Issues in Controlled Substance Use: Papers and Commentary, Conference on Issues in Controlled Substance Use (1980)

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INFORMAL SOCIAL CONTROLS AND THEIR INFLUENCE ON SUBSTANCE USE Deborah Maloff, Howard S. Becker, Arlene Fonaroff, and Judith Rodin INTRODUCTION When we talk about addiction or habitual substance use, we usually ask why people take "so much" of a substance when it is clear that less would be better or, in some instances, that none at all would be better yet. That question presupposes that we know the optimal amount, but differences of opinion about how much is optimal lead to much of the argument over these matters. A more neutral question allows us to avoid the moral elements of the problem and attach our questions to a larger body of social science thinking: how do people "decide" how much of a given substance they will take and when? (The decision, of course, may be made without conscious reflection.) Put this way, the question is reminiscent of Durkheim's famous question in Suicide. Durkheim wanted to show the importance of the social variable in human affairs and thought that nothing would be more convincing than to demonstrate that suicide, the most private of acts, actually is rooted in social life. He did it by showing that the sui- cide rate varies with features of social organization: single people kill themselves more frequently than married people, urbanites more fre- quently than rural residents, Protestants more frequently than Cath- olics. In each case, he argued, the second member of the pair is more deeply involved in a web of social life while the first leads a more individuated existence. But what mechanism leads from decreased involvement in social life to suicide? Durkheim suggested, as the explanatory variable, that par- ticipation in highly organized social life leads people to accept socially defined limits on desires. Many of the things people desire are of such a character that they can be consumed in very large quan- tities. There is no physical limit, for example, on the amount of jewelry or rich clothing one might have. Even when there is some physical limit—time alone limits the number of cigarettes one can smoke, although the amount of nicotine might be increased by using other means of administration—no one ingests as much of a substance as is physically possible. What stops them? This question has as many answers as there are disciplines that investigate human behavior. The sociological answer is that people stop short of the maximum possible consumption of anything because their

social group sets limits beyond which a reasonable member would not go. Recognizing that these limits are commonly accepted, group members in- ternalize them as reasonable guides to their own behavior, often imbuing them with moral as well as practical force. This interpretation allowed Durkheim to explain suicide as something people do when they are so re- moved from social influences that they can find no way to limit their desires; one response to the pain of the ensuing insatiable desire is to kill oneself. Durkheim could also thus explain a puzzling anomaly in suicide rates: rates rise not only in times of economic depression but also during economic booms. In both boom and bust the violent shift in people's economic situations nullifies the force of previously influ- ential social norms. Neither the person who has lost everything nor the one who has incalculably more than had ever been anticipated can appeal to what they had hitherto known as the right way to do things to organize their consumption. Although both Durkheim's logic and especially his data have come under severe attack, we can begin with the premise that people control their consumption of various items by referring to the established norms that regulate how much people like them usually consume or ought to con- sume. Since Durkheim's time, various investigations (especially into the use of drugs) have broadened our conception of the ways membership in social groups can influence people's consumption patterns. We know both that there are sizable variations in amounts and schedules of use by such social variables as class, ethnicity, age, sex, and geographic location and that there is a variety of ways that membership actually impinges on the process of use. It should be clear that we are not discussing the question of sub- stance abuse. That term invariably embodies a judgment that some amount or kind of use is immoral, unwise, or unhealthy. These judgments, inevi- tably, are debatable, whether they involve pitting the ethical system of one group or society against that of another or judging people's actions by the code of their own group. We prefer to deal with the likely out- comes of the ways in which social groups influence substance use and leave to the readers the problem of deciding which outcomes ought to be guarded against or prevented and which ones ought to be promoted. Our strategy is to compare what is known about use of alcohol, tobacco, other drugs, and food, to see more clearly how participation in social groups enables people to know how much of a substance is "enough" or "too much" to be used. We assume that people differ with respect to psychological variables influencing substance use and biological suscep- tibility to substances, and that substances do have substantial pharmaco- logical effects. We want to describe the influence of sociocultural fac- tors (specifically, informal social controls that stem from group member- ship) on patterns of consumption. In using the terms formal and informal social controls, we refer to the difference between rules created and enforced by the state and its agencies and subsidiaries (such as schools and law enforcement agencies) and by such private governments as the managements of corporations (who make quasigovernmental rules for their employees), on one hand; and the informal rules and other guides to behavior created in microenvironments by groups that have no clearcut code or mechanisms for enforcement (such

as families, friendship groups, teenage cliques, and the like), on the other. The operations of large-scale social institutions—the government, the industries (legal and illegal) that manufacture and dis- tribute substances, the advertising and media industries, and the medical and legal professions (considered as corporate bodies)—create the con- ditions in which people, acting in their everyday microenvironments, produce and respond to informal controls. (For a general approach to some of these questions see Spradley, in this volume. In relation to the food industry, see Aronson, l978.) To summarize the results of our review of the literature on in- formal controls, we find that social groups develop cultural recipes, formulae describing what substances can be used in what amounts to achieve desired results. People learn to use substances by learning these recipes and developing a taste for the effects they make possible, through association with others who teach them what, when, why, how, where, and with whom to use. Sumptuary rules specify who is eligible to use what substances for what purposes and, secondarily, who will learn which recipes; positive and negative sanctions reinforce these provi- sions. Finally, the everyday workings of ordinary social relations make it expedient for people to use substances in some ways and inconvenient to use them in others. Cross-cultural data from anthropological, sociological, and psycho- logical research involving a variety of substances illustrate each of these phenomena. Durkheim's strategy suggests the major questions we will raise throughout. What kinds of people engage in what kinds of social interaction around the use of these substances? What kinds of information, ideas, theories, knowledge, and feelings about what kinds of substances circulate among the parties in these relationships? What rules govern appropriate use and the penalties for inappropriate use? What are people's conceptions of how things are ordinarily done so that doing them differently would be troublesome, and what are their notions of the best ways to achieve desired results? CULTURAL RECIPES How do people know how much is enough? One answer is that in every social group, cultural recipes describe how to use certain substances to attain desired results—that is, cultural recipes tell people what, how much, when, and how to use in order to become healthy, socially uninhib- ited, high, or whatever other result is desired. (See Harding and Zinberg, l977; Zinberg, et al., l977; Zinberg, et al., in press.) When people undertake an activity in the belief that it will produce a par- ticular result, the cultural molding of perception makes it likely that they will experience that result. So substances tend to produce the results for which people use them, thus confirming the cultural pre- dictions as to how and why they should be used.

The Purposes of Use People have used substances in order to achieve a variety of ends, including: the prevention of illness, to gain strength and energy, to treat an illness, to cure insomnia, to cure a hangover, to have a sense of belonging, to gain status, to facilitate social intercourse, to aid in coping, to reduce inhibitions, to stimulate mental activity or clear thinking, to celebrate special events, to have fun, to become euphoric, as an aphrodisiac, and as part of religious or magic rituals. Some of these uses—such as drinking coffee to start the day, taking an aspirin to relieve a headache, or taking heroin to avoid withdrawal—are considered necessary for routine existence, to enable one to function normally. Others—such as taking LSD to alter one's con- sciousness or drinking wine to relax inhibitions at a party—alter the person in some way so that special activities can be performed or enjoyed. Some examples of recipes for substance use for a variety of pur- poses follow. l. Substances may be used to maintain a normal, healthy state. Many Latin American societies, such as the Guatemalan community of Santa Lucia, classify foods as hot, cold, or fresco (cool, fresh). People believe they should eat a balanced diet of hot and cold foods to avoid illness (Cosminsky, l977). In the United States, to achieve the same purpose, people believe they should eat three meals a day with a balance of proteins, carbohydrates, and fats as well as fruits and vegetables as sources of vitamins. 2. Substances may be used to treat illnesses or other undesirable physical or emotional states. If illness does occur, Santa Lucians ad- minister hot substances to treat such cold illnesses as pulmon (i.e., respiratory ailment) and fresco substances for such hot illnesses as inflamation or fever (Cosminsky, l977). Alcohol, like food, is also used for its medicinal benefits. In l9th century Ireland, alcohol was a uni- versal medicine to "keep the cold out of the stomach" and to cure stomachaches, insomnia, fainting, and hangovers. Whiskey was a recom- mended cure-all for young men in low spirits (Bales, l949). Hot toddies are contemporary favorites in England and Scotland to ease head colds and coughs, and American physicians sometimes prescribe alcohol for elderly people and others. Popular folklore suggests that men can increase their sexual capabilities by eating oysters and other special foods. 3. Substances may be used for social and recreational purposes. In the United States, people use alcohol, cocaine, marijuana, and a variety of other legal and illicit drugs for relaxation or to have fun. High school students have reported that among the purposes of drinking are "to be gay" and "to get high" (Straus and Bacon, l953). 4. Substances may facilitate the performance of special activi- ties or events. In their review of Human Resources Area File data on 247 nonliterate societies, Blum et al. (l969) found that hallucinogens are used most often for mind-modifying or religious purposes. Navahos use peyote, for example, as an important vehicle for participating in reli- gious and ceremonial events (Aberle, l966). 5. People may use substances in order to belong or fit in. Over two-thirds of the respondents in Maxwell's (l952) study of drinking in

