To know how to reduce harmful drug use, we must first know what explains it. The major explanations for harmful drug use come from the fields of biology, psychology, and sociology. Each of these are explained below, including the three main sociological theoretical perspectives.
Biological Explanations
In looking at drug use, the field of biology focuses on two related major questions. First, how and why do drugs affect a person’s behavior, mood, perception, and other qualities? Second, what biological factors explain why some people are more likely than others to use drugs?
Regarding the first question, the field of biology has an excellent understanding of how drugs work. The details of this understanding are beyond the scope of this chapter, but they involve how drugs affect areas in the brain and the neurotransmitters that cause a particular drug’s effects. For example, cocaine produces euphoria and other positive emotions in part because it first produces an accumulation of dopamine, a neurotransmitter linked to feelings of pleasure and enjoyment.
Regarding the second question, biological research is more speculative, but it assumes that some people are particularly vulnerable to the effects of drugs. These people are more likely to experience very intense effects and to become physiologically and/or psychologically addicted to a particular drug. To the extent this process occurs, the people in question are assumed to have a biological predisposition for drug addiction that is thought to be a genetic predisposition.
Research on identical twins suggests that alcoholism has a genetic basis.
Michael Dorausch – Identical Twins Jedward – CC BY-SA 2.0
Most research on genetic predisposition has focused on alcohol and alcoholism (Hanson et al. 2012). Studies of twins find that identical twins are more likely than fraternal twins (who are not genetically identical) to both have alcohol problems or not to have them. In addition, studies of children of alcoholic parents who are adopted by nonalcoholic parents find that these children are more likely than those born to nonalcoholic parents to develop alcohol problems themselves. Although a genetic predisposition for alcoholism might exist for reasons not yet well understood, there is not enough similar research on other types of drug addiction to assume that a genetic predisposition exists for these types.
Many nonbiological factors also explain the harmful use of and addiction to alcohol and other drugs. We now turn to these factors.
Psychological Explanations
Psychological explanations join biological explanations in focusing on why certain individuals are more likely than others to use drugs and to be addicted to drugs (Hanson et al. 2012). Some popular psychological explanations center on personality differences between drug users and nonusers. These explanations assume that users have personality traits that predispose them to drug use. These traits include low self-esteem and low self-confidence, low trust in others, and a need for thrills and stimulation. In effect, drug users have inadequate personalities, or personality defects, that make them prone to drug use, and once they start using drugs, their personality problems multiply.
One problem with research on personality explanations is methodological: If we find personality differences between drug users and nonusers, should we conclude that personality problems cause drug use, or is it possible that drug use causes personality problems? Most of the research on personality and drug use cannot answer this question adequately, since it studies drug users and nonusers at one point in time, a method called cross-sectional research. To answer this question adequately, longitudinal research examines the same people over time. Among initial drug abstainers at Time 1, if those with the personality traits mentioned earlier turn out to be more likely than those without the traits to be using drugs at Time 2, then we can infer that personality problems affect drug use rather than the reverse. Longitudinal research on personality and drug use that studies adolescents and college students does indeed find this causal sequence (Sher, Bartholow, & Wood 2000). However, some scholars still question the importance of personality factors for drug use and addiction (Goode 2012). They say these factors have only a small effect, if that, and they cite research questioning whether personality differences between users and nonusers in fact exist (Feldman et al. 2011).
Other psychological explanations are based on the classic concept from behavioral psychology of operant conditioning – the idea that people and animals are more likely to engage in a behavior when they are rewarded, or reinforced, for it. These explanations assume that people use drugs because drugs are positive reinforcers in two respects. First, drugs provide pleasurable effects themselves and thus provide direct reinforcement. Second, drug use often is communal: People frequently use drugs (alcohol is certainly a prime example, but so are many other drugs) with other people, and they enjoy this type of social activity. In this manner, drug use provides indirect reinforcement.
From a sociological perspective, both biological and psychological explanations for drug use and addiction fail to account for the enormous influence of social factors, though some psychological perspectives do consider the significance of immediate environments such as family members and friends. Sociological explanations focus more closely on social contexts, including social bonds, groups, institutions, inequalities, and more.
