Journal of Counseling and Development, 65:23-24, 1986
The "Cure" for Adolescent Drug Abuse: Worse than the Problem?
Oetting and Beauvais's article is important and accurate in locating the kernel of adolescent drug and alcohol abuse in the interaction between the sentient person, the environment, and the experience provided by a substance or more accurately, any of a variety of substances. The authors are wrong, however, in assigning an ineluctable status to the "disease" of addiction as identified by physical dependence. In doing so, they suggest the possibility that a separate group of factors governs the behavior of those who are "physiologically addicted," "physically dependent," or "genetically predisposed to addiction." No such set of factors exists, and, indeed, nothing in their research suggests otherwise.
Rather, Oetting and Beauvais's findings that users take many different drugs and that their drug use is extremely dependent on context directly contradict disease-based assertions. Disease theories explicitly reject the influence of situational factors on drug and alcohol consumption, and it is simply not possible to make sensible biological statements about similar human drives to take entirely dissimilar chemicals (Peele, 1985). The evidence that the same people misuse a variety of substances and that they share other values, attitudes, and behavioral, social, and situational traits is actually basic evidence against disease conceptions of drug use. The same psychological (e.g., lack of confidence and sense of isolation), social, and environmental deficiencies that these adolescents use drugs to remedy in the absence of alternate opportunities for and values toward non-drug gratification explain chronic, addicted drug use (Peele, 1985).
As the pioneering psychopharmacologist Harold Kalant has declared, the problem with theories of drug dependence is that they do not answer the " fundamental question why a person, having experienced the effects of a drug, would want to go back to reproduce that chronic state" ("Drug Research," 1982, p. 12). Because Oetting and Beauvais have no data to contradict Kalant's disavowal of drug dependence as an explanation for the disease of drug abuse and because of their own non-disease based approach to the problem, one might wonder about the need for them to defer at all to disease conceptions of drug use. Probably they wanted to offer positive words about all approaches to the problem. They may find, however, that this conciliatory nod is large enough for disease proponents to drive a gunboat through.
The producers of the CBS Evening News (on the May 20 edition) called a CompCare treatment facility with the story of a girl whose father suspected that she was using marijuana. The girl was dating an older boy and had defied her parents. The facility hospitalized her after an initial interview (in the news program it was indicated that there has been a 350% increase in the hospitalization of teenagers during the 1980s), despite her protestations that she did not have a drug problem. A counselor claimed that her denial which he said 95% of patients made proved that she was chemically dependent. CompCare and other treatment centers have now arranged for facilitators to train school personnel in intervention techniques that involve confronting the child with peers, parents, employers, and teachers, who insist that unless the suspected sufferer of dependence and denial enters treatment immediately (a taxi is waiting outside), they will cease dealing with him or her.
Because almost two-thirds of high school seniors have taken an illicit drug in the past year, quite a few adolescents could conceivably be targets for such interventions. But disease-based treatments are not reserved for those thought to be abusing drugs. The National Association for Children of Alcoholics (NACoA), established in 1983, has declared that "children of alcoholics require and deserve treatment in and of themselves," whether or not they have ever had a drinking problem ("The Founding, Future and Vision of NACoA," 1983, p. 19). Combining the 22 million Americans whom Dr. Douglas Talbott believes "have an alcohol problem related to the disease of alcoholism" (Wholey, 1984, p. 19) with their relatives and with young people who have taken drugs indicates that there is a disease growth industry of enormous proportions one that could include nearly half of all Americans. (Compare this with the membership of roughly 100 that Alcoholics Anonymous had enlisted when its "Big Book" was first published in 1939.)
Also remarkable is the claim that this burgeoning number of disease sufferers is genetically vulnerable: They learn in treatment that their condition is inbred, lifelong, and irreversible. Successful therapy means patients must accept that constant relapse is the only alternative to remaining in treatment and abstaining the rest of their lives. Therefore, acceptance of therapy and its disease message almost guarantees relapse, because there are few adolescents who will abstain forever.
The notion of congenital proclivity for addiction (as described by Oetting and Beauvais) is now widely accepted. It is based loosely on findings of enhanced genetic liability for alcoholism among children of alcoholics. Such findings actually pertain to only a relatively rare strain of familial alcoholism in men (and, in fact, the definitions of which alcoholics are involved have shifted from study to study). Even accepting that such a group of susceptible individuals exists absolutely does not mean that alcoholism is immediate or inevitable for any individual (Peele, 1986). Addiction is always an expression of a whole life-style and an accumulation of behavioral steps. Vaillant (1983), a disease theory proponent, noted that his research offered "no credence to the common belief that some individuals become alcoholics after the first drink; the progression from alcohol use to abuse takes years" (p. 106). Vaillant suggested that "individuals with many alcoholic relatives should be alerted to recognize the early signs ... of alcoholism and to be doubly careful to learn safe drinking habits" (p. 106).
