr. Louis Sousa of St. Ditmas Hospital in Paterson,
New Jersey, and were supposedly presented at a conference of geneticists
at Oxford University. Several interested observers (Fiedler 1971;
Wittman 1971) checked on the validity of these facts. They discovered
that (1) Louis Sousa was not a physician but a laboratory technician;
(2) the paper in question was never delivered at a conference
of geneticists at Oxford; (3) Sousa was discharged from St. Ditmas
about five or six years before the pamphlet was distributed; (4)
Sousa has subsequently left the country, under indictment for
perjury on another matter. But notice the manipulation of the
symbols of legitimacyattributing Sousa with a medical degree
when he has none, invoking the prestige of Oxford Universityin
an effort to convince readers of the pamphlet that marijuana must
indeed be harmful. If such an impeccable authority claims genetic
damage, how could it be false?
WHAT IS A DRUG?
After emphasizing the ideological biases hidden in most analyses
of the drug reality, it is now possible to attempt several crucial
definitions, utilizing these insights as a basis. To be adequate,
any definition should perform the following functions: (1) it
should group together all the things that share a given relevant
trait and (2) it should set apart those things that do not share
that trait. What is the defining trait that all drugs share? And
what separates a drug from something that we cannot properly call
Most of us believe that all drugs have some intrinsic property
that automatically classifies them as drugs. Even the experts
assume that the category "drug" is based on a natural
pharmacological realitythat a drug must be something
or do something that makes it part of a natural, organic,
and chemical entity. Yet any search for a purely pharmacological
definition of drugs would be fruitless. No formal, objective characteristic
of chemical agents will satisfy both criteria of an adequate definition
simultaneously. There is no effect that is common to all "drugs"
and that at the same time is not shared by "nondrugs."
Some drugs are powerful psychoactive agentsthey influence how
the mind works; others have little or no impact on mental processes.
Some drugs have medicinal properties; others have no medical value
at all. Some drugs are toxicthey require very small amounts
to kill living beings; the toxicity of other drugs is extremely
low. Some drugs build tolerance very rapidlyincreasingly higher
doses are required to achieve a constant effect; others do so
slowly or not at all. Some drugs are "addicting"they
produce a physical dependence; others are not. There is no conceivable
characteristic that applies to all substances considered drugs.
The classic definition of a drug to be found in nearly every introduction
to pharmacology is "any chemical substance that affects living
protoplasm." Unfortunately this widely adopted definition
is far too broad to be of real usea glass of water fits the
definition, as does a bullet fired from a gun, a cold shower,
a meal, a cup of coffee, aspirin tablets, or even this book.
When we turn to the social definition, we find that the concept
"drug" is a cultural artifact, a social fabrication.
A drug is something that has been arbitrarily defined by certain
segments of society as a drug. Although all substances called
drugs do not share certain pharmacological traits that set them
apart from other, nondrug substances, they do share the trait
of being labeled drugs by members of society. What this
means is that the effects of different drugs have relatively little
to do with the way they are conceptualized, defined, and classified.
The classification is an artificial one; it resides in the mind,
not in the substances themselves. But it is no less real because
it is arbitrary. Society defines what a drug is, and the social
definition shapes our attitudes toward the class of substances
so described. The statement "He uses drugs" calls to
mind only certain kinds of drugs. If what is meant by that statement
is "He smokes cigarettes and drinks beer," we are chagrined,
since cigarettes and beer are not part of our stereotype of what
a drug is, even though nicotine and alcohol are certainly drugs
by at least one criterionthey are both psychoactive.
