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Is Recreational Drug Use Normal?
American society focuses a tremendous amount of energy and resources on drug related issues. During the 1970's and 1980's the federal government conducted a "War on Drugs" spending billions of dollars on law enforcement programs alone (American Public Health Association, 1992). All levels of government from local to national, focus substantial resources on education, law enforcement, regulation and safety issues related to drugs. Also, the political arena has been a major area for the publicization and politicization of drug issues. At the same time, alcohol, tobacco, prescription, and over the counter drug producers are multibillion dollar industries that play a major role in our nation's commerce. The illegal drug trade is a massive, underground business which permeates both public and private aspects of society. On a personal level, most Americans consume more than one form of psychoactive drug. Given these realities, it is imperative that we as a society understand our use of and behaviors connected with drugs. This paper will attempt to address a fundamental component of these issues, namely, is recreational psychoactive drug taking normal behavior?
Definition of Use
Critical to this discussion is an understanding of what recreational psychactive drug use is and is not. Drug consumption can be categorized into the areas of drug use and drug abuse. Drug use has been defined as taking a drug in such a manner that sought for effects are attained with minimal hazard (Irwin, 1973). If Mary Doe (an adult) consumes a martini with her Sunday dinner, this is an example of drug use. Drug abuse is taking a drug to such an extent that it greatly increases the danger or impairs the ability of the individual to adequately function or cope with their circumstances (Irwin, 1973). If Mary Doe drinks so many martinis at dinner time every evening that she passes out at the table, her meal unfinished, having argued with her husband and frightened her children, then this would be drug abuse. By definition, then, the negative health consequences of drug consumption are the result of the abuse of these substances, not of their use.
A very important but little noted fact about drug consumption in America is that most is use not abuse, with the exception of tobacco consumers 90% of whom are abusers. One of the present authors has previously estimated that only 10-20% percent of all illicit drug takers develop a problem of abuse (Duncan & Gold, 1983; Duncan & Petosa, 1994). Evidence from the Epidemiologic Catchment Area Study (Anthony and Helzer, 1991) has revealed the more precise figure that 20.27% of all users of illicit drugs have experienced a period of abuse at some time during their drug use history. The prevalence of current drug abuse or dependence among persons who reported illicit drug use was 4.19%. The first symptoms of drug abuse typically occurred within two to three years after beginning illicit drug use and the median duration of a case of drug abuse/dependence was four to five years. Our discussion is focused on drug use and assumes that drug abuse is abnormal by various criteria.
Individual Drug Consumption
Psychoactive drug consumption is part of human history. Written records from thoughout our past and across the planet attest to the consistent use of these substances (Genesis 30: 14 16; Heimann, 1960; Musto, 1989; Snyder, 1970; Stewart, 1967). An assortment of drugs have been consumed for a variety of reasons recreational, therapeutic and religious over thousands of years.
Currently most, if not all, Americans consume psychoactive drugs in one form or another (Duncan and Gold, 1982). The National Household Survey on Drug Abuse (1991) revealed that 37% of Americans aged twelve and older, some 74.4 million persons, reported having used illicit drugs. Use of illicit drugs during the past month was reported by 6.4%. Lifetime experience of using alcohol was reported by 83.2%, while 51.2% reported alcohol use during the past month. Having ever smoked cigarettes was reported by 73.2% and 26.7% reported current use. No recent prevalence figures exist for the use of caffeine or other unrecognized drugs, but between coffee, tea, cola, and chocolate, experience with caffeine must be nearly universal. How many American adults have never taken an over the counter or prescription drug, never drank a beer or a cola, never smoked a cigarette or a "joint," nor consumed any of the myriad of other drugs that are so plentiful in modern society?
Further research by the federal government and others indicates that a large number of American adolescents consume illicit drugs (National Institute on Drug Abuse [NIDA], 1987). Evidence also indicates that young Americans use more drugs than adolescents in other developed countries (NIDA, 1987). Of the millions of adolescents who experiment with or use drugs, the overwhelming majority go on to adulthood without a drug abuse problem (The Drug Abuse Council, 1980).
