Choice Theory

When psychological dependence occurs, the user feels psychological discomfort if use is terminated. Dependent users tend to believe that they will use the chemical for the rest of their lives as a regular part of social or recreational activities. They question whether the desired emotional state can be achieved without the use of the chemical, and they have a pre- occupation with thinking and talking about the chem- ical and activities associated with using it.

Users also generally develop a tolerance for some drugs, which means they have to take increasing amounts over time to achieve a given level of effect. Tolerance depends partly on the type of drug, be- cause some drugs (such as aspirin) do not create tolerance.

Drug addiction is difficult to define. In a broad sense, addiction refers to an intense craving for a particular substance. The problem is that this defini- tion could be applied to an intense craving for a variety of substances—pickles, ice cream, potato chips, strawberry shortcake. To avoid this problem, we will define addiction as an intense craving for a drug that develops after a period of heavy use.

Why Do People Use and Abuse Alcohol and Other Drugs? The effects of using drugs are numerous, ranging from feeling light-headed to death through overdos- ing. Drug abuse may lead to deterioration in health, relationship problems, automobile accidents, child abuse, spouse abuse, loss of job, low self-esteem, loss of social status, financial disaster, divorce, and arrests and convictions.

A distinction needs to be made between responsi- ble drug use and drug abuse. Many drugs do have beneficial effects when used responsibly; aspirin re- lieves pain, alcohol helps people relax, tranquilizers reduce anxiety, antidepressant drugs reduce depres- sion, amphetamines increase alertness, morphine is a painkiller, and marijuana is useful in treating glau- coma. Irresponsible drug use is abuse, which was defined earlier in this chapter.

Why do people abuse drugs? The reasons are nu- merous. Drug companies widely advertise the bene- ficial effects of their products. The media (such as television and movies) glamorize the mind-altering effects. Many popular songs highlight drinking. Bars and cocktail lounges have become centers for socializing, and promote drinking. Through such channels, Americans have become socialized to ac- cept drug usage as a part of daily living. Socializa- tion patterns lead many people to use drugs, and for some the use is a stepping-stone to abuse.

Attitudes toward drug use also encourage abuse. For example, some college students believe they should get blitzed or stoned after a tough exam. Ryne Duren (1985), former pitcher for the New York Yankees, asked this question: “I started becom- ing an alcoholic at age four, even though I had my first drink at age nine—how can this be?” Duren went on to explain that at a very young age he became socialized to believe that a real man was “someone who could drink others under the table,” and that the way to have fun was to get high on alcohol.

People abuse drugs for a variety of reasons. Some people build up a tolerance to a drug and then

HIGHLIGHT 11.6

Steroid Use in Baseball

On March 30, 2006, baseball commissioner Bud Selig asked former Senator George Mitchell to investigate steroid use in baseball. On December 13, 2007, Mitchell released his report. The report found steroid use to be rampant among former and current players.

Eighty-six former and current players were named in the report. (It is thought that there are many other users among baseball players who have not yet been identified.) Steroids have been on baseball’s banned substance list since 1991; how- ever, testing of Major League players did not begin until 2003.

Seven Most Valuable Player Award winners were named in the report, along with 31 All-Stars—at least one for every

position. Some of the biggest names in baseball are alleged to have been users, including Barry Bonds, Roger Clemens, Mark McGwire, David Justice, Jason Giambi, Gary Sheffield, Miguel Tejada, Lenny Dykstra, Rafael Palmeiro, Andy Pettitte, Chuck Knoblauch, and Alex Rodriguez. (Some of these players have denied, under oath, that they used steroids.)

To avoid testing positive for steroids, many athletes looking for an edge have now turned to human growth hor- mone (HGH) to build muscle. It is difficult to detect, and the best test available has a window of detection of only 48–72 hours.

Psychological Aspects of Young and Middle Adulthood 505

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increase the dosage to obtain a high. Physical and psychological dependence usually leads to abuse. People with intense unwanted emotions (such as loneliness, anxiety, feelings of inadequacy, guilt, de- pression, insecurity, and resentment) may turn to drugs. For many abusers, their drug of choice be- comes their best friend because they tend to person- alize it and value it more highly than they value their friends. The drug is something that they can always count on to relieve pain or give them the kind of high they desire. Many abusers become so highly attached to their drug that they choose to continue using it even though it leads to deterioration of health, divorce, discharges from jobs, automobile accidents, alienation from children, loss of friends, depletion of financial resources, and court appear- ances. Drug abusers usually feel they need their drug as a crutch to make it through the day.

Abusers develop an intimate relationship with their drug of choice. Even though this relationship is unhealthy, the drug plays a primary role in the abuser’s life, dictates a certain lifestyle, fills a psycho- logical need, and more often than not takes prece- dence over family, friends, and work. Most abusers deny their drug usage is creating problems for them, because they know that admitting they have a drug problem means they will have to end their relation- ship with their best friend, and they deeply believe they need their drug to handle their daily concerns and pressures. Drug abusers are apt to use a number of defense mechanisms in order to continue using drugs. They rationalize adverse consequences of drug abuse (such as the loss of a job) by twisting or dis- torting reality to explain the consequences of their behavior while under the influence. They minimize the adverse consequences of their drug use. They use projection to place the blame for their problems on others; for example, “If you had a wife like mine, you’d drink too.”

