Cohen, Peter (1990),
Introduction into the author's bias. In: Peter Cohen (1990), Drugs
as a social construct. Dissertation. Amsterdam, Universiteit van Amsterdam.
© Copyright 1990 Peter Cohen. All rights reserved.
I. Introduction into the author's bias
The four sections, assembled for this dissertation, have been published earlier in 1983 (Heroin dependence pathological?), 1985, (Cocaine and Cannabis), 1986 (On Rehabilitation), and 1988 (Cocaine use in Amsterdam)[*]. In this introduction some of the principles that helped me in writing these publications are presented.
An important background of my work is an opinion about the competency of much medical and social science when applied to drugs. These sciences seem to be unable to describe and explain the phenomenon of drug use without an unusually strong bias. This bias is produced by a cultural dependency on concepts of much larger significance than drug use itself. As a result the object is almost completely blurred from view.
Note that I do not claim to be right. Of course, I construct my own view on both science and drugs. An important bias here is my own political distaste for discriminatory forms of control. Furthermore, I have been assisted by an epistemology offered by the many varieties of sociology, political economy and psychology. I could not help but seeing much of what happened around me in the drug arena as "social constructions"; realities created by a myriad of relationships between persons who used concepts to understand a reality that would adapt them for their survival within these relationships[*]. And since the inequality of power is one of the structural characteristics of interpersonal (or for that matter, inter-organisational) relationships, much of the so called scientific analysis of drug use would tend to be most instrumental to the survival of the most powerful. Power, of course, is not only connected to wealth or decision making, but also to the construction of morality and ideology.
Long before I started writing about drug use I realized the validity of the general concept that science is one of the fundamental instruments of political and ideological conflicts. The determination of which branches and concepts of science will be developed or applied is, apart from chance and some interdisciplinary logic, dependent upon economic and political power. Because power cannot be evenly distributed in a community (the university included) those in power will develop science according to their interests and taste. One should not look upon this as dishonesty or exploitation per se, but in most cases, as honourable and quite inescapable.
The concepts I initially used to attain a detailed understanding of the relation between concepts and power were the "I", the "Ego", and the "individual" (Cohen, 1980). Educated as a social psychologist, I critically investigated many psychological and sociological theories in order to come to grips with the use of social science for the conceptual construction of the "ego" and "the individual".
To summarize, I learned that in present Western society, dominated as it is by entrepreneurial activity, persons have to very often find their way against or without others. Therefore, generally a person will learn to "experience himself alone, in the centre of things for whom everything else exists outside himself, separated by an invisible wall from him, assuming as self evident that other individuals experience the same". (Elias, 1969, p. 125) I followed Norbert Elias in the theory that this "Homo Clausus" concept of the individual is a specific historical construction. Of course, this construction is not the intentional product of some office or ideologue, but a by-product of people in their mutual and socially structured relationships. It goes unnoticed, like breathing. It follows that naïve science will explain the individual as a Homo Clausus. In this way psychiatry, psychology and sociology are tools of a class of people who interpret, influence and try to shape others and society from this dominant perspective on the individual.
In the short essay "On Rehabilitation" one will easily recognize my constructionist point of view. I simply do not take seriously the reasons for the use of drugs that are often mentioned in scientific literature. My psychological bias tells me to look for motives behind the words, and my sociological bias compels me to search for these motives in the field of power inequalities. One discovers that the so called 'reasons' why people take drugs are convenient conceptual constructions that are fitted to a predetermined, mostly psychopathological model of explanation of drug use and 'dependence'.
However, as observed by Musto, it might very well have been the emergence of a new class of professional medical men at the end of the last century that helped to socially define illegal (often so called 'non-medical') drug use. Professionals related to the maintenance of physical or mental health and the management of pain have throughout history been very powerful people.
