Drug Abuse

X The Family of the Addict

Considering its subject, this chapter should have been in an earlier section of the book, among the chapters on the environment in which drug use flourishes. To be sure, we are here, as in the immediately preceding chapters, dealing with a special group of drug-users, those who graduate from initial experimentation and more-or-less frequent use of narcotics to the ranks of the addicts. We are here still concerned with the characteristics of those who go on from use, not merely to the development of dependency, but to a craving for narcotics even when freed from the physiological dependence on them. In chapters VIII and IX, we described the characteristic personalities found in these cases, the kinds of people who, given the experience of narcotics, go on to become addicted. In this and the following chapter, however, we are again concerned with the environment. Personalities do not develop in a vacuum; they emerge from the interactions of individuals with their environments, particularly with the social aspects of these environments and, more particularly, with the significant others of the early family environments. The story of addiction would, therefore, not be fully told if we were to end it with a description of what we take to be the addiction-prone personality; we want to know something about how such personalities are bred.

No scientific inquiry ever leads to the end of the path. Suppose, for instance, that we were to succeed in determining the characteristics of environments that produce particular varieties of personality. We could then take the position that the full story would not have been told until we learned something about how these environments came to be, and so on ad infinitum. The end of such an inquiry is the probably unattainable end of science—the point at which all possible questions are answered—and no individual or group of individuals can be expected to pursue it. By the same token, then, why not stop at the point of having identified the characteristic personality of the addict and leave it to other studies to find out how such personalities are generated?

For that matter, such studies would not have to start from scratch. A good deal is already known about how personalities are formed; and, given a personality description, there is a fair likelihood that one can do a creditable job of reconstructing the kind of environment that must have produced such a personality. As a matter of fact, this was our first step in the investigation we are about to describe. We asked ourselves: What kind of early home environment must the typical addict have had? Then we set out to find out whether our imaginative reconstruction of this environment was correct.

From this point of view, the present investigation is a study of the validity of current personality theory, rather than per se an investigation of the role of the family in drug addiction. For us to undertake the latter kind of investigation on its own terms, we would have had to confront the enormous complexities of family structure and function' and to look for characteristic differences between the family situations of individuals who become addicted and those who do not. An inquiry of this scope did not seem to us to be indicated and was, in any case, far beyond our resources.

There was, however, a compelling reason for checking the accuracy of our imaginative reconstruction of the early family situations of addicts, and, for our immediate purpose, this had nothing to do with a desire to check the validity of the theorizing that underlay the reconstruction.

We did not seriously question that addicts have the kind of personality that psychiatric and clinical-psychological investigation revealed. What was open to question was whether such a personality is to be counted among the factors that lead to addiction or whether it is a consequence of addiction and the kind of life that addicts are compelled to lead. In other words, does the given personality pattern actually precede the addiction or does it emerge only afterward? Is it not conceivable, for instance, that everyone has these characteristics to some degree and that the life of the addict strengthens them while weakening and submerging compensatory and contradictory characteristics? The obvious answer is to study addicts before they become addicted or, better, to choose individuals with what is thought to be addiction-prone personalities and others with a variety of other personality patterns, expose them all to heroin, and see which ones become addicted. Needless to say, the second approach was not possible at the age levels with which we were concerned,2 and the first approach offers its own problems.

If we were in no position, however, to study large numbers of boys, determine which ones had presumably addiction-prone personalities, and then wait to see whether the eventual addicts came from this group, we could still approach the issue indirectly. If we could show that addicts came from backgrounds likely to produce such personalities, then the supposition that the personality patterns preceded and developed independently of the addiction would be greatly strengthened. If we failed in such a demonstration, then our misgivings would be intensified, although there would still remain the possiblity that our theorizing as to the early environment was at fault.

This was the reasoning that led to the present investigation, and it explains the placement of the present chapter. It is only incidentally an inquiry into environments, although the findings are of interest in their own right; it is intended primarily as a check on the hypothesis of an addiction-prone personality.

The very concept of addiction-proneness implies that the addiction-prone personality is not peculiar to addicts. The assumption is that, given this personality type, an individual who is sufficiently exposed to experiences of taking narcotics is especially likely to become addicted. The same individual obviously could not become addicted if he were never exposed. The logic of the situation, then, calls for a comparison of individuals who have a good deal of experience with narcotics but do not become addicted with individuals who have and do.