the United States reported that they drank because "it seems the thing to do" or "on some social occasions because it would help me to fit in bet- ter with the others." A review of cross-cultural definitions of the purposes for which substances are used reveals a tremendous diversity. Substances used for one purpose in one society may be used for a different purpose in another environment. Jamaicans, for example, believe ganja (marijuana) maintains health and use it as a tonic to treat certain illnesses, to enhance appe- tite and relaxation, and even to build strength and energy (Rubin and Comitas, l976). But in the United States marijuana is used primarily to relax and to have fun rather than to treat illness or to give the user energy. Similarly, Edwards, in his discussion of cultural plasticity, describes how one tribe may use as an energizer the same drug another tribe uses as a tranquilizer (Harding and Zinberg, l977). This suggests that the purposes of use are not dependent solely upon the pharmaco- logical properties of the substance but are influenced by sociocultural factors as well. Cultural recipes that describe to users the effects or benefits of using a substance have profound impacts on the user's experience. As Becker (l963) points out in his study of marijuana use in the United States, the presence of "symptoms" is not enough for people to experience being high. Rather, they must learn to recognize the symptoms and to connect them with use of the drug. Through interaction with experienced users, the novice learns to find pleasure in the experience and to define the symptoms as enjoyable. It is in this sense that set and setting have their profound influ- ence on drug effects. Cultural recipes dispose people to use substances in order to have one or more of the many results the pharmacological properties produce, by telling them that this is what they can expect. Their expectations, as many studies how shown, mold their perceptions (Aberle, l966; Becker, l963 and l974). As Weil (l972) has noted, amphet- amines can produce sedation under the right conditions of set and set- ting, and barbiturates can produce stimulation. In fact, the expecta- tions created by cultural recipes can even produce measurable physiologi- cal changes. O'Brien's (l977) studies of conditioned drug effects demon- strate that, even in the absence of heroin, expectations of heroin effects can influence self-reports of high or euphoria, and such auto- nomic changes as pupillary constriction, decreased respiratory rate, or increased skin temperature. These learned responses resemble the placebo effect, which suggests that drug effects can be learned. O'Brien's ex- periments also demonstrate that pre-injection rituals and expectations of drug effects increase both subjective response and autonomic changes fol- lowing a test dose of a narcotic. Appropriate Occasions for Use Cultural recipes also prescribe when, where, and with whom a sub- stance should be used in order to achieve desired states. In the United States alcoholic beverages, generally used for social purposes, are appropriate at the cocktail hour, but not in the morning. Similarly,

l0 one may appropriately drink at home but not at a business meeting, and with others but not alone. In contrast, one may eat nutritious food necessary for health maintenance at any time of day, alone or with others, but not in such locations as church or school. We can classify occasions of use as ordinary or nonordinary, depending upon the purpose of use. Ordinary occasions are associated with a normal, healthy physical and emotional state. Fitting in with others may also be related to ordinary occasions for use, since fitting in or belonging may be necessary to maintain a functioning, normal existence. Thus, we eat three meals a day— breakfast in the morning, lunch at midday, and dinner in the evening—not only to keep ourselves healthy but also to follow the particular pattern that enables us to fit in with others. Similarly, Italians drink in an "ordinary" way: Lolli (l958) found that 70 percent of the Italian men and 94 percent of the Italian women in his study drank alcohol exclusively and routinely with meals, believing this a healthful practice as well as a valued custom. On nonordinary occasions people use substances for special pur- poses: to treat an illness, to celebrate an event, to have fun or to prepare oneself for a special task or activity. The Andean peoples of Bolivia and Peru, for example, treat alcohol as a sacred substance, reserved for such social occasions and rituals as baptisms, betrothals, and marriage. They almost always use it in a social setting, rarely alone (Carter, l977). Many societies consider family or community fes- tivities and celebrations appropriate occasions for drug use. Bunzel (l940) found that the people of Chichicastenango, Guatemala, confine their consumption of alcohol to market days and festivals. These drink- ing parties typically became occasions for the relaxing of social inhibi- tions in contrast with the extreme decorum observed at other times. In England and Wales, people usually use alcohol to have fun. Customary drinking habits include frequent visits to public houses, bars, or other places to which people "go in for a drink." Rowntree and Lavers (l95l) estimated that in l949, more than 80 million visits per week were paid to public houses, which serve as important centers of social life. People sometimes use substances to fit in on nonordinary as well as on routine occasions. They may use substances in special group rituals to participate as a member of the group, rather than to experience sub- stance effects. For example, people who ordinarily prefer not to drink may drink champagne at weddings just to fit in. Manner of Use Cultural recipes describe how to use substances, including the routine of administration and the rituals surrounding use. Recipes tell people which methods—eating, smoking, or injecting—are appropriate and what paraphernalia to use. Recipes prescribing the correct manner of use often provide users with the most practical, effective, and expedient ways of attaining what they want to attain. For example, people learn to smoke marijuana in groups, in which the joint is passed from one person to another, thus enabling the users to adjust the intensity of the high (Harding and

ll Zinberg, l977). Similarly, although it may be eaten, marijuana is usually smoked, which enables users to experience more intimate effects and to gauge how much more is needed to become high. They have less control over the intensity of the effects when marijuana is ingested. Like marijuana, most substances are associated with one predominant mode of administration. Heroin, for example, is most often injected, the technique that produces the strongest and most immediate effects. Rituals surrounding use also reflect the purposes of use. Brandt (l950) describes the peyote ritual of the Kiowa-Apache in which the user holds the button in his right hand, motions toward the fire several times, puts the button in his mouth, and then rubs his hands over his head, arms and legs, especially in places where there is sickness or pain; the ritual emphasizes the curative powers of peyote. Although cultural recipes often seem related to practical ways of attaining desired results, they may also be arbitrary. For example, illegal methandone, in contrast with heroin, is usually taken orally, in part because the liquid methadone dispensed by clinics is not always injectable, and in part because the liquid methandone is received in a context in which the oral route is "the natural way of using it" (Agar, l977). Even when there is a practical reason for using a substance in a certain way, users may be unaware of those practical concerns and merely follow conventions for the sake of conformity; marijuana users may not know that the way they use marijuana allows them to adjust the intensity of the high. How Much is Enough? Every culture contains recipes that tell people how much of a sub- stance should be used to achieve certain purposes. In the United States, we take two aspirins to cure a headache, one or two cocktails to relax us and whet our appetites before dinner, and several cups of coffee at a business meeting to stimulate our activity. Recipes for proper amounts vary situationally and within subcultures. The limits—both minima and maxima—on the amounts of a substance people want or feel are appropriate for their particular needs are defined, at least in part, through inter- action in the groups to which they belong. The culturally defined limits on how much is enough are often quite broad, depending upon the nature of the substance, the purposes for which it is used, and the behavior one displays when under its influence. At a cocktail party in the United States one may have as many drinks as one likes so long as one's behavior remains appropriate to the occasion; one may drink almost unlimited cups of coffee without social censure. Cul- tural limits thus vary within as well as among groups. Recipes for Ordinary Occasions To maintain themselves in a normal, healthy functioning state, most Americans eat three meals a day. Some take a vitamin pill every morning for health maintenance and some routinely drink a few cups of coffee in

l2 the morning so that they can wake up and work more efficiently. Some societies use alcohol routinely on ordinary occasions for similar main- tenance functions. In lower Normandy, France, no one would think of end- ing a meal without a cup of brandy (Mouchot, l955). In Peru, alcohol is consumed routinely by children in small quantities to "open the appetite, clear the head, kill microbes, etc." (Simmons, l962). Recipes for Treatment People learn how much of a substance to take or what not to take in the event of illness or other undesirable states. North Americans often take large doses of orange juice for the common cold. A common recipe for treating a hangover in the British Isles, reported by Stivers (l976) is taking a drink the day after a night of drinking, "a hair of the dog that bit you." Other recipes for treatment may require the withdrawal of certain substances. For example, Guatemalans and Many West Indian soci- eties regard the withdrawal of foods as an essential treatment for child- hood diseases (Reed, l966; Fonaroff, l968). Recipes for Special Events The use of substances in as large amounts as possible is sometimes prescribed in connection with nonordinary occasions. In rural Aymara, where drunkenness is a valued, almost sacred state, an individual can down as many as l00 shots of alcohol during a one-to-eight-day bout. Drinking bouts usually accompany public rituals, rites of crisis (related to illness, misfortune, or healing), and rites of passage. Between these rituals and rites, the populace is totally sober (Carter, l977). Hard drinking is often a valued goal for social and recreational purposes. In rural Greece, for example, men drink large quantities, "holding their liquor," to have fun and prove their manliness and honor. Since the ability to drink large quanitites is tied to reputation, men become inventive nondrinkers. They may hide their glasses, pretend that empty glasses are full, and use other ruses to give the appearance of consuming more than they do (Blum and Blum, l969). Stivers (l976) and Bales (l949) report the same emphasis on hard drinking for social pur- poses among the Irish, who see drinking as a means of gaining respect among one's peers and showing friendship for one's drinking partners. Some groups define more moderate limits as appropriate for even recreational purposes. Jews have had low alcoholism rates, despite the use of alcohol in such nonordinary events as traditional rituals, rites of passage, and observances of the Sabbath. Snyder (l962) found that Jewish college students perceived pressures toward moderate drinking and sobriety from their Jewish peers but saw the non-Jewish milieu as a source of pressures to drink to excess. Many students surveyed defined sobriety as a Jewish virtue and drunkenness as a Gentile vice.

