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SCIENTIFIC HORIZONS2
Abstract
This paper argues that recent developments in the understanding of psychobiological states may help to explain
individual differences in susceptibility to addiction. It points out that the construct of arousal is deficient for
this purpose and that a more fruitful approach views humans as bundles of state-dependent selves, strongly
affected by self-efficacy and response expectancies. Coping skills, enhancement behaviors, and other state-regulating techniques are seen as crucial to liability to chemical dependency and the social learning underlying
their genesis is explored. Under this view drug experiences are held to be analogous to hypnotic inductions and
psychological approaches to therapy could usefully focus on helping addicts develop a metaperspective on the
succession of psychobiological states.
Introduction
The drive to alter psychobiological states has
been increasingly viewed as innate, even in nonhuman species.' Indeed, one is hard-pressed to
find adult humans who eschew all psychoactive
substances. The question, "Why do some people
become dependent on them?" has received considerable research attention, perhaps at the
expense of the question, "Why do the majority of
people who are exposed to psychoactive drugs
fail to become dependent on them?" Despite the
attempts of addicts to portray the experiences of
using heroin, cocaine, and so forth as totally
compelling, most people who try these drugs do
not become dependent. Similarly, only a small
percentage of those who try alcohol make its use
the centre of their lives. These individual differ-
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Self constructs are viewed here as state-dependent; the succession of states that characterizes
human experience means that normal individuals, despite their illusion of unity, are more
accurately modeled as bundles of selves. I will
argue that the emergence of dreaded, personally
repugnant selves may be central to the problem
of liability to chemical dependency. Under this
view, the use of a psychoactive substance becomes elevated in an individual's motivational
hierarchy to the extent that it replaces dysphoric
states and the attendant negative selves with
positive ones. I explore evidence relating to individul differences in expectancies, coping skills,
and enhancement behaviors as these bear on
susceptibility to addiction. Particular attention is
paid to the role of early social learning in the
genesis of psychobiological states. Sub-clinical
dissociation and state masking are highlighted as
mechanisms enabling individuals to lose awareness, at least in part, of e states most troubling
to them. Data on placebos and on non-chemical
addictions suggest that dmg experiences are
analogous to hypnotic inductions. Further support for this view comes from the contrasting
withdrawal experiences of medical patients and
street addicts which clearly derive fi-om the substantial phenomenologieal difference in the
opiate experiences of these two groups. Willpower, inimical to the formation of addictions, is
reconceptualized as an aspect of the ability to
take a metaperspective in regard to psychobiological states. I sketch some of the clinical and
social policy implications of this position, emphasizing the importance of altemative avenues
of reinforcement.
The phenomenological experience of these different states varies so enormously that they are
never lumped together under a single rubric. It
may be noted that in normal conversation the
word 'arousal' is rarely used without a qualifier
(e.g. sexual arousal).
This commonly held distinction is supported
by numerous studies I have cited elsewhere'"^
which show that the various states humans
experience differ physiologically as well as phenomenologically. In other words, the repeated
failure of the supposed referents of arousal to
intercorrelate reflects the reality that many quite
dissimilar states show some sort of elevated
physiological activity. The construct of arousal
divorces the elevated physiology from the psychological contexts of these states, attempting to
find commonality in the disparate physiological
activity of, for example, fear, sexuality, and grief.
This is a construct validation problem of the first
magnitude.
Although it is true that insomniacs use sedatives to sleep, and narcoleptics and long-distance
drivers use stimulant drugs to stay awake, most
psychoactive drug use cannot be explained in
terms of arousal. A simple arousal model applied
to recreation drug use poses some puzzles: Why
would people simultaneously ingest heroin and
cocaine (a 'speedball'), as do an estimated half
million Americans?' From an arousal perspective, such behaviour would seem an expensive
way of staying the same. Clearly, something is
occurring which is beyond the capacity of the
arousal model to explain. It is apparent that
individuals generally alter their states with drugs
because they expect to feel better, not to become
more or less aroused. An earlier focus on the
arousal differences between opiate and psychomotor stimulant drugs has been replaced by a
recognition of their shared action on a brain
reward system, relegating the arousal differences
to the status of 'side effects'.'" In fact, according
to Wise (1988), "Classification of drugs as stimulants or depressants can be arbitrary, because a
drug that is a stimulant at one level of analysis
can be a depressant at another"."
