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Book Review
Substance Use & Abuse
Russell Durrant and Jo Thakker
ISBN: 0-7619234-2-X 2003 311 pages Sage Publications, Thousand Oaks, California
Sherry Saggers
Centre for Social Research, Edith Cowan University, Perth, WA
Drug use appears to be part of the human condition. With some apparent exceptions, all human societies have made use of psychoactive substances available to them, with blurred lines between what constitutes a 'drug', 'food' or 'medicine'. The term drug is inclusive here, with the authors noting the historically-specific contexts in which a substance moves between a licit and illicit status. Caffeine and cocaine have both been enjoyed in different times and places because of their effects on cognition, emotion and behaviour.
The aim of this book is to foreground cultural and historical perspectives in a bio-psychosocial approach to drug use. The authors, both psychologists, see the book as complementing the considerable existing literature focusing on the biological and psychological dimensions of drug use. Instead of examining 'what drugs do to people', they're interested in 'what people do with drugs' (quoting Hugh-Jones 1995: 47-48, in Durrant and Thakker 2003: 15).
Using a model which examines the interaction of biological, cultural-historical and psycho-social variables on the individual, the authors structure their discussion around key questions relating to why people use drugs, why and how issues of abuse and dependence arise, why patterns of drug use change over time, and what range of policies and practices are appropriate, given what is known about drug use.
After an introductory chapter on the approach to the analysis of drug use, other chapters examine the nature and scope of drug use and abuse; an evolutionary perspective on drug use; an historical overview of drug use throughout the world; the relative impact of historical forces on patterns of use; the role of culture in drug use; an overview of treatment approaches; and an analysis of prevention, treatment and public policy.
The authors make clear from the start their view that most people use drugs with few ill effects, becoming neither substance misusers (or abusers, in the authors' terminology) nor dependent, at least according to the DSM-IV and ICD-10 diagnostic criteria. Despite the antiquity of drug use for medicinal, recreational, religious, or nutritional reasons, much less is known of the benefits of psychoactive substances to human societies than the widely-acknowledged harms.
To explain this persistent drug use the authors draw upon an integrated evolutionary model, in which biology and culture interact as people explore and make use of plants in their local environments. Along with plants for food and medicine, the effects of psychoactive plants are also added to the menu. These plants operate in a complex manner within the brain to enhance positive experiences (such as heightening sexual response) and to mask negative experiences (such as physically exhausting or boring work). Drug use also plays a part in sexual selection, with risky and competitive behaviour by young men part of the repertoire they use to attract sexual partners. Once men are married with children, risky drug use declines. This helps to explain, according to the authors, the gendered nature of psychoactive drug use, although they also note that behaviours which may have been adaptive thousands of years ago, may no longer be so. While speculative in parts, this chapter provides an engaging analysis which will be novel to many in the substance field.
True to its title, most of the book is devoted to historical and cultural perspectives on drug use and the authors provide a comprehensive overview of the history of drug use. This serves as a timely reminder of the sometimes rapid changes in the status of drugs: with cocaine and opiates, for example, legally available and enthusiastically taken only a hundred years ago. Examining the forces of history which have influenced these patterns of drug use, the authors use Zinberg's focus on drug, set (referring to the personality structure and mental state of the person at the time of use) and setting to explicate responses by authorities to emerging problems of drug use.
Drug use is culturally mediated, and the authors draw together a wide range of sources to examine traditional and contemporary use of drugs by different cultural groups throughout the world. To answer the question they pose about why substance use and related problems appear to be common among particular cultural and sub-cultural groups today (such as alcohol use among Indigenous Australians) the authors provide what they call an integrated model of the role of cultural factors in substance use. However, the model accords as much weight to structural factors such as political and economic marginalisation (correctly, in my view) as it does to so-called cultural factors.
An historical and cross-cultural review of how drugs have been conceptualised and treated shows that what constitutes a 'drug problem' is context-specific. The very notion of addiction, for instance, was part of a growing discourse about the notion of the self and the need for control over that self. The authors note the historical vacillation between biological, psychological and social (or moral) perspectives, continuing into the present. They warn against both dismissing ideas and practices used in other times and places to deal with substance misuse, or a cultural relativism which views all such practices as equally valid or efficacious.
The final chapter examines prevention, treatment and public policy and provides a balanced overview of the biological, social and cultural factors mediating the impact of prevention and treatment options. The emphasis on harm reduction strategies as an alternative to medicalising or criminalising drug use is consistent with the authors' view that drug use has been with us always, and that the 'just say no' approach has had little positive impact and is not supported by the majority of people who continue to use a variety of licit and illicit drugs.
This book is a valuable addition to the growing number of texts on substance use and misuse. Students, academics and researchers in psychology, health and social work, in particular, are likely to learn most from this book, although anthropologists and sociologists wanting to know more about drug use will also find it of interest.
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