l3 Recipes for Accomplishing Certain Activities Specific amounts of some substances are prescribed for accomplish- ing certain tasks or performing certain activities. Participants in American Indian Peyote rituals facilitate spiritual experiences by eating a minimum of 4 peyote buttons, with an average of l2-20 a night (LaBarre, l969). Peruvian Indians use enough coca to sustain themselves on long journeys along narrow mountain paths. Journeys are even measured in terms of the cocada (about 45 minutes), the length of time one chew of coca will sustain a traveler (Carroll, l977). Recipes for Belonging The amount of a substance people use may be influenced primarily by the desire to belong to a social group that uses specified amounts of the substance. Spradley (l973), in his account of public drunkenness in urban skid row areas, notes that social drinking offers a sense of be- longing for homeless men. The bars they frequent serve as churches, clubs, employment agencies, and, most important, places to find friend- ship. Studies of drug use among United States college students indicate that patterns of use are associated with the life-style of the students' social groups. Groves (l974) found that one of the best predictors of people's marijuana use was simply what school they attend, which implies that schools require certain patterns of use in order to fit in. The Breakdown of Cultural Recipes We see how effective cultural recipes ordinarily are when they break down or are no longer recognized as legitimate, as in times of rapid social change due to urbanization or ethnic invasion. As Durkheim suggests, people cannot depend upon group norms for guidance when social situations are drastically disrupted. Transitition from rural to urban life in India provides an example of the breakdown of traditional norms for using alcohol. People's de- parture from rural agricultural communities weakens traditional restric- tions against drinking, resulting in high alcohol consumption in the large cities (Chopra et al. , l942). The industrial population accounts for about one-quarter of the total alcoholic drinks consumed in India. Bales (l949) describes similar alcohol control problems among the Hopi and Zuni of western New Mexico after the arrival of the Spanish set- tlers. Although these Indians used alcohol in a ritual manner in their aboriginal state, liquor brought in by the Spaniards caused so many prob- lems that it was used for a period and then rejected entirely. The Indians could not successfully control their use of the Spanish liquor. MacAndrew and Edgerton (l969) argue that the Indians learned their changes for the worse after alcohol use from white men. Many tribes had institutionalized drinking in earlier, calmer times, but white traders provided examples of changes for the worse behavior. The deterioration

l4 of traditional Indian values may explain the Indians' acceptance of drunkenness as a disinhibitor, thereby allowing for changes for the worse. Prohibition in the United States provides another example of the breakdown of cultural recipes. Once drinking was prohibited, those who violated the law by continuing to drink did so in an atmosphere in which previous informal controls and rules for appropriate use were no longer valid. People went to speakeasies not just to drink, but to get drunk (Zinberg, l978). Cultural Recipes and Evolutionary Adaptation The diversity of cultural recipes across cultures raises questions about how these recipes, prescribed patterns of substance use, origi- nate. Why does one culture follow one set of prescriptions and taboos, while another culture follows a different set of recipes? Rozin (l975) suggests the existence of institutionalized nutritional wisdom in the food habits that people have adopted, for example, the practice of cook- ing food has practical adaptive functions—killing bacteria, making food more digestible, retarding decay, etc.—although the original rationale ^or cooking may be that warm, cooked food simply tastes better. The choices and combinations of foods used traditionally by cultures also express nutritional wisdom. Mexican peasant cuisine combines corn and beans, which provide protein in the absence of meat and provide a better amino acid balance than either one alone. The corn is usually ground with lime and cooked as a tortilla, which supplements a diet otherwise low in calcium (Rozin, l975). People may persist in nutritionally wise conventional food habits without being conscious of the adaptive functions of the foods they eat. Spices are justified biologically as sources of micronutrients, but it has not been proven that people use them for health reasons. Researchers think spice use may have arisen because it masks the taste and smell of spoiled food and provides variety in the diet (Rozin, l975). Also, many widespread food habits have no apparent biological advantages and may even be harmful to a culture. Rozin (l975) suggests that cuisine-based unwillingness to eat unfamiliar foods can have serious health conse- quences in times of famine—for example, the unwillingness to eat wheat during the l943 Bengal rice famine. Availability may also explain how cultural patterns of substance use emerge. The foods people eat are generally related to climatic and land use variables and to the availability of naturally occurring plants, animals, and domesticated species which can be conveniently raised (Rozin, l975). Access and availability have a tremendous influence on drug use patterns as well. LEARNING TO USE In every social group people learn methods of substance use char- acteristic of their culture: which substances to use for which purposes, rules for appropriate use, and taboos related to foods and drugs. How do

l5 people learn cultural recipes? Who learns from whom? How do patterns of rank and deference determine who is willing to be taught by whom? How do people learn to use a substance in microenvironments despite negative sanctions and prohibitions in the macroenvironment? People usually learn to use substances through insraction with other users. They may simply observe people they admire and respect using these substances in an environment that suggests that use is an appropriate activity. Or others—usually parents, siblings, or peers— deliberately teach the learner that certain benefits will follow if a substance is used in a particular way. Learning occurs more easily in a comfortable setting, where people learn to associate positive experiences or feelings with food or drug use. Not only are they taught to define food or drug reactions as plea- surable, but those intimates who have encouraged substance use reward it with approval or acceptance. Similarly, people learn taboos by associ- ation with others who disapprove the use of certain substances and teach the would-be user of likely negative consequences. Negative sanctions reinforce taboos, for example, against eating ham in a kosher home. The kinds of practices people learn about substance use depend on who teaches them those practices. Specifically, parents or other author- ity figures usually teach people to like and use substances approved by conventional society, while peer groups teach them to use illicit sub- stances, or substances disapproved for their age status. Parental and Family Influence The literature provides ample evidence that parents introduce their children to substances used and accepted by the dominant culture. Simmons (l962) describes the way a Peruvian community serves liquor to young children as a tonic; as already noted, it is thought to improve the appetite and kill bacteria, among other healthful benefits. In this com- munity almost all adult males drink so that children have many opportuni- ties to observe drinking and to learn about it by example. Children usually receive their first drink at familial birthday celebrations, while the introduction of heavy drinking comes under the tutelage of fathers or other older male relatives. Bunzel (l940) describes a similar situation of parental influence among the Guatemalan Indians of Chamula. From early infancy, children are habituated to alcohol along with mothers' milk. At fiesta time, everyone in the village, from the young- est child to the oldest woman, drinks enormous quantities and is, to some degree, intoxicated. Families often introduce people to tobacco smoking, too. Damon's (l973) study of smoking in seven preliterate societies (four in Melanesia and three in sub-Sahara Africa) found that 44 percent of the smokers in all seven groups were initiated into smoking by family members (and another 27 percent by friends). In Jamaica, where the use of ganja is common (particularly among the lower classes), parents introduce children to ganja tea, which is believed to have medicinal qualities. While ganja smoking is primarily a peer activity, ganja tea drinking is intergenera- tional, adults providing tea for minors (Rubin and Comitas, l976).