Thus there is a popular conception of drugs (mainly illegal drugs)
and a psychopharmacological definition (psychoactive drugs) that
are somewhat independent of one another. A given chemical substance
may be a drug within one definition or sphere of interest but
not another. Substances such as primaquine, primadone, prinadol,
priodox, priscoline, and privine have important medical uses and
are described in reference works on therapeutics. Yet it would
not occur to the man on the street that any of these substances
were drugs. Other substances such as peyote, kava-kava, betel
nuts, coca leaves, and Amanita muscaria are used by certain
tribal peoples, but they would not appear anywhere in a work on
therapeutic medicine. Penicillin has been one of the most valuable
drugs in medical therapy in human history, but it is not used
illicitly on the street. Alcohol is a drug in a psychoactive sense,
but not if we were to adopt conventional society's definition:
a man who drinks liquor does not think of himself as a drug user,
and he would rarely be so defined even by nondrinkers. Nothing
is a drug according to some abstract formal definition, but only
within certain behavioral and social contexts. Which substances
we elect to examine in any discussion of drugs is always arbitrary
and depends entirely on our purposes.
Therefore when anyone speaks or writes of drugs, whether layman
or professional, physician, sociologist, journalist, or politician,
he is referring to a social and linguistic category of entities,
not to a natural or pharmacological category. Thus the claim
that the "willingness of a person to take drugs may represent
a defect of superego functioning in itself" (Fink, Goldman,
and Lyons 1967, p. 150) means simply that individuals who ingest
substances that society has arbitrarily chosen to label "drugs"
supposedly share certain neurotic personality traits, traits
not generally shared by those who ingest substances to which society
does not assign the label "drugs." This distinction
is crucial, and cannot be ignored.
One discussion points out that "nothing is a drug but naming
makes it so" (Barber 1967, p. 166). Common substances such
as ink, soap, gauze bandages, iron, and salt are considered drugs
within certain medical contextsthat is, they are considered
to have therapeutic utility and are used to heal, or for diagnostic
... almost anything can be called a "drug." There
is nothing intrinsic to any physical or biological substance that
makes it a drug or does not. The same substance can be called
a "drug" in one social context and called something
else in another. For example, the ink that is used in fountain
pens is not a drug when used in that way, but it may legally be
defined as a drug if it is used as a diagnostic agent in connection
with anti-fungal materials which are also defined as drugs....
When we look at drugs in a generalized and comprehensive way,
what we see is that it is not so much the substance of a material
that makes it a drug, but rather some particular social definition
(Barber 1967, p. 2).
WHAT IS A NARCOTIC?
The term "narcotic" has been used in two radically
different ways in our society. The popular and legal definition
has been "any illegal drug." When a drug seizure is
made by the police, newspapers will proclaim: "Police Confiscate
Narcotics." Many state statutes define marijuana as a narcotic.
Medically, pharmacologically, and scientifically, however, the
term "narcotic" means a chemical substance that dulls
the body's sensitivity to pain; this function is called "analgesia."
Thus narcotics serve an important medical and therapeutic function.
But they are also pharmacologically addictingthat is, they
produce an actual physical dependency in both animals and man.
Within this definition only a very narrow range of drugs may properly
be called narcotics, and these are discussed in Chapter 6.
Why should confusion arise between the popular and the medical
definitions of narcotics? Why should the law, government figures,
and the man in the street think of narcotics as "illegal
drugs," while the scientist and the physician define
them as "painkilling drugs"? And why should government
officials stoutly defend the unscientific definition? Several
years ago Donald Miller, chief counsel for the Bureau of Narcotics
and Dangerous Drugs, a subunit of the Department of Justice, stated:
"So far as I can see, I do not think it is irrational to
legally define marihuana as a 'narcotic drug' " (Miller 1968,
p. 55). Elaborating on the categorization, Miller noted:
Despite some physiological differences in the effects of the drugs
in the opium family and marihuana, the inclusion of marihuana
in the statutory definition of "narcotic" is not constitutionally
improper. The word "narcotic" is commonly used to designate
drugs having the consciousness-altering characteristics of marihuana,
i.e., stupor, mental lethargy, marked alterations of mood, and
possible physiological harm (Miller 1968a, p. 93).
