The American Drug Culture

Thomas S. Weinberg, Gerhard J. falk, Ursula Adler Falk

• Publisher: SAGE Publications, Inc
• Year: 2017
• ISBN:
  9781506304694
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

The American Drug Culture uses sociological and other perspectives to examine drug and alcohol use in U.S. society. The text is arranged topically, rather than by categories of drugs, and explores diverse contexts of drug use including popular culture; sexuality; the legal and criminal justice systems; other social institutions; and mental and physical health. It features more coverage of alcohol, the most widely-used drug in the U.S., than other texts for this course. Authors Thomas S. Weinberg, Gerhard Falk, and Ursula Falk include case studies from their field research to give you empathetic insights into the situation of those with substance and alcohol use disorders.

Chapter 1 Introduction: Sociological and Other Explanations for Drug and Alcohol Use and Abuse¹

The Growing Nationwide Opioid Epidemic

BUFFALO, New York—David Edick had always been close to his son, Benjamin. When he was a little boy, Benjamin enjoyed challenging his dad to Super Mario—and beating him at the video game.

Now, with Benjamin a grown man at 30, the father of a child of his own, the relationship revolved around cooking, working out together, and catching New York Mets and Denver Broncos games from the comfort of matching black leather recliners in David’s house in Buffalo, New York.

In the spring of 2015, Benjamin moved in with his dad, having struggled with drugs for about a year. He had gotten clean, though, and had found work repairing gutters. Every morning, he’d meet with other members of a local support group—meetings that gave him hope, he told David.

When Benjamin didn’t come home on the afternoon of July 23, David at first wasn’t that concerned. He figured his son was working late. But by 10 p.m., David began to worry. He searched Benjamin’s room but found no drugs. When his son didn’t turn up by the next morning, he reported him missing.

Later that day, officers came to his door. “I thought, Oh, he’s in trouble—he’s in jail,” David recalled.

Police told him his son was dead. He had been found in his car, head resting against the headrest as if asleep, the victim of a “heroin epidemic” sweeping not just upstate New York but the entire nation. (Daileda 2016)

Benjamin Edick was one of many victims of what has been termed a growing heroin epidemic in the United States (Horowitz 2017; Ingraham 2017; Owens 2017). Erie County, New York, the county that contains Buffalo and its suburbs, has been experiencing what officials are calling a “wave” of opioid-related deaths. In 2016, there were 357 confirmed or suspected opioid-related deaths, compared to 256 deaths in 2015 and 128 in 2014. In a period of just 11 days in late January and early February of 2016, there were 23 overdose deaths from a high-powered batch of heroin (O’Brien 2016). It is suspected that some of these deaths were caused by heroin containing fentanyl, a synthetic painkiller 30 to 50 times more potent than heroin (H. Davis 2016; O’Brien 2016). The situation is so dire that the county executive expressed his fear that the opioid- and prescription-related overdose deaths will wipe out the county’s population gains (Tan 2016).

Photo 1.1: A lethal combination of heroin cut with fentanyl.

Benjamin Lowy/Reportage Archive/Getty Images

The situation in western New York is reflective of a larger opioid epidemic sweeping the country (“Drug Overdose Deaths” 2015). Heroin is now the leading cause of overdose deaths in the United States (Glatter 2016). In fact, according to data from the Centers for Disease Control and Prevention (CDC), there were more deaths from heroin overdoses in 2015 than there were from gun homicides (Schumaker 2016). The CDC reports that heroin-related overdose deaths have more than quadrupled since 2010 and that there was a 20.6% increase in such deaths from 2014 to 2015 (CDC 2017a). The CDC notes that “the main driver of drug overdose deaths” is both prescription and illicit opioids, which were implicated in 33,091 deaths in 2015. Significant increases in drug overdose deaths during this period predominantly occurred in the Northeast and South. (CDC 2016c). The National Institute on Drug Abuse (NIDA) reports a 2.2-fold increase of deaths from all drugs from 2002 to 2015, with a steeper incline in deaths for males. Deaths from opioids during that same period increased 2.8-fold, again with male deaths showing a steeper incline than deaths of females. For heroin-related deaths, there was a 6.2-fold increase in total deaths, with an even larger and steeper rise in deaths for males than females (NIDA 2017). Deaths from fentanyl overdoses more than doubled from 1,905 people in 2013 to 4,200 in 2014 (Rettner 2016).

Why has there been such a dramatic increase in opioid-related deaths, presumably reflecting an increase in their use? The most common explanation is that this is due to the overprescribing of prescription pain killers such as Vicodin, Percocet, and Oxycontin, which became popular in the 1990s (Caba 2015; Eskew Law 2016; Ingraham 2017; Lopez 2016; Owens 2017; The Week Staff 2016). When people can no longer obtain these drugs by prescription, they first may turn to the black market to obtain them but eventually discover heroin, which, at $5 a bag, is one eighth the cost of pills and easier to obtain (Caba 2015; The Week Staff 2016). The strongest risk factor associated with heroin use is addiction² to prescription opioid painkillers (Caba 2015). “Over 50% of recent heroin addicts report that they began their opioid use through the abuse of prescription opioid medications” (Eskew Law 2016). Lopez (2016) notes that “a 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.”