The psychiatric and clinical-psychological studies of the personalities of addicts have not been based on such comparisons. In this respect, we have not done any better. There is, of course, the logical problem of deciding whether a nonaddicted user is really not addicted or merely not yet addicted. The fact of long-continued nonaddictive use would be presumptive evidence in favor of the first of these alternatives or, at least, that such individuals are not so addiction-prone as others who have fallen along the way. Such long-continued nonaddictive users would, therefore, constitute a reasonable comparison group. Unfortunately, although we were able to establish the existence of such individuals,3 this was done in a study of a very limited number of boys, so that the absolute number of such cases that we could readily locate was too small to meet the requirements of such a study. Moreover, the conditions of locating these cases would have made it difficult to use them in the kind of study we were contemplating.

It should, therefore, be clear that the present investigation had a limited objective. It was designed to check the possibility that the characteristic personality picture found in addicts may be a consequent rather than an antecedent of addiction. It will be seen that our conclusion with respect to this possibility is in the negative; we conclude that conditions favorable to the development of such personalities are found in the early lives of addicts. It will also be seen that such conditions were not found in a control group, matched with our addicts on a variety of characteristics but having no history of drug use or delinquency. It will remain uncertain, however, whether we would or would not have found similar conditions in the lives of users who do not become addicted. Consequently, it remains only hypothetical that these personality characteristics account for the transformation of users into addicts; there remains a distinct possibility that we are still dealing with factors conducive to use rather than with factors conducive to addiction, given use.4

Finally, before going on to the report of the investigation, we should point out that the nature of the present inquiry limits us to those aspects of the early family environment concerning which we could reasonably hope to get relevant and dependable information from a limited number of interviews with family members. Consequently, we can only hope to deal with relatively gross aspects of the personality picture developed in chapters VIII and IX.

Translation of Personality Characteristics into Hypothetical Early Environments

On the basis of studies and clinical reports of the personality of the addict, we may say that the potential male addict suffers from (1) a weak ego structure, (2) defective superego functioning, and (3) inadequate masculine identification. In addition, the typical young addict's attitude usually involves (4) a lack of realistic orientation toward the future and (5) a distrust of major social institutions.

From a psychological perspective, these may be considered personal predispositions to becoming an addict; but they may also be considered as a consequence of accepting the role of an addict, with the sanctions this entails in our society. In part, this study of the family is a further testing of the "susceptibility" alternative in terms of the following logic: (1) We assume that personal characteristics are significantly influenced by experiences in the family milieu where one undergoes his earliest,, closest, and most sustained relationships. (2) If the personal characteristics of the addict are not consequences of being an addict, but are rather personal predisposing conditions to becoming an addict, then the family environment of juvenile addicts must be such that it enhances, nourishes, and stimulates the five personal characteristics listed above. (3) If the evidence indicates that the milieu, relationships, and experiences of the addict differed from that of his peers who did not become addicts, we not only will obtain support for the "susceptibility" hypothesis, but we will have another link in our understanding of why certain youths in high-drug-use areas are especially likely to become addicts.

The hypotheses of this study may be summarized now as follows: The family background of the male adolescent opiate addict is such that it interferes with the development of a well-functioning ego and superego and with his sense of identification as a male. Furthermore, his family background discourages the formation of realistic attitudes and orientations toward the future and trustful attitudes toward major social institutions.

RELEVANT FAMILY EXPERIENCES

Before the start of the actual field work, it was necessary to define each of the five personal characteristics in the light of psychoanalytic and psychological theory and research. The next step, for each defined concept, was to draw up a list of family background factors that one would expect to be conducive to the development of the personality characteristic in question. The logic involved and the steps of this procedure are given in some detail for the first hypothesis in the text of this chapter. For the remaining hypotheses, much of the relevant material is relegated to Appendix L.

Hypothesis I. The family background of the addict is conducive to the development of a weak ego structure.

Definition: A person with a well-functioning ego should be able to assess reality correctly, be reasonably inner-directed, be able to accept pain and frustration without excessive behavior disruption or personality disintegration, have an accepting attitude toward himself, have a sense of competence, and possess a meaningful sense of identity.

This definition, however, is not a sufficient basis for a categorical listing of relevant aspects of the family background to be investigated. The following statements, therefore, serve as a bridge between the definition, couched in psychological terms, and the situation, couched in experiential terms, which we regard as conditions that would interfere with the development of a well-functioning ego. The rationale for considering certain family experiences as conducive to weak ego functioning may be summarized as follows:

(1) The experience of being accepted by others and being worthy of their love is needed for self-acceptance. Hence, hostility on the part of the mother interferes with the development of self-acceptance by the child. Institutional or foster home experience also tends to diminish experiences of being accepted by others.