Actually, the defenders of classifying marijuana as a narcotic
have an ideological and propagandistic purpose in mind. "Narcotic"
has become a kind of code worda discrediting labelfor
a drug whose use is (supposedly) "bad" for the user.
In the view of the propagandists, attaching such a labeleven
if it is absurd from a scientific point of viewmakes it easier
to persuade the public that the drug is in fact harmful and dangerous.
The scientific definition of a narcotic ("painkiller")
is relegated to minor importance, and the moral meaning ("bad")
is given a center stage position. Apparently there is a fear on
the part of propagandists that removal of the label "narcotic"
from marijuana would imply that it is not in fact dangerous. Notice
the clear political overtones of this labeling process in the
following statementthe reaction of Representative Charles Wiggins,
a Congressman, to the statement made by a physician, Sidney Cohen,
that marijuana is not medically or pharmacologically a narcotic:
You say quite positively marihuana is not a narcotic. It is not,
but only because medical science has chosen to define a narcotic
in a fairly narrow sort of way. What I am fearful of, Doctor,
is that those who listen to the words, "marihuana is not
a narcotic" will not be medical doctors at all, but will
rather be just ordinary people who will read into that
that it is not dangerous. Now you do not mean that, do
you? [my emphasis] (Pepper 1970, p. 13)
It is easy to see from this quote the great hold that definitions
have on men's minds; it is also clear that our way of defining
something has immense ideological implications. Science and politics
interpenetrate one another at crucial junctures, and it will be
one of the tasks of this book to explore these connections. It
should be clear that the popular and legal definition of the term
"narcotic" has very little to do with the pharmacological
and scientific definition. We will encounter this phenomenon frequently.
DRUG ADDICTION AND DEPENDENCE
In the early 1960s, the World Health Organization, in an effort
to devise a new terminology that would apply to the "abuse"
of all drugs, not just addicting drugs, adopted the term "drug
dependence." According to WHO "drug dependence"
... a state of psychic dependence or physical dependence, or
both, on a drug, arising in a person following administration
of that drug on a periodic or continued basis. The characteristics
of such a state will vary with the agent involved, and these characteristics
must always be made clear by designating the particular type of
drug dependence in each specific case.... All of these drugs have
one effect in common: they are capable of creating, in certain
individuals, a particular state of mind that is termed "psychic
dependence." in this situation, there is a feeling of satisfaction
and psychic drive that require periodic or continuous administration
of the drug to produce pleasure or to avoid discomfort (Eddy et
al. 1965, p. 723).
Under the new terminology, each drug has its own characteristic
type of dependence: there is a "drug dependence of
the morphine type," a "drug dependence of the cannabis
[marijuana] type," a "drug dependence of the alcohol
type," and so on. In other words, the new terminology is
a definition, or a series of definitions, by enumeration, for
it was felt that no single term could possibly cover the diverse
actions of the many drugs in use (or "abuse").
In reality, however, the new definition, as well as the accompanying
elimination of the term "addiction," is without any
utility and confuses more than it clarifies. Its intent is patently
ideological in nature: to make sure that a discrediting label
is attached to as many widely used (or "abused") drugs
as possible. Under the old terminology, it was not possible to
label a wide range of drugs as "addicting." As in the
"narcotics" controversy, it was necessary to stigmatize
such substances as marijuana with a term that sounded very much
like "addicting" but that also had a ring of truth to
it. In other words, the scientists and physicians who created
the new terminology were being employed as propagandists to convince
the layman that nonaddicting substances were just as "bad"
for him, that he would be just as "dependent" on them
as on any truly "addicting" drug, and that the repeated
use of both arose out of a compulsion. Under the new terminology,
drugs and patterns of drug use that are really radically different
are linked together to appear similar in important respects.
