Appendix D

Motivation and Other Factors Related to Non-Medical Drug Use

D.1 GENERAL

The Commission has available numerous sources of information concerning the causes of non-medical drug use, the motivation of users and the factors associated with this phenomenon. Among these sources are the testimony presented at the public hearings of the Commission and in private meetings with the Commissioners and staff; reports from our participant observers and other researchers who worked with the Commission; evidence and comments presented at special symposia organized by the Commission to which a number of world experts were invited; and the results of surveys that have been carried out by the Commission, universities, drug foundations and individual scholars. In addition the Commission has studied and critically analysed the major psychiatric, psychological and sociological literature dealing with the motivational and other factors associated with the nonmedical use of drugs.

There has been a very great increase in the volume and quality of research and interpretation available. Many aspects of non-medical drug use can be described with accuracy, and we can make reasonable attempts at explaining the phenomenon. However, as for any other human phenomenon, it is not possible to provide final, comprehensive and definitive explanations. Our understanding will improve as more research is completed.

CAUSES, MOTIVATIONS AND ASSOCIATED FACTORS
In the context of our existing knowledge of non-medical drug use the term cause must be used with caution. In general usage, cause is taken to mean that which is invariably and unconditionally followed by a certain specific effect. When the term is used in this sense we know of nothing that can be demonstrated to inevitably produce non-medical drug use at either the group or individual level. We can, however, point to various factors that are frequently associated with the phenomenon. A number of these conditions (social, psychological, political, economic, philosophical, etc., in nature) can be seen to be frequently and intimately associated with non-medical drug use. They may or may not have an underlying role in producing it or in increasing the probability of it occurring.

The term motive refers, generally, to that which induces an individual to act. While motive may be held in common by members of a group or social category, a discussion of motivation must take account of the idiosyncratic. It is never possible to be certain that we can accurately describe, let alone fully comprehend and understand, the motivation of another person. Data about an individual's motives can be gathered from his own statements about the reasons for his conduct, as collected in interviews and questionnaires. Data can also be gathered by means of various projective tests which seek to probe beneath the level of consciousness. Data concerning motivation can be taken from the interpretations of those who observe or analyse behaviour. But there is never an ultimate check on the validity of the data. The individual reporting his motives may or may not want to divulge the most important ones and may or may not truly understand himself.

Even were it possible to fully understand and explain the use of some drug by an individual or group in some community in a particular year, we would not be in a position to posit universally applicable generalizations about the use of that drug. The context of drug use necessarily varies from person to person, place to place and through time. The use of heroin, for instance, has often been associated with the ghetto conditions of ethnic minorities in the United States, but heroin use in Canada and England is not as frequently related to these conditions. A few years ago an explanation of marijuana use would stress the religious and philosophical quest associated with its use by some cannabis smokers, while a contemporary description might well give only passing reference to these searchings.

NECESSARY CONDITIONS

While we cannot accurately point to the specific causes of non-medical drug use, we can indicate certain conditions which must be present for the phenomenon to occur. For example, the availability of heroin and the presence of a population of heroin users in a community are almost always preconditions for the spread of the use of this drug. Needless to say, an interest in the drug or a willingness to experiment with it may be present without the drug or users, but this interest per se cannot lead to use. However, availability alone does not necessarily produce use. Thus, availability is a necessary but not sufficient condition for increased use of a drug.

Supply often precedes demand. For example, when new drugs are introduced for research purposes or appear on the market for the first time, there may be a considerable timelag before an interest in the drug is generated. To a large extent this interest appears to be fostered by word of mouth or example. As knowledge of the existence of the drug spreads, some individuals become curious about its effects or otherwise interested in using it themselves. They may then either deliberately seek a supply or wait for an opportunity to fortuitously arise. Historically the commercial production, advertising and marketing for medical purposes of opiates, barbiturates, LSD, amphetamines and a number of other drugs played a role in generating an interest that eventually led to their widespread non-medical use. In turn, information about non-medical use spread, creating new curiosity and interest and fostering new demand. Once this availability-interest chain of individual and social factors is established, the prevention of continued or expanded use of a drug is extraordinarily difficult.

MACRO-SOCIAL CONDITIONS

There have been many suggestions that social conditions such as poverty, ghetto or slum residence, unemployment or frustrating, dull and repetitious work, and minority or ethnic group status are among the important factors underlying the non-medical use of certain drugs. These conditions, for example, have often been found to be associated with the use of alcohol and the opiate narcotics. A number of scholars have hypothesized that the war in Vietnam fostered an alienation among many young people that, in turn, provided fertile soil for the spread of the use of cannabis and LSD. Alienation from what is perceived to be an overly bureaucratized society that seems to offer little scope for emotion and feeling has also been noted.