(2 ) The receiving of overwhelming love, affection, and indulgence impairs the ability to defer gratification in light of the requirements of reality. This situation also tends to magnify Oedipal conflicts, thus interfering with their adequate resolution.

(3) Overanxious parental reactions and concern with illness interfere with the development of the ability to withstand pain and discomfort. They also hamper the development of a sense of competence by facilitating a view of the world as filled with overwhelming dangers which cannot be coped with.

(4) Marked social or cultural disparities among parental and with peer identification models interfere with the development of a clear-cut sense of identity and group membership.

(5 ) Lack of warmth between parents makes for affective imbalance; the people whom I love and whose love I want do not love each other. This tends to impair the development of self-acceptance.

(6) Unrealistic concern about the dangers of life or unusual limitations of normal childhood experiences interfere with the development of an ability to correctly assess reality, to cope with real problems, and to feel competent.

(7 ) Frustration by others may be interpreted as lack of love and lack of being lovable, thus interfering with the development of a feeling of self-acceptance. Overindulgence impairs correct assessment of reality and the ability to withstand pain and frustration.

(8) Unusual limitations on the experiences of the child lead to the development of a sense of incompetence later in life when the boy is confronted with others of his own age who have developed competence and sophistication as a result of their more varied experiences.

(9) Parental expectations that are markedly higher or lower than the ability of the child may lead to an unrealistic sense of competence or to feelings of incompetence.

With this rationale5 as a background, we can turn to our list of specific factors in the family background which we regard as interfering with the development of a well-functioning ego. The numbers after each of the items in the list in Table X-1 refer to the numbered sentence or paragraph of the rationale to which they are related.

It cannot be expected that any one of these experiences alone necessarily impedes the development of a well-functioning ego. We did assume, however, that if many of these features were present in the family background, ego functioning would probably be impaired. We further assumed that the impairment of ego functioning depends on the cumulative impact of a large number of such experiences and that the variety of such experiences and their persistence over time may be taken as indicators of the degree to which a home provides many such experiences. It was therefore predicted that more of these kinds of experience would be found in the background of addicts than nonaddicts. Accordingly, an index was developed to measure the extent of such experiences in the background of each boy to be studied.°

It is important to emphasize that the index does not and is nor intended to measure the subject's adequacy of ego functioning. In fact, it does not measure any attribute of a person at all. What such an index does purport to measure is an aspect of the family environment as it impinged on the boy. The meaning of a high score on this index is that the family environment of the subject was such that, in the light of current formulations of personality development, one would expect impairment in ego functioning. Such a background is presumed to be conducive to weak ego development. A high score, therefore, indicates that the potential of the family background for adequate ego development is judged to be poor. What the index accomplishes is a comparison of the family backgrounds of addicts and controls in terms of their judged potential for adequate ego development as measured by this index. Details as to how the information that enters the index was gathered is presented later in this chapter.

It will be noted that we have not confined the components of the indexes to the earliest formative years and even permit some extension into the present. This would seem to contradict the basic purpose of the inquiry. We have assumed, however, some constancy in the developmental environment. Thus, a later negative environmental feature would lead us to give less weight to evidence that the same feature was positive in earlier years. Similarly, we would give most weight to a feature which is consistently negative at several life stages. The index automatically provides such adjustments for items which occur at several periods. For the nonrecurrent items, we have assumed that the rating may reasonably be taken as indicative of a persistent pattern.

A similar logic was employed for each of the other hypotheses related to the effect of the family environment. Each personality chara-cteristic or attitude was first defined and conceptualized. Then, with the aid of a rationale for selecting relevant family experiences, a list of items was prepared to form an index of the potential harmful effects on the personality feature under consideration. For each of the remaining hypotheses, the item list and rationale can be found in Appendix L.

Hypothesis II: The family background of the addict tends to make for defective superego functioning.

Definition: By "adequate superego functioning," we mean that a person more-or-less unconsciously screens all possibilities of behavior that offer themselves to him from the viewpoint of culturally approved standards of legitimacy and obligation which he has taken over as his own and generalized from the examples set by his parents and from his experiences of the demands and prohibitions that they express.

The incorporation of these standards depends on processes independent of the standards at which the individual may arrive on the basis of his experiences of the long- or short-range consequences of particular kinds of behavior in particular kinds of situations. The social significance of the superego inheres precisely in the facts that it provides for individual standards of behavior not dependent on a person's limited experience and that their application is not dependent on the limited egocentric perspective of their situationally adaptive value to him.