If we wish to adopt a less propagandistic stance toward the terms
"psychic" or "psychological" dependence, it
is necessary to abandon them altogether. The difference between
psychic dependence and classic addiction (that is, physical dependence)
is the following. If you take or are administered a truly addicting
drug such as heroin, morphine, or any of the barbiturates in sufficient
doses over a long period of time, you will become addictedthat
is, your cells will crave the drug, and if the drug is discontinued,
you will undergo withdrawal sickness It does not matter what you
think, what ideas and attitudes you have about the use or effects
of the drug, your cells will still crave that drug. (Even if you
have not been told that you are being given the drug you will
experience discomfort, although you will not attribute your discomfort
to the drug.) In contrast, if you take or are administered a nonaddicting
drug such as marijuana over a period of time, nothing essentially
will happen to you when you are "withdrawn" from the
drug. It is impossible to induce addiction to marijuana.
Now some individuals do use nonaddicting drugs such as marijuana
regularly and frequently. But to say that marijuana "causes"
a psychic dependence is meaningless. Medical "authorities"
label continued (or even sporadic) marijuana use as "dependence"
for the simple reason that they cannot understand why anyone should
want to use it at all. It is not the properties of marijuana that
"cause" a psychic dependence; rather it is the personality
structure of certain individuals who happen to use it frequently.
It is the individuals that bear looking into, not the drug. It
is illogical to attempt to explain something that is variable
(some users smoking marijuana heavily and some infrequently) in
terms of something that is constant (the drug supposedly producing
a psychic dependence).
Eliot Freidson, a sociologist, has labeled psychic dependence
"the overwhelming product of psychiatric scholasticism";
in a letter to the editor of Trans-action magazine, Freidson
commented on the "psychic dependence" of marijuana:
"What does this phrase mean? It means that the drug is pleasurable,
as is wine, smoked sturgeon, poetry, comfortable chairs, and Trans-action.
Once people use it, and like it, they will tend to continue
to do so if they can. But they can get along without it
if they must, which is why it cannot be called physically addictive"
(Freidson 1968, p 75). The point is that psychic dependence means
the use on a continued basis of anything that certain medical
figures disapprove of. The key word here is disapprove, since
the use of other substances that these medical figures do not
disapprove of is not labeled a dependency.
An addicting drug makes cells dependentit makes them "crave"
that drug. When a pharmacologist says that a drug such as morphine
or alcohol produces a physical dependence, he means simply that
body cells respond in a certain way to continued administration
of these drugs. However, it would be completely improper to say
that as a direct consequence of this cellular response humans
become addicted to the drugs in question. Whether humans do in
fact become addicted is dependent largely on social and psychological
Nonaddicting drugs do not produce a biochemical dependence in
animal cells. Whether or not they lead to continued use is also
a social and psychological matter, but continued administration
of a nonaddicting drug cannot be equated with a dependence, physical
or psychic. A person who has taken high-quality heroin several
times a day over a period of time is un4uestionably physically
dependent on heroin. A person who smokes marijuana several times
daily is displaying a pattern that is a manifestation of something
going on in his mind and in his social milieu, and it has little
to do with marijuana as a drug.
It should be clear, then, that there are two quite separable components
in the addiction-dependence equation: one is the direct physical
action of the drug; the other is how people respond, behaviorally,
to the physical action. One component does not translate automatically
into the other. The knowledge of what a drug does to the human
body does not explain what humans will do in relation to the drug
The basic fallacy of the World Health Organization's new terminology
is its reductionismthat is, its assumption that the biochemical
properties of a drug determine the behavioral reality in relation
to that drug. If the old definition of addiction is understood
as a strictly biochemical description, then it contains some validity,
although with serious flaws. But the new terminology is completely
invalid, because it is trying to deal with the social dimension
by absorbing, distorting, and underplaying what is in fact the
central feature of drug taking.
Physicians commonly employ the term "abuse" to refer
to the use of a drug outside a medical context; this is the official
definition of drug abuse given by the American Medical Association.
The term, however, conveys a moral rather than a scientific
judgment. Since "abuse" clearly connotes something negative
or bad, to employ the term is to discredit and stigmatize drug
use rather than to understand or describe it. Those who use the
term declare that nonmedical drug use is invariably harmful, without
first investigating whether it is in fact so or what constitutes
harm in the first place. "Abuse" puts forth the claim
that only physicians should be permitted to administer drugs.