Keniston and Roszak in the United States, and Zijderveld and Crook in Canada, have made notable contributions to relating broad, macro-social forces to the non-medical use of drugs. Keniston deals with drug use as part of a pattern of passive responses to the alienation experienced by university students."' Roszak sees drug use developing as part of an evolving counter culture that rejects the contemporary "technocratic society".23' Zijderveld, in a similar manner, treats drug use as an aspect of some persons' rejection of our presently "abstract society".424 Crook, in a paper prepared for the Commission, stresses the failure of the major social institutions to provide situations and opportunities for meaningful and satisfying social participation by the young.96

None of these approaches find the source of drug use in the traditional social and individual problems of economic deprivation or minority status. Rather they stress the psychological problems of the well-to-do and socially privileged who cannot find satisfaction or meaning in the relatively affluent life offered them by their parents.

Keniston was one of the first writers to deal with broad social conditions as background causes of student drug use, relating them to alienation, counter culture and, eventually, the non-medical use of drugs.'87. 188 The causes he notes vary depending on the level-of-use being discussed. Occasional users ("tasters" or "seekers") are said to be motivated by a variety of factors, including their intellectual orientation, the high value accorded by them to the search for truth, and their privileged social background. He argues that the pressure of sophisticated academic institutions, insofar as they attach priority to conventional success goals like high marks and scholarships, is an additional stimulus to the creation of a counter culture. The occasional users may give a higher priority to values such as expressiveness and immediate experience than to the conventional success goals. In contrast, Keniston sees the heavy user ("the head") as highly alienated to the point of rejecting many fundamental American values, such as material success, far more than does the occasional user. The latter, he suggests, has merely rearranged his priorities. Keniston also refers to the activists who believe in the traditional values of justice and equality and realize them in actuality. However, he feels that the activist alternative became increasingly inappropriate for white alienated college students with declining opportunities for their participation in the civil rights movement and their conclusion that the war on poverty was a false promise. Hence, the probability of turning to the passive drug alternative increased.188 The heavy user is said to feel estranged from others and from his own experience. Drug use in a counter cultural context, then, provides him with an alternative to facing certain pressures, and may even give him a feeling of union with others from whom he would otherwise feel estranged. Keniston also argues that students with psychological problems are more likely to turn to heavy drug use than better adjusted students at times of depression or anxiety, although he does not suggest that this accounts for a significant amount of student drug consumption.1S7

Roszak emphasizes the technocratic nature of society as the source of alienation.321 He suggests that the quality of contemporary life is woefully deficient in terms of subjective satisfactions, and neither economic accomplishments nor equality can substitute for these dissatisfactions. He describes contemporary social conflict as occurring between generations rather than classes, and the response is the making of a new culture rather than a new class or political movement. Sensuality, immediacy, emotion and mysticism are valued in the counter culture. Drug use, if not actually conducive to these values, is certainly compatible with them and, hence, encouraged.

Drug use, according to Zijderveld, is part of a protest against an abstract society with its emphasis on objectivity, rationality and routine, and its refusal to allow people to live as complete beings with human emotions, beliefs and needs.424 Three "ideal-types" of protest are posited: "gnostic" (in which drug use is prominent), "anarchist" and "activist". The gnostic response involves the rejection of western rationality and a withdrawal into subjective experience which, in a consumption-minded society, can be precipitated with least effort by the use of drugs. A deeper absolute sense of reality is sought, which cannot be obtained with the plodding scientific method of the abstract society. Drug use is also part of the anarchistic response, but, in this case, it is not intended for consciousness expansion but, rather, symbolizes rejection of the establishment and an attempt to return to a more natural, individual and less routinized style of life.

Crook sees young people rejecting a society which they perceive as devoid of human concerns and dominated by a bureaucratic social system.96 He also emphasizes a more traditional conflict of generations. He suggests that many young people feel that they are being denied opportunities for a meaningful participation in their society. He argues that these are feelings which they share with the poor but that they feel this denial much more strongly than do the members of the lower social classes and have more opportunities to rebel. Crook also notes that in industrial societies such as Canada there is a tendency for childhood to be shortened but for adolescence to be prolonged. The young child, he suggests, may be indulged, but high standards and expectations are set for the adolescent who is also expected to have learned to postpone immediate gratification for later rewards. In Crook's view many parents who grew up during the Depression attempt to live vicariously through their children, and this further heightens the demands that are made on the adolescent. These factors collectively increase the probability of conflict between the members of different generations. He argues that a number of these problems are particularly acute in Canada. Many Canadian parents are themselves alienated due to the rather recent shift of this country from a predominantly rural to an urban, industrialized culture—a shift to which many parents have not wholly adapted themselves. Moreover, the potential for conflict between generations is enhanced because many of these parents hold values that are anachronistic and inappropriate to the urban setting in which their children are growing up.