l6 The family socializes children to conventionally approved food habits. Rozin (l975) describes the exposure of a Mexican peasant child to the odors and tastes of tortillas, beans, and the sauce made of toma- toes and chili peppers. Growing up in a home that uses these foods and seasoning, "The child will experience features of these foods in the mother's milk, as well as in the odors of the home" (p. 294), and thus becomes familiar with the characteristic smells and tastes of its culture. Esteemed Role Model Influences Some evidence shows that people adopt habits of substance use, both legal and illicit, in an attempt to emulate others they admire or to be more adult. In many societies, drug use is a rite of passage through which one attains adult status. Blum and Blum (l969), describing drink- ing customs in rural Greek communities, indicate that young men visit the coffee house, the scene of public drinking, to learn how to take part in public life, one of a man's most important activities. In a study of smoking in the United States, Meyer et al. (l973), who found that child- ren are more likely to smoke if their parents smoke, argue that these children learn that smoking is a prerogative of adulthood. People sometimes use drugs because of their association with popu- lar or folk heroes, whom the user knows only by reputation. Siegel's (l977) interviews with 85 cocaine users showed that they often found cocaine appealing because of its rarity, high price, and association with certain legendary figures (see also Sandoval, l977). Winick, in his l959 study of 409 jazz musicians, identified as one of the factors influencing them to use marijuana the use of drugs by several well-known modern jazz musicians. Drug use was thus part of the image younger musicians emu- lated. Winick also refers to the drug climate in some bands, created by the attitudes of the band leader and other band members. In this envi- ronment, marijuana use became a norm. Peer Group Influence In addition to parents or other adults who provide models for young people to imitate, the peer group influences taste acquisitions, particu- larly for illicit drugs. Blum's (l969) survey of 200 American adults found that, while parents introduce their children to beer, wine, and spirits, peer groups influence adolescents to use a wider range of sub- stances: beer, wine, spirits, tobacco, marijuana, amphetamines, nar- cotics, and other illicit drugs. Accounts of learning to use marijuana (Becker, l953; Goode, l970; Harding and Zinberg, l977) stress the impor- tance of peers who are experienced users and who teach the novice how to use the drug, what reactions he or she will have, and how to interpret these reactions. To the new users, curiosity and mystery surround the first experience, seen as a kind of milestone in their lives. The experience of first use is typically a ritualized affair in a secure setting (Harding and Zinberg, l977). Friends and familiar environments help learning to occur more efficiently.

l7 Hollingshead (l949) reports that adolescents in Elmtown learn to use tabooed substances (alcohol and tobacco) in the clique environment. If one's clique smokes and drinks, one learns to smoke and drink. Although some of Elmtown's adolescents had been allowed to drink with their families, they usually had their first drinks away from home with best friends. Clique drinking among boys continued throughout high school. Among girls, the clique appears to have had less influence; a girl smoked on a date only if her boyfriend smoked. This suggests that females learn to use drugs from male peers rather than from female peers, a theory borne out by studies of marijuana use (Schaps and Sanders, l970) and heroin use (Rosenbaum, unpublished; see also Becker, l974). Kandel's (l974) analysis of drug use among secondary school stu- dents in New York state provides further evidence of the role of friends in introducing adolescents to drug use. She found that the overall in- fluence of parental drug use on adolescent illegal drug use is small, although marijuana use is correlated with maternal drug use and with maternal and paternal alcohol use. Best friend's self-reported use is more highly correlated with adolescent marijuana use. The effect of peers is thus far larger than the effect of parents. In fact, Kandel's data suggest that marijuana use, rather than any school, religious, or recreational activity, is the single most important activity or charac- teristic that friends have in common, other than such demographic char- acteristics as sex, age, and race. Drug users are also more likely than nonusers to say that they learned most of what they know about drugs from their peers rather than from parents, teachers, or the media. Interviews with heroin users (Powell, l973 and Brown et al., l97l) also indicate that friends and environments influence whether a person uses heroin. The ritual of use helps maintain one's identity as part of a particular group. A number of studies in the United States (McArthur et al., l958; Salber et al., l963; Blum et al., l969) have reported tobacco use as a peer group phenomenon. These studies also show that parents' and sib- lings' smoking increases the likelihood of smoking and thus support the conclusion that people learn to smoke through exposure to smokers. Media Influences People also learn to use substances through exposure to mass media advertising or portrayals of substance users. Although a positive con- nection between media messages and illegal drug use has not been demon- strated, it has been established that commercials promoting over-the- counter drugs (Kramer, l973) do increase sales. The effects of other media inputs are less clear, but Winick (l973) has suggested that images of drug users in popular films or television programs may influence attitudes toward drug use. Similarly, Schwartz, et al., (l973) and Kramer (l97l) suggest that popular song lyrics, countercultural magazines that disseminate information about drugs, and other material aspects of the drug culture (T-shirts, head shops, etc.) advertise and promote drugs, with adolescents as their target group. This widens the informal

l8 drug information network, telling people how to use drugs and what drug effects will be. The media carry negative as well as positive messages with regard to drug use. In addition to antidrug advertising campaigns, many tele- vision programs portray drug users in an unfavorable light. We do not know whether these messages reduce drug use or, on the contrary, glam- orize and call attention to it. It is particularly difficult to measure media effects with regard to illicit drug use. Although some research shows that antismoking publicity has helped to reduce the number of smokers (Warner, l977), teenage smoking has increased, and other studies find that media messages only strengthen existing tendencies (O'Keefe, l97l). Many researchers have concluded that the complexities of the issues involved have prevented the accurate gauging of media impact and doubt that adequate data can ever be obtained (Liebert and Schwartzberg, l977). Learning to use substances, then, and learning the rules that accompany proper use is a process that involves input from familiar, respected, or pervasive sources. These sources—whether parents teaching children to eat eggs for breakfast, teenagers teaching their best friends to roll marijuana cigarettes, or television commercial encouraging beer drinking—transmit knowledge about what is desirable to use, the way sub- stances should be used, appropriate settings for use, and benefits of use. Conflicting Messages Learning to use substances becomes more complicated in complex, heterogenous societies that offer conflicting messages about appropriate cultural recipes. Most modern industrial societies "cannot be expected to transmit coherent and mutually reinforcing standards for conduct" (Gagnon, l977, p. 229). As people move from one social context to another (school, work, leisure), the environment suggests alternative codes of conduct. Even official institutions compete with each other in teaching conflicting substance use practices. While the medical industry encourages people to give up cigarettes, the tobacco industry tries to increase demand. Conflicting messages related to appropriate substance use recipes are even more apparent in the case of illicit substances used by drug subcultures. The conflict between official control systems and people's micro- environments is especially clear when we consider the way large-scale institutions shape microenvironments. The substance use practices people learn from drug subcultures are to some extent a function of the existing control apparatus. For example, the heroin subculture in the United States and the very character of the heroin experience arise from the illegality of the drug, which in turn influences its cost, the "hustle" necessary to obtain the drug, and other features of heroin addiction.

l9 SUMPTUARY RULES Sumptuary rules specify who is eligible to use what substances with respect to such matters as age, sex, ethnicity, or socioeconomic status. (We do not always find direct statements of rules prohibiting substance use by people of particular status and have sometimes made the argument indirectly, from evidence of nonrandom distributions of use.) There are other bases for eligibility as well—festive drinking in Tahiti and Bora Bora was traditionally confined to married adults (Lemert, l964). Occu- pational status may also determine who is eligible to use substances; Carroll (l977) reports that, in Bolivia, coca is distributed to relay messengers, soldiers, and court orators as an energizer, to facilitate performance of their duties. Eligibility requirements based on broad social categories such as age, sex, and class are often combined or overlapping. For example, adult and adolescent males but not young boys are allowed to drink in Samoa (Lemert, l964), and sex-specific rules for drinking behavior vary by social class in the United States (Cahalan et al., l969). Eligibility requirements are also coupled with rules regarding appropriate occasions for use. Britons, particuarly in the North, feel strongly that women should not enter public houses unless there is a special room set apart for them (Rowntree and Lavers, l95l). Similarly, women in the United States are more likely than men to drink at home and on weekends or holidays, rather than away from home and during the week (Maxwell, l952). Hollingshead (l949) reports that the girls of Elmtown snubbed and gossiped about other girls who smoked "on the street", while boys were not subject to the same standards. Since the feminist movement in the United States, these sex-specific rules are likely to have changed. Age Age is frequently a requirement for substance use. Adults allow children to use substances only for limited purposes: to prevent or treat illness, rarely to facilitate work or get high. The food habits of a culture, on the other hand, are quickly transmitted to very young children. The use of many substances is frequently put off until adolescence or later, even if the child observes it from infancy. In the United States, tobacco smoking incidence figures rise steadily across the l3-l8- year age range (Williams, l97l). Similarly, children seldom drink coffee or alcohol, although they may repeatedly witness their parents using them. These and other unpalatable substances, for reasons that are unclear, become acceptable gradually as the child approaches adulthood. Rozin (l975) suggests that the initial negative response to the sub- stances is overcome by the desire to attain adult status by eating and drinking what adults eat and drink. It may also be that children simply are not expected to need to achieve the purposes usually associated with these substances. In addition to substances visible in the home in childhood, ado- lescents use other substances to which they are introduced by peers,