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nature of situations that are problematic for individuals. Yet most of us, even the highly
competent, have incompetent selves that can be
evoked under certain circumstances"I can't do
anything right". For those fortunate individuals
who characteristically experience a sense of selfefficacy, temporary lapses in confidence might be
cured by nothing more than a hot meal. Others
experience enormous difficulty in emerging from
unpleasant states, or in entering pleasant ones.
This can readily become a vicious cycle, due to
the nature of the expectancies that are developed. When (non-chemical) expectancies are
negative in all three areasoutcome, selfefficacy, and, especially, response expectancies
the desire for positive state change can easily take
on a compulsive quality, as is seen in addiction.
Outcome, self-efficacy, and response expectancies
In social learning, theory the occurrence of a
response is hypothesized to be a function of the
expectancy that the behavior will be reinforced
and of the value of the expected reinforcement."
This has come to be called an outcome expectancy, to distinguish it from two other types of
expectancies which were implicit in the original
formulation. Self-efficacy is the belief that one is
able to execute the behavior on which reinforcement is contingent;" response expectancies are
expectancies for the occurrence of nonvolitional
responses, that is, responses that are experienced
as occurring automaticallyemotions, conversion symptoms, sexual arousal, pain, and so
forth.'' As an example, an individual might
believe that writing a book would lead to getting
tenure (outcome expectancy), but would be
unlikely to act without the efficacy expectancy
("I can write a book") and the response expectancy ("Getting tenure will make me happy").
Data from three areas of investigation, placebo
effects, fear reduction, and hypnosis, indicate
that response expectancies generate corresponding subjective experiences. Frequently, the
auth-enticity of these self-reported effects is corroborated by corresponding changes in behavior
and physiological activity. For example, expectancies have been reported to produce dermatitis
and bum blisters, and to have cured warts and
ichthyosiform erythrodermia.'^ It is now widely
believed that reponse expectancies can mimic,
offset, and even reverse the effects of powerful
satisfying. People who are characteristically content tend to set minimal goal levels well below
the level to which they aspire (hope for an 'A',
settle for a 'C'), whereas alcoholics have been
shown to have minimal goal levels close to their
level of aspiration, and higher than they ought
reasonably to expect to achieve.^'' Although setting high minimal goals may function as a
short-term means of bolstering shaky selfesteem, it can be disastrous as a long-term strategy. Repeated failures to meet these goals
engender frustration and disappointment which
may then be dealt with by alcohol consumption.
Psychobiological states are a product of
myriad biological, psychological and social processes. Behaviours as prosaic as eating healthy
foods and getting sufficient rest contribute to the
maintenance of positive states in some individuals. Similarly, various lifestyle choices have
implications for the states people experience.
Engaging in certain behaviors tends to produce
states people value and sometimes describe as
'highs'. These would include vigorous exercise,
intimate conversation, yoga, meditation, massage, reading, aesthetic experiences, soaking in
hot tubs, satisfying sex, meaningful work, and
play of all sorts.
What these behaviors perhaps have in common is their affordance of an opportunity for
self-forgetfulness. As described by Csikszentimihalyi:
Self-forgetfulness does not mean losing touch
with intemal or external processes, however.
On the contrary, these may be registered more
intensely and vividly than at other times. What
is lost is not the awareness of one's body or of
one's functions, but only the self construct
(p. 43)."
