Drug Pol icy and Human Nature - Springer978-1-4899-3591-5/1.pdfDrug Pol icy and Human Nature Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug

Drug Pol icy and Human Nature Psychological Perspectives on the Prevention, Management, and Treatment of III icit Drug Abuse

Drug Pol icy and Human Nature Psychological Perspectives on the Prevention, Management, and Treatment of Illicit Drug Abuse

Edited by

Warren K. Bickel and

Richard J. DeGrandpre University of Vermont Burlington, Vermont

Springer Science+Business Media, LLC

Library of Congress Cataloging-in-Publication Data

On file

ISBN 978-1-4899-3593-9 ISBN 978-1-4899-3591-5 (eBook) DOI 10.1007/978-1-4899-3591-5

© 1996 Springer Science+Business Media New York Originally published by Plenum Press, New York in 1996 Softcover reprint of the hardcover 1st edition 1996

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No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

Contributors

B. K. ALEXANDER Simon Fraser University, Burnaby, British Columbia, Canada V5A IS6

WARREN K. BICKEl Human Behavioral Pharmacology Lab, Department of Psychiatry, University of Vermont, Burlington, Vermont 05401-1419

JOSEPH V. BRADY Behavioral Biology Research Center, Hopkins Bayview Research Campus, Johns Hopkins University School of Medicine, Bal­timore, Maryland 21224-6823

BREENA H. BRY Graduate School of Applied and Professional Psychology, Rutgers University, Busch Campus, Piscataway, New Jersey 08855-0819

JONATHAN CAULKINS Drug Policy Research Center, RAND, Washington, DC 20537 and Carnegie Mellon University, Pittsburgh, Pennsylvania 15213

H. WESTLEY CLARK University of California at San Francisco and Veterans Administration Medical Center, San Francisco, California 94121

GARY A. DAWES Simon Fraser University, Burnaby, British Columbia, Can­ada V5A IS6

RICHARD J. DeGRANDPRE Human Behavioral Pharmacology Lab, Depart­ment of Psychiatry, University of Vermont, Burlington, Vermont 05401-1419

JOHN l. FALK Department of Psychology, Rutgers University, New Bruns­wick, New Jersey 08903

SHARON M. HALL University of California at San Francisco and Veterans Administration Medical Center, San Francisco, California 94121

DWIGHT B. HEATH Department of Anthropology, Brown University, Prov­idence, Rhode Island 02912

ARTHUR P. LECCESE Kenyon College, Gambier, Ohio 43022

v

vi CONTRIBUTORS

ROBERT MacCOUN Graduate School of Public Policy, University of Cali­fornia at Berkeley, Berkeley, California 94720, and Drug Policy Research Center, RAND, Washington DC 20537

A. THOMAS MclELLAN Center for Studies of Addiction, University of Pennsylvania, and Veterans Affairs Medical Center, Philadelphia, Pennsyl­vania 19104

STANTON PEELE Morristown, New Jersey 07960

ANTON R. F. SCHWEIGHOFER Simon Fraser University, Burnaby, British Columbia, Canada V5A IS6

KAREN LEA SEES University of California at San Francisco and Veterans Administration Medical Center, San Francisco, California 94121

CONSTANCE WEISNER Alcohol Research Group, University of California at Berkeley, Berkeley, California 94720

JOSEPH WESTERMEYER Departments of Psychiatry and Anthropology, Uni­versity of Minnesota, Minneapolis, Minnesota 55455

Preface

The formation of drug policy is a complex phenomena influenced by a multi­tude of sources. Among others, these influences include historical factors, contemporary public opinion regarding the nature and magnitude of drug use and abuse, the portrayal of illicit drugs and drug use in the media, and lobbying efforts by special interest groups (e.g., The Drug Policy Foundation), including government agencies (e.g., the Justice Department and law enforcement). An additional source of influence are the activities of specialists directly engaged in studying drug use and treating drug dependence. This includes individuals involved in drug treatment, anthropological and cultural studies, policy analy­ses, basic psychological and pharmacological research, research on the epide­miology of drug use and dependence, and research on prevention. This influ­ence by specialists might be usefully distinguished from those influences first mentioned for two reasons: First, studies of drug use and dependence attempt to uncover empirical generalizations about drugs, and second, because these findings are empirical, there is a hope that they guide, at least to some extent, the actions of other forces that more directly determine drug policy.

