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CHAPTER 2
The Etiology of Addiction
Almost everyone has an easy answer to the
question: Why do people use drugs? According
to Stewart (1987), heroin addicts
use “junk” the fi rst time because they are curious.
Heroin has a mystique. It is used by pop stars, writers,
and glamorous people, and they like its effect.
For those who fi nd daily life to be fairly humdrum,
heroin can be the ultimate filler of gaps—it can
substitute for career, religion, romance, or virtually
anything else. Weil and Rosen (1993) believe
that drug use (and addiction) results from humans’
longing for a sense of completeness and wholeness,
and searching for satisfaction outside of
themselves. As noted author (and addict) William
S. Burroughs (1977) indicated in Junky, “Junk
wins by default. I tried it as a matter of curiosity.
I drifted along taking shots when I could score. I
ended up hooked” (p. xv). This notion of drift is a
recurrent theme in theories of addiction.
People begin using cocaine for some of the
same reasons. According to Baum (1985), his clients
provided these excuses for using cocaine:
“The mystical reputation aroused my curiosity.” . . .
“It’s available and being offered all the time.” . . .
“It gave me a sense of well-being, like I was worth
something.” . . .
“It felt good to be a part of a group.” . . .
“It was a great way to escape.” (pp. 25–42)
The reasons why people continue to use drugs
to the point of becoming physically and/or psychologically
dependent on them are more complex.
Some have attempted to explain this phenomenon
as a defi cit in moral values, a disease, conditioning
or learned behavior, or as a genetic propensity.
Still others see it as a “rewiring” of the brain (see
Chapter 3 ). At this point, there is no one single
theory that adequately explains addiction.
Jacobs (1986) attempted to develop a general
theory of addiction, drawing on his experience
and research with gamblers. In his view, addiction
is a dependent state acquired over time to
relieve stress. Two interrelated sets of factors are
required to predispose persons to addiction: an abnormal
physiological resting state, and childhood
experiences producing a deep sense of inadequacy.
He argues that all addictions (drugs, sex,
alcohol, etc.) follow a similar three-stage course of
development.
Most models of addiction assume that an addiction
is an “addictive disease” (Washton, 1989,
p. 55). As such, it continues to exist whether or
not the addicted person continues to use the drug.
Even if a person who has the disease is abstinent for
a long period of time, the symptoms of addiction
will appear again from renewed contact with the
drug. The disease model of addiction rests on three
primary assumptions: predisposition to use a drug,
loss of control over use, and progression (Krivanek,
1988, p. 202). Johnson (1973) put it somewhat
differently in saying, “The most signifi cant characteristics
of the disease [ alcoholism ] are that it is primary,
progressive, chronic, and fatal” (p. 1). There
are others, such as Peele (1985), who question the
validity of this model. Speaking of the complex
nature of addiction, he rejects all strictly biological
explanations and says that addiction cannot
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26 PA R T O N E ● Theories, Models, and Definitions
be resolved biologically because “lived human
experience and its interpretation are central to
the incidence, course, treatment, and remission
of addiction (see Preface).” An adequate theory
would have to synthesize pharmacological, experiential,
cultural, situational, and personality
components.
Drummond (2001) provides an interesting
perspective on theories of drug craving, most
of which can be classified into three categories:
(1) phenomenological models, which are based on
clinical observation and description; (2) conditioning
or cue-reactivity models, which are useful in the
exploration of craving and relapse; and (3) cognitive
models, which are based on social learning theory.
He concludes that no one theory provides an
adequate explanation of the phenomenon of craving.
Addiction, drug dependence, and craving are all
terms used to identify the phenomenon of loss of
control over drug-taking behavior, although each
has a slightly different meaning.
Etiological Theories
Addiction is not easily defi ned. For some, it involves
the “continued, self-administered use of a substance
despite substance-related problems, and it results
in tolerance for the substance, withdrawal from
the substance, and compulsive drug-taking behavior
due to cravings” or drives to use the substance
(Schuckit, 1992, p. 182). However, the American
Psychiatric Association’s criteria for dependence do
not require that tolerance or withdrawal be present
(see Chapter 5 ).
There are at least as many explanatory theories
of addiction as there are defi nitions. We will
focus on three broad theoretical categories—
psychological theories, biological theories, and
sociocultural theories—as well as discuss some
alternative explanations. These theories are not
mutually exclusive, and divisions sometimes
seem quite arbitrary. None is presented as the
correct way of explaining this phenomenon. We
do have preferences, and we lean more toward
certain models than others, but no single theory
adequately describes the etiology of addiction or
dependence. (For a more comprehensive treatment
of etiology, see Ott, Tarter, and Ammerman
[1999].) As social workers, it seems fitting to
suggest that the “person-in-environment” model
may ultimately provide the best mechanism for an
understanding of addiction. We will return to this
perspective at the end of the chapter.