The tools and concepts of these professionals may change in history. The modern power to mediate between (a large majority of) drugs and the use of drugs is a new and tremendously important instrument. In contemporary Western society drug use is not left to the individual responsibility of the consumer. It is assumed that the consumer is not able to exercise this responsibility. Every consumer of drugs is therefore forced to first consult a 'drug broker', which produces in turn an almost total monopoly of the drug broker class. Total prohibition of certain drugs is the focal point of the assumption that drugs should be excluded from the realm of consumer freedom. In this sense the existence of 'illegal' or 'non medical' drug use is a vital concept for present day legitimizations of medical power. This particular concept has been internalized by all categories of the public, although it has been attacked by theoreticians such as Szasz[*], And as long as the definition of "illegal drug use" helps medical professionals to retain their power, a large majority of them can be expected to hold to it.
Power also plays a role in the management of minorities. How tHe management of minorities is related to our history of drug prohibition is illustrated in "Cocaine and Cannabis". Management of minorities does not only relate to the opportunities of economic exploitation, but also applies to the warding off of fear. If mainstream groups develop fear of minorities for whatever reason, there is a small likelihood that scientists belonging to these mainstream groups will not share these fears. Science can then be used to translate popular and crude verbalisations into an 'objective' scientific discourse of warding off policies that legitimate the use of physical force against the feared minorities. One of the most common legitimizations of the use of physical force is the redefinition of drug use as crime or "crime generating". Once this has been accomplished the social institutions that will care for drug users can be defined as the police, prison personnel or, in extreme cases, the army.
The article on the assumed psychopathology of heroin dependence focuses on the use of psychological theory for the essential construction of drug dependence as illness. The redefinition of illegal drug use as pathology is on first view completely different from its redefinition as crime. The difference, however, is mainly in the selection of control institutions. The violence of health institutions towards the users of illegal drugs is often less outspoken than the violence of criminal justice institutions. This is a difference that can be very important for individuals that are subject to this violence. But both medicalization and criminalization are techniques to control defined deviant groups and in this sense they are identical.
The article on the psychopathology of heroin addiction evaluates the empirical evidence we have for just one of the medicalization techniques commonly applied to illegal drug use[*]. Following Zinberg I conclude that the conventional combinations of behaviour we define as heroin dependence are mainly a product of society's reactions toward a frequent heroin user, not of the effects of heroin itself. We are so conditioned by medicine to think in terms of the pharmacological effects of a substance that drug-use related behaviours are automatically associated with the substance. But the effects of a substance are almost always mediated by the user and the social context in which use takes place. A failure to understand this interaction gives rise to an invalid emphasis on the pharmacological dimension. This distorted emphasis is often connected to narrowly conceived psychiatric models of explanation.
If, apart from a few cases, regular drug use in general and heroin use in particular would be no longer defined in terms of pharmacology and pathology a conceptual cornerstone of 20th century prohibitionism would seriously erode.
Investigation of the concept of addiction itself, as an expression of "central cultural conceptions about motivation and behaviour" (Peele, 1985, XII) would have been a logical extension of my bias. But until this dissertation I never attempted to venture into this trickiest and most fundamental of labyrinths in the field of drug use.
Conceptually shifting away from the incorrigible association between frequent use of illegal drugs and pathology, a drug use career with all its secondary social effects can be researched in a completely different way.