Psychology as an empirical discipline has long been interested in the use of psychoactive drugs. At the level of basic science in psychopharmacology, a most important contribution has been the demonstration that drugs of abuse function as reinforcers and thus enter into the same psychological processes as do other appetitive stimuli. Prior to this recognition, abused drugs were viewed as unique entities that entered into chronic use because they alleviated a withdrawal state created previously by the drug. Psychology's interest as a therapeutic enterprise also has a long standing, and psychologists were among the first to develop and test treatments for drug dependence. Given the health costs and societal costs of various drug abuse problems, these efforts are important for both the individual and the larger community. Meanwhile, other psychologists have been involved in examining the role that childhood settings and experiences can play in determining later drug use. Prevention efforts that

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VIII PREFACE

identify risks for drug dependence are among the most important and the most challenging areas of research. Most recently, psychologists have begun to address issues specific to public policy, including assessments of psychology's role in policy development.

In this volume we have brought together a group of specialists whose work, when taken together, addresses the primary psychological issues relevant to the making of drug policy. The purpose of the volume, however, is not merely to inform social scientists and policy makers about the various features of research on illicit drugs, but also to give psychologists an opportunity to provide policy recommendations based on their own knowledge and expertise. In doing this, we hope to show that psychology can inform us about illicit drugs and drug dependence and can participate in the formation of policy.

To reflect these aspects of drug policy-the psychological science of psychoactive drugs and the psychology of policy-we have organized the volume into five parts. In the first three parts (covering psychological science), contemporary research is reviewed with respect to drug policy. Basic science is discussed in Part I first in terms of the evolution of drug abuse (Chapter 1), and then in terms of the clinical implications of basic processes involved in drug use (Chapter 2). The chapters in Part II examine the problem of changing drug use at the individual, cultural, and societal levels (Chapters 3-5). Part III comprises a thorough discussion of innovations in drug treatment services (Chapters 6 and 7).

The last two parts of the volume also examine psychological aspects of drug policy but with a greater emphasis on policy issues (covering the psychol­ogy of drug policy). The chapters in Part IV provide a critique of assumptions underlying current drug policies and then propose policy alternatives (Chapters 8 and 9). This is followed by Part V, comprising four chapters that look at different social and cultural factors involved in the psychology of drug policy (Chapters 10-13).

Together, these five parts provide the reader with a comprehensive ac­count of psychological aspects of drug policy and, hopefully, further the contributions of psychology to policies regarding the nonmedical use of psy­choactive drugs.

Warren K. Bickel Richard J. DeGrandpre

Contents

Part 1. Informing Drug Policy via Psychological Science: Basic Research in Drug Abuse and Its Determinants

Chapter 1. Environmental Factors in the Instigation and Maintenance of Drug Abuse ............................... 3

John L. Falk

The Estrangement of Science and Policy ..................... 3 Science and Drug Policy .................................. 4 A Brief Critique of Pharmacological Determinism in Drug Abuse 6 Intravenous Self-Administration: Utility of a Classic

Pharmacological Approach .............................. 10 Nonpharmacological Sources for the Reinforcing Function of

Drugs and Drug Abuse ................................. 12 Concluding Remark ...................................... 23 References ............................................. 24

Chapter 2. Psychological Science Speaks to Drug Policy: The Clinical Relevance and Policy Implications of Basic Behavioral Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Warren K. Bickel and Richard J. DeGrandpre

Research-Derived Principles ............................... 32 Empirical Support ....................................... 40

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x CONTENTS

Policy Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 References ............................................. 47

Part II. Informing Drug Policy via Psychological Science: Changing Drug Use

Chapter 3. Psychological Approaches to Prevention . . . . . . . . . . . . . 55

Brenna H. Bry

Protective Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Risk Factors ............................................ 59 Prevention Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Summary and Recommendations ........................... 70 References ............................................. 72

Chapter 4. Drug Abuse, Drug Treatment, and Public Policy

Sharon M. Hall, H. Westley Clark, and Karen Lea Sees

77

Contingency Management ................................. 78 Skill Training ........................................... 84 Pharmacotherapy ........................................ 86 Summary............................................... 94 References ............................................. 94

Chapter 5. Cultural Factors in the Control, Prevention, and Treatment of Illicit Drug Use: The Earthlings' Psychoactive Trek................................................... 99

Joseph Westermeyer

Drug-Alcohol Production and Commerce in Prehistoric and Historical Contexts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Substance Use in Cultural Context .......................... 105 Modes of Control over Drug Production, Commerce, and Use. . . . 109