20 particularly illicit drugs. Studies of heroin addicts in the United States have found the age range at first use to be from early to late adolescence: l4 according to Proctor (l97l), l7 according to Brotman and Freedman (l968), and l8-20 according to Newmeyer (l973). Some substances, used for the first time in adolescence, are rarely used by middle-aged or older adults. Calhoun (l975) found that the col- lege students in his study of six United States suburbs used marijuana and hallucinogens much more frequently than did the adults. Heroin use in the United States is also most common among young adults and decreases in incidence with the onset of middle age. In general, it appears that illicit substances in the United States are most likely to reflect this age distribution. While in one sense no one is eligible to use illicit substances, children and the elderly are less likely to participate in those social groups that allow their use (e.g., Winick, l972). Sumptuary rules sometimes identify kinds of substance use specif- ically appropriate for the elderly. Clinard (l962) reports that while drunkenness is not permitted in British pubs, "old-timers" are given more freedom in this respect than are others. Sex Sex-specific prohibitions and taboos regarding substance use occur frequently. The Tiv of Nigeria forbid women to eat pork (Mead, l955). In some Latin American communities, men resist enriched corn or manioc meal because they believe it will cause impotence (Read, l966). There may be sex-specific rules for use even when both men and women are eli- gible to use; in the United States, boys learn to drink like a man while girls learn to eat like a lady. The literature provides numerous illustrations of drugs used ex- clusively by men. In Samoa (Lemert, l964), most men begin to drink before the age of l5, but no drinking is observed among women. Simi- larly, Weil (l977) found that among the Cubeo Indians of the Amazon basin women prepare coca leaves for men, who use coca every day from adoles- cence to old age, but women and children never use it themselves. While there are few indications of drugs used by women and for- bidden to men, there are some substances used predominantly by women but not prohibited to either sex (for example, Valium in the United States). Sex-specific rules are often associated with the reproductive cycle. The Zulu, for example, forbid milk to pregnant, lactating, or menstruating women (Lee, l957). In the United States, pregnant women are encouraged to eat nutritious foods and to avoid such drugs as alcohol and tobacco. Class The use of many substances is associated with a particular socio- economic class. The Zapotec Indians of Mexico allow only members of the upper classes and priests to drink (Price, l975). In India, the upper and middle strata of society drink moderately, while custom encourages

21 the heavy use of fermented liquors among the lower castes (Chopra et al., l942). The Jamaican lower classes smoke ganja more than the middle classes (Rubin and Comitas, l976). Those who aspire to upward social mobility use ganja less, to avoid the stigma attached to ganja users by "respect- able' community members. In the United States, class is associated with differential pat- terns of drinking. Inhabitants of Vansburg, Michigan (Stone, l962) per- ceived the difference between standing drinkers and sitting drinkers as a characteristic class difference. The middle classes evaluated drinking accompanied by spontaneous affective behavior negatively, while certain taverns associated with the working class represented expressive drink- ing, where people are allowed to get drunk and disorderly. SANCTIONS Societies enforce sumptuary rules and other guidelines for sub- stance use behavior by using positive and negative sanctions to reward those who use in a way appropriate to their social position, at the right times and in the right amounts, and to punish those who diverge from com- monly held notions of appropriate substance use. The state and other official bodies typically use formal sanctions, while informal groups rely on such informal means of approval and disapproval as the awarding or withholding of prestige, rank, acceptance, admiration, disrespect, ostracism, or ridicule. Formal sanctions vary among societies depending on the sanctions available to the ruling body. The United States government rarely uses formal sanctions to reward approved behaviors; it does use such punish- ments as fines, prison sentences, or official warnings for illicit drug use or improper use of legal drugs. Informal sanctions tend to parallel formal sanctions. For example, the American community as a whole, fol- lowing the lead of the law, tends to disapprove the use of heroin, the use of tobacco by minors, and the public display of drunkenness, regard- ing people who do these things as immoral as well as unwise. Conversely, controlled drinking and the nonuse of illicit drugs is generally ap- proved. However, within the United States, the potential formal sanc- tions of society at large and subcultural values and sanctions regarding substance use sometimes clash. A heroin user, for example, may gain prestige among his or her peers and enjoy being part of the "chemical elite" (Proctor, l97l), despite the threats of punishment from law enforcement agencies. Who Sanctions? Clearly, the sources of formal sanctions are a society's policy makers and enforcers. Informal sanctions have multiple sources, which are similar to the sources who teach people the rules for appropriate use. Children are subject to informal sanctions from parents, other authority figures, and peers, while adults are sanctioned primarily by

22 their peers. In groups that deviate from the standards of the dominant culture, positive sanctions from peers and the rewards and benefits attributable to the substance used seem to offset the negative sanctions threatened by official institutions. What is Sanctioned? Many aspects of substance use are subject to sanctions. The quan- tity used, the way one behaves while under the influence as well as the circumstances under which substances are used are all culturally pre- scribed and reinforced by sanctions. Those who use the prescribed amount of a substance (which, at the extreme, may be none at all) in prescribed ways will be approved and accepted by their peers, while those who use too much or too little of a substance in an improper manner with improper outcomes will be disapproved by their peers and may be subject to formal punishments. Informal negative sanctions are sometimes applied to people who fail to use enough of a prescribed substance. Field (l955) reports that drinking is a sign of manliness among Soviet manual workers, and those who do not join in are accused of being "weak sisters." Controlled Use or Abstinence Groups that value controlled use or abstinence reward that behavior and show disapproval of those who use substances to excess. The Chinese traditionally view heavy drinking as a disgrace; when they become drunk, they try to "awaken" themselves by drinking hot tea (Moore, l948). Simi- larly, during Prohibition in the United States, public attitudes often associated sobriety with virtue and the use of alcohol with vice. Those who disapproved drinking believed that no one would be able to control use successfully, hence total abstinence was the only reasonable goal (Zinberg, l978). Behavior Under the Influence People often evaluate and sanction the effects of substance use as well as use itself, for example, drunken behavior under the influence of alcohol. While drunkenness is shameful in some cultures, many other societies reward drunken behavior. Drunken men were usually treated with care and affection in l8th century Ireland (Bales, l949). Similarly, in the Guatemalan village of Chamula, drinking is a necessary part of every social contact, and people assume a protective and conciliatory attitude toward a drunken man (Bunzel, l940). Other societies in which no stigma is attached to the drunkenness of eligible users include the Samoans (Lemert, l964), the Tarahumara of Mexico, and the Camba of Bolivia (MacAndrew and Edgerton, l969). In many of these societies, drunkenness is a matter of pride and is positively reinforced so long as it is limited to prescribed behaviors. The Mohave of Southern California and

23 Arizona (Price, l975) do not appreciably change their behavior when intoxicated, continuing to behave in a quiet and reasonable manner. In contrast, drunkenness sometimes provides an opportunity for people to engage in otherwise forbidden activities. In Oaxacan villages, drunks have great social license—to shout insults, intrude uninvited into social gatherings, and behave in other usually unacceptable ways (Dennis, l975). Among the Tarahumara, drunkenness allows people to engage in violence or extramarital sexual activity without sanction (MacAndrew and Edgerton, l969). Acceptable drunken comportment may also vary within a society, depending on the social context. In the traditional wine ceremony of the Papago Indians, people sing and are peaceful, but secular drinking is accompanied by aggressiveness (Price, l975). Similarly, among the Kuma of New Guinea the use of a wild mushroom eaten all year long produces "mushroom madness" only during certain seasons. Madness is a periodic expression of behavior usually disapproved, but there continue to be socially defined limits to behavior. Open aggression toward kinsmen is strongly disapproved even during mushroom madness (de Rios, l973). EXPEDIENCE The routines of life make some ways of using substances less troublesome than others, because doing things that way fits in best with what others are doing. People find it expedient to use substances in some ways and inconvenient to diverge from conventional patterns. Ease or convenience, then, reinforces learned patterns of substance use and is a potent form of social control in its own right. Substance use prac- tices that allow people to achieve desired states in the least trouble- some ways vary by substance, setting, purpose of use, and by such user characteristics as sex, age, and class. It may be expedient to use some, none, or a large amount of a substance, depending on the substance, cir- cumstances and conditions of use, and characteristics of the user. Convenient Amounts People usually find it expedient to use substances in conventional amounts. Food, tobacco, and alcohol packaging all suggest how much is enough and how much is too much for use. Food portions served by res- taurants determine a convenient amount to be eaten at a meal (Stunkard and Kaplan, l977; Coll, et al., l978). Similar packaging exists for illicit substances: a coke spoon holds 5-l0 milligrams of cocaine (Siegel, l977); cigarette rolling papers hold limited amounts of marijuana. However, one can frequently, and not necessarily inconveniently, buy and use more than one unit of a packaged substance. One can easily smoke and drink almost indefinitely despite the size of the cigarette or the drinking glass. Packaging may be most important in setting lower limits for how much is consumed—for example, it would be wasteful and inconvenient to drink half a bottle of beer.

