International Journal of the Addictions
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
The Need for Standardized, Scientific Criteria for Describing Drug-Using Behavior Donald G. Walker To cite this article: Donald G. Walker (1975) The Need for Standardized, Scientific Criteria for Describing Drug-Using Behavior, International Journal of the Addictions, 10:6, 927-936, DOI: 10.3109/10826087509028351 To link to this article: http://dx.doi.org/10.3109/10826087509028351
Published online: 03 Jul 2009.
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The International Journal of the Addictions, 10(6), pp. 927-936, 1975
The Need for Standardized, Scientific Criteria for Describing Drug-Using Behavior Donald G.Walker, Ph.D. Center for the Study of Social Behavior Research Triangle Institute Research Triangle Park, North Carolina
The purpose of this paper is to indicate the need for scientific criteria which can be applied toward the development of standardized measures of drug use. By scientific criteria are meant the dimensions by which the drug use of individuals or groups of individuals can be unambiguously defined. Each criterion that is developed should have the following characteristics : (1) utility, ( 2 ) objectivity, and (3) quantifiability. The utility of a criterion can be judged in terms of the development and testing of theory, the formulation and evaluation of social policy, and the diagnosis and treatment of problem drug use. Criteria should be developed with utility in each of the areas just described. The goal would be to develop minimum sets of criteria that will allow for efficient communication about the drug use of individuals or groups. Objectivity requires that different observers be in agreement regarding the veracity of an empirical event. As an example of the lack of objectivity 927 Copyright 0 1975 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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in current drug use research, almost all instruments are based on the untested assumption that the respondents agree on what substances belong in the various drug categories (e.g., narcotics). The criteria developed must be objective in that different observers, by using these criteria, will tend to describe the drug use of an individual or group in an identical manner. Quantification of criteria is essential for two reasons. First, numerical indices make it possible to report results in finer detail than is possible with relative terms such as “more” or ‘‘less.’’ A second advantage is that it permits the use of more powerful mathematical analyses to assess the results of research.
OVERVl EW The National Commission on Marihuana and Drug Abuse (1973) made the following comment regarding drug-using criteria (p. 93) : Drug-using behavior is too often described by an array of nonspecific, unscientific and judgmental terms. Consequently, it is often difficult to ascertain who is being described, what kind of behavior involving which drugs is being evaluated, what conditions and circumstances are most likely to generate serious risktaking behavior, or what the actual and potential risks of such behavior are likely to be relative to both the individual and the society. Such nonspecific, unscientific, and judgmental criteria make comparisons of the results of various research programs difficult if not impossible to conduct. A major contribution to drug use research will be the development and acceptance of standardized, scientific criteria for describing drugusing behavior. In a recent survey of studies of illicit drug use (Glenn, 1974), it was noted that some 60 terms were used to describe the drugs on which use data were collected. Different researchers often used different definitions for the same term (e.g., “hallucinogens”), and classified drugs in different ways. There were many cases when it was not clear just what substances a given term was meant to include. Following is a list of the most common terms used in the studies cited by Glenn: Marijuana Hallucinogens
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Psychedelics Amphetamines Stimulants Uppers Barbiturates Depressants Downers Tranquilizers Inhalents Solvents Volatiles Narcotics It is interesting to note that marijuana was almost always classed by itself while other substances (e.g., cocaine, opium, heroin, morphine) tended to be grouped under a more general term (e.g., narcotics). The result was usually a mixture of general and specific terms to describe the substances of abuse. Sometimes the respondent was required to choose between two equally ambiguous terms like “speed” and “pep pills” (Babst and Brill, 1972). The survey by Glenn also revealed the variety of approaches researchers have used to indicate the extent of drug use. One of the most popular methods was to report drug use in terms of ever used versus never used. Sometimes this method was modified by adding additional categories for ever use as reported by the Utah State Board of Education (1972): Used Used Used Used
once 2-5 times 6-10 times more than 10 times
Another variation of the ever-use method was to give names to these categories as reported b y Nelson and Panzarella (197 1) : Experimental ( 1 4 times) Casual (5-19) Heavy (20-199) Habitual (200+) The other popular method for describing the extent of use was to have
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the respondents indicate how often they used each substance within a specified time period, like the previous month or the previous year. Johnston (1973) instructed respondents to indicate their extent of drug use during their high school years and their extent of use during the year after high school in a retrospective study. The frequency categories he used were: Nearly every day Once or twice a week Once or twice a month 3-10 times a year Once or twice a year
To date, as indicated in Glenn’s survey, extent of drug use is described with a wide array of crude frequency indicators with rarely a reference to the quantity and purity of typical doses. In an attempt to bring some order to this chaos, the National Commission on Marihuana and Drug Abuse has defined five classes of drug-using behavior (pp. 95-98) : Experimental Use
