Chapter 6 - Users and uses: form, practice, context

Factors related to use

Following logically from what we saw in the previous section, studies on factors that could explain the use of drugs, and cannabis in particular, deal primarily with initiation or experimentation.

The INSERM report examines a set of studies on factors that could explain cannabis use: the influence of the family environment (use by parents, socialization, parental teaching methods, quality of the parent-child relationship, parental models), peers (symbolic values of use, norms) and educational and social environments.[1][41] There is no clear conclusion, but the report notes that the studies manage either poorly or not at all to take into account the user’s role in social situations and consequently the incremental impact on use arising from the variability of social stresses as well as the methods of integration. We would also add that these studies do not reflect trajectories of use.

First of all, along with DrugScope, we note that the epidemiological approach to analysis of drug use, cannabis in particular, is based on a medical model of analysis of the prevalence of disease, whereas the reasons (which are not necessarily the causes) for drug use can very easily lie outside the medical field and, in a broader sense, outside the psychosocial model. Attributing dependence – understood here in terms of a disease – to factors pertaining to the relationship between the locus of control and the environment has consequences for the understanding of the phenomenon as well as for public policy. The report by this British body contains a table of the explanations of drug use we feel it useful to reprint here.

 

Attribution Explanations of Drug Use [2][42]

Attribution	Common Sense Meaning	Resulting Public Policy
Internal x stable   Internal x unstable   External x stable     External x unstable	Drug use is a disease (dependence model)   Drug use is the periodic seeking of pleasure    Shortcomings in the environment explain drug use   Availability of drugs explains their use	Treatment model   Reduced demand model (replace drugs with something else) Change the environment     Reduced supply model

 

 

In fact, we must not forget that, with regard to psychoactive substances, the medical model of disease is still a dominant model for comprehension and forms the other part of the public response along with the penal model.[3][43] As we were told several times, drugs, and cannabis in particular, are not dangerous because they are illegal, they are illegal because they are dangerous. We will have occasion to comment on this statement in greater detail in the following chapters.

For now it is enough to remember that attempts to explain drug use most often involve looking for defects in personality or the environment rather than trying to understand the choices made by users.

Among the factors related to the locus of control, studies identify primarily:

··               Peer influences: the first uses depend on the influence of other young people in the group;

··               Family influences: a family environment where parental supervision is lacking, where drug use is tolerated, where siblings or parents have criminal backgrounds, and where parents themselves are users;

 

Among the factors related to the environment, studies mention:

··               The availability and accessibility of drugs: the more drugs are available, the greater their use will be;

··               Social tolerance: the more drug use is accepted, the higher levels of use will be;

··               Perception of risk: the less the risk of social disapproval or the perceived risk to health, or the risk of legal action, the greater the use there will be.

 

According to the report Monitoring the Future, there is no doubt that young people’s perceptions of drugs and their attitudes towards them determine the levels of use, which in return must determine public policy:

 

Early in the decade of the 1990s we noted an increase in the use of a number of illicit drugs among secondary students and some important changes among the students in terms of certain key attitudes and beliefs related to drug use. (…) Specifically, the proportions seeing great risk in using drugs began to decline, as did the proportions saying they disapproved of use. As we predicted, those reversals indeed presaged “an end to the improvements in the drug situation that the nation may be taking for granted.” The use of illicit drugs rose sharply in all three grade levels after 1992, as negative attitudes and beliefs about drugs continued to erode. This pattern continued for some years. [4][44]

 

And further on:

 

We can summarize the findings on trends as follows: over more than a decade – from late 1970s to the early 1990s – there were very appreciable declines in use of several illicit drugs among twelfth-grade students, and even larger declines in their use among college students and young adults. These substantial improvements – which seem largely explainable in terms of changes in attitudes about drug use, beliefs about the risks of drug use, and peer norms against drug use – have some extremely important policy implications. One is that these various substance-using behaviours among American young people are malleable – they can be changed. It has been done before. The second is that demand-side factors appear to have been pivotal in bringing about those changes. The reported levels of availability of marijuana, as reported by high school seniors, has held fairly steady throughout the life of the study. (Moreover, both abstainers and quitters rank availability and price very low on their list of reasons for not using.). And in fact the perceived availability of cocaine actually was rising during the beginning of the sharp decline in cocaine and crack use, which occurred when the risks associated with that drug suddenly rose sharply. (…) Over the years, this study has demonstrated that changes in perceived risk and disapproval have been important causes of change in the use of several drugs. These beliefs and attitudes surely are influenced by the amount and nature of public attention paid to the drug issue in the historical period during which young people are growing up. A substantial decline in attention to this issue in the early 1990s very likely helps to explain why the increases in perceived risk and disapproval among students ceased and began to backslide. [5][45]

 

In other words, social disapproval – through government information campaigns, for example – can generate attitudes that reject drug use and will be reinforced by actions likely to increase the risks associated with use (the risk of arrest, for example).

