Culture: Drugs, Alcohol, and Tobacco

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Culture Drugs, Alcohol, and Tobacco

• Culture, Health, and Illness
• Ch. 8

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Total Drug Effect

• The effect of any medication on an individual
  (total drug effect) depends on
• Pharmacological properties
• Attributes of the drug
• Attributes of the recipient
• Attributes of the person prescribing the drug
• Physical setting (micro-context)
• Social/cultural/political/economic environment
  (macro-context)

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• Macro-context

Micro-context
Prescriber
Recipient
Drug
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Placebo Effect

• The total drug effect, but without the presence
  of a drug.
• The belief of those receiving or administering
  the substance or procedure in the efficacy of
  that placebo or procedure that it can have
  psychological and physical effects.
• Been shown to provide relief for arthritis,
  angina, pain, hay fever, headaches, ulcers,
  hypertension, anxiety, depression, and even
  schizophrenia.
• Also shown to induce side-effects.

Click on pill for recent article from MSNBC
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Placebos

• Placebos, whether medications or procedures, are
  culture-bound and context-bound in that they are
  administered within a specific social and
  cultural context that validates both the placebo
  and the person administering it.
• It is an essential ingredient in all forms of
  healing and in everyday life.
• Other components include the emotional dependence
  of those seeking healing in the society on
  prominent people in that society, such as healers.

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The Drug

• Various factors about the drugs itself can impact
  the success of the placebo effect. These
  include
• Color
• Brand name affiliation
• Size
• Taste
• Texture
• Shape
• Overall appearance
• Route or intake

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The Recipient

• What one thinks about drugs
• What one knows about drugs
• What one has been told
• Whether (s)he is of the same
  mindset as the prescriber.
• Placebo type personality
• Over-anxious
• Emotional dependence
• Immaturity
• Poor personal relationships
• Low self-esteem

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The Prescriber

• The characteristics of the prescriber are crucial
  to the placebo effect. These include certain
  cultural symbols, such as a doctors coat,
  stethoscope, charms, prescription pad.
• Others include their age, appearance, clothing,
  manner, air of authority, belief in the drug or
  placebos effect.
• The confidence the recipient has in the
  prescriber contribute to the effect.

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Drug Dependence

• Psychological dependency relates to the
  psychological need of the person to crave the
  drug-induced symptoms or their need to stave off
  the withdrawal symptoms.
• The symbolic meaning of the drug is a significant
  factor in dependency.

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Drug Dependence

• Drug use is strongly tied to the social values
  and expectations of the macro-context.
• The drug can be used to normalize or improve
  social relationships by bringing it into
  alignment with those around you. This is
  illustrated by the belief of only 1/3 of
  participants in a study believing aspirin was a
  drug.
• The trust a society places in its prescribers,
  which may be influenced by those making the
  drugs, is also an essential element in dependency.

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Physical Dependency/Drug Addiction

• Physical dependency, or addiction, is a physical
  concept relates to the actual physical need of
  the person to stave off the withdrawal symptoms,
  such as caffeine drinkers or smokers who shift to
  a lower level in their consumption, but
  unconsciously increase the frequency to keep the
  levels consistent in their bloodstream.
• The socio-cultural environment in which the drug
  taking occurs has set rules.

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Physical Dependency/Drug Addiction

• The level to which one is integrated into a
  culture, such as soldiers in Vietnam during the
  war, may determine how easily one can kick the
  habit. If the culture is dismantled, such as
  when the soldiers returned home, the ability to
  end a dependency is often easier.
• In many cases, religious figures or healers (ex.
  Malay Bomohs) have been successful in assisting
  people to end their drug habits.