Experimental use is defined by the Commission as the shortterm, nonpatterned trial of one or more drugs, either concurrently or consecutively, with a variable intensity but maximum frequency of 10 times per drug, used either singly or in combination. Experimental use is primarily motivated by curiosity or the desire to experience new feeling or mood states, or to assess anticipated drug effects. It most often occurs in the shared company of one or more drug-experimenting friends or social acquaintances and is generally viewed in the context of social activity. Social-Recreational Use
Social or recreational use, like experimental drug use, occurs in social settings among friends or acquaintances who desire to share an experience perceived by them as both acceptable and pleasurable. Unlike experimental use, social and recreational use tends to be more patterned but considerably more variable in terms of frequency, intensity, and duration. The most distinguishing characteristic of such use is that it is a voluntary act and, regardless of the duration of use, tends not
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to escalate in either frequency or intensity to patterns of uncontrolled and uncontrollable use which is personally rather than socially motivated. Nor is it sustained by virtue of the dependence of the user in any meaningful sense of that term.
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Circumstantial-Situational Use
Circumstantial use is generally task-specific, self-limited use which may be variably patterned, differing in frequency, intensity, and duration. The distinguishing feature of this pattern is that use is motivated by the perceived need or desire to achieve a known and anticipated effect deemed desirable to cope with a specific, sometimes recurrent, situation or condition of a personal or vocational nature. Such users include students whose drug use is attendant to examination preparation, long distance truckers who rely on drugs to provide extended endurance and alertness, military personnel using drugs in stress and combat situations, athletes who use drugs to improve their performance or to extend their endurance, and most forms of self-medication in response to a particular task or situation. As is illustrated by the individual who goes on an alcohol binge three or four times a year, usually when particular stress situations become unbearable, circumstantial use can be episodic but intense and enduring. Generally, individuals do not exhibit impairment of dysfunction during use, except, perhaps, in spree use situations such as an alcohol binge, and they generally discontinue use subsequent to task completion without experiencing physiological or psychological impairment or reduced individual or social functioning. Intensified Drug Use
Intensified use is generally a long-term, patterned use of drugs at a minimum level of at least once daily and is motivated by an individual’s perceived need to achieve relief from a persistent problem or stressful situation or his desire to maintain a certain self-prescribed level of performance. Use includes both social and nonsocial settings, but often takes the form of recurrent self-medication. Included here are the housewife who regularly consumes barbiturates or tranquilizers, and the daily tranquilizerusing or heavy alcohol-consuming executive.
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A distinguishing characteristic of this class of behavior is the regular use of one or a combination of drugs escalating to patterns of consumption which might properly be defined as dependence. For individuals who adopt this pattern, drug use becomes a normal and customary activity of everyday life. However, these individuals generally remain both socially and economically integrated in the life of the community; there appears to be no substantial change in their major behavior patterns or key interpersonal relationships consequent to their drug use, although some decrement in functioning may be apparent depending on the frequency, intensity, and amount of use, Compulsive Drug Use
Compulsive use is patterned at both high frequency and high intensity levels of relatively long duration, producing physiological or psychological dependence such that the individual cannot at will discontinue such use without experiencing physiological discomfort or psychological disruption. It is characterized primarily by significantly reduced individual and social functioning. Motivation to continue use at this level stems primarily from the need to elicit a sense of security, comfort, or relief related to the person’s initial reasons for regularly using the drug; that is, it is primarily psychologically motivated and reinforced. Where the individual is dependent psychologically upon a drug which also has physiologic dependence-producing characteristics, such as alcohol, barbiturates, and heroin, the dependence is secondarily reinforced by the individual’s desire to avoid the pain and distress of physical withdrawal. Therefore, compulsive use may be characterized by preoccupation with obtaining adequate and sufficient amounts of the drug in order to forestall the abstinence syndrome. It should be noted, however, that by no means all persons who are clinically so categorized fit the description of the street “junkie” or “skid row” alcoholic, nor is total involvement with an underworld supply network or life style inevitable. This group might include “hidden” drug-dependent persons such as some opiate-dependent physicians, barbiturate-dependent housewives, and alcohol-dependent white-collar workers. It remains to be seen whether these definitions will be accepted by the
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research community, and whether they can be operationalized. As they are now stated, they lack the specificity and precision to qualify as scientific research criteria. Furthermore, there is no empirical evidence to indicate that this classification scheme mirrors reality in some useful way.