The Moral Model
One of the earliest theories offered to explain the
etiology of addiction is humankind’s sinful nature.
Since it is diffi cult to show empirical evidence of
a sinful nature, the moral model of addiction has
been generally discredited by modern scholars.
However, the legacy of treating alcoholism and
drug addiction as sin or moral weakness continues
to infl uence public policies regarding alcohol and
drug abuse. Perhaps this is why needle/syringe
exchange programs have been so strongly opposed
in the United States.
Psychological Theories
Another explanation for the origins of craving alcohol
and mind-altering drugs lies in the psychological
literature—that is, the literature that deals with
one’s mind and emotions. Psychological models defi
ne addiction as an individual phenomenon but do
not necessarily exclude or minimize social factors
or other elements in the development of an addiction.
There are actually several different psychological
theories of alcoholism and drug addiction; they
include cognitive-behavioral, learning, psychodynamic,
and personality theories, among others.
Cognitive-Behavioral Theories. The cognitivebehavioral
theories offer a variety of motivations
for taking drugs. One such explanation states
that humans take drugs to experience variety
(Weil & Rosen, 1993). The need for variety is demonstrated
in cross-cultural expressions such as
singing, dancing, running, and joking. Drug use is
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C H A P T E R 2 ● The Etiology of Addiction 27
an individual can avoid the unpleasant symptoms
of withdrawal. Repetitive action motivated by the
avoidance of unpleasant stimuli is called negative
reinforcement. (In an alcoholic, the need to avoid
withdrawal symptoms generally occurs from 6 to
48 hours after the last drink.) Another source of
negative reinforcement may lie in the avoidance of
unpleasant things other than withdrawal. There
is a high correlation between traumatic events
and subsequent substance abuse (Janoff-Bulman,
1992). The traumatized individual may take drugs
to avoid unpleasant memories or heightened physiological
states such as startle responses.
Learning Theory. Closely related to cognitivebehavioral
theories is learning, or reinforcement, theory.
Learning theory assumes that alcohol or drug
use results in a decrease in psychological states such
as anxiety, stress, and tension, thus positively reinforcing
the user. This learned response continues until
physical dependence develops, at which time the
aversion of withdrawal symptoms becomes a prime
motivation for drug use (Tarter & Schneider, 1976).
There is a considerable amount of evidence
to support that part of learning theory related to
alcohol use and physiological aversion. Abrupt
cessation of drinking will lead to unpleasant symptoms
of withdrawal (A & DRCC, 1995). For the
alcoholic, withdrawal can lead to trembling, shaking,
hallucinations, and tonic-clonic seizures, formerly
known as grand mal seizures. Similarly, for
the heroin addict, abrupt withdrawal may lead to
symptoms much like a case of severe fl u. In each
case, the addict quickly learns that these symptoms
may be avoided by resuming use of the drug.
An interesting view of becoming a heroin addict
is provided by Krivanek (1989). Dependencies
that involve drug use follow the same basic principles
of learning theory, as all other dependencies.
Krivanek views drug dependence as a psychological
phenomenon that can vary in intensity from
a mild involvement to an addiction that seriously
restricts the user’s other behaviors. Pattison,
Sobell, and Sobell (1977) view alcoholism as
a continuum. That is, “An individual’s use of
associated with a variety of activities—for example,
religious services, self-exploration, altering moods,
escaping boredom or despair, enhancing social
interaction, enhancing sensory experience or
pleasure, and stimulating creativity and performance.
A study on inner-city youths revealed that
youths are motivated to take drugs out of a desire
for variety, citing curiosity, celebration, getting
high, and rebelling as reasons for drug use. (In the
study, the youths celebrate or explore drugs by using
alcohol at home, whereas they choose to use
illegal marijuana away from the home [Esbensen
& Huizinga, 1990].) Assuming that people enjoy
variety, it follows that they repeat actions that
bring pleasure (positive reinforcement).
The desire to experience pleasure is another
cognitive explanation for drug use and abuse.
Some animals seek alcohol and even work for it (by
pushing a lever) to repeat a pleasant experience.
