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INTRODUCTION The term control and its variants arise frequently in discussions of substance use and abuse. However, the meaning shifts in important ways depending upon the level of abstraction, the subject matter, and the specialty of the writer. Broadly described, controls are the regulatory mechanisms that direct the behaviors of systems. In this sense, controls in substance use regulate (l) substance-seeking behaviors, (2) substance-using patterns, and (3) behavioral changes produced by taking substances. The papers in this volume use each of these meanings. The label substance abuse is an imprecise term frequently applied to any use of certain drugs and the amounts, frequencies, circumstances, or effects of the use of others that exceed normative specifications. In this context, controls usually mean factors that discourage or restrain use. This meaning also implies motive forcesâa preference or craving for the desirable effects produced by a substance or for avoid- ance of withdrawalâthat require opposition by controls to keep use and/or its effects within normative bounds. Controls may also apply to factors that encourage substance use so that it meets normative speci- fications. In this sense, controls direct individuals to use a substance or to use it in a particular way because it is culturally believed to be healthful, relaxing, or to have other benefits. The concept of control may be useful at different levels of scientific analysis: the biological levelâfor example, the ethanol intake control system that McClearn discusses in his paper in this volume; the psychosocial levelâfor example, learned attitudes, ten- dencies, and patterns, self-control techniques, and the effects of social setting; and the societal levelâfor example, laws, customs, market forces, and mass public education. Historically there have been many ideas about controls and sub- stance use. The opiates, for example, have been regarded in society as extremely dangerous. The prevalent belief is that their effects are so potent as to destroy the ability of almost any individual, once started, to desist from continued use, which in turn adversely affects health, judgment, task performance, and social responsibility. Popular con- ceptions of opiate users largely involve the depraved addict, "the man with the golden arm." These views were supported for years by data describing the intractability of the habits of the inmates of the
Lexington Public Health Hospital, the federal prison hospital for convicted users of opiates. In contrast, periodic regular use of opiates that interferes little with effective functioning has been described only briefly in the literature. Societal reactions to opiate use frequently regard any user as an overuser and focus on abstinence as the only reasonable goal. For other substances, such as alcohol, tobacco, and high-caloric foods, popular beliefs are that most people are capable of moderate, safe use but that there are special, vulnerable people who are particu- larly susceptible to the seductive properties of these substances, and for whom controlled use or moderate use is not a reasonable goal. Beliefs about controls and substance use are often colored by moral judgments; "excessive" use is often seen as a moral or character defect. The purpose of this conference is to help clarify the nature of the controls that limit or amplify substance use and its effects. The committee's concerns, as expressed at the conference, give attention to a wide range of substance use behaviors that fall between abstinence and excessive use and to the variables that influence these behaviors. The four position papers address a set of selected issues from this domain. The first paper, "Informal Social Controls and Their Influence on Substance Abuse," is concerned with controls stemming from membership in social groups. People learn appropriate substance use from familiar or respected others, who encourage and reward particular patterns. When, where, with whom, and how much one uses is to some degree regulated by group norms and sanctions. Similarly, social learning and group norms provide guidelines for how to behave "under the influence" and suggest what substance effects to expect. These and similar questions are reviewed and examined in this paper. How can knowledge of control factors in the United States be upgraded and extended? We have elaborate, costly networks for collect- ing information on people who are in trouble because of their use of .substances. We also have studies that report what is being used, by whom, andâto some extentâhow much and how often. What we lack are bridges between these two bases of knowledge: for example, data on the nature and strength of existing social controls and on self-perceptions of the need for control. We know relatively little about the effects of conflicts in substance use norms, the effects of environmental setting in mediating normative goals, or the willingness and ability of individ- uals to terminate or reduce use without outside intervention. These issues are discussed the the second paper, "Toward the Acquisition of Data on Controlled Substance Use." The third paper, "Redemption of the Overuser," is about how society defines and attempts to control the overuser and to transform him/her into an abstainer or controlled user. A number of theoretical and practical issues face society in restoring controls that have become badly damaged or destroyed. The problems of defining overuse and designing appropriate "treatments" and treatment goals and evaluating them are discussed. The fourth paper develops the thesis that genetic factors in the ethanol intake control system can be studied in animal models. Many ancient and modern conceptions about overusers include beliefs about
special vulnerabilities of individuals in the use of specific sub- stances, whether these involve hypersensitivity to the pleasurable effects, insufficient willpower to resist temptation, or defective moral judgment in distinguishing right from wrong. In modern terms, there is a tradition that genetic factors make some individuals particularly vulnerable to the overuse of substances. One experimental basis for examining these possibilities is to develop animal models wherein important variables, such as preference for substances, can be isolated and analyzed in the laboratory. These issues are reviewed and discussed in the paper "Animal Models as Pharmacogenetic Tools."