At the same time, however, there does exist a second set of standards, oriented to the gratification of personal desires, but tempered by foresight with respect to the probable consequences of particular gratifications and, hence, calling for self-imposed restraint with respect to some gratifications and acceptance of some unpleasant experiences for the sake of a long-range, maximum gratification.7

The existence of two independently derived sets of standards generates the possibility of confficting standards. The possibility of such conflict implies that a normal person must also have available the possibility of resolving and minimizing such conflicts. This, in turn, implies some specifications for each set of standards. On the one hand, with regard to the experientially based standards, the individual has to learn that his incorporated standards are relevant to the adaptive consequences of his actions, that, for instance, he is not likely to derive a full measure of gratification from the implementation of desires under conditions that violate the incorporated standards, even though other conditions are favorable. On the other hand, the incorporated standards must not so circumscribe the possibilities of legitimate actions as to make gratification virtually impossible.

We may, hence, distinguish two major types of defective superego functioning. The first type is based on poorly internalized prohibitions and restraints which result in failure to accept social norms, values, and behavior patterns (the so-called weak superego). The second type is based on the internalization of overly restrictive, severe, and punitive parental attitudes which enhance anxiety and guilt and which may lead to antisocial behavior in a provocative quest for punishment and penance.

Separate subindexes were developed to measure each of these two forms in order to test the subhypotheses that each of these two types of environmental force would be found more frequently in addict than in control family backgrounds.

Hypothesis III: The family background and experiences of the addict serve to impair the development of an adequate sense of masculine identification.

Definition: By "adequate sense of masculine identification," we mean that the male (1) has settled on styles of behavior; mannerisms of dress, movement, gesture, and speech; social, sexual, recreational, and occupational responsibilities; goals and interests; and on the kinds of situations in which he will be self-assertive, independent, aggressive, etc. with respect to which there is a fairly clear social consensus that they are appropriate (or at least not inappropriate) to the male sex; and (2) feels, without having to give much thought to these matters and without having to prove to himself or to others, that these styles, mannerisms, goals, etc. are "natural" and appropriate to him and that the complementary styles, etc. are neither "natural" nor appropriate to him.

To be sure, the particular styles, mannerisms, and goals which distinguish the sexes and the degree of emphasis placed on sexual differentiation may vary considerably from society to society, from one historical era to another in a given society, and even to some degree from stratum to stratum in a particular society at a given time. Moreover, the criterion of sex appropriateness is not necessarily consistent as the individual moves through various developmental stages and social statuses. Thus, the absence of any interest in boy—girl relationships, as such, is hardly likely to be considered of any import in the prepubescent boy in our society; but, as the boy advances through his teens, a continued absence of such interest is generally likely to evoke some degree of social disapproval; and, even here, if it should, for instance, become clear that the young man is heading toward the Catholic priesthood, this behavior pattern would tend to lose its significance with regard to the issue of masculine identification and be viewed as an act of renunciation rather than as a sex-maturational failure.

Thus, it appears that the definition of masculine identification that we have given above is not sufficiently dynamic. The crux of the matter seems to be that the person with an adequate sense of masculine identification easily slips into the styles regarded as sex-appropriate to his age and position in society and that he readily adjusts his perspective with regard to the "naturalness" and appropriateness of the corresponding changes. The basic feature, then, of an adequate sense of masculine identification is an unostentatious commitment to the masculine identity and, within the framework of the culture, to the age- and status-appropriate behavioral prescriptions that such an identity implies. Given this basic commitment and allowing for some inconstancy in the defmidarn of what is regarded as sex-appropriate, the various features of the orienting definition follow. The psychiatric and clinical-psychological conclusions concerning the sense of masculine identity in male addicts are based on the kinds of indicator suggested in the definition. Here, however, we shall find it easier to follow the line of the underlying commitment.

When one talks about appropriateness, he is obviously discussing standards of behavior, so that the development of masculine identification is an aspect of the development of the ego and superego. In selecting this aspect for special attention, however, we are operating in terms of the specific observation concerning the characteristic personality patterns of addicts. In terms of the general theoretical orientation on which we are basing the present development, it happens to be an especially critical aspect. It involves the first major commitment to a group identity in the life of the individual. The effectiveness of later commitments to additional group identities (and, hence, in large measure, of the socialization of the individual) is, we think, heavily conditioned by the effectiveness of earlier commitments. A man, for example, is in our opinion hardly likely to be comfortable with himself as an American (i.e., not simply as a person who happens to be a legal resident and citizen of the country, but as a member of the total community) or as a member of a religious or ethnic group if he has not yet succeeded in making himself comfortable in his masculine identity.