24 Conditions other than packaging set upper limits on how much of a substance one can conveniently use. For example, the emphasis on thin- ness in societies like our own makes it expedient to use limited amounts of food, since the obese person suffers many inconveniences: seats in airplanes, buses, and theaters are often too narrow; clothing comes in limited sizes; wedding dresses are not made beyond size l0; and only a limited selection of styles are available for fat men and women (Strauss, l966). Occasions for Use When Others Use People find it expedient to use substances when other people do, on occasions designed as appropriate for substance use. At cocktail parties, it is so expedient to drink that people who do not drink may hold a glass throughout the cocktail party in order to fit in. It is similarly expedient to drink during community rituals in a variety of cultures. In some Latin American societies every public event or cere- money is marked by drinking. People often find it convenient to use substances at particular times of day; most people, for instance, eat certain meals at certain times. Lewin (l943) reports that in the United States, people eat according to the clock: a person waking at noon to go to work will eat foods appropriate for lunch, not breakfast. It would be inconvenient to eat cereal for dinner, particularly if one eats with others. Restaurants usually do not even use the same menu at all times of the day. As a Sign of Respect or Politeness In many societies, one can insult people by refusing food or drink. Among the Aymara, community leaders greeting community members are expected to invite them to partake of both coca and alcohol, and the offer should not be refused. Tribal outcasts are those who refuse to accept the love of their hosts by refusing to imbibe (Carter, l977). Goldblatt et al. (l965) describe the eating habits of lower-class Czechs, noting that there is a great deal of Sunday visiting during which people eat large quantities of food. Refusing second and third helpings at meals is considered impolite. To Facilitate Another Activity Substance effects make it expedient to use substances at times when they facilitate planned activities, and to abstain when substance effects interfere with them. For example, United States drivers find it expedi- ent to use coffee as a stimulant for long distance driving, but not before going to sleep. Damon (l973) found that the Bushmen of Botswana smoked tobacco in a rapid succession of deep inhalations to facilitate

25 the trance state achieved during the medicine dance, their central ritual event. Many substances interfere with activities in which people must engage and are therefore inconvenient to use at certain times. Harding and Zinberg (l977) report that the marijuana users they studied agreed that they should not be high at work or at school. In the Peruvian com- munity of Lunahuana (Simmons, l962), drinking may occur on any occasion, at any time of the day, anywhere, except in church where drinking would interfere with the required sobriety. Speed of Use The speed or pace of substance use is often influenced by expedi- ence. In England and Ireland, friends meet at public taverns and buy rounds for one another. Each person adapts his drinking pace to the group and never sits without a drink, so that each can buy a round in turn (Stivers, l976; Bales, l949; Clinard, l962). In this situation it would be inexpedient to drink more quickly than the others because one would then be left without a drink. A slow drinking pace would be equally inconvenient. Eating speed may also be influenced by expedience. For example, people are likely to eat more quickly in fast food restaurants set up for quick meals, than in other kinds of restaurants (Stunkard and Mazer, l978). Availability and Expedience Substances are usually more available to people who are eligible to use them. Availability also influences the differential convenience of using legal versus illicit substances. In the United States, where alco- hol is almost universally available, the majority of the drinking age population are considered light to heavy drinkers (U.S. Department of Health, Education, and Welfare, l974). Illicit substances, relatively less convenient to obtain and use, are used to a lesser extent (e.g. Calhoun, l975). Robins's (l973) study of 470 soldiers who returned from Vietnam demonstrates that when substances were accessible and cheap, they were used relatively often. Most of the respondents reported that mari- juana was always available in Vietnam and that at least half the men in their units used it regularly. Almost all the men were personally offered narcotics and 43 percent reported that they had tried narcotics in Vietnam. After Vietnam, narcotics use declined, the two most impor- tant deterrents being risk of arrest and expense, both factors making use less expedient than it had been. CONCLUSIONS AND IMPLICATIONS Our review of the ways in which informal social controls affect substance use in a variety of settings suggests a number of conclusions

26 and implications for public policy. We have also identified questions not yet adequately addressed by the research literature. Research Needs Purpose of Use The purposes for which people use substances appear to be a major explanatory variable when we look at different substance use patterns across and within cultures. Although some evidence suggests that these purposes of use are related to sociocultural factors, we need more com- parative research on the role of cultural recipes in influencing individ- ual reactions to substances. Further research is also needed to explore the extent to which conventions and recipes associated with substance use are practical means of achieving desired results. Similarly, to what extent are cultural recipes adaptive actions that benefit the users? To what extent can the origins of substance use patterns be traced to some sort of community wisdom regarding the effects of using a particular sub- stance in a particular manner? Learning to Use Within Multiple Environments Individuals often learn to use substances within the context of a microenvironment that diverges from macroenvironmental values and prac- tices related to substance use. What characteristics of microenviron- ments can make them more effective in transmitting cultural recipes? To what extent, and under what circumstances do microenvironments reflect the values of macroenvironments? Differential Use Along the Life Cycle Substance use practices vary in any society depending on user char- acteristics such as age and sex. For example, in the United States, most heroin users are young adults or adolescents, rarely middle aged or el- derly; and women in many societies appear to be relatively immune to the use of particular substances. What mechanisms explain these differential patterns of use and how do these patterns vary across substances? To what extent are the purposes of use related to these patterns, for example, are the young expected to achieve purposes different from those desired by adults? What unique characteristics of adolescents, the el- derly, women, and other population groups make them more or less likely to become involved with certain substances? Expedience It seems likely that expedience is one of the most potent informal social controls, yet we know little about it. How do cultural recipes

27 and sumptuary rules become translated into social arrangements that make it expedient to adhere to these rules? In what situations does expedi- ence cease to operate as an important control? (For example, people use heroin even when it is exceedingly troublesome to do so.) Disapproved vs. Approved Substances We know more about the role of both formal and informal controls in the case of the use of disapproved substances than in the case of ap- proved substances. Research is focused on matters that are considered problems rather than on matters that seem to be working well and causing no difficulty. Thus, we know more about controls on drugs and alcohol than about controls on food and cigarettes. We need to know a great deal more about the way people acquire eating preferences —schedules and habits, for instance—for these data would tell us what kinds of patterns might develop if we deregulated substances now affected by formal legis- lative controls. Policy Issues Formal and Informal Controls In deciding whether formal controls are necessary and which formal controls to implement, policy makers might consider the advantages, dis- advantages, and likely consequences of both formal and informal mechan- isms in regulating any substance. The materials presented in this paper suggest that informal controls usually operate as traditions, developed over a long period of time in a relatively stable social milieu. These controls break down or come to be thought of as no longer legitimate in situations of rapid social change, in which such phenomena as ubraniza- tion, the influx of ethnic minorities, or invasion by ethnic conquerors have occurred. This suggests that formal social controls are seldom seen by those to whom they are applied simply as measures designed to deal with a restricted problem of substance use, but rather, in those larger contexts, as part of a package of repressive measures. Informal social controls usually embody the view of the immediate consumers of substances. Conversely, formal controls embody the views of those responsible for maintaining an image of the society as doing well and in good shape and who have to answer in some venue for the results of their policies. Informal social controls arise and are maintained through constant adaptation as they are applied, while formal controls, once enacted, remain fixed, with occasional formal revisions. Informal controls are thus more flexible. There is no simple relationship between the operation of formal or informal controls, on one hand, and resulting morbidity and pathology, on the other. It seems likely that accurate information about how to achieve the most desirable substance effects and to avoid the most harm- ful ones would probably be more advantageous to the user than inaccurate information. But there is no guarantee that formal controls will either

28 be based on or promulgate accurate information (Becker, l974). Empirical investigation in each case of substance use must determine whether the people who create and enforce informal controls are more knowledgeable about substance effects, benefits, and hazards than those who enforce and create formal controls. Policies That Rely On Informal Mechanisms When we speak of policy implications we are talking about formal social controls, for we can hardly have a policy about informal con- trols. We cannot legislate such matters as what young people will tell each other confidentially about their experiences with a particular sub- stance. We can legislate what kinds of substances will be legally avail- able, in what form, in what quantities, subject to what taxes, with what penalties for violation of the applicable regulations, etc. We can have a policy about informal controls only in two senses: we can leave the regulation of substance use to informal controls, and we can take actions that will have a second-order effect on substance use. That is, we may discourage substance use by making rules that make it inconvenient to use th.e substance in certain ways. For example, we might forbid the sale of soft drinks in school cafeterias or forbid the provision of ashtrays in various places. The laws regulating the hours during which alcohol may be purchased are designed to have this effect. Similarly, while we can- not make a policy about what people tell each other about their drug experiences, we can make information available that could be passed on through those same channels. Presumably drug education works best when it operates through informal channels. The characteristics of informal and formal controls lead us to sug- gest increased deregulation of illicit substances. There has been little reliance on informal control mechanisms in the past, yet these may be effective policy alternatives for controlling substance use and addiction. REFERENCES Aronson, Naomi (l978) Fuel for the Human Machine: The Industrializa- tion of Eating in America. Unpublished dissertation, Brandeis University. Aberle, David (l966) The Peyote Religion Among the Navajo. Viking Publications in Anthropology Number 42. New York: Wenner- Gren Foundation for Anthropological Research, Inc. Agar, Michael (l977) Cultural differences in rates of alcoholism. Quarterly Journal of Studies on Alcohol 6:480-99. Becker, Howard S. (l963) Outsiders: Studies in Sociology of Deviance New York: Free Press.