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POLYDRUG USE Assuming that greater specificity and precision can be achieved with the classes of drug-using behavior identified by the National Commission, an important weakness would remain. That is the failure of this scheme to adequately describe polydrug use. Researchers generally focus on the use of specific drugs rather than on providing an overall description of use (cf., Langrod, 1970). Even when researchers report on the use of several drugs, as is typical of drug-use surveys, indications of the extent of combination drug use are rarely given. This is unfortunate, especially since the data are generally available and could be used for this purpose. At best, the practice of reporting only specific drug use (or use of substances in specific drug categories) results in an incomplete picture of the situation. For example, suppose a drug survey shows that 40% of a population is reporting marijuana use and 15% is reporting the use of amphetamines. The extent of drug use in that survey population (discounting the use of other drugs) ranges from 40 to 55%, depending on the number of marijuana users who are also amphetamine users. The proportion of drug users who are multiple drug users is generally found to be quite high. In a study of institutionalized heroin addicts (Langrod, 1970) it was found that nearly all the subjects reported use of marijuana, and over one-third reported use of cocaine, amphetamines, baribiturates, and other drugs. According to the author, “The mean number of drugs used by respondent, not counting heroin, was 3.4. Only one in ten reported using none or one other drug in addition to heroin.” In a study of adolescent drug use (Hughes, Schaps, and Sanders, 1973), the authors concluded that “the majority of heavy drug users are not ‘speed (amphetamine) freaks’ or ‘acid (LSD) heads,’ but are in reality multiple drug users who may take drugs in many different combinations.” At worst, reporting only the use of specific drugs results in improper medical diagnosis (cf., Gay, 1972) or erroneous conclusions in research. In a recent critique of a study linking marijuana use to brain damage (Grinspoon, 1972), the author pointed out that all of the “marijuana” users were, in reality, multiple drug users. Of the 10 cases studied, the author con-
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cluded that “All of the brain damage observed could have been caused by the ingestion of other drugs or the impurities often found in street drugs.” The importance and pervasiveness of polydrug use is beginning to be recognized in both research and treatment (cf., Drugs and Drug Abuse Education Newsletter, Scope Publications, July 1973). But much remains to be done in terms of the development of measurement criteria for describing polydrug use.
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OTHER DIMENSIONS OF USE The National Commission’s classification scheme is important because it emphasizes factors other than quantity and frequency (the usual research criteria) in the description of drug use. These factors include motivation for use, setting in which use occurs, degree of drug dependence, social and economic integration, physical functioning, psychological disruption, and amount of preoccuptation with drugs. The Commission’s scheme does, however, omit some potentially important dimensions in describing drug use. These include massing (or spacing) of doses, dose size, route of administration, probable metabolic rates, and actual substance administered. Metabolic rates, massing of doses, and dose size are frequently assessed in the description of alcohol use (Cahalan and Cisin, 1968a, 196813; Jessor, Graves, Hanson, and Jessor, 1968; Ewing and Rouse, 1972). Route of administration is not typically a problem in alcohol use because alcohol is rarely taken by any route other than oral. This is a simple situation in comparison with some drugs which can be smoked, sniffed, eaten, or injected (in several different ways), and the effectiveness of a given dose varies considerably with the route of administration. The actual substance administered is also rarely a problem in alcohol research. Alcohol is found in three primary forms (beer, wine, and distilled spirits), usually in a known concentration of solution with water. An individual can have a high degree of confidence that he is actually ingesting a known concentration and purity of alcohol when he thinks he is. Such is not the case with the controlled substances generally referred to as drugs, especially the street variety. In reviewing problems associated with cannabis research (Triesman, 1973), the author made the following comments regarding the street purity of cannabis (p. 669): Even the cannabis is of absolutely unknown quality. A study by Van der Helm (1972) of cannabis samples bought from street dealers shows that 10 perecent of samples was markedly impure,
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and another 10 percent contained no cannabis at all. Peterson’s (1971) study of samples bought in street sales by regular buyers showed that when the purchase was assayed, “what is commonly called marijuana in the United States revealed on analysis to consist of a mixture of crushed leaves, flowers, and often twigs of the Indian Hemp plant Cannabis sativa.” The mixture could vary from being psychoactively inert to halluninogenic, depending on dosage and quality. Only 66 percent of samples actually contained any cannabis, and this portion was adulterated with many, usually psychoactively inert, substances. It would be scientifically inaccurate to say we were talking about the effects of marijuana on the behaviors and personalities of those who inhaled this strange mixture. Studies of “users” of the “drug” in real-life situations could never presume to anything so apodictic. Even in the commonly accepted pathophysiology of a syndrome like chronic heroin addiction, appearances and reality do not always coincide. The vein tracts and skin abscesses typically associated with chronic heroin addiction are really the result of adulteration by quinine hydrochloride (Primm and Bath, 1973). In discussing the syndrome they call pseudoheroinism, the authors reviewed the role and significance of numerous substances (e.g., procaine, methyl pyrilene, and caffeine) in typical heroin addiction syndromes. The authors conclude (p. 2 7 Q “chronic heroin addiction (in the United States) has been revealed to be a disease in which the major drug of abuse (quantitatively) is not heroin but quinine, and which is characterized by signs and syndromes caused not by heroin but by nonheroin factors.” The authors go on to conclude that the small amounts of heroin in street heroin in the United States precludes true addiction based on physical dependence, and instead is “based primarily upon a psychological dependence which is drug-dissociated.”