Moreover, whatever the consequences of the degree of success in establishing a secure masculine identity, the most serious consequences occur at the threshold of maturity, with the burgeoning of sexual impulse and of a social premium on phallic prowess, the pressures toward commitment to an occupational line, the need to commit oneself to a wife, and the responsibilities of raising a family. The effectiveness of one's commitment to the masculine identity can hardly be said to be the only determinant of how well one copes with so complex a confrontation, but it is surely a major factor. We have already dealt with a number of indications that the teen-ager who turns to narcotics is especially vulnerable in this confrontation. The most important result of success or failure in establishing a commitment to the masculine identity comes many years later, as one approaches and crosses the threshold to maturity.8

Our assumption is that the major factors determining masculine identity are associated with the child's relationship to his father (or-to some other male who stands in the relationship to him of father to child) .° Specifically, this implies that the father figure is himself an adequate representative of socially acceptable patterns of masculinity, at least within the range of the child's perception of him, and that the child identify himself with his father. It is, of course, not within the scope of the present study to measure the degree of identification with the father. We can, however, attempt to recapture the availability of conditions favorable to such identification. An appropriate index of relevant family experiences was constructed.

Hypothesis IV: The family background of the addict tends to impair the development of a realistic level of aspiration with respect to long-range goals.

Definition: By "level of aspiration with respect to long-range goals," we mean that the person has ambitions which are plausibly related to potential and existing opportunities with the desire and ability to defer gratification in the service of long-range goals. The corresponding index, therefore, lists features of family experience that could be expected to impair the development of this outlook.

Hypothesis V: The family experiences of the addict tend to encourage a distrust of major social institutions.

Definition: By "distrust of major social institutions," we mean an outlook deviating markedly from the one described in the following sentences. Normally, we take for granted that the governmental agencies which protect our lives, property, and rights and that the educational, religious, and charitable organizations which are concerned with our welfare and personal development have a core of humanitarian concern, honesty, and trustworthiness. This does not prohibit us from regarding particular instances of such institutions with disapproval, anger, or cynicism. But, despite such instances, we accept the institution as a valid and potentially useful social arrangement. We generally trust persons who embody these institutions until they betray this trust; should they deceive us, we criticize them as individuals, though we maintain much of our regard for the institution per se.

We attempted to reconstruct the kind of home situation that would be conducive to an attitude of distrust and developed a corresponding index.

Method of the Study

Access to the families of our sample of addict subjects was obtained through the cooperation of Riverside Hospital, which was most helpful in this as in the other studies reported in this volume.

The control group was selected from a list of boys graduating in a four-year period from two parochial and three junior high schools in high-drug-rate neighborhoods.1° These names were screened by reference to the Social Service Exchange and on the basis of information supplied by social agencies and schools in order to eliminate families in which any of the youngsters had a court record or were known as habitual delinquents, chronic truants, or narcotics-users. Letters were sent to the eligible families requesting cooperation in a study of how young men grow up in their neighborhood.

Of those available for interview, we matched the addicts and controls for age. Neighborhood influences were comparable because almost all boys in each group were selected from high-drug-use areas. Similarly, in order to make the two groups comparable as to ethnic cultural patterns, we tried to select ten native white, ten Negro, and ten Puerto Rican families for each group. The fact that the families were also found to be equivalent in occupational status of the chief wage-earners and in the educational achievement of the mother adds to the comparability of the samples (see Table X-2). It should be noted, however, that the control families were to some extent self-selected in that they were willing to cooperate in the study; it is possible that families willing to cooperate are "better" than other families in the same areas which produce neither addicts nor delinquents. The families of the addict cases, of course, also had to be willing to cooperate in order to be usable, "hut they were inherently under greater pressure to do so. On the other hand, however, the greatest difficulty in recruiting control families for the study was that we could not trace them so many years after the date of the last known address; if anything, one would expect the bias here to go in the opposite direction, that is, for the "better" families to be the more likely to move away. In any case, what most convinces us that we were not grossly misled in taking the results of this study seriously were the magnitude and pervasiveness of the differences that, as we shall see, appeared between the two sets of families. One would have to do much discounting, indeed, to wipe out these differences.

The interviewing of the families was conducted by twelve advanced students of social work from the New York School of Social Work and from the School of Social Service of New York University. Prior to the interviewing, a guide was constructed which focused on the areas of family experience relevant to our indexes. The topical headings of the interview guide were: physical characteristics of the neighborhood and the house, household and family composition, health history of the family, the present and early adolescent life situation of the subject, childhood training and socialization, relationships within the family, and relationships between the family and the "outside world."