Once on this road (coupled with the view of the instrumental function of science for drug political status quo) one quickly recognizes "realities" that have been excluded as an object of scientific inquiry. A good example is the pleasure that drugs provide. Drug-related pleasure or other non-negative functions of drug use cannot be easily investigated within a political structure that is committed to the prohibition of drugs as a defense against evil. Imagine a high officer of the Inquisition in the late Middle Ages allowing for the possibility that a large proportion of heretics were "non evil"! This would have been impossible. (Is this principally different from the current ban on the use of the expression "recreational drug use" from the publications written with grants from the National Institute on Drug Abuse -- NIDA -- in the USA, because drug use should not be even conceived as "non sick"?[*])
The pleasure of drug use is a topic of empirical description appearing inconspicuously in both publications on cocaine reprinted in this dissertation. Cocaine use has not been portrayed as a reinforcer of compulsive behaviour as it is often presented from the perspective of pathology. In contrast, I have made room for the perspective of the majority of users in which it often appears as one of the hedonistic entities of everyday life. The importance of taking drug related pleasure as a research topic can be illustrated by the serious attempt to understand controlled drug use. One of the conclusions of my cocaine user study was that most cocaine users do not lose control. Apparently some "control mechanisms" exist and they are not restricted to cocaine. This conclusion has been reached by a growing number of drug researchers[*]. A full understanding of control mechanisms is still lacking as well as a a thorough theoretical investigation of this concept itself. But, assuming the validity of such a concept, one of the regulators of drug use might very well be a relative change in drug related pleasure when drug use exceeds certain limits. My cocaine study showed that when a level of use of 2.5 grams of cocaine per week is exceeded, the number of reported unpleasant negative effects rises steeply. This could very well be one of the explanations of why levels above 2.5 gram per week are so rarely maintained over longer periods in my sample of experienced cocaine users, even though many respondents are very well able to financially support such levels of use.
In many psychological and sociological views on drug use both the concepts of drug related pleasure and controlled use are of little or no importance. Heroin and cocaine allegedly cannot be used in a controlled and pleasurable manner because the concepts of control and pleasure conflict with ruling notions. Loss of control and extreme misery is what the use of these drugs will yield. Empirical verification from an epidemiological point of view of such ex cathedra notions is still rare. The purpose of my study "Cocaine Use in Amsterdam" was indeed to empirically verify through epidemiological research the prevailing notions of cocaine use.
If one realizes that much of our knowledge about the use of cocaine has come from studies done by clinicians, one also comes to realize that there is a sampling bias with the data that clinicians use use in their generalisations. This problem is similar to the problem one would have if our knowledge about the use of alcohol would be derived solely by the knowledge gathered by clinicians working in alcohol treatment. Alcohol users not seen by these medical professionals of course do exist and are indeed the great majority of the users of alcohol. My aim in the cocaine user study was to verify whether long term cocaine users not seen by clinicians would show the same problems as the ones that do present themselves for treatment. Or, in contrast, are the "invisible" users of cocaine comparable to alcohol users who are not seen by clinicians? And if so, is self control and possibly self management of eventual drug related malfunctioning an exception or the rule?[*]
Another aim of the cocaine user study was to explore what could be scientifically determined about the regular use of cocaine from a perspective that does not assume a priori that regular cocaine use is related to (mental) pathology. I simply wanted to know how experienced cocaine users report about their consumption, what pro's and con's they would define, how they eventually handle unwanted side effects and if they develop certain rules of use. For someone who does not automatically associate regular use of cocaine with loss of control and all kinds of dramatic dysfunctioning, the results of the study are hardly surprising.
The selection of the publications that comprise this dissertation is grounded upon their illustrative significance for some of the issues that I have mentioned. Each of them deals with a certain mix of conventional wisdom, conventional 'fact' or conventional application of concepts in social sciences. Together they can serve as an integrative perspective on drugs and drug use as research objects and behaviours that need not be so heavily fetishized or charged with emotions and mores.
These publications also try to demonstrate that psychology and sociology can be productive in distancing a researcher from what has become mainstream "drug abuse" science. The emphasis is on changing perspectives.
Nevertheless, some factual statements would be different if written now. For instance, I would no longer say, as I do in "Cocaine and Cannabis" that cannabis or cocaine do not produce tolerance. Instead, I would now dissect the general concept of tolerance into specific tolerance for each different main effect of the drug used in its social and recreational patterns. I would then, in turn, attempt to list as far as possible dose related tolerance for some specific effects. And if I would find that no valid research about differential tolerance for cocaine or cannabis effects exists, I would leave this aspect of comparative risk analysis open.