SUMMARY To date there exist no measurement criteria in the field of drug abuse research that could be regarded as being scientific. As a result, the measures typically employed are of dubious reliability and validity, the findings of independent researchers cannot be compared meaningfully, and rational communication about drug abuse issues is exceedingly difficult. Yet little has been done to bring scientific objectivity to this field of research, nor does there appear to be a clamor of insistance to do so.
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There is clearly a need for the development of scientific (objective, quantifiable) criteria for describing drug-using behavior. The criteria developed should have general utilities for policy making, diagnosis, and research applications.
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REFERENCES BABST, D.V., and BRILL, L. Drug Abuse Patterns among Students in an Upstate New York Urban Area. New York State Narcotic Addictions Control Commission, 1972, mimeograph. CAHALAN, D., and CISIN, I.H. American drinking practices: Summary of findings from a national probability sample. I. Extent of drinking by population subgroups. Quart. J. Studies Alc. 29: 130-151, 1968a. CAHALAN, D., and CISIN, I.H. American drinking practices: Summary of findings from a national probability sample. 11. Measurement of massed versus spaced drinking. Quart. J. Studies Alc. 29: 642-656, 1968b. EWING, J.A., and ROUSE, B.A. Measuring Alcohol Consumption: The “Alcohol Quotient. ” Chapel Hill, North Carolina: Univ. North Carolina Center for Alcohol Studies, 1972, mimeographed. GAY, G.M. “Doctor, there’s an unconscious junkie in your waiting room.” Contemp. Drug Problems 1 : 735-746, 1972. GLENN, W.A. A Compendium of Recent Studies of Zllegal Drug Use. Research Triangle Institute, Final Report, Contract no. HSM-72-72-169, 1974. GRINSPOON, L. Marijuana and brain damage: A criticism of the study by A.M.G. Campbell et al. Contemp. Drug Problems 1 : 811-814, 1972. JESSOR, R., GRAVES, T.D., HANSON, R.C., and JESSOR, S.L. Society. Personality, and Deviant Behavior. New York: Holt, Rinehart, and Winston, 1968. JOHNSTON, L. Drugs and American Youth. Ann Arbor, Michigan: Institute for Social Research, 1973. LANGROD. J. Secondary drug use among heroin users. Intern. J. Addictions 5 : 611635, 1970. NELSON, K.E., and PANZARELLA, J. Preliminary Findings-Prevalence of Drug Use, Enlisted Vietnam Returnees Processing for ETS Separation. Oakland Overseas Processing Center, 1971, mimeograph. PRIMM, B.J., and BATH, P.E. Pseudoheroinism. Intern. J. Addictions 8: 231-242,1973. SECOND REPORT OF THE NATIONAL COMMISSION ON MARIHUANA AND DRUG ABUSE: Washington, D.C.: U.S. Government Printing Office, 1973. TRIESMAN, D. Logical problems in contemporary cannabis research. Intern. J. Addictions 8 : 667-682, 1973. UTAH 1972 STATEWIDE DRUG ASSESSMENT. Utah State Board of Education, 1972, mimeograph.