Alcohol and other drugs are chemical surrogates of
natural reinforcers such as eating, drinking, and
reproductive behavior. Social drinkers and alcoholics
both report using alcohol to relax, even though
tests of actual tension-reducing effects of alcohol
have yielded quite different results; scientific observations
of persons using alcohol actually show
them to become more depressed, anxious, and
nervous (NIAAA, 1996). The dependent behavior
is maintained by the degree of reinforcement the
alcohol provides, and this, in turn, depends on the
actor’s perception of his or her need hierarchy and
“the likelihood that this course of action will meet
the most important needs better than other available
options” (Krivanek, 1989, p. 96). Since alcohol
and drugs are more powerful and persistent
than natural reinforcers to which the human brain
is accustomed, they set the stage for addiction.
With time, the brain adapts to the presence of
the drug or alcohol. The removal of the substance
from the host reveals certain abnormalities experienced
by the brain. The host experiences unpleasant
withdrawal symptoms, such as anxiety,
agitation, tremors, increased blood pressure, and in
severe cases, seizures. Naturally, one wants to avoid
painful stimuli; by consuming the substance anew,
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28 PA R T O N E ● Theories, Models, and Definitions
deprivation are not specific to alcoholism or addiction
to other drugs. In fact, they are commonly
reported by non-addicted adults with a variety of
other psychological problems. Perhaps the most
serious shortcoming is in the psychodynamic theories’
implications for the treatment of alcoholism
or drug addiction. Many counselors warn that a
nondirective approach that focuses solely on the
patients’ development of insight into their problems
neglects the addictive power of alcohol or
other drugs (Cunynghame, 1983).
Nevertheless, there is a feeling among some
scholars (Collins, Blaine, & Leonard, 1999) that
psychodynamic approaches should not be dismissed
because they serve “to guide a substantial
portion of clinical practice” (p. 162). Even though
the empirical support of psychodynamic theory is
scanty, it has shown a remarkable resiliency and the
ability to capture the imagination of practitioners.
Personality Theories. Personality theories,
which frequently overlap the psychodynamic
theories, assume that certain personality traits
predispose an individual to drug use. An individual
with a so-called alcoholic personality is often
described as dependent, immature, and impulsive
(Schuckit, 1986). Other personality theorists
have described alcoholics as highly emotional,
immature in interpersonal relationships, having
low frustration tolerance, being unable to express
anger adequately, and confused in their sex-role
orientation (Catanzaro, 1967). After reviewing
these personality theories, Keller (1972) summarized
them in Keller’s law: The investigation of any
trait in alcoholics will show that they have either
more or less of it. However, the many scales that
have been developed in an attempt to identify alcoholic
personalities have failed to distinguish consistently
the personality traits of alcoholics from
those of non-alcoholics. One of the subscales of
the Minnesota Multiphasic Personality Inventory
(MMPI) does differentiate alcoholics from the general
population, but it may actually detect only the
results of years of alcohol abuse, not underlying
personality problems (MacAndrew, 1979).
alcohol can be considered as a point on a continuum
from nonuse, to nonproblem drinking, to
various degrees of deleterious drinking” (p. 191).
Learning theory is helpful in treatment
planning because it addresses the adaptive consequences
of drinking. (For a more extensive discussion
of adaptation and addiction, see Peele
[1998].) Also, behavioral treatments have incorporated
learning theory into a treatment framework
based on the premise that what has been
learned can be unlearned (Bandura, 1969). It
follows that intervening early is important, since
there will be fewer behaviors to unlearn. Learning
theory is also quite adaptable to the systems view,
which is followed throughout this book.
Psychodynamic Theories. Psychodynamic theories
are more difficult to substantiate than most
other psychological theories because they deal with
hard to operationalize concepts and with events that
may have occurred many years before the onset of
addiction. Although Dr. Sigmund Freud never devoted
a single paper to the subject of alcoholism, his
disciples were not the least bit reluctant to apply psychoanalytic
theories to alcohol addiction. The earliest
explanations linked alcoholism with the “primal
addiction” of masturbation (Bonaparte, Freud, &
Kris, 1954). Later, most explanations linked alcoholism
to ego defi ciencies, suggesting that alcohol
is used to attain a sense of security. This theory assumes
that during childhood, inadequate parenting,
along with the child’s individual constitution,
caused the child to form weak attachments to significant
others, resulting in a need to compensate
for or dull the insecurity. This is accomplished in the
consumption of alcoholic beverages (Chordokoff,
1964). Alcohol abuse has also been explained by
psychoanalytic theorists as an expression of hostility
and of homosexuality. Still others view alcoholics
as self-destructive, narcissistic, or orally fi xated
(Schuckit, 1986). Psychoanalytic theory has even
blamed the development of alcoholism on the failure
of mothers to provide milk (Menninger, 1963).
