- Paperback: 277 pages
- Publisher: Yale University Press; 1 edition (February 11, 1986)
- Language: English
- ISBN-10: 0300036345
- ISBN-13: 978-0300036343
- Product Dimensions: 6.1 x 0.7 x 9.2 inches
- Shipping Weight: 1.2 pounds (View shipping rates and policies)
- Average Customer Review: 6 customer reviews
- Amazon Best Sellers Rank: #1,282,761 in Books (See Top 100 in Books)
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Drug, Set, and Setting: The Basis for Controlled Intoxicant Use 1st Edition
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This is such an important book and really answers questions like, "Why can someone control their drug use their whole life until say they are 50 and go thru a divorce and for the first time do not control their drinking".(It has to do with mindset, mentioned in the title) Or why did so many soldiers get addicted to heroin while fighting the Vietnam War but once they came home completely stopped all heroin use. (It has to with access to the "drug" and the "setting" mentioned in the title.) So much of his research flies in the face of AA and their dogma. Only recently have drug rehab centers opened in California that specifically say they do not subscribe to the tenants of AA and do not believe you have an addictive personality and that you must avoid all your friends and family for the rest of your life since they drink socially. (AA was never based on any science but rather Bill W.'s random prescriptions to stop drinking.) And since you had a problem at this one point in your life you will forever be a drug addict and can't ever go back to drinking socially. Not in five years not in 100 years. Even though you did control you alcohol use up until you were 50 (to go back to my previous example of the person going through a divorce.)
Zinberg's writing all revolves around hardcore scientific studies and common sense and goes against so much nonsense pedaled by AA and drug counselors who still simply can't get their heads around this idea that people could control their drug use. Even though people go their whole life, say, controlling their use of marijuana or alcohol, that simply can't be true of heroin. (Guess what, some percentage of people who do heroin control its use and never get addicted.) After you read this book you'll understand why that is so. It all seems so obvious after you read this book. There are some useful things in AA and this book, inadvertently, explains why certain elements of AA can be useful and why other prescriptions of AA make no sense. (I'm not saying controlling heroin use is so simple or that you can't die the very first time you inject a drug, but this book is not a manual to avoid killing yourself while using drugs. Nothing of the sort.) I've only touched upon the books contents in the most cursory and crude way.
If you read about Zinberg's career at Harvard you'll see he was so ahead of everyone, and really still is. Ideally, someday this book will go back into print and be part of any drug abuse program aimed at drug counselors. As I said before if you understand the factors that go into controlled intoxicant use, you will better understand uncontrolled or abusive use of drugs and alcohol.
The purpose of his research was to show that controlled intoxicant use is possible. That's the first bias. It's a study to prove a point. But what worries me is that people can "anchor" their perceived positive feelings (escapism) with opiate use and that's when people can go down the slippery slope. The long term damage through opiate use, even if people can have "controlled use", is not given attention.
In his data analysis (p.76), the number of compulsive subjects using opiates for depression is 80% while for controlled subjects only 21%. It is a quantitative study design starting with a hypothesis and then proving it, which is what quantitative studies do, but then in chapter 4 he uses qualitative methodology but transcribes only the tapes from controlled users and not the compulsive users (in order to prove his point). He does not address the problematic users who end up homeless on the street.
What Zinberg did not focus his attention on (because he sets out to prove controlled use) is that if 80% of compulsive users use it to beat depression, then potentially, advocating "controlled" use might have dire consequences, as evidenced in my work as a counsellor who has worked with many sad cases of drug dependence. Many of these people started out as "controlled" users, until something in their life goes wrong (breakup, death in family, etc) and then they become problematic users who lose their house, their family, their self-esteem, and maybe even very nearly their lives.
The closing paragraph of the book says this:
Throughout the duration of my project my subjects continued to make one point clear: at certain times, if not during the whole of their using careers, they experienced benefits from their intoxicant use and from different patterns of use. Thus despite the reigning cultural morality, future studies of intoxicant use should take into account not only the liabilities but also the benefits of drug use itself and also the differing patterns of use.
The spirit of the book throughout is to show you how SOME people can experience highs and function well from drug use (duh, so what? - we can get high on more wholesome things such as helping the less fortunate and getting a real buzz!) Throughout the book he implicitly condones drug use because of the "benefits".
I would be sold on his idea of controlled use if he could have shown another study with the hypothesis that "opiate use is detrimental to life expectancy, health, family, social, financial, career aspects of life, in the long term" and that study fails the hypothesis.
You can prove whatever you WANT to prove!
I give it a two star because the implicit personal bias throughout the book is ANNOYING. Without that bias, and with the same findings, the concluding paragraph might be more responsible and read something like this instead:
From my research, it appears that some opiate users are able to control their intoxicant use and experience positive effects that are beneficial to their lives, without becoming problematic users. It would seem that the traditional view that all opiate users must progress from experimental to moderate use, then become addicted and finally becoming compulsive users may not be accurate. However, there is a possibility that controlled users can become compulsive users and that there may be long-term negative effects. Further research is needed to explore these possibilities, particularly if emotional stressors present in users' lives. Before such data becomes available, it would be responsible to assume such possibilities as the negative consequences of slipping into compulsive use with long term ill effects, may outweigh the positive experiences of controlled use.