ISSN: 0020-773X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/isum19
The Need for Standardized, Scientific Criteria for Describing Drug-Using Behavior Donald G. Walker To cite this article: Donald G. Walker (1975) The Need for Standardized, Scientific Criteria for Describing Drug-Using Behavior, International Journal of the Addictions, 10:6, 927-936, DOI: 10.3109/10826087509028351 To link to this article: http://dx.doi.org/10.3109/10826087509028351
Published online: 03 Jul 2009.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=isum19 Download by: [ECU Libraries]
Date: 29 March 2016, At: 21:40
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The International Journal of the Addictions, 10(6), pp. 927-936, 1975
The Need for Standardized, Scientific Criteria for Describing Drug-Using Behavior Donald G.Walker, Ph.D. Center for the Study of Social Behavior Research Triangle Institute Research Triangle Park, North Carolina
The purpose of this paper is to indicate the need for scientific criteria which can be applied toward the development of standardized measures of drug use. By scientific criteria are meant the dimensions by which the drug use of individuals or groups of individuals can be unambiguously defined. Each criterion that is developed should have the following characteristics : (1) utility, ( 2 ) objectivity, and (3) quantifiability. The utility of a criterion can be judged in terms of the development and testing of theory, the formulation and evaluation of social policy, and the diagnosis and treatment of problem drug use. Criteria should be developed with utility in each of the areas just described. The goal would be to develop minimum sets of criteria that will allow for efficient communication about the drug use of individuals or groups. Objectivity requires that different observers be in agreement regarding the veracity of an empirical event. As an example of the lack of objectivity 927 Copyright 0 1975 by Marcel Dekker, Inc. All Rights Reserved. Neither this work nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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in current drug use research, almost all instruments are based on the untested assumption that the respondents agree on what substances belong in the various drug categories (e.g., narcotics). The criteria developed must be objective in that different observers, by using these criteria, will tend to describe the drug use of an individual or group in an identical manner. Quantification of criteria is essential for two reasons. First, numerical indices make it possible to report results in finer detail than is possible with relative terms such as “more” or ‘‘less.’’ A second advantage is that it permits the use of more powerful mathematical analyses to assess the results of research.
OVERVl EW The National Commission on Marihuana and Drug Abuse (1973) made the following comment regarding drug-using criteria (p. 93) : Drug-using behavior is too often described by an array of nonspecific, unscientific and judgmental terms. Consequently, it is often difficult to ascertain who is being described, what kind of behavior involving which drugs is being evaluated, what conditions and circumstances are most likely to generate serious risktaking behavior, or what the actual and potential risks of such behavior are likely to be relative to both the individual and the society. Such nonspecific, unscientific, and judgmental criteria make comparisons of the results of various research programs difficult if not impossible to conduct. A major contribution to drug use research will be the development and acceptance of standardized, scientific criteria for describing drugusing behavior. In a recent survey of studies of illicit drug use (Glenn, 1974), it was noted that some 60 terms were used to describe the drugs on which use data were collected. Different researchers often used different definitions for the same term (e.g., “hallucinogens”), and classified drugs in different ways. There were many cases when it was not clear just what substances a given term was meant to include. Following is a list of the most common terms used in the studies cited by Glenn: Marijuana Hallucinogens
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Psychedelics Amphetamines Stimulants Uppers Barbiturates Depressants Downers Tranquilizers Inhalents Solvents Volatiles Narcotics It is interesting to note that marijuana was almost always classed by itself while other substances (e.g., cocaine, opium, heroin, morphine) tended to be grouped under a more general term (e.g., narcotics). The result was usually a mixture of general and specific terms to describe the substances of abuse. Sometimes the respondent was required to choose between two equally ambiguous terms like “speed” and “pep pills” (Babst and Brill, 1972). The survey by Glenn also revealed the variety of approaches researchers have used to indicate the extent of drug use. One of the most popular methods was to report drug use in terms of ever used versus never used. Sometimes this method was modified by adding additional categories for ever use as reported by the Utah State Board of Education (1972): Used Used Used Used
once 2-5 times 6-10 times more than 10 times
Another variation of the ever-use method was to give names to these categories as reported b y Nelson and Panzarella (197 1) : Experimental ( 1 4 times) Casual (5-19) Heavy (20-199) Habitual (200+) The other popular method for describing the extent of use was to have
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the respondents indicate how often they used each substance within a specified time period, like the previous month or the previous year. Johnston (1973) instructed respondents to indicate their extent of drug use during their high school years and their extent of use during the year after high school in a retrospective study. The frequency categories he used were: Nearly every day Once or twice a week Once or twice a month 3-10 times a year Once or twice a year
To date, as indicated in Glenn’s survey, extent of drug use is described with a wide array of crude frequency indicators with rarely a reference to the quantity and purity of typical doses. In an attempt to bring some order to this chaos, the National Commission on Marihuana and Drug Abuse has defined five classes of drug-using behavior (pp. 95-98) : Experimental Use