Traditional Bomoh healer
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Alcohol Use and Abuse

• Alcohol is one of the most widely used chemical
  comforters in the world. It is also used as
  food, medicine, a narcotic, an energizer, an
  aphrodisiac, a form of payment, a preservative, a
  disinfectant, and as a religious drink.
• Excessive use is a feature of many groups
  globally, which is why it is also a serious
  public health issue globally (1.8 million deaths
  annually)

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Alcohol Use and Abuse

• At the level of the individual, the effect of
  alcohol depends on physical (ones build, stomach
  contents, gender, drink volume or type),
  psychological (personality, current emotional
  state), and socio-economic (attitude of culture
  toward normal or problematic drinking, income
  level) factors.

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Alcoholism Models

• Moral
• Disease
• Political/Economic
• Socio-Cultural

The American Temperance Society (1862)
The ALDH2-2 Alcohol Gene
Court Street Shuffle Web Site
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Alcohol Cultures

• Abstinent
• Ambivalent
• Permissive
• Over-permissive

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Alcohol Cultures Identity

• The focus is on creating and maintaining social
  identity and social relationships.
• This includes the purpose (badge of identity,
  socialization) setting, whether public or
  private, whether it takes place in a male or
  female space.

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Alcohol Variables

• Family Drinking
• Family Structure
• Personality Variables
• Spouses Drinking Behaviors
• Drinking Environment

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Protective Cultural Factors

• Exposure of children to alcohol at an early age
  in a stable family
• Use of alcohol in a very diluted form
• Alcohol being viewed mainly as a food and
  consumed at meals
• Parents presenting an example of moderate
  drinking
• Drinking not being given any moral importance
• Drinking not considered proof of adulthood or
  virility
• Abstinence being socially acceptable
• Drunkenness being socially unacceptable
• Widely accepted norms about acceptable drinking
  behavior

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Tobacco

• Tobacco is also a chemical comforter, which may
  act with stimulant and depressant effects.
• In most cases, cultural influences encourage
  smoking behaviors, which are the single greatest
  modifiable danger to ones health.
• Symbolic meanings are associated with smoking
  dependencybeyond the pharmaceutical properties
  of nicotine or tobacco.

WHO Tobacco Atlas
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Demographic, Health, and Behavioral Factors
Associated With Smoking

• In one recent study (Plotnikoff, R., et al,
  2007), older individuals, females, individuals
  with higher educational attainment, those who are
  not regularly physically active were more likely
  to have smoked in their lifetime.
• However, physical activity was a significant
  factor in ones likelihood of successfully
  quitting.
• Age, marital status, and income were also
  significantly associated with quitting.

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Rationale for Teen Smoking

• To control their mood
• To fit in with their friends and peer group
• To create or maintain a social image
• Because they are dependent on the physical and
  psychological effects
• Curiosity
• Family influence
• Personal choice

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Precontemplators

• In a British study, 45 of smokers rejected
  outright the dangers of smoking to their heart
  health.
• 14 completely accepted it caused heart disease.
• 11 that it caused lung cancer.

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Economic Aspects of Smoking

• The tobacco industry uses economic arguments to
  persuade governments, the media and the general
  population that smoking benefits the economy. It
  claims that if tobacco control measures are
  introduced, tax revenues will fall, jobs will be
  lost and there will be great hardship to the
  economy
• Philip Morris is the worlds largest
  transnational tobacco company. However, excluding
  the US domestic market, BAT sells the most
  cigarettes worldwide and has the largest network
  in the most countries.
• In the USA alone over 10 billion is spent a year
  on marketing cigarettes, and this at a time when
  advertising is prohibited on television and
  radio, when there are limitations on certain
  types of outdoor advertising and sponsorship, and
  when cigarette sales are falling.

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Exportation of Drugs

• 50 of all the worlds drugs are produced by 25
  firms.
• 75 of the worlds population lives outside of
  the U.S. and the cost of imported drugs is a
  major economic drain.
• Poorer nations represent only 20 of legal drug
  users, but they pay a disproportionate cost and
  still dont have access to the WHOs List of
  Essential Drugs.

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Religious Drugs

• Marijuana
• Psilocybin
• Peyote
• Ayahuasca
• Morning glory
• Iboga
• Jimson weed

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