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COMMENTS ON "INFORMAL SOCIAL CONTROLS" John Kitsuse While the paper, "Informal Social Controls and their Influence on Substance Use" assumes that individual differences exist with regard to susceptibility to substances and that substances do have significant pharmacological effects on individuals, its focus is on the role of sociocultural factors as influencing or controlling substance use. The question is asked: How do people learn to control their use of sub- stances? The authors state that no one ingests as much tobacco as is physiologically possible. What stops them? The sociological answer is that group norms set limits beyond which a reasonable group member would not go. The paper goes on to document the ways in which informal social controls, stemming from group membership, do in fact stop people from overuse. The issue with which the paper does not deal is the problem of substance abuse. People do ingest as much of some substances as is physiologically possible. How do social controls fail to stop them? The authors suggest that abuse occurs when cultural recipes break down, but they do not discuss the extent to which individuals learn substance abuse in the same manner as they learn substance use. While it is stated that group norms bring people to appropriate limits of use, telling us what is optimal and what is too much, it is not clear why people engage in substance abuse, having learned how much is too much. Perhaps Sutherland's theory of differential association is appli- cable to this question. This theory suggests that criminal behavior is learned, just like any other kind of behavior. Whether an individual learns criminal behavior depends on who his or her associates are. Further investigation in this direction might provide useful in an attempt to investigate how people learn substance abuse. Additionally, a systematic search of the literature is desirable to provide a better understanding of how cultural recipes break down and what the outcomes are. In light of the paper's emphasis on controlled use rather than abuse, the stated policy implications are questionable. While it is demonstrated that informal social controls are effective for moderate users, there is no evidence of their effectiveness for those who have learned substance abuse. Thus the policy directive to rely upon informal mechanisms may be less advisable than the authors suggest. 36

SUBSTANCE USE: CONTEXT, MEANING, AND INFORMAL CONTROL James P. Spradley The control of substance use is a cultural universal. Every society surrounds the use of substances with rituals, myths, meanings, taboos, and cultural rules. These act as a complex system of regula- tion that controls what is ingested, how it is ingested, why it is in- gested, and how little or how much is ingested. In their paper, "Informal Social Controls and Their Influence on Substance Use," Maloff, Becker, Fonaroff, and Rodin document this unversal fact of sub- stance control. With a systematic review of the crosscultural litera- ture, they show the vast range of meanings that become attached to sub- stances and their use. One cannot finish reading this paper without a new appreciation for the fact that tasting, smelling, snorting, inject- ing, eating, drinking, inhaling, smoking, and absorbing are not simply physiological acts. All have meanings beyond the action itself. It is as if the human animal could not engage in these activities without first creating elaborate rituals to make them appropriate and mean- ingful. In responding to this paper I want to focus on what I believe is the single most important contribution: what I call the contextuali- zation of substance use. The authors did not succumb to the usual scientific practice of merely isolating variables. Rather, they contextualized substance use and the informal controls of that use. They continually assert and then demonstrate by marshaling the evidence that in order to understand substance use we must focus on patterns of usage, the web of meanings, the interrelationships among variables. From my perspective as an anthropologist, this contextualizing approach appears to yield the greatest dividends. Human acts must be seen as part of a larger social and cultural system. Isolating vari- ables like age, race, frequency of use, and chemical composition of a substance may not be a shortcut to explaining use. Indeed, this more accepted strategy for determining causal relationships frequently over- simplifies and distorts the human situation. If there is a central theme in the paper, it is that the use of any substance is part of a pattern. Use is related to cultural recipes, group membership, learn- ing processes, eligibility requirements, social sanctions, and the very expedience that results from the dynamic pattern of use. However, one of the barriers to contextualizing substance use, to seeing it within a pattern of wider meanings, is the fact that language 37

38 imposes on us a linear arrangement of ideas. Like all discursive writ- ing, the Maloff et al. paper appears to present a sequence of discrete ideas and variables. We are led by means of the tacit syntactical structure of language to accept a false assumption (without realizing it): that the cultural recipes, sumptuary laws, learning processes, social sanctions, and expedience are distinct, separate entities. Although the authors repeatedly link these together, the linear arrangement of ideas forces them apart. Although the authors contextu- alize all these aspects of substance use and control, there is a strong tendency to decontextualize them when we read. In order to partially overcome this tendency and in order to heighten the contextualizing of substance use, I want to present a nonlinear model that represents the central features of the informal control system they have presented (Figure l). My aim in presenting this model is to call attention to the relationships among the ideas and then to see if this perspective can generate some fruitful insights into the informal control of sub- stance use and policy issues. At the center of this model is the individual substance user. He or she regularly smokes a cigarette, puts salt on cantaloupe, or takes Vitamin E and B^. Our goal is to explain why such people use sub- stances at all, to see how informal controls regulate their use. What keeps such a person from smoking l0 packages of cigarettes each day, emptying the salt shaker on the cantaloupe, or devouring the entire bottle of vitamins? Certainly some of the control factors lie within the individual's psychobiological makeup. But this alone does not account for substance use. The hexagon represents the cultural recipes a person acquires, largely through membership in various social groups. I have included sumptuary laws and learning as part of those recipes since they are governed by cultural rules. The dotted lines of influence from the hexagon to the individual reflect the fact that the analytic categories are permeable, each interpenetrating the others. One of the major reasons that people vary in their substance-using patterns is that the hexagon (its content) varies greatly from one society to another and from one social group to another. In their paper, Maloff et al. have thoroughly documented how this aspect of the informal control system can vary from one place to another. The circle surrounding the hexagon represents the social group to which one belongs. The day-by-day regulation of substance use occurs in some culturally constituted social group. The group exerts social control by means of social sanctions represented by the tiny circles with two arrows. Someone says, "You're putting too much salt on your cantaloupe," or "Here, take your vitamins, they're good for your heart." These social sanctions help to control or regulate, in an informal way, the actual use of substances. Indeed, as a person changes social groups, the use of substances changes. Everything within this circle describes the microenvironment in which people carry out their daily lives; this microenvironment has a profound influence on the pattern and meaning of substance use. But if we focus on this microenvironment exclusively, we will end up blaming the user, even blaming the victim, if his or her use has negative

Liquor Industry Pharmaceu- tical Ind- us tr Food Industry Tobacco Industry Media MACRO-ENVISONMENT Medical Industry Congress State Governments Figure l. INFORMAL SOCIOCULTORAL CONTROL SYSTEM FOR SUBSTANCE USE D The cultural recipies, including • learning to use substances and sumptuary laws and customs. • Institutions of the larger socio cultural system. «->s P **. Social group to C 0- which a person \ J belongs (one's Ox,--" reference group) Informal social sanctions (positive and negative) used by social groups. .» indicates direction of -» informal control 39

40 consequences. For all that occurs within the microenvironment is strongly influenced by pervasive informal controls in the macroenviron- ment, the larger institutions of society. The last circle that connects these institutions and shows heavy arrows impinging on the social group is this macroenvironment. Let us take one small example as to how this enters into the informal control system of substance use. The National Institute on Drug Abuse (NIDA) is an institution in the larger society that funds research on sub- stances. Their policies are set by administrators in Washington and funds are disbursed through a complex review system for research on substances and their use. Some projects are funded, others are not funded. In other words, a selection occurs, one that has profound affects on individuals. How does this operate in the informal control system? One of the major institutions in the macroenvironment that pro- motes the use of substances is the pharmaceutical industry. A major element in this industry is a social group, spread among many compa- nies, known as detail men. These men travel from one pharmacy to another, from one physician to another, marketing the wares (the sub- stances) of the pharmaceutical industry. Now, to my knowledge, NIDA has never funded research on this group, has never requested research proposals for understanding this group, and has never seriously con- sidered such investigations. Yet, this group, the detail men, are the legitimate, socially approved, and highly paid pushers of substances (drugs). They perform many functions, including encouraging physicians to prescribe certain substances, informing physicians of their value, and helping to create a demand for them. Let us move briefly into the center of the social control model. A woman opens up the medicine cabinet to take her usual dose of Valium. She does this because her physician has suggested it will help alleviate her symptoms. He has prescribed this substance in part because a detail man took him to dinner, gave him large samples, and informed him of the value of Valium. The detail man continues doing this, in part, because NIDA has never examined the social and cultural processes involved in the culture of detail men, to see how they func- tion in the larger informal control system. Thus, the detail men, the pharmaceutical industry, and the National Institute on Drug Abuse are all involved in the informal control system of substance use. Further- more, NIDA uses its resources to study things other than government subsidies of tobacco farmers, the decision-making processes in the food industry, and hundreds of other aspects of the macroenvironment. Such choices of research support are made on the basis of policies and with good reasons—still, they have implications for social control. It is important to keep in mind that substance use always occurs within a context. It seems to me that looking from this overall con- textualizing perspective, several implications emerge, most of which were stated in the Maloff et al. paper: l. Expedience is an inherent characteristic of control struc- tures. It is not merely another element in the structure of control so much as a characteristic of that structure. If control is seen as a single variable or several related variables, expedience is hard to