But since the term "drug" is a social and not a medical
concept, such strictly medical claims are inconsistent. One never
hears of "medically unsupervised" use (and therefore
"abuse") of alcohol, even though alcohol has effects
similar in many ways to those substances that physicians feel
they ought to control or veto. By the AMA definition, any use
of marijuana, regardless of its medical consequences, constitutes
abuse, since the drug is not approved for medical purposes by
most, and by the most credible, physicians. Purposes such as euphoria,
pleasure, relaxation, or mind transformation are considered illegitimate.
As "abuse" is used in context, however, it conveys the
distinct impression that something quite measurable is being referred
to, something very much like a disease, a medical pathology, a
sickness in need of a cure. Thus the term simultaneously serves
two functions: it claims clinical objectivity, and it discredits
the phenomenon it categorizes. "Abuse" announces to
the world that the nonmedical taking of drugsactually, only
certain types of drugs, since legal drugs such as alcohol
are magically exempt from the definition (and thus the medical
definition is a passive and curious reflection of the legal situation)is
undesirable, that the benefits obtained from illegal drugs are
counterfeit, and that they are in any case outweighed by the hard
rock of medical damage. But since the weighing of values is a
moral and not a scientific process, we are able to see the ideological
assumptions built into the term Furthermore, the linguistic category
demands verification. By labeling anything "abuse,"
it becomes necessary to prove that the label is valid. The term
so structures our perceptions of the phenomenon that it is possible
to see only "abusive" aspects in it. Therefore data
must be collected to "demonstrate" the damages of nonmedical
drug use. In such ways do science and medicine become the handmaidens
of morality and politics.
DRUG EFFECTS AND THE DRUG EXPERIENCE
The prevalence of ideology in the drug realm is exemplified
by the unwillingness of most observers, including physicians and
scientists, to attempt a systematic investigation of the reality
of drug use from the point of view of the user. This unwillingness
is typically verbalized in a rhetoric of objectivitythe user
is inevitably biased and hence cannot tell us anything about the
phenomenon of drug use. This position confuses "objective"
and "subjective" effects, and tends to ignore the drug
experience. The fact is that no one except the drug taker is capable
of reporting the nature of the drug experience; thus it is absolutely
essential to elicit his descriptions. At the same time, we are
totally at the mercy of those descriptions. Traditional behaviorists
surmount this dilemma by completely ignoring internal states,
judging them to be too ephemeral and subject to distortion and
error to be reliable. Clinicians, at least of the psychoanalytic
school, resolve the dilemma by assuming that overt descriptions
and statements by drug users represent some deeper hidden meaning
that only the psychoanalyst can understand and interpret. But
if we wish to put together a complete picture of the drug reality,
we cannot afford to be so restrictive. How can we utilize descriptions
by subjects of the drug experience without becoming a victim of
such distortions as might obtain from reliance on this type of
A few examples will highlight this "objective-subjective"
dilemma. Recent laboratory experiments have shown that, contrary
to the opinions of most users and nonusers alike, marijuana does
not cause dilation of the pupils of the eyes (Weil, Zinberg, and
Nelsen 1968). The traditional behavioral scientist will cite this
finding as an example of how even experienced users will believe
the myths about marijuana, and hence as further proof that it
is risky to accept the "subjective" word of drug users
about any aspect of the drug reality.
However, there are different levels of the drug reality.
The presence or absence of some external drug manifestations (such
as pupil dilation) can be verified objectively. Other drug effects
are located purely within the subjective realm and are beyond
the reach of traditional scientific instruments; in order to explore
them we must ask the drug user to re-create the subjective and
expressive character of the drug "high." It would be
absurd to claim that science can "disprove" the reality
of a drug experience as it can the occurrence of a certain physiological
effect. Rather the two are in totally different realms. For example,
marijuana users often claim that they can hear music more acutely
under the influence of the drug (Halikas, Goodwin, and Guze 1971;
Tart 1971; Hochman and Brill 1971). However, researchers have
been unable to verify this in laboratory experiments: under the
influence of marijuana, the activity of perceiving and reporting
on auditory stimuli is not significantly different from normal
(Caldwell et al. 1969).