Why Do People Take Psychoactive Drugs?
What motivates people to consume drugs? There have been numerous theories proposed to explain drug use as psychopathology. Broader motivational theories have been less common and less fully developed. Ray and Ksir (1993) sum the matter up by stating that people consume drugs to reduce pain or increase pleasure. Cohen (1971) expresses the same concept somewhat differently when he states the following principle:
People use drugs to "feel better" or to "get high." Individuals experiment with drugs out of curiosity or hope that using drugs can make them feel better. (p.17)
Cohen (1971) and Dohner (1972), in papers published a year apart, with each citing the other's earlier work, proposed similar lists of motives for illicit drug use. Cohen's typology has been the more widely used of the two. Cohen described eleven motives for drug use, as follows: Physical, including relaxation, stimulation and relief from sickness; Sensory, to magnify the senses; Emotional, to relieve negative mood states; Interpersonal, which included use to gain peer acceptance or to defy authority figures, as well as to break down communications barriers or to cement relationships; Social, including both promotion of social change and tuning out intolerable social situations; Political, to express political protest; Intellectual, to escape mental boredom or to achieve new insights or solve problems; Creative Aesthetic, to enhance creativity or enjoyment of the arts; Philosophical, to achieve insight into the meaning of life or other philosophical questions; Spiritual Mystical, to attain transcendance or enlightenment; and Miscellaneous, including adventure, risk seeking, drama or "kicks."
Bowker (1978) attempted to test Cohen's typology of motives. He did so by surveying students in three private secondary schools and two colleges and a random sample of adults in two samll cities and a rural county. Respondents were surveyed about their use of twelve categories of drugs and their reasons for that use. He reduced the number of motives from eleven to eight by combining Physical and Sensory, Social and Interpersonal, and Philosophical and Spiritual. He also renamed Cohen's Miscellaneous motive as Adventure/Curiosity. He found that the primary motive for drug use was Physical Sensory, followed closely by Adventure/Curiosity. Emotional motives were third, followed by Creative/Aesthetic and Social/Interpersonal.
Bowker found that different motives were associated with the use of different drugs. He found that narcotics were used principally for Physical motives; hallucinogens were used for Adventure/Curiosity and Creative/Aesthetic motives and to a lesser degree for Intellectual and Social/Interpersonal motives; and marijuana was used for Adventure/Curiosity, Creative/Aesthetic, Social/Interpersonal, and Emotional reasons. Cocaine was not included in Bowker's study.
Secondary school students reported using marijuana primarily for Adventure/Curiosity and Creative/Aesthetic reasons but Physical/Sensory, Emotional, and Social/Interpersonal motives also played an important role. Hallucinogens were used overwhelmingly for Creative/Aesthetic motives, but a substantial majority of users were also motivated by reasons of Adventure/Curiosity. Narcotics using students reported Adventure/Curiosity and Emotional motives. Bowker did not report the motives of college students in any detail, noting that they were in-between school students and adults.
Looking back over the preceding comments, it is apparent that the potential reasons for using drugs are just about as diverse as the total range of motivations for all human behavior. Drugs are not used for unique reasons which are specific only to drugs, nor are they used predominantly for pathological reasons. They are used by different persons for different reasons and by the same person for different reasons at different times. Going beyond this idea, Siegal (1989) has argued that there is an innate drive in all human beings to use drugs. Weil (1972) may have been closer to the point in arguing that humans have a biological need to alter consciousness. Drugs, in the context of this view, are but one of the many means to satisfy this need.
The Concept of Normality and Drug Use
What is normal, human behavior? What characteristics distinguish normal from abnormal behavior? The concept of normality is not easy to define. Green and Anderson (1986) in discussing mental health argue that normal is that which is accepted as the usual and must be regarded as within a range. Normality can be viewed from several viewpoints statistical, clinical, moral, legal, personal, (i.e., subjective), and sociocultural.