Vaillant's cautious tone is entirely lost on those administering disease-oriented therapy and prevention programs for the young. Administrators of such programs currently favor recommendations of permanent abstinence for those they consider to be at risk. Yet Fillmore (1975) discovered that college students who manifested blackout and other alcoholic symptoms rarely continued to do so into adulthood. In fact, in a later report on these data, Fillmore, Bacon, and Hyman (1979) found that young people with the most vivid symptoms of alcohol abuse were less likely to have drinking problems in middle age. As a result of a renewal of intense prohibitionism toward both drugs and alcohol, recommendations of abstinence are not restricted to those with family or personal histories of substance abuse. Unfortunately, offering children increasingly dire warnings about the dangers of these substances has not yet caused many to avoid them.
Such scare tactics, moreover, may be counterproductive. Oetting and Beauvais note that those who as young children harbor negative feelings about illicit drugs initially warn others against using drugs, but by their senior year in high school they cease to do so. In their impressive study of drinking among Glasgow youth, Davies and Stacey (1972) found that young people who drink heavily had parents who disapproved more strongly of drinking in the first place. Similarly, Robert Pandina (personal communication, November 5, 1984) of the Rutgers Center of Alcohol Studies found a trend for young drug abusers in his New Jersey sample to have had the most negative attitudes toward drugs before using them. Apparently, when such adolescents face the substance use that is commonplace in high school today, they are ill-equipped to avoid and control it.
In the aftermath of President Reagan's much-heralded 1982 "war on cocaine," cocaine is more available and more people abuse this drug today than 3 years ago. This situation signifies the worst of both worlds; that is, drug use is widespread (in some cases almost ubiquitous), and more and more young people have been convinced that they cannot hope to control their exposure to these substances. Adolescents are presented with a Manichaean world view in which evil cannot be avoided and people are incapable of resisting evil when confronted with it. This sense of a world full of imminent and irresistible danger is exactly the opposite of what people need to encourage in their children.
Oetting and Beauvais identify peer clusters as a crucial element in the cause and treatment of substance abuse but offer some appropriate cautions against overinterpreting this result. As Kandel (1978) indicated, it is as accurate to say that like children group together as it is to say that peer influence determines behavior. In other words, the question may be why some children cannot find constructive involvements and instead join destructive groups. Ultimately, the data Oetting and Beauvais review agree with other important research (cf. Pandina & Schuele, 1983) in indicating that eliminating the appeal of intoxication for many adolescents and the uncontrolled use of drugs and alcohol by a few requires that society give children the competencies, values, and opportunities to find superior alternatives to drug use for relating to their worlds (cf. Peele, 1983).
The mission of those concerned with adolescent drug abuse is to create a cultural climate that encourages children to value and to achieve independence, adventure, intimacy, consciousness, activity, fun, self-reliance, health, problem-solving capacities, and a commitment to the community (Peele, 1983). There is no better antidote for drug abuse than adolescents' beliefs that the world is a positive place, that they can accomplish what they want, and that they can gain satisfaction from life. Enabling children to develop this outlook is certainly no small order; however, all efforts to simplify the task are doomed to fail. High on the list of futile policies and one that displays nothing so much as our fear and ineffectuality is labeling drug abusers as victims of disease. We are all the victims for this mistake.
Davies, J., & Stacey, B. (1972), Teenagers and alcohol: A developmental study in Glasgow (Vol. 2). London: Her Majesty's Stationery Office.
Drug research is muddied by sundry dependence concepts. (1982, September 1). Journal of the Addiction Research Foundation, p. 12.
Fillmore, K., Bacon, S.D., & Hyman, M. (1979). The 27-year longitudinal panel study of drinking by students in college, 1947-76 (Final report, No. C-22). Berkeley, CA: Social Research Group.
Fillmore, K.M. (1975). Relationships between specific drinking problems in early adulthood and middle age: An exploratory 20-year follow-up study. Journal of Studies on Alcohol, 36, 882-907.
The founding, future and vision of NACoA. (1983, December). U.S. Journal of Drug and Alcohol Dependence, p. 19.
Kandel, D.B. (1978). Homophily, selection, and socialization in adolescent friendships. American Journal of Sociology, 84, 427-436.
Pandina, R.J., & Schuele, J.A. (1983). Psychosocial correlates of alcohol and drug use of adolescent students and adolescents in treatment. Journal of Studies on Alcohol, 44, 950-973.
Peele, S. (1983). Don't panic: A parents guide to understanding and preventing alcohol and drug abuse. Minneapolis: CompCare.
Peele, S. (1985). The meaning of addiction: Compulsive experience and its interpretation. Lexington, MA: Lexington Books.
Peele, S. (1986). The implications and limitations of genetic models of alcoholism and other addictions. Journal of Studies on Alcohol, 47, 63-73.
Vaillant, G.E. (1983). The natural history of alcoholism. Cambridge, MA: Harvard University Press.
Wholey, D. (1984). The courage to change. Boston: Houghton Mifflin.