The traditional laboratory scientist will feel that this disproves
the users' claims, and he will view it as evidence of the distortions
inherent in reasoning from subjective reportsas well as evidence
for relying exclusively on laboratory findings accumulated by
trained scientists. However, to conclude that the drug user is
simply an untrustworthy guide through the dark wood of fact would
be hasty and simple-minded. To understand the subjective impact
of sense stimuli, we have to abandon the strict laboratory
approach. Users report overwhelmingly that their identification
with, involvement in, appreciation of, and enjoyment of music
under the influence of marijuana are heightened, that the experience
of listening to music becomes richer and more exciting when they
are high. This is not a question of a "misperception"the
user's experience is in fact the perception itself, and the perception
is the phenomenon to be measured. The subjective grasp of the
experience is the very reality itself.
Similar observations may be made with regard to time. Under the
influence of marijuana, users commonly report that time appears
to pass very slowly, that it is elongated, and they consistently
overestimate the amount of time passing (Tart 1971; Goode 1970;
Hochman and Brill 1971; Halikas, Goodwin, and Guze 1971). Now
there are a number of different ways of approaching time. To the
laboratory scientist, time is a fixed quantum that can be divided
into infinitely reproducible segments of equal magnitude. Thus
the researcher would say that the marijuana user, under the influence
of the drug, estimates the passage of time incorrectly. But this
conception is not relevant to the dimension of meaning, to
the quality of time as experienced. By looking at the marijuana
users' experience as a "distortion," the laboratory
scientist is imposing his own views on the reality and is attempting
to disprove the validity of the perception itself. The fallacy
of the strict behaviorist approach is the substitution of the
observer's perspectivethat of the scientistfor that of his
subjects. It is the failure to take the role of the other, to
see the world as the subject sees it.
This discussion should not be construed either as a glorification
of what the subject feels to be true or as an affirmation of the
position that subjective feelings cannot be studied at all. As
David Matza, a sociologist of deviant behavior, has pointed out,
attempting to grasp the "subject's definition of the situation
... does not mean the analyst always concurs with the subject's
definition of the situation; rather, his aim is to comprehend
and illuminate the subject's view and to interpret the world as
it appears to him" (Matza 1969, p. 25). The subjective
view is not necessarily "right"whatever that might
mean regarding one or another propositionbut it does merit
understanding on its own ground, and for that purpose its truth
or falsity in strictly empirical terms is more or less irrelevant.
Because many subjective feelings have no "scientific"
or empirical validity, traditional positivistic pharmacology and
behaviorist psychology have avoided levels of experience conveyed
by the subject through language, through explanations of what
he feels. This barrier is now breaking down, and an expanded conception
of what science can deal with is emerging. Subjective feelings
can be studied "objectively"that is, it is possible
to attempt an understanding of the world as it appears to the
subject, and to accomplish this "scientifically." There
is no contradiction here. What the subject feels and says he feels
is a field of data that can be investigated by means of the traditional
canons of scientific method. Throughout this book, I will attempt
to walk the fine line between these two perspectives. In short,
instead of adopting the narrow and arbitrary conventions of traditional
behaviorism, ignoring verbal statements and self-descriptions
of feelings and experience as irrational or epiphenomenal, I am
suggesting that a truly scientific approach toward reality would
be to accept them as one dimension of phenomena under study. To
exclude subjective states from scientific scrutiny is as arbitrary
as thinking of them as the only legitimate version of reality.
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and Funkhouser 1970), 59 percent favored making marijuana legally
as restricted as alcohol; in contrast, only 9 percent felt this
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