Statistical normality is simply those behaviors in which a majority of people engage. From the standpoint of a normal curve model normal behavior would cluster around the mean while abnormal behavior would be two or more standard deviations away from the mean. Since most adults and adolescents use psychoactive drugs, "drug use" is statistically normal behavior. Drug abuse or a complete absence of drug taking behavior is statistically abnormal. Indeed, the non user may be "deviant" in the purely statistical sense. It may well be that the primary question among youth presented with the opportunity for experimentation is no longer "Why?" but "Why not?" (Cohen, 1971).
If one separates legal and illegal consumption a somewhat different picture emerges. Illegal drug usage rates are lower than the use of legal drugs. However, tens of millions of Americans have experimented with and/or occasionally use illegal drugs. Thus, at minimum, a substantial segment or minority of our population use or have used these drugs. Sarason and Sarason (1993) note "... deviant or unusual behavior is not necessarily maladaptive" (p. 5). A limitation of this perspective relates to our evaluation or judgments about either statistical normality or abnormal behavior. A lone Jew living in a predominantly Christian community would be a statistical abnormality. However, no rational analysis would consider the Jewish individual behaviorally deviant or abnormal. Conversely, leprosy would be statistically normal among residents of a leprosarium. Again, however, leprosy is still not a desired condition.
Clinical abnormality would be those behaviors, disorders or syndromes which health professionals classify as exhibiting pathology or disease. Examples would include pneumonia, cancer, bipolar disorder and schizophrenia. For drug taking behavior the criteria for clinical abnormality would be those for Substance Abuse Disorder or Substance Dependence Disorder as specified in the American Psychiatric Association's (1994) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition -- commonly known as DSM IV.
According to DSM IV, "the essential feature of Substance Abuse is a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances" (p. 182). The criteria for the disorder are that recurrent use of the drug has resulted in at least one of the following: failure to fulfill major role obligations at work, school or home, use in situations in which it is physically hazardous, repeated legal problems, or persistent social or interpersonal difficulties.
"The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance related problems" (DSM-IV, 1994, p. 176). The diagnosis may be applied when three or more of the following criteria are met: tolerance; withdrawal; loss of control; persistent desire to or inability to cut down; a great deal of time spent obtaining, using and recovering from effects of the drug; giving up other activities in order to use the drug; continued use despite physical or psychological problems caused by use. The mild, occasional or recreational use of drugs, whether legal or illegal clearly does not meet these criteria of clinical abnormality. DSM IV, in fact, explicitly states that, "Substance Related Disorders are distinguished from nonpathological substance use ... by the presence of tolerance, withdrawal, compulsive use, or substance related problems" (DSM-IV, 1994, p. 190).
Moral normality is concerned with the principle of right and wrong in relation to human action and character (Merriam-Webster's Collegiate Dictionary II, 1984). Many individuals view drug consumption, particularly of alcohol, tobacco and illegal drugs, as morally wrong. Their religious dogma, for example, may classify this behavior as a sin and against the will of God. On the other hand, many others see drug use as behavior that is not a moral issue but rather a matter of individual choice or as a morally acceptable choice.
Legal normality relates to the status of a behavior in relation to the judicial system. Anything illegal is abnormal while all legal behaviors are normal. The distribution or possession of illegal drugs and the distribution of alcohol and tobacco to minors are thus legally abnormal. Whereas, the possession of or distribution to adults of alcohol and tobacco is legal and normal under most circumstances. Exceptions to this would include drinking and driving and smoking tobacco in legally prohibited areas. Possible advantages of this definition include the clear, publically stated laws that people know about and can choose to obey. Clifford (1992) argues, however, that drug law enforcement varies across America contributing to increased negative consequences of drug abuse in e
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