Experimental use is defined by the Commission as the shortterm, nonpatterned trial of one or more drugs, either concurrently or consecutively, with a variable intensity but maximum frequency of 10 times per drug, used either singly or in combination. Experimental use is primarily motivated by curiosity or the desire to experience new feeling or mood states, or to assess anticipated drug effects. It most often occurs in the shared company of one or more drug-experimenting friends or social acquaintances and is generally viewed in the context of social activity. Social-Recreational Use
Social or recreational use, like experimental drug use, occurs in social settings among friends or acquaintances who desire to share an experience perceived by them as both acceptable and pleasurable. Unlike experimental use, social and recreational use tends to be more patterned but considerably more variable in terms of frequency, intensity, and duration. The most distinguishing characteristic of such use is that it is a voluntary act and, regardless of the duration of use, tends not
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to escalate in either frequency or intensity to patterns of uncontrolled and uncontrollable use which is personally rather than socially motivated. Nor is it sustained by virtue of the dependence of the user in any meaningful sense of that term.
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Circumstantial-Situational Use
Circumstantial use is generally task-specific, self-limited use which may be variably patterned, differing in frequency, intensity, and duration. The distinguishing feature of this pattern is that use is motivated by the perceived need or desire to achieve a known and anticipated effect deemed desirable to cope with a specific, sometimes recurrent, situation or condition of a personal or vocational nature. Such users include students whose drug use is attendant to examination preparation, long distance truckers who rely on drugs to provide extended endurance and alertness, military personnel using drugs in stress and combat situations, athletes who use drugs to improve their performance or to extend their endurance, and most forms of self-medication in response to a particular task or situation. As is illustrated by the individual who goes on an alcohol binge three or four times a year, usually when particular stress situations become unbearable, circumstantial use can be episodic but intense and enduring. Generally, individuals do not exhibit impairment of dysfunction during use, except, perhaps, in spree use situations such as an alcohol binge, and they generally discontinue use subsequent to task completion without experiencing physiological or psychological impairment or reduced individual or social functioning. Intensified Drug Use
Intensified use is generally a long-term, patterned use of drugs at a minimum level of at least once daily and is motivated by an individual’s perceived need to achieve relief from a persistent problem or stressful situation or his desire to maintain a certain self-prescribed level of performance. Use includes both social and nonsocial settings, but often takes the form of recurrent self-medication. Included here are the housewife who regularly consumes barbiturates or tranquilizers, and the daily tranquilizerusing or heavy alcohol-consuming executive.
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A distinguishing characteristic of this class of behavior is the regular use of one or a combination of drugs escalating to patterns of consumption which might properly be defined as dependence. For individuals who adopt this pattern, drug use becomes a normal and customary activity of everyday life. However, these individuals generally remain both socially and economically integrated in the life of the community; there appears to be no substantial change in their major behavior patterns or key interpersonal relationships consequent to their drug use, although some decrement in functioning may be apparent depending on the frequency, intensity, and amount of use, Compulsive Drug Use
Compulsive use is patterned at both high frequency and high intensity levels of relatively long duration, producing physiological or psychological dependence such that the individual cannot at will discontinue such use without experiencing physiological discomfort or psychological disruption. It is characterized primarily by significantly reduced individual and social functioning. Motivation to continue use at this level stems primarily from the need to elicit a sense of security, comfort, or relief related to the person’s initial reasons for regularly using the drug; that is, it is primarily psychologically motivated and reinforced. Where the individual is dependent psychologically upon a drug which also has physiologic dependence-producing characteristics, such as alcohol, barbiturates, and heroin, the dependence is secondarily reinforced by the individual’s desire to avoid the pain and distress of physical withdrawal. Therefore, compulsive use may be characterized by preoccupation with obtaining adequate and sufficient amounts of the drug in order to forestall the abstinence syndrome. It should be noted, however, that by no means all persons who are clinically so categorized fit the description of the street “junkie” or “skid row” alcoholic, nor is total involvement with an underworld supply network or life style inevitable. This group might include “hidden” drug-dependent persons such as some opiate-dependent physicians, barbiturate-dependent housewives, and alcohol-dependent white-collar workers. It remains to be seen whether these definitions will be accepted by the
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research community, and whether they can be operationalized. As they are now stated, they lack the specificity and precision to qualify as scientific research criteria. Furthermore, there is no empirical evidence to indicate that this classification scheme mirrors reality in some useful way.