A study conducted in Newfoundland and Labrador involving a sample of 3,293 people is an example of this approach applied in Canada.[6][46] The questionnaire included questions about activities (family activities, housework, extracurricular activities, school work, sports, work, religious life), the availability of cannabis, use by parents, peers and the individual, parental and peer norms regarding cannabis, personal preferences and norms regarding cannabis. Analysis of variance dealt with the interaction of these various variables to explain personal use of cannabis. Overall, the model explains only 57% of use in the provincial sample, 65% for boys and 54% for girls. The results show that peer use is the main factor related to personal use (29% of variance), followed by personal preferences (themselves influenced by peer norms), personal norms and having to do chores around the home. Availability is not directly related to use and works through peer norms and use. Parental use is strongly linked to perceived availability. The authors conclude that this model has clear implications for interventions to prevent cannabis use:

 

In the province wide sample, Peer Use, Peer Norms, Availability, Own Preferences and Own Norms together account for 56% of the 57% of Own Use predicted by the model. Peer Norms and Availability work though Peer Use, so important targets for intervention should be Own Norms, Own Preferences and Peer Use. Of these variables, Own Preferences and Peer Use contribute the most to prediction of Own Use, together accounting for 48.8% of the variance. It is of interest that a large part of availability is predicted by Parental Use, suggesting Peer Use arises from possible supplies of the marijuana/hashish from parental sources. This ought to be a target for intervention strategies as well. The model suggests sources of influence on target variables that ought to be considered in any intervention strategies. [7][47]

 

Taking into consideration the limits of the model as well as the differentiation between the sexes and provincial health districts with respect to the relative weight of the independent variables, we have to wonder if this type of analysis is a true reflection of use, including initial use. Furthermore, in the light of international trends in use on the one hand, and studies on users on the other, we wonder about the postulates of this type of mechanical model based on the rationality of the actors.

Finally, Aquatias et al., conducted a study on cannabis use among youth in the suburbs of Paris.[8][48] The authors make a particularly interesting distinction between forms of use based on user characteristics and the ideological representations of cannabis use. They demonstrate in particular (1) that there exist “hard” uses of soft drugs and (2) that the traditional distinction between the festive, socially integrated and group-regulated forms of use among middle class youth, and the excessive and socially unregulated uses of disadvantaged youth does not hold. Depending on factors related to their environment, both groups can have regulated and unregulated forms of use.

Factors traditionally associated with unregulated use such as social disenfranchisement, poor living conditions in the suburbs and the lack of professional integration, are only part of the picture. Other factors related to tensions arising in the environment (for example family-related problems or being in conflict with the law) and the capacity to remain autonomous from their social milieu also play an important role in the trajectories of these cannabis users.

 

[Translation] In trying to understand what factors determined these different forms of cannabis use among these youths, we have obviously noted the importance of factors related to social dislocation: difficulties in social integration and a lack of financial resources capable of fostering their autonomy from the living environment.

However, facing similar difficulties to get a job and socio-economic resources, some smoke cannabis without any excess, some not at all and others smoke considerably. Even within the group of youth who have a job, some smoke high potency cannabis intensively while others have more regulated forms of use and consume less.

Social dislocation is obviously a factor explaining the different forms of use just as integration in the job market serves to regulate these practices. But these complementary factors only constitute the more general context to these behaviours of intensive and prolonged use of cannabis.

(…)

Among those who experience social dislocation the most, those who smoke cannabis in an intensive and prolonged manner also experience the strongest social tensions such as problems with their local reputation, being in conflict with the law or family related problems… (…).

Conversely, those who have a more regulated use are both better integrated in their environment and at the same time more autonomous with respect to local social life. [9][49]

 

The authors propose a classification of forms of use which we reproduce since it has, in part, inspired our own classification.[10][50].

  

	Regulated solitary uses	Regulated group uses	Unregulated solitary uses	Unregulated group uses
Intensive use	After work	Boredom	Personal problems	Holidays, parties
Medium or low level of use	Before and after work	Generally in the evening Boredom

 

 

Finally, the authors distinguish between four levels of use:

··               Occasional: from experimentation to use in parties;

··               Moderate daily use: 3 to 5 joints per day or about one gram;

··               Strong daily use: 5 or 6 joints per day or between 0.9 and 1.2 grams;

··               Intensive daily use: over 1.2 gram per day.

To summarize

From an analysis of the life stories of users and their “trajectories”, we have learned primarily that, for a proportion of experimenters, which varies between 15% and 20% of the population, who will become regular users, the circumstances and patterns of their “career” as a user vary considerably but that for a significant proportion of these long-term users, use is integrated into their social and personal life.

Further, contrary to some studies, uses of cannabis are not determined only by a series of psychological or environmental factors. In all cases, it seems that specific events, elements of one’s particular life story, can trigger unregulated forms of uses, characterized in particular by intensive and solitary use. While such unregulated uses appear to be temporary, we did not come across any study that examined the trajectories of these users.

We also note that negative social attitudes and the characteristic of the cannabis market appear to have little impact on patterns of use.

Finally, we note that regular use does not necessarily mean problem use. At the same time, we have learned that early onset and rapid progression towards regular use are factors in problem use. In other words, and this will be important for choosing public policy and interventions, initiation at a young age (under age 16) and rapid progression towards regular use (under age 20) are markers that should be used to identify and prevent heavy use. Chapter 7 will discuss this issue in greater detail.