A major problem with psychoanalytic theories
is that experiences such as early childhood
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C H A P T E R 2 ● The Etiology of Addiction 29
3. A sense of social alienation and a general tolerance
for deviance.
4. A sense of heightened stress. (This may help
explain why adolescence and other stressful
transition periods are often associated with severe
drug and alcohol problems.) (pp. 11, 15).
Research on personality theories of addiction
seems to have waned during the 1990s, and there
are few recent empirical studies that focus on this
explanation for addiction.
Biological Theories
Biophysiological and genetic theories assume
that addicts are constitutionally predisposed to
develop a dependence on alcohol or drugs. These
theories support a medical model of addiction.
Their advocates apply disease terminology and
generally place responsibility for the treatment
of addicts in the hands of physicians, nurses, and
other medical personnel. In reality, the medical
model is generally practiced only during the detoxifi
cation phase.
Generally speaking, biological theories branch
into one of two explanations: neurobiological
and genetic. There has been such an explosion
of knowledge in recent years in the neurobiology
of addiction that we have devoted a separate chapter
to it (see Chapter 3 ). But at this point, we will
briefl y review the research on genetics.
Genetic Theories. Recent studies supported by the
National Institute on Drug Abuse (NIDA, 2008)
found that a variant in the gene for a nicotinic
receptor subunit doubled the risk for nicotine addiction
among smokers. This is the first evidence
of a genetic variation influencing both the likelihood
of nicotine addiction and an individual’s risk
for the severe health consequences of tobacco use.
National Institute on Alcohol Abuse and Alcoholism
(NIAAA) has funded the Collaborative Studies
on Genetics of Alcoholism (COGA) since 1989, but
specifi c genetic factors have never been established
as a definite cause of alcoholism, although the
There is some evidence that individuals with
an antisocial personality (as defi ned in the DSM-IV ,
APA, 1994) have a higher incidence of alcoholism
than the general population. There is no evidence
that this personality disorder caused the alcoholism,
but these individuals were more disposed to
develop alcohol problems because of their antisocial
personality. Apart from this relatively rare occurrence
of the antisocial personality, alcoholics
have not been found to exhibit a specifi c cluster of
personality traits (Sherfey, 1955). Vaillant (1994)
argues persuasively that personality (as well as psychological)
factors are, at most, of minimal consequence
as a cause of alcoholism. There have been
similar attempts to link a constellation of certain
personality traits to drug addiction as well as alcoholism
(Gossop & Eysenck, 1980). A consensus
seems to have evolved that personality traits are
not of much importance in explaining drug dependence.
In fact, most of those who work in this fi eld
agree that an individual can become dependent
irrespective of personality attributes (Raistrick &
Davidson, 1985). One book lists 94 personality
characteristics that have been attributed to drug
addicts by various theorists (Einstein, 1983).
These include many characteristics that are polar
opposites of one another—for example: poor selfimage
and grandiose self-image, ego infl ation and
ego contraction, self-centered and externalization,
pleasure-seekers and pleasure-avoiders, and several
dozen other contradictory pairs.
A report to the National Academy of Sciences
(“Addictive Personality,” 1983) concludes that
there is no single set of psychological characteristics
that embraces all addictions. However, there
are, according to the report, “signifi cant personality
factors that can contribute to addiction.” These
factors number 4 (not 94) and are as follows:
1. Impulsive behavior, difficulty in delaying
gratifi cation, an antisocial personality, and a
disposition toward sensation seeking.
2. A high value on nonconformity combined
with a weak commitment to the goals for
achievement valued by the society.
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30 PA R T O N E ● Theories, Models, and Definitions
polymorphisms (Nichols, 1986). A more recent
study reports that the so-called dopamine D2 receptor
gene, which affects the capacity of cells to
absorb dopamine, was present in 77 percent of the
brains of alcoholics and only 28 percent of nonalcoholics
(Blum et al., 1990).
In 1990, the front page of an edition of The
New York Times hailed the discovery of a gene
claimed to be directly linked to alcoholism. Two
years later, this so-called alcoholism gene, formally
known as the dopamine D2 receptor gene, had become
the focus of a bitter controversy. Blum and
Noble insisted that their finding had been amply
documented by subsequent research, and they took
steps to market a test for genetic susceptibility to alcoholism.
Blum suggested that job applicants, children,
and perhaps even fetuses could be tested.