Sociological Explanations
Sociological explanations emphasize the importance of certain aspects of the social environment – social structure, social bonds (such as to family, the community, or school), social interactions, and culture – on drug use and addiction. The sociological model of drug use and addiction examines how social phenomena may lead individuals to use mind-altering substances to cope with difficulty and distress. It also examines how social inequalities can make the impacts of drug use worse for some social groups than others.
For drugs like heroin and crack that tend to be used mostly in large urban areas, the social structure, or, to be more precise, social inequality, certainly seems to matter. As sociologist Elliott Currie has observed, the use of these drugs by urban residents, most of them poor and of color, reflects the impact of poverty and racial inequality: “Serious drug use is not evenly distributed: it runs ‘along the fault lines of our society.’ It is concentrated among some groups and not others, and has been for at least half a century” (1994: 3). This fact helps explain why heroin use grew in the inner cities during the 1960s, as these areas remained poor even as the US economy was growing. Inner-city youths were attracted to heroin because its physiological effects helped them forget about their situation and also because the heroin subculture – using an illegal drug with friends, buying the drug from dealers, and so forth – was an exciting alternative to the bleakness of their daily lives. Crack became popular in inner cities during the 1980s for the same reasons.
Social bonds to families and schools also make a difference. Adolescents with weak bonds to their families and schools, as measured by such factors as the closeness they feel to their parents and teachers, are more likely to use drugs of various types than adolescents with stronger bonds to their families and schools. Their weaker bonds prompt them to be less likely to accept conventional norms and more likely to use drugs and engage in other delinquent behavior.
Regarding social interaction, sociologists emphasize that peer influences greatly influence one’s likelihood of using alcohol, tobacco, and a host of other drugs (Hanson et al. 2012). Much and probably most drug use begins during adolescence, when peer influences are especially important. When our friends during this stage of life are drinking, smoking, or using other drugs, many of us want to fit in with the crowd and thus use one of these drugs ourselves. In a related explanation, sociologists also emphasize that society’s “drug culture” matters for drug use. For example, because we have a culture that so favors alcohol, many people drink alcohol. And because we have a drug culture in general, it is no surprise, sociologically speaking, that drug use of many types is so common.
Within the sociological perspective, a sociopharmacological approach looks at how social, economic, and health policy might exacerbate harm to people using substances. Sociopharmacology is a sociological theory of drug use developed by long-time drug use researcher Samuel R. Friedman (2002), who writes that approaches toward understanding drug use that focus on the psychological traits of the people using the drugs and the chemical traits of the drugs ignore socioeconomic and other social issues that make individuals, neighborhoods, and population groups vulnerable to harmful drug use.
To consider how the sociopharmacological approach plays out in everyday life, consider how drug policy prohibits the use of heroin and results in several harmful effects. New syringes can be hard to find. People will inject in unclean and rushed circumstances, which may negatively impact their health by putting them at risk of contracting HIV or life-threatening bacterial infections. (We discuss the harm reduction approach to address this concern in the Strategies page.)
Friedman also notes that the social order matters. People who experience class, gender, racial, or other oppression suffer harm. As a way to deal with that harm, they may choose to self-medicate with drugs or alcohol. For example, working a low-paying service job where you deal with unhappy customers and mistreatment from your boss may lead you to blow off steam by using substances. Individualistic theories of drug use stigmatize and demonize individuals who use drugs as being weak or criminal. According to the sociopharmacological approach, if anything should be demonized, it should be the social order, not the individual who uses drugs (Friedman 2002).
This type of analysis is also thought of using the analytic concept of risk environments developed by Tim Rhodes. A risk environment is a social or physical space where a variety of things interact to increase the chances of drug-related harm (Rhodes 2002). An analysis of risk environment looks at how the relationship between the individual and the environment impacts the production or reduction of drug harms.
To the extent that all the factors discussed above matter for drug use, sociologists say, it is a mistake to view drug use as stemming solely from an individual’s biology or psychology. Although these problems do play a role for some individuals’ use of some drugs, drug use as a whole stems to a large degree from the social environment and must be understood as a social problem, not just an individual problem.
Beyond these general sociological explanations of why people use drugs, we may examine the three classical sociological perspectives: Structural functionalism, conflict theory, and symbolic interactionism. The Theoretical Perspectives Snapshot table below summarizes this discussion.