Thus, in conclusion I have observed that the specific ways in which psychology and sociology have looked upon drug use and selected topics for research are often purely instrumental in not endangering the existence of the a priori's of the present "drug problem". On the other hand, both disciplines yield notions that enable us to clarify and identify this instrumentalism. Where an individual scientist will stand might be a matter of chance, but most probably it is a result of his attachment to conventional perspectives and prejudice on drug use or drug dependence. And the chances for developing a non-conventional scientific outlook on illegal drugs become slimmer as financial support for drug research is regulated by drug policy institutions whose aim is to support conventional drug politics. This works also the other way round. No doubt my way to look upon matters of drugs has been very much influenced by the simple circumstance of living in the Netherlands where drug policy is deviant when seen from a global perspective. Both psychological and sociological concepts have been used and are used by official policy bodies in this country to defend and legitimize this deviance. Here at least some research can be funded precisely because its main questions fit non-conventional drug politics. In this sense my work is also instrumental, creating its own constructions more or less in line with recent work of others in the Netherlands (Leuw, 1981, Jansen and Swierstra, 1982, Van de Wijngaart, 1990).
Finally, a neutral view on drugs is highly improbable in a world that translates the drug issue in war metaphors. I am convinced that only the abolition of drug prohibition might ultimately create the conditions for a maximum of independent scientific involvement in the issue.
- I am highly indebted to Jason Ditton, Richard Hartnoll, Charles Kaplan, and Russell Newcomb who helped me translating these publications into English.
- I use the term 'social construction' in a common sense way, with only a very vague notion of the existence of a large school of thought in sociology that has social constructions as its object.
- Szasz also discussed this item extensively in Rome, March 1989, at the founding conference in the Italian Parliament of the International League against Drug Prohibitionism.
- Another medicalization technique is to generalize rare somatic risks, or medical risks of extreme drug use patterns for all drug use; this technique is not discussed here.
- Of O'Hare, P.: Ideology, Research and Policy. In The Intl Journal on Drug Policy.Vol 1/3.p.24-26
- See e.g. Zinberg, N.: Drug, Set and Setting: the basis for controlled intoxicant use. Yale University Press, 1984. Zinberg studied the use of marihuana, LSD and heroin. Cf also Rosenbaum, M. et al: Exploring Ecstacy: A descriptive study of MDMA users. Final report to the National Institute of Drug Abuse, Rockville 1989.
- The concepts of "self control" and "self management" of problems are used here in such a way that they include mechanisms that are dependent on the existence of small and private social control systems made up of several people or small groups.
- Cohen, P.: Het groeps-ego concept en de verhouding psychologie-sociologie. IWA 1980. (The group ego concept and the relation between psychology and sociology).
- Elias, N.: Sociology and Psychiatry. In: Foulkes, S. H and Stewart Prince, G. (Ed): Psychiatry in a changing society. London 1969.
- Musto, D.: The American Disease. Origins of narcotic control. Yale-University, 1973.
- Szasz, Th.: A plea for the cessation of the longest war of the 20th century: the war on drugs in CORA (Eds): The cost of prohibition, proceedings of the congress, organized by the Coordinamento Radicale Antiprohibizionista, European Parliament, Bruxelles, Oct 1988.
- Peele, S.: The meaning of addiction. Compulsive experience and its interpretation. Lexington, 1985.
- Leuw, E.: Een criminologische visie op deviant druggebruik. in: Goos, C. en van der Wal, H. (Eds) Druggebruiken, verslaving en hulpverlening. Alphen 1981 p 77-106.
- Janssen, O. en Swierstra, K.: Heroïnegebruikers in Nederland. Groningen 1982.
- Van de Wijngaart, G.: Competing perspectives on drug use. The Dutch experience. Dissertation, Utrecht 1990.