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POLYDRUG USE Assuming that greater specificity and precision can be achieved with the classes of drug-using behavior identified by the National Commission, an important weakness would remain. That is the failure of this scheme to adequately describe polydrug use. Researchers generally focus on the use of specific drugs rather than on providing an overall description of use (cf., Langrod, 1970). Even when researchers report on the use of several drugs, as is typical of drug-use surveys, indications of the extent of combination drug use are rarely given. This is unfortunate, especially since the data are generally available and could be used for this purpose. At best, the practice of reporting only specific drug use (or use of substances in specific drug categories) results in an incomplete picture of the situation. For example, suppose a drug survey shows that 40% of a population is reporting marijuana use and 15% is reporting the use of amphetamines. The extent of drug use in that survey population (discounting the use of other drugs) ranges from 40 to 55%, depending on the number of marijuana users who are also amphetamine users. The proportion of drug users who are multiple drug users is generally found to be quite high. In a study of institutionalized heroin addicts (Langrod, 1970) it was found that nearly all the subjects reported use of marijuana, and over one-third reported use of cocaine, amphetamines, baribiturates, and other drugs. According to the author, “The mean number of drugs used by respondent, not counting heroin, was 3.4. Only one in ten reported using none or one other drug in addition to heroin.” In a study of adolescent drug use (Hughes, Schaps, and Sanders, 1973), the authors concluded that “the majority of heavy drug users are not ‘speed (amphetamine) freaks’ or ‘acid (LSD) heads,’ but are in reality multiple drug users who may take drugs in many different combinations.” At worst, reporting only the use of specific drugs results in improper medical diagnosis (cf., Gay, 1972) or erroneous conclusions in research. In a recent critique of a study linking marijuana use to brain damage (Grinspoon, 1972), the author pointed out that all of the “marijuana” users were, in reality, multiple drug users. Of the 10 cases studied, the author con-
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cluded that “All of the brain damage observed could have been caused by the ingestion of other drugs or the impurities often found in street drugs.” The importance and pervasiveness of polydrug use is beginning to be recognized in both research and treatment (cf., Drugs and Drug Abuse Education Newsletter, Scope Publications, July 1973). But much remains to be done in terms of the development of measurement criteria for describing polydrug use.
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OTHER DIMENSIONS OF USE The National Commission’s classification scheme is important because it emphasizes factors other than quantity and frequency (the usual research criteria) in the description of drug use. These factors include motivation for use, setting in which use occurs, degree of drug dependence, social and economic integration, physical functioning, psychological disruption, and amount of preoccuptation with drugs. The Commission’s scheme does, however, omit some potentially important dimensions in describing drug use. These include massing (or spacing) of doses, dose size, route of administration, probable metabolic rates, and actual substance administered. Metabolic rates, massing of doses, and dose size are frequently assessed in the description of alcohol use (Cahalan and Cisin, 1968a, 196813; Jessor, Graves, Hanson, and Jessor, 1968; Ewing and Rouse, 1972). Route of administration is not typically a problem in alcohol use because alcohol is rarely taken by any route other than oral. This is a simple situation in comparison with some drugs which can be smoked, sniffed, eaten, or injected (in several different ways), and the effectiveness of a given dose varies considerably with the route of administration. The actual substance administered is also rarely a problem in alcohol research. Alcohol is found in three primary forms (beer, wine, and distilled spirits), usually in a known concentration of solution with water. An individual can have a high degree of confidence that he is actually ingesting a known concentration and purity of alcohol when he thinks he is. Such is not the case with the controlled substances generally referred to as drugs, especially the street variety. In reviewing problems associated with cannabis research (Triesman, 1973), the author made the following comments regarding the street purity of cannabis (p. 669): Even the cannabis is of absolutely unknown quality. A study by Van der Helm (1972) of cannabis samples bought from street dealers shows that 10 perecent of samples was markedly impure,