Group training and discussion sessions were held to ensure that interviews covered each of the aspects of family life in which we were interested. Two to four case-work interviews were conducted with the parents and other important figures in the lives of the patients and control subjects. For each case, detailed process recordings and an evaluative case summary were obtained.

After completing the interviews for a family, the interviewer also filled out a check-list questionnaire This questionnaire was designed so that it would be possible to compute index scores of family experiences predicted for each of the personality and attitude characteristics. As a precaution, the interviewers were not informed of the predictions and theoretical rationale until all data had been collected. Further checks on the possibility of biased results are described in Appendix M.

Results and Discussion

Each of the five major hypotheses about the addicts' family experiences was strongly supported by the data (see Figure X-1 and Table X-3) .a In contrast to our control cases, the addicts were reared in a family milieu which, in terms of our psychological theorizing, we would regard as contributing to the development of weak ego functioning, defective superego, inadequate masculine identification, lack of realistic levels of aspiration with respect to long-range goals, and a distrust of major social institutions. Moreover, each of the hypotheses was supported within each ethnic group separately—native whites, Negroes, and Puerto Ricans.

In addition to the hypothesis that addict backgrounds would include more experiences making for defective superego functioning, two subsidiary predictions were made in relation to the superego. Two kinds of environmental force were postulated, one making for inadequate internalization of socially accepted standards, the other making for an overly severe and punitive type of superego functioning.

We had expected, perhaps naïvely, both types of experience to be found more frequently in the background of addicts than of controls, one type for some cases, the other type for other cases.

The analysis indicates that there was a clear-cut difference between our two groups only with respect to the environmental factors that would favor weak superego functioning. There was no difference at all between the groups on our measure of forces making for strong and severe superego functioning (see Table X-3).1.1 But, although almost all addicts came from backgrounds conducive to the poor internalization of socially acceptable norms, about half also experienced other family influences that would nevertheless tend to make them subject to unreasonably strong guilt feelings. In other words, though the families of the addicts did not, on the average, differ from those of the controls in the latter respect, about half the addicts showed both kinds of environmental impairment. This finding is consistent with the assumption that the environmental forces making for strong inhibitions in the acting out of socially disapproved impulses are quite independent of those making for strong guilt feelings. It is, of course, also possible that we were simply not able to tap those features of the environment conducive to such a severe superego. The relevant environmental vectors are to be found in the pre-Oedipal precursors of the superego, and the factors involved may well be too subtle to be detected by the method we used.

SOME COMMON FEATURES IN THE FAMILY EXPERIENCES OF ADDICTS

The over-all results of the analysis of our indexes gives strong support to the view that family experiences play an important role in the etiology of addiction.

We shall now inspect our data from a somewhat more detailed perspective, emphasizing some experiences with respect to which there are statistically significant differences between the addict and control groups. Table X-5 gives the percentages of addicts and controls who had certain family experiences as indicated by the check-list questionnaire.

Some of the most striking contrasts in the experiences of our addicts and controls occurred in the relationship of the boy to the father or father figure. There was no father figure at all in the homes of about one-half the addict cases for some significant period. When he was present, the father was usually emotionally distant or hostile in his attitudes toward the boy. Furthermore, when present, the father figufes often presented immoral models through their own deviant activity with respect to criminality, infidelity, alcoholism, and the like. And, though only a minority of the addicts had a father figure judged to be primarily concerned with day-to-day gratification of appetites and desires and given to quick and uninhibited discharge of energy (i.e., "impulse-oriented," in the terminology of Table X-5), this was true for none of the father figures of the control subjects. As one would expect from this pattern, the father figures of the addicts often had unstable work histories. They had pessimistic and fatalistic attitudes toward their own future, and, similarly, they often held unrealistically low aspirations for their sons' careers.

In terms of the quantity of interaction between father and son, there was not much contact between them. This was because the father had little to do with his son or was openly hostile toward him or because there was no relationship at all owing to the absence of a father figure from the home.

In almost all the addict families (97 per cent), there was a disturbed relationship between the parents, as evidenced by separation, divorce, open hostility, or lack of warmth and mutual interest. In these conditions, the mother usually became the most important parent figure in the life of the youngster. But, whatever the vicissitudes of the relationship between the boy and his mother, one theme was almost invariably the same—the absence of a warm relationship with a father figure with whom the boy could identify.