States of this sort have been referred to as "being
in the flow" and as peak experiences; they are
believed to result at times in peak performance.^^
It seems intuitively plausible that for individuals who regularly experience such states,
drug-induced states might lack allure. The costbenefit analysis for a given drug experience
would be radically different for such individuals,
compared with those for whom the drug seems
the only avenue to produce positive states, or to
avoid negative ones. It is perhaps for this reason
that alcoholics are said to have particularly detailed recollections of their first drink.^' The
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Many individuals have pleasant, or even ecstatic initiatory experiences with a particular
drug and nonetheless fail to make that drug the
centerpiece of their lives. Typically, these people
have many other avenues of reinforcement'^ and
are making satisfactory progress toward achieving the positive incentives in their lives and in
removing the negative ones.'' They generally
have positive non-chemical response expectancies, a functioning set of enhancement behaviors,
and well-developed emotion-focused coping
skills.''" Of course, some individuals are protected from excessive involvement with a
particular drug by genetic disaffinity. For example, more than half of Orientals have an
unpleasant flushing reaction in response to alcohol."" Yet the vast array of psychotropic drugs
available insures that a drug of potential abuse
exists for everyone.
There is no reason to assume that those who
will proceed to develop full-blown substance
abuse careers have initiatory experiences any
more pleasurable than those who will become
casual or non-users. What is salient is the conThe perspective on drug ingestion that trast between prior and drugged states. Some
emerges from these new developments de-em- individuals are plagued by dysphoric debilitating
phasizes the pharmacological properties of the states that feature concomitant negative selves;
either their expectancy for altering them nonchemically is low or they are predisposed to seek
solutions that involve little effort. Perhaps they
lack meaningful goals, or, having them, feel unable to progress toward them. Suddenly, the
ingestion of a substance effects a magical transformation.
Drugs have the power to alter reactions to
incentives: Maladaptive shifts have been demonstrated even in rats."^ In humans, these
chemically-induced motivational adjustments
"Who cares?"serve as one mechanism of deepening an individual's involvement in drugs. As
striving toward non-drug incentives is gradually
abandoned, the individual's range of potential
reinforcers narrows accordingly. The abused
substance and other substance abusers become
the paramount reinforcers.
What may make substance use rise most
rapidly in a motivational hierarchy, however, is
the effect on sense of self If an individual suffers
protracted, recurrent states featuring personally
repugnant selves, vulnerability to substance
abuse exists. Were these negative states to be
transformed by drug ingestion, such that a positive self were experienced, the individual would
be at risk. Using this substance on a regular
basis, particularly if this use interfered with other
means of inducing positive states, would be expected to exacerbate that risk. To the extent that
other ways of generating self-worth were undermined, the drug experience would become more
captivating. Each instance of use would further
weaken nascent addicts' beliefs in their ability to
feel better without drugs; attempting to do without the substance and relapsing would reduce
self-efficacy and non-chemical response expectancies still fiirther.
Tolerance, withdrawal, and relapse
Bodies homeostatically attempt to regulate functioning in the face of these repeated drug
onslaughts. Nerve cells gradually compensate for
the presence of drugs, enabling brains to continue ftjnctioning at the increasingly higher dose
levels that individuals require to achieve the
same effect (tolerance). To the degree that the
body uses mechanisms that oppose the effects of
the drug, in addition to those that simply decrease its effect, physiological dependence is
created."" Abstinence would then result in a
withdrawal syndrome.
This is taken by some to be the hallmark of
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addiction, but data suggest otherwise. Many individuals have become physiologically dependent
on morphine, and even heroin, as part of their
medical treatment. When the medical necessity
ends, these people typically terminate consumption, experiencing influenza-like symptoms but
not craving for the drug.