Theoretical Perspectives Snapshot
| Theoretical perspective |
Contributions |
| Structural functionalism |
Drug use is functional for several parties in society. It provides drug users the various positive physiological effects that drugs have; it provides the sellers of legal or illegal drugs a source of income; and it provides jobs for the criminal justice system and the various other parties that deal with drug use. At the same time, both legal drugs and illegal drugs contribute to dysfunctions in society. |
| Conflict theory |
Much drug use in poor urban areas results from the poverty, racial inequality, and other conditions affecting people in these locations. Racial and ethnic prejudice and inequality help determine why some drugs are illegal as well as the legal penalties for these drugs. The large multinational corporations that market and sell alcohol, tobacco, and other legal drugs play a powerful role in the popularity of these drugs and lobby Congress to minimize regulation of these drugs. |
| Symbolic interactionism |
Drug use arises from an individual’s interaction with people who engage in drug use. From this type of social interaction, an individual learns how to use a drug and also learns various attitudes that justify drug use and define the effects of a drug as effects that are enjoyable. |
Structural Functionalism
Recall that functionalist theory emphasizes the need for social stability, the functions that social institutions and social phenomena serve for society’s well-being, and the threats (or dysfunctions) to society’s well-being posed by certain aspects of society. In line with this theory, sociologists emphasize that drug use may actually be functional for some members of society. For the people who use legal or illegal drugs, drug use is functional because it provides them the various positive physiological effects that drugs have. For the people who sell legal or illegal drugs, drug use is functional because it provides them a major source of income. Illegal drug use is even functional for the criminal justice system, as it helps provide jobs for the police, court officials, and prison workers who deal with illegal drugs. Legal and illegal drugs also provide jobs for the social service agencies and other organizations and individuals whose work focuses on helping people addicted to a drug.
At the same time, drugs have many dysfunctions for society, as discussed this chapter, and this fact must not be forgotten as we acknowledge the functions of drugs. Drugs use is dysfunctional when it interfere's with an individual's or social group's ability to fully contribute to society or when it otherwise harms an individual or others in that person's life. Some functionalists may agree with conflict theorists that the criminalization of Black people (discussed below) as part of drug policy is a dysfunction of the criminal justice system and the institution of the state more broadly.
Conflict Theory
Conflict theory stresses the negative effects of social inequality and the efforts of the elites at the top of society’s hierarchy to maintain their position. This theory helps us understand drug use and drug policy in multiple respects. First, and as noted just earlier, much harmful drug use in poor urban areas results from the poverty, racial inequality, and other conditions affecting people in these locations. They turn to illegal drugs partly to cope with their situation, and partly because the illegal drug market is a potentially source of income for people with little formal skills or education.
Second, conflict theory emphasizes that racial prejudice and inequality help determine why some drugs are illegal as well as the criminal penalties for these drugs. For example, the penalties for crack cocaine are much harsher, gram for gram, than those for powder cocaine, even though the two drugs are pharmacologically identical. Crack users are primarily in poor Black urban areas, while powder cocaine users are primarily white, many of them at least fairly wealthy. These facts prompt many observers to say that the harsher penalties for crack are racially biased (Tonry 2011). This and other processes are part of a larger process of the criminalization of people of color, particularly Black people, for drug use. Criminalization is the act of making something illegal (Definition of Criminalize 2023) or deeming a social group as 'criminal.' The 1970 Comprehensive Drug Abuse and Control Act (US House 1970) created drug categorizations, called schedules, based on the drug’s potential for abuse and dependency and its accepted medical use. This system of categorization acknowledged the medical use of some drugs while heightening the criminalization of other drugs. Criminalization is racialized, meaning that it varies by race. Black (and Brown) people have been hypercriminalized, particularly in the war on drugs. Conflict theorists emphasize the power dynamics and harms of racialized criminalization and the war on drugs.
Other evidence for this argument is seen in the history of the illegality of opium, cocaine, and cannabis. As discussed earlier, racial/ethnic prejudice played an important role in why these common drugs in the nineteenth century became illegal: Prejudice against Chinese immigrants for opium, prejudice against Black Americans for crack cocaine, and prejudice against Mexican Americans for cannabis ('marijuana').
