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Grund sifaneck-cross-cultural dimensions of self-regulation-towards a multi-drug model
 

Grund sifaneck-cross-cultural dimensions of self-regulation-towards a multi-drug model

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    Grund sifaneck-cross-cultural dimensions of self-regulation-towards a multi-drug model Grund sifaneck-cross-cultural dimensions of self-regulation-towards a multi-drug model Presentation Transcript

    • Cross-Cultural Dimensions of Self-Regulation: Towards a Multi-Drug Model Jean-Paul Grund, Ph.D. The Lindesmith Center, Open Society Institute, Department of Sociology, UCONN & Stephen Sifaneck, Ph.D. Institute for AIDS Research, National Development & Research Institutes, John Jay College of Criminal Justice, CUNY
    • Is use of intoxicants abnormal? Deviant behaviors of (a minority of) consumers of illegal drugs are often directly attributed to a substance which renders them powerless. This popular wisdom is in various forms mirrored in several scientific explanations:  Over-powering pharmacological properties: “[Drugs] hijack the brain, eroding, but not erasing, the ability to control ... use.” (HDK, NYT, 41798)  deficient personality structures, impaired psychological development, acute distress, psychiatric problems.  Environmental deficits, (poverty, racism).
    • From a global and historical perspective, Intoxicant use is a norm  Societies differ only in respect to which drugs are defined as acceptable or unacceptable.
    • From a global and historical perspective, Intoxicant use is a norm   Societies differ only in respect to which drugs are defined as acceptable or unacceptable. Definitions may change over time.
    • From a global and historical perspective, Intoxicant use is a norm    Societies differ only in respect to which drugs are defined as acceptable or unacceptable. Definitions may change over time. We are not alone. A wide variety of species deliberately seek to change their consciousness by ingesting a range of psychoactive substances. (Siegel, 1990)
    • From a global and historical perspective, Intoxicant use is a norm     Societies differ only in respect to which drugs are defined as acceptable or unacceptable. Definitions may change over time. We are not alone. A wide variety of species deliberately seek to change their consciousness by ingesting a range of psychoactive substances. (Siegel, 1990) In the more complex human context, drug use fulfills important instrumental and symbolic functions for individuals and the social group.
    • Conceptual Problems and Bias (1)   Discourse: a strong concensus on nomenclature remains absent despite several efforts over the last decades (Edwards et al., 1981). The concept of addiction, for example, is generally presented as an isolated individual behavior without acknowledging the impact of "central cultural conceptions of motivation and behavior" (Peele, 1985) that vary across cultures and effect drug taking behavior.
    • Conceptual Problems and Bias (2)  Methodological limitations traceable to biased samples of addicts, generally collected in treatment settings lead to problems of conceptual generalization. – Behavior that is dysfunctional or abnormal from the clinician's perspective can be highly functional from the drug user's perspective. – Just as law enforcement personnel, clinicians generally see drug users “at their worst.”
    • The Presenters’ Bias    it is necessary to look beyond the clinical presentation of drug use and study its various expressions in their natural environment. Studying drug use in its natural setting offers a significant opportunity to collect basic information on patterns of use, interactions and other behaviors of drug users. It can show how these behaviors interact with external determinants, such as drug policy.
    • Some observations     90+% of alcohol users consume in a controlled fashion with few or no negative effects. Similar ratios have been observed in traditional opium using cultures. Women, particularly those with children, have higher abstinence rates than men after treatment for alcohol problems. Nowadays we see few “Bad Trips,” despite significant levels of psychedelics use.
    • Some observations     The average dose of XTC in the Netherlands is 1-1.5 tablets, while in Britain it is not unusual to take 4 or more tablets a night. Swedish cannabis users have much higher rates of psychiatric morbidity than Dutch users. Dealing cocaine smokers use more cocaine, but experience less cocaine-related problems than street users. Ketamine is typically snorted in New York, swallowed in London, and injected in Moscow.
    • Some observations   Although cannabis can be bought without fear of procecution in so-called coffee shops throughout the Netherlands, only 1.7 to 3 % of the population over age 12 used the drug in 1996 (LMP). Despite much stricter policies, a government study found in 1996 that 4.2 to 5.3 % of the U.S. population had used marihuana in the last month.
    • Pharmacology is not Destiny    Different people respond differently to the same drugs. The same people respond differently to the same drugs under different conditions. The effects of drugs are moderated by the psychological make-up of the user and the social environment in which drugs are consumed.
    • Drug Zinberg, 1982 Set Setting
    • Functions of Ritual  Ritualized behaviors serve a multitude of instrumental and symbolic functions, both for individuals and their social group. – Reduces fear and uncertainty; – Strengthens self-confidence, social solidarity; – Prepares for the execution of certain tasks; – Symbolizes transitions from one state to another, for example in a wedding ceremony, or when getting high.
    • BLUNTS & BLOWTJES
    • Blunts & Blowtjes     Cannabis preparation rituals Combination of Cannabis and Tobacco Symbolic meaning Self-regulatory function of rituals in different cultural contexts
    • The ritual sharing of drugs  In the Netherlands, heroin and cocaine are primarily obtained and frequently used at socalled deal and use addresses.  Usually several people are present in a pub-like atmosphere and in 50% of registered observations drugs were shared.
    • The ritual sharing of drugs  Instrumental function of drug sharing – Preventing withdrawal. "Helping" with a "betermakertje" (a little dose to ameliorate withdrawal) is a common motivation.
    • The ritual sharing of drugs  Symbolic and social functions of drug sharing – Opening of communication channels; – Strengthening ties among individual users – Strengthening social networks;
    • The ritual sharing of drugs  Symbolic and social functions of drug sharing – Opening of communication channels; – Strengthening ties among individual users – Strengthening social networks; – Smothering social conflict and feelings of animosity; – Creating and reinforcing feelings of identity, social solidarity and group cohesion.
    • Non-Injecting Heroin Use in NYC (A. Neaigus, PI)   Sample: N = 611 NIUs Sample typology: – Never injectors 70% – Experimental injectors 8% – Ex-injectors 22% Use alone 34%, with single partner 21%  Reported no dependence 35% 
    • A paradoxical observation  The ability to exercize control over individual drug use is not evenly spread over all users. – Some cocaine users, such as dealers, use large amounts of cocaine seemingly with little or no cocaine-related problems. – Other users --typically the "down and out" street junkies-- actually use much less cocaine, but seem most susceptible to cocaine-related problems.
    • Two conclusions   Self-regulation is more than limiting the intake of drugs. It is a multidimensional process, which includes prevention and management of drug related problems. The effectivity of rituals and rules in regulating drug use is moderated by additional factors which impact on the individual's ability to comply with these rituals and rules.