These medical patients have a different experience of withdrawal than do street users because
their reasons for using the drug, and indeed their
experience of it, are quite different. Street users
relieve dysphoric psychobiological states with
opiate drugs; they are typically inducted into a
state featuring euphoria and indifference to anxiety-provoking situations. Medical patients, by
contrast, generally report a sense of tranquility
with pain relief, with some complaining of dysphoria and the inability to think clearly."^ When
the pain for which they were prescribed the
opiate subsides, their physician terminates the
drug while assuring them that the discomfort of
withdrawal will soon passand it does. For the
street addict, abstinence engenders a state which
may be a more intense version of the aversive
state that initially prompted regular use. While
the intensity level might be new, the negative
self-relevant cognitions and bad feelings may be
all too familiar, underscoring the belief that this
state will not pass without more drugs.
Relapse is often precipitated by negative affective experiences,""'" possibly by increasing the
incentive value of the substance. In their responses to stress, relapsed alcoholics were
discriminated from recovered alcoholics and
matched controls by their use of avoidance coping strategies."" A prospective study of alcoholics
attempting to change found that developing an
altemative satisfying behavior was the main predictor of success."*^ Thus, it seems that relapse
may be associated with deficient emotionfocused coping and an inability to induce positive states non-chemically.
Decision rules, willpower, and the development of a metaperspective
Because the various behaviors that create and
maintain an addiction represent a series of
choices, decision theory may be fruitftjUy applied
to this area."" Perhaps susceptibility to addiction
is in part associated with decision rules which
give present characteristics much greater weight
than future possibilities. The ability to delay
ratification has been shown to predict to all kinds
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Rob Neiss
of success,'" and, along with the ability to persevere with intentions under adverse conditions, is
said to be a component of 'willpower'. This
attribute is widely believed to be inimical to the
formation of addictions, but as yet has attracted
little empirical research.
Willpower could be reformulated as an aspect
of the ability to take a metaperspective in regard
to psychobiological states. Many people function
with relatively little metaperspective; their experience of themselves as a unified self is largely a
fiction. The T that resolutely proclaims a diet in
the moming is not the same T that raids the
refrigerator at night. One state succeeds another;
each features its own self claiming to speak for
the whole person. According to Rossi, "The
apparent continuity of consciousness that exists
in everyday normal awareness is in fact a precarious illusion that is only made possible by the
associative connections that exist between related bits of conversation, task orientation, etc"
(p. 41).^'
The capacity to witness the succession of
states is crucial to the development of a metaperspective. As self-observation is cultivated, the
automaticity with which certain states are evoked
by situations is decreased in favor of the experience of choice. This could take the form of metacognition"Are these fearful thoughts rational?"or proceed in other modes"How do I
feel about becoming angry?" This process would
not lead to a dull uniformity characterized by the
absence of states, but rather a sense of being
more keenly alive as disaggregations are lessened
and situations are met with more complete
awareness. Elsewhere, I have discussed techniques useful in developing a metaperspective."
The development of a metaperspective is the
work of a lifetime and early social leaming is of
critical concem. The ability to delay gratification, for example, is not learned in a vacuum; it
is taught, it is modeled, and, above all, it is
provided a context in terms of situations wherein
reinforcement is ultimately forthcoming. Many
children experience an environment in which it
would make no sense to save for the ftiture due
to the likelihood of being "ripped off". Similarly,
endeavors are not likely to be undertaken in
hopes of future reward unless social conditions
give the appearance of fostering such an eventuality. As loss of love and opiate withdrawal bear
a striking neurological similarity," the experience of being lovedand of lovingmight offer
so. Increasing clients' awareness of state alterations would seem to be a necessary step in
helping them to decrease automaticity and increase choice.
Psychotherapy may be effective in helping
some individuals to develop a metaperspective
on their states. However, many people face obstacles that are not altogether of their own
making. Movement toward meaningfiil goals,
crucial in maintaining positive states, might be
difficult to achieve because of external circumstances, particularly in the lower socioeconomic
strata. Having a stake in conventional life has
apparently saved many middle- and workingclass heavy cocaine users from addiction.'''
It therefore makes sense to implement social
policies that maximize the opportunity afforded
young people to make something of their lives.
21,
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