Third, conflict theory emphasizes the huge influence that multinational corporations have in the marketing and sale of the legal drugs – alcohol, tobacco, and many prescription drugs – that often have harmful individual and societal consequences. To maximize their profits, these companies do their best, as noted earlier, to convince Americans and people in other nations to use their products. They also spend billions of dollars to lobby Congress. The tobacco industry hid for years evidence of the deadly effects of its products. All these efforts illustrate conflict theory’s critical view of the role that corporations play in today’s society.
Symbolic Interactionism
Symbolic interactionism focuses on the interaction of individuals and on how they interpret their interaction. Given this focus, symbolic interactionism views social problems as arising from social interactions. As such, it understands drug use as a behavior arising from an individual’s interaction with people who engage in drug use. From this type of social interaction, an individual learns how to use a drug and also learns various attitudes that justify drug use and define the effects of a drug as effects that are enjoyable.
A study of drug use that reflects this approach is Howard S. Becker’s (1953) classic article, “Becoming a Marihuana User.” Becker wrote that someone usually begins smoking cannabis in the presence of friends who are experienced cannabis users. This social interaction, he argued, is critical for new users to wish to continue using cannabis. To want to do so, they must learn three behaviors or perceptions from the experienced users who are 'turning them on' to cannabis use. First, new users must learn how to smoke a joint (cannabis cigarette, which was the common mode of use at the time) by deeply inhaling the smoke and holding in the smoke before exhaling. Second, they must perceive that the effects they feel after smoking enough cannabis (spatial distortion, hunger pangs, short-term memory loss) signify that they are 'stoned' (under the influence). Their friends typically tell them that if they are feeling these effects, that they are indeed stoned. Third, they must learn to define these effects as pleasurable – if people suddenly experience spatial distortion, intense hunger, or memory loss, they might very well worry they are not okay. To prevent this from happening, their friends say things to them such as, “Doesn’t that feel good!” This and similar comments help reassure the new users that the potentially worrisome effects they are experiencing are not only bad ones but enjoyable ones. Becker demonstrated how cannabis use – a taboo topic at the time – is learned through social interactions.
Other interactionist theories may focus on symbols associated with drugs and drug use, such as the one portrayed below, which some people display on their clothes or accessories. Similarly, individuals use the phrase '420 friendly' (a linguistic symbol) to denote that they are welcoming to cannabis use and likely use themselves.
Cannabis is by far the most popular illegal drug in the United States, though it has been legalized in some states.
© Thinkstock
Other symbolism can be seen in portrayals of heroin users appearing decades older than they are, to draw attention to the harms of the drug through the image of accelerated aging. Drug symbolism is even seen in Hollywood films such as The Wolf of Wall Street, in which drugs are associated with power and wealth. In the film, character Jordan Belfort (played by Leonardo DiCaprio) states, "On a daily basis I consume enough drugs to sedate Manhattan, Long Island, and Queens for a month. I take Quaaludes 10-15 times a day for my 'back pain,' Adderall to stay focused, Xanax to take the edge off, pot to mellow me out, cocaine to wake me back up again, and morphine, well, because it's awesome."
Finally, as with other topics, symbolic interactionism would be interested in how being labeled a 'drug abuser' or 'addict' would influence individuals, who may internalize that label and become more likely to engage in harmful drug use or who may have reduced feelings of self-worth. For instance, the image of a heroin user 'shooting up' is one that has appeared in many movies and TV shows. It has captured the public’s concern more than perhaps any other illegal drug, apart from opioids more recently and crack cocaine in the 1980s and 1990s. As sociologist Goode (2008: 307-308) explained,
"For decades, it was the most feared, the most dreaded, the 'hardest' drug; heroin has virtually defined the drug problem. In spite of being somewhat overshadowed since the mid-1980s by cocaine, and specifically crack, heroin probably remains the single substance the American public is most likely to point to as an example of a dangerous drug. Until recently, disapproval of any level of heroin use was greater than for any other drug. And, until recently, heroin addicts were the most stigmatized of all drug users. Heroin is the epitome of the illicit street drug. Its association in the public mind with street crime, even today, is probably stronger than for any other drug. The stereotype of the junkie is that he or she is by nature a lowlife, an outcast, a 'deviant,' a dweller in the underworld, an unsavory, untrustworthy character to be avoided at any cost."
Labels such as 'addict' (used even by the sociologist above) are in fact stigmatizing, which is why health professionals typically no longer use them and instead refer to substance use disorder.