Theories About Drug Use A variety of theories have been offered as to why people use drugs. Biological theories assert that physiological changes produced by the drugs eventu- ally generate an irresistible craving for the drug. Some biological theories also postulate that some people are predisposed by their genetic structure to abuse certain types of drugs. For example, some au- thorities believe that genes play a role in predispos- ing some people to alcoholism. Behavioral theories hold that people use drugs because they find them

pleasurable and continue to use them because doing so prevents withdrawal distress. Interactionist theo- ries maintain that drug use is learned from interac- tion with others in our culture. For example, people drink alcohol because drinking is widely accepted. Interactionist theories assert that those who use ille- gal drugs such as marijuana or cocaine have contact with a drug subculture that encourages them to ex- periment with illegal drugs.

Interaction in Family Systems: A Theoretical Approach to Drug Abuse Wegscheider (1981) maintains that chemical depen- dency is a family disease that involves and affects each family member. Although she focuses on the families of alcoholics, much of what she says may also apply to the families of other types of chemical substance abusers.

She cites several rules that tend to characterize the families of drug abusers. First, the dependent person’s alcohol use becomes “the most important thing in the family’s life” (Wegscheider, 1981, p. 81). The abuser’s top priority is getting enough alcohol, and the family’s top priorities are the abuser, the abu- ser’s behavior, and keeping the abuser away from al- cohol. The goals of the abuser and of the rest of the family are at completely opposite poles.

A second rule in an alcoholic family is that alco- hol is not the cause of the problem. Denial is para- mount. A third family rule maintains that the dependent person is not responsible for his or her behavior and that the alcohol causes the behavior. There is always someone or something else to blame. Another rule dictates that no one should rock the boat, no matter what. Family members strive to protect the family’s status quo, even when the family is miserable. Yet other rules concern for- bidding discussion of the family problem either within or outside of the family, and consistently avoiding stating one’s true feelings. Wegscheider (1981) maintains that these rules protect the depen- dent person from taking responsibility for his or her behavior, and that the rules serve to maintain the drinking problem.

Wegscheider (1981) goes on to identify several roles that family members typically play. In addition to the chemically dependent person, there is the chief enabler, the family hero, the scapegoat, the lost child, and the mascot.

The chief enabler’s main purpose is to assume the primary responsibility for family functioning. The

506 Understanding Human Behavior and the Social Environment

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abuser typically continues to lose control and relin- quishes responsibility. The chief enabler takes on more and more responsibility and begins making more and more of the family’s decisions. A chief enabler is often the parent or spouse of the chemi- cally dependent person.

Conditions often continue to deteriorate as the chemically dependent person loses control. A posi- tive influence is needed to offset the negative. The family hero fulfills this role. The family hero is often the person who does well at everything he or she tries. The hero works hard at making the family look as though it is functioning better than it is. In this way, the family hero provides the family with self-worth.

Another role typically to played by someone in the family is that of scapegoat. Although the alco- hol abuse is the real problem, a family rule man- dates that this fact must be denied. Therefore, the blame must be placed elsewhere. Frequently, an- other family member is blamed for the problem. The scapegoat often behaves in negative ways that draw attention to him or her (for example, the per- son gets caught stealing, runs away, or becomes ex- tremely withdrawn). The scapegoat’s role is to distract attention away from the chemically depen- dent person and onto something else. This role helps the family avoid addressing the problem of chemical dependency.

Often, someone plays the role of lost child. This is a person who seems relatively uninvolved with the rest of the family and never causes any trouble. The lost child’s purpose is to provide relief from some of the pain the family is suffering. At least there is someone in the family who neither requires much attention nor causes any stress. The lost child is sim- ply there.

Finally, chemically dependent families often have someone playing the role of mascot. The mascot is someone who has a good sense of humor and appears not to take anything seriously. Despite how much the mascot might be suffering inside, he or she provides a little fun for the family.

In summary, chemical dependency is a problem affecting the entire family. Each family member suf- fers from the chemical dependency, yet each assumes a role in order to maintain the family’s status quo and help the family survive. Family members are driven to maintain these roles no matter what hap- pens. The roles eventually become associated with survival.

The Application of Theory to Client Situations: Treatment for the Chemically Dependent Person and His or Her Family One of the first tasks in treatment is for the chemically dependent person to take responsibility for his or her own behavior. The abuser must acknowl- edge that he or she has a problem before beginning to solve it. Several concepts are critical in working with the family (Wegscheider, 1981). Family members must first come to realize the extent of the problem. They need to identify the chemical abuse as their ma- jor problem. Additionally, they need to learn about and evaluate their family dynamics. They need to eval- uate their own behavior and break out of the roles that have been maintaining the chemical abuse. The chief enabler, in particular, must stop making excuses and assuming the chemically dependent person’s responsi- bilities. If the chemically dependent person is sick from a hangover and cannot make it to school or work the next day, it must be that person’s responsibility, not a parent’s or spouse’s, to call in sick.

Family members eventually learn to confront the chemically dependent person and give him or her honest information about his or her behavior. For instance, they are encouraged to tell the dependent exactly how he or she behaved while having a black- out. If the dependent person hit another family member while drunk, this fact needs to be con- fronted. The confrontation should occur not in an emotional manner but rather in a factual one.

The family also needs to learn about the pro- gression of the disease. We’ve already discussed some characteristics of drug dependence. There is a typical progression of an alcoholic’s feelings and behavior. At first, only occasional relief drinking occurs. Drinking becomes more constant. The de- pendent person then begins to drink in secret and to feel guilty about drinking. Memory blackouts begin to occur and gradually increase in frequency. The dependent person feels worse and worse about his or her drinking behavior, but seems to have less and less control over it. Finally, the drinking be- gins to seriously affect the person’s work, family, and social relationships. A job may be lost or all school classes flunked. Perhaps family members leave or throw the dependent person out. The de- pendent person’s thinking becomes more and more impaired.

EP 2.1.3b, 2.1.6b, 2.1.10a, d, e, g, & j

Psychological Aspects of Young and Middle Adulthood 507

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