4l grasp. If it is seen as a part of the pattern, a part of the struc- ture, all the empty spaces represent expedience. The structure has a certain rigidity about it that makes it easier to go along with the structure. To change is to begin reversing some of the arrows and lines of influence. 2. Informal control takes at least two forms: personal and impersonal. The hexagon represents internalized values that act as a personalized form of social control. The circle represents informal controls that also come from persons—the social group. But when we move to the macroenvironment we find that although control is informal (i.e., not backed by police or legal force), it is no longer personal. We might find a chain of actions through people (detail man-physician- Valium user), but the institution works to control in a largely imper- sonal manner. Much more research is needed on this impersonal, in- formal control process. We can also see that formal controls operate at several levels in the model: on the user, on the groups in which a user lives, and on the institutions of the macroenvironment. In general, our society has used the formal controls largely on the individual rather than on the other areas represented by the model. 3. The breakdown of cultural recipes must be distinguished fron changes in social groups. Thus, a person may change his or her pattern of substance use because the cultural recipes have broken down; on the other hand, that person may simply change social groups. This means exposure to new social sanctions that influence substance use. 4. We need to examine changes in individual substance use pat- terns. Often they may occur because someone moves from one group to another. In Figure 2 I have enlarged this model to show how it may look in complex, heterogeneous societies. We can see that different patterns of use are represented by the four individuals, but each is living within a different informal control system. Changes in use result from moving from one control system to another. When one moves out of the family and its control to the peer group, a change may occur. Both may be influenced (differently) by the same macroenviron- ment, but the overall pattern of social control will be different. 5. The microenvironments represented in Figure 2 are not merely control systems that increase use; they also inhibit use. It is easy to think of each environment represented (M-l, M-2, M-3, M-4) as groups of drinkers, heroin users, etc. But, they may just as well be a branch of Alcoholics Anonymous, TOPS (a weight loss group), or a local church that operates as a control system. In a sense, an Alcoholics Anonymous group and a bottle gang on skid row have the same function: each can become a circle around a hexagon within which an individual either uses or does not use. In either case, these patterns operate to control, informally, the use of a substance. In conclusion, let me repeat that this model is only another way to represent what Maloff et al. have so well presented in their paper. I have tried to mine the detailed review of data and the theoretical insights presented to see if there were any additional insights that might be generated by looking at the overall pattern. Substance use is

H S3 1 CO § M i «0 J CSI t en 42

43 not an isolated phenomenon. It always occurs as part of a larger pattern. Contextualizing substance use is a major task, one that Maloff et al. have done in an excellent manner.

INFORMAL SOCIAL CONTROLS: GENERAL CONFERENCE DISCUSSION Richard L. Solomon The general discussion following the presentation of the paper on informal social controls began with a spirited analysis of the meaning of the term substance abuse. It appears to be a term that can be defined within a cultural framework, mirroring the expectations and demands of cultural groups. It can be defined within an economic framework, mirroring the sets of exchange values set by a given economic setup. It can be defined by a normative framework, mirroring the distribution of amounts of use per day in a given population. It can be defined in a medical framework, mirroring the current state of the art and science of medicine in relation to the concept of health and amounts of use in determining levels of health. From an anthropo- logical perspective, many societies have no concept of abuse at all. Criteria employed in our society to define abuse—e.g., incapacitation as a result of use—may actually be the goal of use in other societies. Becker emphasized that it is not so important to make rigid distinc- tions between use and abuse as it is to understand how and why some people find it appropriate to use a substance all the time, while for others substance use is inappropriate, and still others find it useful to label some substance use behaviors as abuse. The discussion then shifted to a debate about the capacity of commercial data-gatherers to provide useful data on amounts of sub- stances consumed relative to the information and advertising provided and relative to changes in the sensory and perceptual attributes of the substances. Many industries provide substances to be used. Do they know, through their own research, which variables affect amounts the public use? There was a sharp difference of opinion on this matter, some conferees believing that the manufacturers and vendors know how to assess people's tastes and preferences, some believing that private industry research was too methodologically unsound to reveal much of anything. Nevertheless, many agreed that the manufacturers and vendors knew very accurately how much of their product was being purchased, information that provides good estimates of consumption and that could be valuable for analysis of substance use in the general population. In connection with the discussion of the quality and accessi- bility of private market research, the efficacy of media advertising of substances was discussed. It was argued that under some circumstances advertising could influence the amount of a substance used. Some work 44

45 suggests, however, that major effects of cigarette and alcohol adver- tisements have been in getting consumers to change brands, not to increase consumption. Some evidence suggests that American Cancer Society advertising on television succeeded in lowering cigarette consumption; hence the cigarette companies were less hesitant to resist the ban on TV cigarette ads, which had the effect of forcing anti- cigarette ads off the air as well. Advertising may not be as important in encouraging substance use as some may think, compared with other factors such as peer pressure. For example, there has been a large drop in the number of middle-aged, male smokers but a large increase in young, female smokers. Advertising is hard to relate to such contrary trends. Smoking is a good example of a behavior that has undergone dramatic and sudden shifts that we find difficult to understand or anticipate. Changes in public attitudes and in formal and informal restrictions regarding smoking have occurred over a relatively short period of time, while the dangers of smoking have been apparent for a longer period of time. Zinberg interrupted the discussion at this point to caution that the group was dealing with an enormously complicated subject and that cigarette smoking is one of the most complex substance use behaviors to analyze in terms of informal social controls. While most substances are limited to appropriate times and places for consumption (in the United States), most people have been able to smoke at any time and in almost any place. Many drugs are much more controllable than tobacco. To use psychedelics, for example, an individual would need several hours without any other planned activities. In contrast, there have been few social sanctions and rituals that control smoking behavior. Solomon pointed out that there are limitations to substance use quite independent of time and place. For example, preference-aversion curves do exist for human salt and sugar users as a function of the concentration of substance per volume of solute or mixture. The relationship between informal social controls and public policy provoked some lively discussion. Many felt that the paper was inappropriately modest in stating that we cannot make policies affect- ing informal social controls. Bunce provided some examples of in- stances in which regulatory agencies have tried to harness informal mechanisms in controlling substance use: in California, the host- responsibility law holds a host of a private party liable for guests' subsequent behaviors caused by substances consumed at the party. Another California law prevents alcohol manufacturers from operating retail outlets, in order to get away from the saloon environment in which excessive drinking is encouraged. Changes in formal controls obviously influence informal controls, just as existing informal con- trols may affect the kinds of formal controls required. Possible future changes in marijuana laws including decriminalization, taxation, or the legalization of homegrown marijuana are likely to influence the kinds of informal social controls operative in marijuana use. Like- wise, informal recipes and norms for controlled marijuana use are influencing public policies related to marijuana use. Terris echoed Bunce's views that public policies could be used to strengthen informal social controls. Laws that restrict the

46 availability of a substance make it inexpedient to use at certain times or in certain places. The relationship between the macroenvironment and the microenvironment must be considered here, since the macro- environment can to a large degree shape the informal processes, rela- tionships, and controls within microenvironments. In the discussion of policy intended to control substance abuse, Spradley suggested that the focus of attention should shift from the individual user to the institutions that produce and distribute sub- stances, which are the true abusers. Remedial legislation should, for example, prohibit manufacturers from putting additives in baby food, which may promote unhealthful food preference, such as for excessive salt, and direct controls toward the quality of substances offered to the public. While policies were generally discussed in terms of governmental products, Becker suggested that it might be appropriate for groups or agencies outside government to develop control policies as well. For example, private organizations may ban smoking in meeting rooms, res- taurants may set aside tables for non-smokers, etc. Finally, Schelling stated that an important topic was missing from the paper on informal social controls: how do informal controls relate to people who use substances but wish they could quit? Informal controls are not necessarily effective in helping self-control problems. This comment suggests that there may be a need for formal policies directed toward those who want to consume less but somehow are failing to do so. The Maloff et al. paper argues convincingly that there are many types of social forces operating upon the use of any substance, some- times as deterrents to use, sometimes to clarify society's expectations for the consequences of substance use, etc. From the psychologist's vantage point, however, additional questions about the differential impact of social forces upon individuals should be raised. Why do some people meet normative expectations for substance use, while others flagrantly disregard them? Such questions involve more than cognition or knowlege of beliefs and expectations about substances. The paper emphasized learning to use substances in sociocultural settings. For the psychologist, learning is a relatively permanent change in behavior that involves motivational and emotional (i.e., irrational) as well as cognitive aspects. Thus, the psychologist sees the need to add an important piece to the account of the sociologist and anthropologist: i.e., an analysis of substance use learning in terms of settings, the response of the user, and the consequences of use in generating habit- ual behavior patterns.