In Blum and Noble’s experiments, the D2
gene was shown to have at least two variants, or
alleles, called A1 and A2. They found the A1 allele
in the genetic material of 69 percent of the alcoholics
studied, compared to only 20 percent of the
controls. Blum and Noble theorized that A1 carriers
may use alcohol or other drugs excessively to
compensate for a reduced ability to absorb pleasureinducing
dopamine.
A study of 862 men and 913 women who
had been adopted early in life by nonrelatives identifi
ed two types of alcoholism (Boham, Cloninger,
von Knorring, & Sigvardsson, 1984). Type I, or
milieu-limited, alcoholism is found in both sexes
and is associated with alcoholism in either biological
parent, but an environmental factor—low
occupational status of the adoptive father—also
had to be present as a condition for alcoholism
to occur in the offspring. Type II, known as malelimited
alcoholism, is more severe but accounts for
fewer cases. It is found only in men, and it does not
appear to be affected by environmental factors.
Vaillant (1983), however, points out the potential
biases in the preceding study. He says that
the study failed to control for the environmental
effect of parental alcoholism. He continues by
pointing out that antisocial personality disorder
must be distinguished from alcohol dependence
statistical associations between genetic factors and
alcohol abuse are very strong (NIAAA, 2009). A
great volume of research has been amassed in this
area over the last several decades, and much of the
evidence points toward alcoholism as an inherited
trait. It has been observed that (1) adopted children
more closely resemble their biological parents
than their adoptive parents in their use of alcohol
(Goodwin, Hill, Powell, & Viamontes, 1973), (2) alcoholism
occurs more frequently in some families
than in others (Cotton, 1979), and (3) concurrent
alcoholism rates are higher in monozygotic twin
pairs (53.5 percent) than in dizygotic pairs (28.3
percent) (Kaij, 1960). Children of alcoholics are
three to seven times more likely to be at risk of alcoholism
(Koopmans & Boomsina, 1995). Having an
alcoholic parent (but not necessarily both parents)
can increase the risk of becoming an alcoholic. Yet
even in the presence of elevated risks, only 33 percent
sons and 15 percent daughters of alcoholics
demonstrate evidence of the disorder.
Some genetic theorists speculate that an
inherited metabolic defect may interact with
environmental elements and eventually lead to
alcoholism. This genetotrophic theory posits an
impaired production of enzymes within the body
(Williams, 1959). Others hypothesize that inherited
genetic traits result in a deficiency of vitamins
(usually of the vitamin B complex), which
leads to a craving for alcohol as well as cellular or
metabolic changes (Tarter & Schneider, 1976).
It is important to remember that, despite the
impressive statistical relationships in these studies
implying a genetic link, no specifi c genetic marker
that predisposes a person toward alcoholism has
ever been isolated. The fi rst biological marker established
for alcoholism was thought to be color
blindness, but a few years later, it was demonstrated
that color blindness was actually a result of
severe alcohol abuse (Valera, Rivera, Mardones, &
Cruz-Coke, 1969). Several other genetic discoveries
have met a similar fate. A workshop on genetic
and biological markers in drug and alcohol abuse
suggests promising areas for genetic research,
such as polymorphisms in gene products and DNA
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C H A P T E R 2 ● The Etiology of Addiction 31
Genome Project (HGP), supported by the National
Institutes of Health and the U.S. Department
of Energy, has been an important impetus in
the search for genes related to alcohol behavior
(NIAAA, 2000). The research was completed in
2003, but analysis of the data may take several
additional years (HGP, 2008).
Sociocultural Theories
There is little high-quality research regarding the
macrovariables that seek to explain addiction
(Esbensen & Huizinga, 1990). Yet, as we mentioned
earlier, almost every known culture has discovered
the use of beverage alcohol. “All societies establish
a quota of deviance necessary for boundary setting”;
rules around alcohol and drug use are a part
of boundary setting. The ways in which different
societies encourage, permit, or regulate the use of
alcohol varies considerably, however.
For the most part, sociocultural theories have
been generated by observations of differences or
similarities between cultural groups or subgroups.
Sociocultural theorists are prone to attribute differences
in drinking practices, problem drinking, and
alcoholism to environmental factors. For example,
socially disorganized communities often fail to realize
the common values of their residents and to
maintain effective social controls. Therefore, innercity
drug use is more rampant than in the suburbs.
We know that differential rates of alcohol use
between genders vary greatly between nations
(Bloomfi eld, Gmel, & Wilsnack, 2006). Unless greater
biological differences occur between women, from
country to country, or between men, from country
to country (a remote possibility), it seems logical that
culture is a strong infl uence on alcohol use.