According to Crook, young people today must submit themselves to a dehumanizing system of education without the compensation of being assured of security, let alone "happiness", when their studies are over. Their parents, raised during the Depression, had even less security, but they could not even imagine escaping the "system". Also, thanks to a longer period of education and their extensive consumption of television, the young of today are far more aware of problems of the world than were their parents.

The result, according to this theory, is a rejection of the bureaucratized, industrialized society, including its rationalism. To a great extent, this rejection of the conventional western intellectual approach to life also includes the rejection of political ideology and political activism. Repudiation of a political activist response, then, leaves only retreatist modes, such as drug use, 'hippie' styles of life, and experiments with other life styles like communes.

Many of the same aspects of the counter culture are described in another, but somewhat different, position. Marijuana use is seen as related to adherence to a "hang-loose ethic", a positively valued alternative set of values, goals, beliefs, norms and attitudes, held by certain young people.36° The hang-loose ethic emphasizes irreverence for the dominant institutions of church and state (marriage, pre-marital chastity, and wealth, for example) and expresses a lack of faith in the competence of the government, schools and parents to fulfil their functions.

Several authors focus on the positive attractiveness of drugs, without reference to any of the "problems" which are often said to trigger drug use. For example, Fort explains drug use as a learned behaviour of persons who have accepted the high value placed on pleasure in their society.'27 The user is not necessarily responding to problems and need not have more problems than non-users. Rather, he is following a well entrenched mode of finding satisfaction.

The theory of alienation has, on occasion, been tested empirically; there are methods of finding out and measuring the degree to which a person feels alienated or estranged from, or unable to act in response to, existing social institutions. Replication of studies conducted with these instruments some years ago could throw needed light on the discussion that is now taking place about the changing character of the youthful drug-using population.

These broad theories, of which the work of Keniston, Zijderveld, Roszak, Crook and Fort are examples, have more to say about the use of mild and strong hallucinogens (even their heavy use) than about the use of 'speed' and the opiate narcotics. A detailed analysis of the factors involved in the use of these latter drugs will follow and may help us provide some specific insight into the dynamics involved in the use of some of those drugs that have a considerable potential for harm. We will also discuss studies immediately pertinent to the factors associated with and motivations involved in the use of strong hallucinogens.

DRUGS OF CONCERN

Alcohol, tobacco, the barbiturates, tranquilizers, and cannabis certainly account for more than ninety per cent of all Canadian psychotropic drug use, and the Commission has at many times examined the factors that account for their use. In its deliberations and recommendations it has carefully considered these underlying dynamics, as well as the data available on the extent of use and the effects of these drugs. Yet we do not think, at this stage, that the Canadian public needs detailed analysis of the factors and motivations leading specifically to the use of these substances. They may be drugs of concern in the sense that we are justifiably overwhelmed by our understanding of the quantities consumed, the fact that they are, in some cases, capable of producing dependence, and the number of persons involved in their use (from all age groups and social strata); but the desire for an understanding of cause focuses on three categories of non-medical use which appear particularly threatening: namely, the opiate narcotics, the amphetamines and the strong hallucinogens. Hence we will focus our analysis of factors and motivations on these three drug categories of greatest immediate concern. Those who are concerned with the etiological dynamics of other types of drug use may turn to the bibliography for references in these areas.

There was a time, some three or four years ago, when it would have been legitimate to try to state the reasons behind the use of a particular drug. Indeed, although the majority of us used at least alcohol (often in combination with one or more other drugs), the upsurge in the use of cannabis, for instance, was such a major cause of concern during a certain period that it appeared to need specific explanation. The alienation and counter-culture theories discussed above were given impetus by this concern about cannabis use. However, a drug-by-drug analysis has become less useful as time goes on, and it is obvious that a wide variety or combination of products is used by many of us, and that multiple drug use is, indeed, the most common pattern of use (see Appendix C.4 Patterns of Use, "Patterns of Multiple Drug Use"). Yet, the opiate narcotics, strong hallucinogens and amphetamines (especially the intravenous use of the latter) lend themselves to a specific analysis of the motivations and factors involved in first and continued use, and, because of their relative potential for harm, they will be discussed separately below.

Whenever possible, psychological and psychiatric theories will be reviewed under "individual factors", whereas macro-social and group conditions that are felt to lead to the use of a particular drug will be analysed under "social factors". However, in order to understand the realities of drug use, it must be noted that this distinction is an arbitrary one for purposes of analysis. It is both difficult and, on occasion, misleading to separate individual from social factors as they are inextricably linked in any comprehensive explanation of the causative dynamics regarding the non-medical use of drugs.