CONTENTS XI

Drug Subcultures and the Drug Trade ....................... 113 Interethnic Differences within the Nation-State ................ 117 Drug Control among Cultures and Nation-States .. . . . . . . . . . . . . . 118 References ............................................. 121

Part III. Informing Drug Policy via Psychological Science: Innovations in Treatment Services

Chapter 6. Achieving the Public Health and Safety Potential of Substance Abuse Treatments: Implications for Patient Referral. Treatment "Matching," and Outcome Evaluation .............. 127

A. Thomas McLellan and Constance Weisner

Introduction ............................................ 127 What Brings Substance Abusers to Treatment? ................ 129 What Outcomes Are Expected from Substance Abuse Treatment? 130 Outcome Domains Based on Public Expectations .............. 132 Methods ............................................... 132 Results ................................................ 138 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Illustrating the Relationships between Substance Use and Public

Health Problems: Case Examples ......................... 146 Strategies for Achieving the Public Health and Safety Benefits of

Substance Abuse Treatments ..................... . . . . . . .. 149 References ............................................. 152

Chapter 7. Drug Policy and the Enhancement of Access to Treatment ............................................ 155

Joseph V. Brady

Introduction ............................................ 155 Program Implementation .................................. 158 Treatment Methods and Procedures ......................... 162 Process and Outcome Evaluation ........................... 163 Policy Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 References ............................................. 173

XII CONTENTS

Part IV. The Psychology of Drug Policy: Psychological Assumptions behind Policy

Chapter 8. Examining the Behavioral Assumptions of the National Drug Control Strategy .................................... 177

Robert MacCoun and Jonathan Caulkins

Effects of Drug Laws on Drug Use ......................... 178 Sociodemographic Considerations . . . . . . . . . . . . . . . . . . . . . . . . . .. 181 Other Actors, Other Roles .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Addressing the U se-Hann Link: Toward Total Hann Reduction .. 188 References ............................................. 195

Chapter 9. Assumptions about Drugs and the Marketing of Drug Policies 199

Stanton Peele

Introduction: Say Whatever You Want about Drugs as Long as It's Negative .......................................... 199

Drug Policy and Models of Drug Abuse and Addiction ......... 203 Harm Reduction, Drug Legalization, and Models of Addiction '" 216 Marketing Alternative Drug Policies . . . . . . . . . . . . . . . . . . . . . . . .. 217 References ............................................. 218

Chapter 10. The Pharmacological Understanding of Psychoactive Drugs: Basic Science in the Context of Differential Prohibition. .. 221

Arthur P. Leccese

Importance of Basic Phannacology ........................ " 221 Retrospective Analysis and Prospective Experiments ........... 223 Basic Pharmacology of Cocaine and Marijuana. . . . . . . . . . . . . . .. 224 Five Questions about Cocaine and Marijuana ................. 226 Differential Prohibition and Research .. . . . . . . . . . . . . . . . . . . . . . . 238 Conclusion ............................................. 241 References ............................................. 242

CONTENTS

Part V. The Psychology of Drug Policy: Social and Cultural Factors Influencing Drug Policy

Chapter 11. American and Canadian Drug Policy: A Canadian

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Perspective ............................................. 251

B. K. Alexander, Anton R. F. Schweighofer, and Gary A. Dawes

The Origin of Drug Laws in the United States and Canada ...... 252 American and Canadian Drug Policy after World War II ........ 259 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 267 References ............................................. 274

Chapter 12. The War on Drugs as a Metaphor in American Culture ................................................ 279

Dwight B. Heath

Declaration of a War on Drugs ............................. 279 Why People Care about Drugs: An Anthropological Perspective .. 283 The Elusive Nature of Drug Problems ....................... 284 Prohibition as a Problem-Solving Strategy . . . . . . . . . . . . . . . . . . .. 290 Blurred Battle Lines in the War on Drugs .................... 292 Hope for an Armistice .................................... 295 References ............................................. 297

Chapter 13. The Impact of Socially Constructed Knowledge on Drug Policy ............................................ 301

Richard J. DeGrandpre

Introduction ........................................... . An Epistemological Framework ........................... . Social Knowledge and Illicit Drug Policy ................... . Changing Policy Means Changing the Contingencies That

Produce It ........................................... . Conclusion References ........................................... ..

Index ................................................... .

301 302 310

317 320 320

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