According to Goode (1972), the social context
of drug use strongly infl uences, perhaps even
determines, “four central aspects of drug reality”
(p. 3): drug defi nitions, drug effects, drug-related
behavior, and the drug experience. The sociocultural
perspective stands in direct opposition to
what is called the chemicalistic fallacy —the view
that drug A causes behavior X.
and that developmental effects of abusing individuals
must be controlled. Furthermore, for his studies,
Vaillant excludes individuals with other major
psychiatric disorders that could, by themselves,
directly contribute to alcohol dependence. Such
cases (direct and uncomplicated cases) are estimated
to represent 60 to 70 percent of the alcoholdependent
population (Schuckit, 1986).
The notion of Type I and Type II alcoholics
hangs, in part, on the age of the onset of alcoholism.
Vaillant (1983) found in a study of alcohol-abusing
men in inner cities and in college that age of onset
and degree of antisocial symptomatology correlated
with disturbed family environments but was independent
of positive or negative heredity for alcoholism.
In other words, this negated the hypothesis that
heredity predicts the age of onset. “Alcoholic abuse
began 11 years earlier for the socially disadvantaged
men with a heredity negative for alcoholism than for
the college men with two or more alcoholic relatives.”
In other words, early-onset alcohol abusers in inner
cities had no more alcoholic relatives than did lateonset
alcohol abusers in college. Furthermore, innercity
men were 10 times as likely as the college men to
come from multi-problem families, to exhibit traits of
sociopathy, to have delinquent parents, and to have
spent time in jail.
These findings lead one to ask: “How do
biological factors interact with environment to
contribute to heavy enough drinking over long
enough periods of time to produce physical and
psychological dependence?” (Schuckit, 1986).
Vaillant (1983) suggests that rather than there
being two kinds of alcoholism, there may be
(1) genetic loading (predicting whether one develops
alcoholism) and (2) an unstable childhood environment
(predicting when one loses control of
alcohol). (Late onset is less associated with dependence,
substance-related problems, hyperactivity,
and dysfunctional families in one’s youth.)
Genetic research on addiction shows promise,
but it is an incredibly complex activity. Even
the most sanguine recent studies still use phrases
such as “the gene that may infl uence alcoholism
and addiction” (Science Daily, 2007). The Human
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32 PA R T O N E ● Theories, Models, and Definitions
condones the use of alcohol to relieve those tensions
is likely to have a high rate of alcoholism.
Bales also believed that collective attitudes toward
alcohol use dramatically infl uence rates of alcoholism.
He classified these attitudes as favoring
(1) abstinence, (2) ritual use connected with religious
practices, (3) convivial drinking in a social
setting, and (4) utilitarian drinking (drinking for
personal, self-interested reasons). The utilitarian
attitude, especially in a culture that induces much
inner tension, is the most likely to lead to problem
drinking, whereas the other three mitigate against
alcohol problems.
Also important in Bales’s (1946) theory is the
degree to which a society offers alternatives to alcohol
use for the release of tension and for providing
a substitute means of satisfaction. A social system
with a strong emphasis on upward economic or social
mobility will excessively frustrate an individual
who has no available means of achieving success.
In such a system, high rates of alcohol use would
be expected (Tarter & Schneider, 1976).
Unfortunately, few alternatives to alcohol
or drugs seem to exist in most modern societies.
In traditional societies, such as the hill tribes
of Malaysia, a shaman may assist tribesmen in
achieving a trancelike state in which endorphin
levels are altered (Laderman, 1987). Also at the
supracultural level, Bacon (1974) theorizes that
alcoholism is likely to be a problem in a society that
combines a lack of indulgence of children with
demanding attitudes toward achievement and
negative attitudes regarding dependent behavior in
adults. Another important factor in sociocultural
theories is the degree of societal consensus regarding
alcohol use. In cultures in which there is little
agreement regarding drinking limits and customs,
a higher rate of alcoholism is expected (Trice,
1966). Cultural ambivalence regarding alcohol
use results in weak social controls and allows the
drinker to avoid being labeled as a deviant.
Culture-Specifi c Theories. According to Room,
in “wet” drinking cultures, alcohol is used almost
daily, with few restrictions on availability. Conversely,
Because no object or event has meaning in
the abstract, all these central aspects must be interpreted
in light of social phenomena surrounding
drug use. For example, morphine and heroin
are not very different pharmacologically and biochemically.
Yet heroin is regarded as a dangerous
drug with no therapeutic value, whereas morphine
is defined primarily as a medicine. Definitions
are shaped by the social milieu surrounding
the use of each substance.