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and another 10 percent contained no cannabis at all. Peterson’s (1971) study of samples bought in street sales by regular buyers showed that when the purchase was assayed, “what is commonly called marijuana in the United States revealed on analysis to consist of a mixture of crushed leaves, flowers, and often twigs of the Indian Hemp plant Cannabis sativa.” The mixture could vary from being psychoactively inert to halluninogenic, depending on dosage and quality. Only 66 percent of samples actually contained any cannabis, and this portion was adulterated with many, usually psychoactively inert, substances. It would be scientifically inaccurate to say we were talking about the effects of marijuana on the behaviors and personalities of those who inhaled this strange mixture. Studies of “users” of the “drug” in real-life situations could never presume to anything so apodictic. Even in the commonly accepted pathophysiology of a syndrome like chronic heroin addiction, appearances and reality do not always coincide. The vein tracts and skin abscesses typically associated with chronic heroin addiction are really the result of adulteration by quinine hydrochloride (Primm and Bath, 1973). In discussing the syndrome they call pseudoheroinism, the authors reviewed the role and significance of numerous substances (e.g., procaine, methyl pyrilene, and caffeine) in typical heroin addiction syndromes. The authors conclude (p. 2 7 Q “chronic heroin addiction (in the United States) has been revealed to be a disease in which the major drug of abuse (quantitatively) is not heroin but quinine, and which is characterized by signs and syndromes caused not by heroin but by nonheroin factors.” The authors go on to conclude that the small amounts of heroin in street heroin in the United States precludes true addiction based on physical dependence, and instead is “based primarily upon a psychological dependence which is drug-dissociated.”
SUMMARY To date there exist no measurement criteria in the field of drug abuse research that could be regarded as being scientific. As a result, the measures typically employed are of dubious reliability and validity, the findings of independent researchers cannot be compared meaningfully, and rational communication about drug abuse issues is exceedingly difficult. Yet little has been done to bring scientific objectivity to this field of research, nor does there appear to be a clamor of insistance to do so.
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There is clearly a need for the development of scientific (objective, quantifiable) criteria for describing drug-using behavior. The criteria developed should have general utilities for policy making, diagnosis, and research applications.
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REFERENCES BABST, D.V., and BRILL, L. Drug Abuse Patterns among Students in an Upstate New York Urban Area. New York State Narcotic Addictions Control Commission, 1972, mimeograph. CAHALAN, D., and CISIN, I.H. American drinking practices: Summary of findings from a national probability sample. I. Extent of drinking by population subgroups. Quart. J. Studies Alc. 29: 130-151, 1968a. CAHALAN, D., and CISIN, I.H. American drinking practices: Summary of findings from a national probability sample. 11. Measurement of massed versus spaced drinking. Quart. J. Studies Alc. 29: 642-656, 1968b. EWING, J.A., and ROUSE, B.A. Measuring Alcohol Consumption: The “Alcohol Quotient. ” Chapel Hill, North Carolina: Univ. North Carolina Center for Alcohol Studies, 1972, mimeographed. GAY, G.M. “Doctor, there’s an unconscious junkie in your waiting room.” Contemp. Drug Problems 1 : 735-746, 1972. GLENN, W.A. A Compendium of Recent Studies of Zllegal Drug Use. Research Triangle Institute, Final Report, Contract no. HSM-72-72-169, 1974. GRINSPOON, L. Marijuana and brain damage: A criticism of the study by A.M.G. Campbell et al. Contemp. Drug Problems 1 : 811-814, 1972. JESSOR, R., GRAVES, T.D., HANSON, R.C., and JESSOR, S.L. Society. Personality, and Deviant Behavior. New York: Holt, Rinehart, and Winston, 1968. JOHNSTON, L. Drugs and American Youth. Ann Arbor, Michigan: Institute for Social Research, 1973. LANGROD. J. Secondary drug use among heroin users. Intern. J. Addictions 5 : 611635, 1970. NELSON, K.E., and PANZARELLA, J. Preliminary Findings-Prevalence of Drug Use, Enlisted Vietnam Returnees Processing for ETS Separation. Oakland Overseas Processing Center, 1971, mimeograph. PRIMM, B.J., and BATH, P.E. Pseudoheroinism. Intern. J. Addictions 8: 231-242,1973. SECOND REPORT OF THE NATIONAL COMMISSION ON MARIHUANA AND DRUG ABUSE: Washington, D.C.: U.S. Government Printing Office, 1973. TRIESMAN, D. Logical problems in contemporary cannabis research. Intern. J. Addictions 8 : 667-682, 1973. UTAH 1972 STATEWIDE DRUG ASSESSMENT. Utah State Board of Education, 1972, mimeograph.