Although this explanation may help us to understand why some users of prescription painkillers acquire a heroin habit, it does not account for those users who do not go on to use heroin. It is only half an explanation. How do they differ from those who become addicted to heroin? In order to fully understand drug use, including alcohol and other nonopioids (e.g., marijuana, LSD, psilocybin, methamphetamines, mescaline, peyote), we need to look for other types of explanations. The difference between those who go on to use heroin and those who do not might be explained, for example, in terms of their personalities, past experiences, interpersonal relationships, opportunity to acquire drugs, and so forth. Formal theories from sociology, social psychology, psychology, and criminology help us to understand drug and alcohol use more completely. In the following section, we look at a number of sociological/social psychological and criminological explanations and illustrate how they have been used to examine substance use. Throughout the book we refer to some of these theories to help us understand drug and alcohol use and the drug culture. Our treatment here is by no means comprehensive or exhaustive. Its purpose is simply to give the reader a feeling for the variety of ways in which drugs and drug users have been viewed and can be understood. In Chapter 8, we present other nonsociological explanations for substance use, particularly focused on alcohol. These theories include psychological, genetic, physiological, and medical perspectives, as well as the Alcoholics Anonymous concept of alcoholism as a disease. In Chapter 11, Dr. Ursula Adler Falk, a psychotherapist, discusses the use of drugs from a psychoanalytical framework, supplemented with compatible sociological literature and theoretical perspectives. In this chapter, Dr. Falk provides real-life case histories to enable the reader to appreciate how theoretical structures enable us to understand how addicts view themselves, others, and their worlds. Additional cases can be found in the appendices.

The last section of this chapter looks at the many ways in which sociologists study drug and alcohol use. We provide examples of research using different methodologies and theoretical frameworks. Again, this section is not intended to be definitive, for this is neither a theory nor a methods book, but to give the reader insight into the complexities of the drug culture and how researchers attempt to understand it.

Sociological Explanations

This book uses sociological perspectives to examine the use of alcohol and other drugs in American culture. Sociological theorizing about drug and alcohol use has a long history. More than 75 years ago, sociologist Alfred R. Lindesmith (1938) proposed an explanation for addiction that emphasized a symbolic interactionist approach. In brief, Lindesmith applied George Herbert Mead’s emphasis on the important role of significant symbols in an individual’s construction of the self to an explanation of the process of becoming an addict. At the time, his theories were controversial, for the dominant position was a psychiatric one, which held that drugs were used by individuals to compensate for their feelings of inferiority. A few years later, E. M. Jellinek (1943) noted that though there was a large body of “sociological” research on alcoholism, there were few attempts to understand this behavior sociologically. He therefore called for the development and application of sociological frameworks in the field. He was an applied physiologist by training and not a sociologist, but Jellinek (1962) nevertheless developed a sociological theory of the progression of alcoholism.

In general, sociological theories may be roughly sorted into macrosociological and microsociological frameworks. Macrosociological perspectives focus on large-scale systems, societies, and social institutions and on their interrelationships and effect on social actors. Examples of macrosociological theories include structural functionalism and Marxian and conflict theories. Microsociological theories examine everyday life, including interaction between and among individuals and objects; how people construct, interpret, and manage meaning; and how they act in terms of these meanings. Examples of microsociological theories include exchange theories, behavioral sociology, symbolic interaction, labeling theory, reference group theory, ethnomethodology, and phenomenological sociology.

Some microsociological approaches, such as symbolic interactionism, labeling theory, phenomenology, and ethnomethodology, take what is called a social constructionist approach to understanding deviance, including substance use (as well as other social behaviors). This perspective, which was conceptualized in the 1950s and early 1960s by writers such as Harold Garfinkel (1956), Howard S. Becker (1951, 1953, 1963), Erving Goffman (1961, 1963), John Kitsuse (1962), Edwin M. Lemert (1967), and others, sees deviance as a subjective matter defined by some social audience (Becker 1963). From this point of view, deviance is a relative concept that varies over time and space. Because various groups and societies see the same behaviors differently, if they are not labeled or categorized in some way, they have no social reality, because they do not engender a response (Thio 2010). For example, in some societies homosexuality does not exist as a social category, even though people engage in sexual behavior with members of their own sex (Amory 1997). Similarly, even though people were physiologically addicted, the labels junkie and drug abuser as descriptive categories did not exist in the early 20th century, before the passing of the Harrison Narcotics Act in 1914.³ Prior to that legislation, the majority of opiate users were women, often of the upper classes, who were given those preparations by physicians to relieve the discomfort of “women’s problems” (Kandall 1997). They were neither stereotyped nor responded to negatively as junkies or drug abusers.

Social constructionists are especially concerned with the creation and application of labels. For example, the pejorative label dope fiend, which first appeared between 1890 and 1895, was used to refer to someone who was addicted to opiates. In an article written in 1940, Alfred R. Lindesmith countered the prevalent image of the dope fiend as “the ‘dope-crazed’ killer or ‘the dope fiend rapist’” (p. 199). Within the heroin subculture, however, the term has a different connotation. Righteous dope fiend is an accolade, rather than a deviant label (Bourgois and Schonberg 2009). Social constructionists understand that labels have power, for they set the parameters for how people are perceived and how they are responded to by others. Changing a label, or creating a new one, affects perception. The changes made in terminology by the American Psychiatric Association (APA) in the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were partially the result of acknowledging this power. Psychiatrists and physicians are, from a social constructionist perspective, social control agents with the authority to make labels stick, with potentially negative consequences for those to whom they apply those labels. According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA n.d.) National Registry of Evidence-Based Programs and Practices (NREPP), “Addiction is no longer included in the fifth edition of the DSM, despite its common usage internationally, bec...