People using morphine as an illegal street
drug experience a “rush” or a “high” generally
unknown to patients using the same drug in a
hospital setting. Psychedelic drugs, such as peyote,
which are taken for religious purposes (as in
some Native American churches), do not typically
result in religious or mystical experiences when
taken simply to get high. Drugs, according to
Goode (1972), only potentiate certain kinds of
experiences; they do not produce them. It is important
to distinguish between drug effects and the
drug experience . Many changes may take place in
the body when a chemical is ingested, not all of
which are noted and classifi ed by the user. A drug
may have a more or less automatic effect of dilating
the pupils, causing ataxia or amblyopia, and
so on, but the experience is subject to the cognitive
system of the user’s mind. A person must be
attuned to certain drug effects to interpret them,
categorize them, and place them within appropriate
experiential and conceptual realms (Goode,
1972). One’s propensity to use drugs, the way one
behaves when one uses drugs, and one’s definitions
of abuse and addiction are all influenced by
one’s sociocultural system. Why else would someone
defi ne heroin and LSD as dangerous drugs, yet
almost never perceive social drinkers and smokers
as drug users?
Supracultural Theories. The pioneering work
of Bales (1946) provides some general hypotheses
regarding the relationships among culture, social
organization, and the use of alcohol. He
proposed that a culture that produces guilt, suppressed
aggression, and sexual tension and that
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C H A P T E R 2 ● The Etiology of Addiction 33
rate is one of the highest in the world, and the Jewish
rate is one of the lowest (Bales, 1946).
Subcultural Theories. There have been many
investigations of sociological and environmental
causes of alcoholism at the subcultural level.
Within the same culture, a great diversity in alcoholism
rates has been related to age, sex, ethnicity,
socioeconomic class, religion, and family background
(Bloomfield, Gmel & Wilsnack, 2006;
Tarter & Schneider, 1976). One of the landmark
studies of social variables at this level was conducted
more than three decades ago by Calahan
(1970). He specifi ed that social environment determines
to a large extent whether an individual
will drink and that sociopsychological variables
also determine the level of drinking. In becoming
a problem drinker, variables such as age, sex, ethnicity,
and social position infl uence the probability
that a person will learn to drink as a dominant
response. Labeling the person as a heavy drinker
then reinforces the probability of that response.
Of course, these processes do not occur in isolation
from other factors, such as the process of
physical addiction. Goode (1984), Laurie (1971),
Imlah (1971), and many others have examined
the sociocultural context of drug addiction and
found there to be many similarities to alcoholism.
A major difference is in the outcast nature of
certain illicit drug users such as heroin addicts.
Users of illegal drugs such as heroin may be more
socially isolated than alcoholics because of their
addiction. Also, certain types of drug addiction
seem to thrive within specifi c subcultures. Heroin
addiction is a persistent problem among jazz musicians.
Inner-city youths frequently “huff ” spray
paint or sniff glue. With three feet of hose and an
empty can, Native American youths on certain
reservations can easily get high on gasoline fumes.
The impact of gender on drug use presents an
interesting perspective on sociocultural theories.
Either a culture-specifi c or subcultural model can
be used in explaining the differences between male
and female drug-related behaviors in the United
States. Historically, female drinking has been less
although legal and social restrictions govern
drinking in “dry” cultures, binge drinking and
even violent drunken behavior may be seen as
acceptable (2001). Levin (1989) describes two
examples of cultural contrast in attitudes toward
drinking: the contrast between French and Italian
drinking practices and the contrast between Irish
and Jewish drinking practices.
There are many similarities between the
French and Italian cultures; both are heavily Catholic
and both produce and consume large quantities
of alcohol. The French, however, drink wine and
spirits, both with meals and without, and both
with and away from the family. The French do
not strongly disapprove of drunkenness, and they
consider it bad manners to refuse a drink. On the
other hand, the Italians drink mostly with meals
and mostly with family, and they usually drink
wine. They strongly disapprove of drunkenness,
and they do not pressure people into drinking. As
one might expect, France has one of the highest
rates of alcoholism in the world, whereas Italy’s
rate is only one-fi fth as great. (In 1952, Italy had
the second-highest rate of wine consumption
in the world, consuming only half of the amount
of wine consumed in France [Kinney & Leaton,
1987].) The strong sanctions against drunkenness
and social control imposed by learning to
drink low-proof alcoholic beverages in moderation
seems to have something to do with the lower
rate of Italian alcoholism.
In a fashion, studies of Irish and Jewish drinking
practices draw some sharp contrasts. The Irish
have high proportions of both abstainers and
problem drinkers, whereas Jews have low proportions
of both (Levin, 1989). The Irish drink largely
outside the home in pubs; Jews drink largely in the
home with the family and on ceremonial occasions.