The families of the addicts did not provide a setting which would facilitate the acceptance of discipline or the development of personal behavioral controls. The standards of conduct offered by the parents were usually vague or inconsistent; the addicts had characteristically (more than 70 per cent) been overindulged, overfrustrated, or experienced vacillation between overindulgence and overfrustration. For about one-fourth of the addicts, though for none of the controls, there was evidence of the absence of a clear pattern of parental roles in the formulation or execution of disciplinary policy.

When we attempt to describe the special relationship between the addict and his mother, there is little evidence of an atypical or unusual relationship between them. There are relevant items which distinguish the addict and control groups at statistically significant levels, but even the largest of the differences involves a minority of the addicts. Thus, there is a substantial group of mothers of addicts which differs from the mothers of the control subjects, but it also differs from the rest of the mothers of the addicts. These mothers had an emotionally distant or hostile relationship with their sons; they markedly distrusted the representatives of major social institutions; they had unrealistically low aspirations for their sons; and they were themselves unrealistically pessimistic or felt that life was, at best, a gamble. Like the typical fathers of the addicts, they also had weak relationships with their sons.

What about the other mothers of the addicts? There is reason to believe that the mothers of the addicts were much more involved in the development of their sons' addiction than indicated by the categories included in the indexes. Clinical observation of the present-day interactions between the addict and his mother point to an early, sustained disturbance in the mother–son relationship related to the addict's current maladaptive patterns.12 However, a review of the detailed process recordings of the addict-family interviews strongly suggests that the relationship between the addict and his mother is complex and individualized. The following chapter, which is qualitatively oriented rather than statistical, presents a number of case studies in which we may perceive more clearly the nature and importance of the addict's relationship to his mother.
 

STATISTICAL FOOTNOTES

a Because the indexes are not perfectly independent of one another, we should note the possibility that the verification or contradiction of one hypothesis may not be completely independent of the verification or contradiction of another. That this possibility is not overly serious is suggested by the following considerations.

We may count the total number of bits of information utilized in the computation of any two indexes, and we may similarly count the number of bits common to both indexes; the ratio of the second count to the first gives us the percentage of overlap. The worst case (i.e., the greatest amount of overlap) is found for indexes IV and V, where the percentage of overlap is 21.4, a degree of overlap that would, in itself, give rise to a correlation between the two indexes of about .46. To this extent, the fates of the corresponding hypotheses are not independent. The percentage of overlap between indexes I and IV is 15.4, involving a correlation of about .39, and between indexes I and V the overlap is 8.0, involving a correlation of about .30.

The intrinsic correlation (we hesitate to call it spurious because, after all, effects in real life often are correlated) between Index IV and indexes I and V taken together (i.e., the multiple correlation) is of the order of .53. In other words, there is a fair likelihood that, if both hypotheses I and V are verified, Hypothesis IV will be carried along with them.

Similarly, the percentages of overlap between indexes I and II and between H and III are both 11.7, involving correlations of about .35; and that between I and III is 4.5, with a corresponding correlation of .21. The intrinsic multiple correlation of Index II with I and III taken jointly is about .45.

The percentages of overlap for the pairs of indexes not yet mentioned (i.e., II and IV, II and V, III and IV, and III and V) are, in each case, zero.

 

1 Taking account, for instance, of variations that exist in the kinds of family status held by persons in the intimate family (i.e., sometimes including some and sometimes all of the following: grandparents, parents, stepparents, siblings, in-laws, near and remote relatives and their marriage partners and children, boarders and other household intimates, etc.); of the varying functions, privileges, obligations, role deviations, role accomplishments, and role personalizations of those who hold these family status positions; of the varying extensions of behavior governed by norms relevant to these family statuses; of the interactions of these persons in and out of these roles; of the varying positions of the families as a whole in the community; of the intrusions of extrafamilial affairs and relationships in the functioning of the family unit; of the changes over time, and so on.

2 Such a study might conceivably be carried out on individuals serving life sentences in penitentiaries. Other approaches involving less extreme measures are also possible, as in the study of the relation between reactions to test administration of drugs and personality dynamics. Cf., for instance, L. Lasagna, J. M. von Felsinger, and H. K. Beecher, "Drug-Induced Mood Changes in Man," Journal of the American Medical Association, 157 (1955), 1006, 1113. The bearing of the latter line of investigation is, however, of limited evidential value because initial reactions are not always trustworthy guides to reactions after some experience with a drug. We have already noted that some of the boys who went on to more-or-less habitual use of heroin experienced initially unfavorable reactions. Many a tobacco-smoker will recall that his early experiences with smoking were similarly unpleasant.