The Irish excuse drunkenness as “a good man’s
fault”; Jews condemn it as something culturally
alien. Bales found Irish drinking to be largely convivial
on the surface, but purely utilitarian drinking
was a frequent and tolerated pattern. Jewish drinking,
on the other hand, was mostly ceremonial.
Again, it is no surprise that the Irish alcoholism
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34 PA R T O N E ● Theories, Models, and Definitions
there is no general answer but that the explanation
lies not only in motives but also in a person’s
cultural background, life circumstances, special
life crises, and physical abnormalities. No single
item will be the reason.
Fingarette (1985) believes that it is no harder
for the alcoholic to choose to stop drinking than it is
for others to abandon activities central to their ways
of life. “We should see the alcoholic, not as a sick
and defective human being, but as a human being
whose way of life is self-destructive. The diffi culty we
face is stubborn human nature, not disease” (p. 63).
In a similar fashion, Peele (1988) has examined
the evidence on addiction and concluded
that “we have disarmed ourselves in combating
the precipitous growth of addictions by discounting
the role of values in creating and preventing
addiction and by systematically overlooking the
immorality of addictive misbehavior” (p. 224).
This is not a revival of the addiction as sin model
but an argument that addicts and alcoholics do
differ from other people in the ways in which
they prioritize their values.
As noted at the outset of this chapter, William
S. Burroughs (1977) attempted to answer the
question, “why does a person become a drug
addict?” in his book Junky. “The answer is that
he usually does not intend to become an addict.
You don’t wake up one morning and decide
to be a drug addict . . . You become a narcotics
addict because you do not have strong motivations
in any other direction” (p. xv). Schaler
(2000) has a similar view of addiction. He denies
that there is any such thing as addiction, in
the sense of a “deliberate and conscious course
of action which the person literally cannot stop
doing” (p. xv). He views addiction as a metaphorical
disease, not a physical disease.
Stages of Alcoholism
One of the fi rst attempts to describe the development
of alcoholism is found in Jellinek’s (1952) study of
2,000 male members of Alcoholics Anonymous. He
accepted than male drinking in the United States,
and being intoxicated is clearly more disapproved
of for women than for men (Gomberg, 1986).
Similar gender differences exist throughout the
world (Bloomfi eld, Gmel, & Wilsnack, 2006). These
double standards may account for the much lower
rate of problem drinking noted among women.
Social pressure and social stigma may result in
less problem drinking by women as a subgroup of
the larger U.S. culture.
Some aspects of this phenomenon may be
culture specifi c, however. The fact that men seem
to drink more and have more problems because of
alcohol in some cultures and not in others fi ts into
a supracultural model of drug use. The degree
of female problem drinking appears to be related
to cultural norms regarding the overall status of
women within different societies. Bear in mind
that the vast majority of the research on alcohol
and drug abuse has been conducted on men only.
Only recently have gender-related issues in this
area begun to be systematically examined.
Alternative Explanations
Fingarette (1985) sees alcoholism as “neither sin nor
disease.” Instead, he views it as a lifestyle. According
to Fingarette, proponents of the disease model describe
alcoholism as a disease characterized by loss of
control over drinking. Recovery is possible only if one
voluntarily seeks and enters treatment and voluntarily
abstains from drinking. Only then can one be
cured. Cured from what? From a disease that makes
voluntary abstention impossible and makes drinking
uncontrollable! This, says Fingarette (1985), is an
amazing contradiction.
His alternative explanation views the “persistent
heavy drinking of the alcoholic as a central
activity” of the individual’s way of life. Each person
develops his or her unique way of life, which consists
of a number of central activities. Some will
adopt parenting as a central activity, while others
will place sex, physical thrills, or their careers at
the center. Why do some people choose drinking
as a central feature? Fingarette (1985) says that
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C H A P T E R 2 ● The Etiology of Addiction 35
(1) all AA members, (2) all in the latter stages of
alcoholism, and (3) all males.
This traditional view of alcohol addiction
was supported by many other prominent scholars,
however. Mann (1968) described alcoholism as a
“progressive disease, which, if left untreated, grows
more virulent year by year” (p. 3). Others seem to
have conveniently ignored available scientifi c evidence
in making assertions such as “the true alcoholic
is no more able to metabolize ethanol than a
diabetic can handle sugar” (Madsen, 1974, p. 94).
Others conclude that alcoholism is the result of an
allergy and that “one does not become an alcoholic:
One is born an alcoholic” (Kessel, 1962, p. 128).