3 See above, the report of the study of drug use in street gangs, chapters VI and VII.

4 It should also be noted that it is possible that such early family environments may be quite characteristic of delinquents (including non-drug-using delinquents) in the urban areas from which our addicts come. Some of the personality characterizations dealt with in this chapter have been applied to delinquents, and it may well be that the others are, as well. Cf., for instance, I. Kaufman, "Three Basic Sources for Pre-delinquent Character," Nervous Child, 11 (1955), 12-15.

5 A similar format is followed for the remaining indexes, i.e., a definition, a set of bridging statements which offer a rationale, and a list of negative or harmful family background factors based on the definition and the rationale from which the index itself is composed. The hypothesis and definition, along with sufficient discussion to clarify what is at issue, is given in the text. The bridging statements and components of the indexes are found in Appendix L.

6 The number of listed impairing experiences or situations in the boy's history which were checked as applicable for the case was divided by the total number of listed items on which we had information. This ratio, expressed as a percentage, was treated as the index score. Scores were computed in the same manner on all five indexes. It will be noted that, in some cases, an item of impairing family experience is listed twice if it occurred during more than one period of the boy's life. Such experience would be given double weight in the index—one credit for each period in which it occurred.

7 It should be evident that the experientially based set of standards involves the ego system. Foresight, for instance, calls for the assessment of reality; and restraint and the acceptance of unpleasant experiences, even though (and perhaps especially because) self-imposed, call for the tolerance of frustration and pain. In popular expositions of psychoanalytic theory, the superego is commonly identified with conscience and the moral side of man's nature. Actually, when considered from the present point of view, the ego is fully as moral as the superego, although the two systems represent differing kinds of morality, one empiiically based and pragmatic, the other transmitted and absolute. Some [cf. E. B. Holt, The Freudian Wish and Its Place in Ethics (New York: Henry Holt & Co., 1915), and I. Chein, "Towards a Science of Morality," Journal of Social Psychology, 25 (1947), 235-238] argue that the former potentially represents, in principle, a higher form of morality, provided that the range of probable consequences of actions is wide enough and the weighting of these consequences sagacious enough. The social need of the superego type of morality rests, on the one hand, on the fact that the capacity of individuals to profit from experience and the range of individual experience—even when vicariously augmented—are limited and, on the other hand, on the social necessity for a reasonably consistent set of standards even though the latter cannot be rigorously justified in experiential, pragmatic terms. The two approaches to morality and the two kinds of standards of behavior commonly interact in the evolution of the transmitted (codified and informal) morality, even though the defenders of the latter insist on no compromise. The ongoing change in the transmitted social morality is obvious in the continuous growth and amendment of formal legal codes, but it also occurs in more subtle ways (both in law and in religioethical systems) through changing interpretation of the standards under the pressure of empirical-moral considerations in the changing human situation. At the social-institutional level, there are individuals who, by variously determined status positions, act as arbiters of such change. There are, of course, no comparable arbiters within a person.

8 If one can imagine a society in which there were utterly no normative correlates of gender beyond the requirement that at least some males and females fulfill the biological reproductive role and with no special rewards or penalties attached to the latter, the issue of sexual identity would be meaningless. At the opposite extreme, if the differentiation of the sexual roles were so perfectly structured as to leave the individual with utterly no degree of freedom, the issue would be equally meaningless. Actually, it is doubtful if any human society has approximated either extreme. We suspect, however, that the issue is most acute in a society such as our own, which simultaneously attaches enormous significance to the differentiation of the sexes (pervasive of almost every area of life) and provides many degrees of freedom with an associated breakdown in traditional lines of differentiation and which does not provide an institutionalized status for a "third" sex. On these matters, cf. Margaret Mead, "Sex and Temperament," in From the South Seas (New York: Morrow, 1939) and Mathilde and Matthias Vaerting, The Dominant Sex (New York: George H. Doran Co., 1923).

9 Hence, in the following, we speak of the "father figure." Similarly, with respect to the mother, we speak of the "mother figure," meaning, thereby, that it is not necessarily the biological mother who is involved.

10 Most of the thirty control cases were families of the fifty control boys previously interviewed in the study of personal background of drug-users, delinquents, and controls, as reported in chapters V and VI. All the families not previously used were obtained from the basic list used in the original study. The present study was, however, carried out two years later.

11 As in the case of the findings related to the major indexes, these findings also obtained when the results were separately analyzed for each of the three ethnic groups.

12 We are not making a statement about clinical observations of the relations of addicts in general to their mothers, but about observations of the addicts dealt with in this chapter and their mothers.

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