Cultural and Social Change

In recent centuries, political, commercial, and technical advances have influenced the types, supply, cost, and availability of psychoactive substances, along with modes of administration (Westermeyer, 1987). International commerce, built on cheaper and more efficient transportation, and increasing income have fostered drug production and distribution. Increasing disposable income has resulted in greater recreational intoxication (Caetano, Suzman, Rosen, & Voorhees-Rosen, 1983). Development of parenteral injection for medical purposes was readily adapted to recreational drug self-administration in the mid-1800s, within several years of its invention. Purification and modification of plant compounds (e.g., cocaine from the coca leaf, morphine and heroin from opium, and hashish oil from the cannabis plant) produced substances that were both more potent and more easily smuggled and sold illicitly. Laboratory synthesis has produced drugs that closely mimic naturally occurring substances (e.g., the stimulant amphetamines, the sedative barbiturates and benzodiaze-pines, the opioid fentanyl, and the hallucinogen lysergic acid) that are more potent and often cheaper than purified plant compounds.

Historical and cultural factors may theoretically affect the pharmaco-kinetics and pharmacodynamics of psychoactive substance, just as the pharma cology of these substances may affect their historical and traditional use. A case in point is the flushing reaction observed among a greater-than-expected number of Asians and Native Americans (but neither universal in these peoples, nor limited to them). Absence of alcohol use among the northern Asian peoples who subsequently peopled much of East Asia and the Americas is a likely explanation, but the exact reason is unknown. The flushing reaction associated with alcohol (Johnson & Nagoshi, 1990) has been offered as a reason for two opposite phenomena:

1. The low rates of alcoholism among Asian peoples, who presumably find the reaction aversive and hence drink little—although rates are increasing across much of Asia (Ohmori, Koyama, et al., 1986).

2. The high rates of alcoholism among certain Native American groups, who presumably must "drink through" their flushing reaction to experience other alcohol effects.

Flushing may be more or less desirable, depending upon how the culture values this biological effect. Among many East and Southeast Asian peoples influenced by Buddhist precepts, flushing is viewed as the emergence of cupidity or rage, with implied loss of emotional control. Modal differences in alcohol metabolism have also been observed among ethnic groups, and these differences support arguments in favor of biological causation. However, the intra-ethnic differences in alcohol metabolism greatly exceed the interethnic differences (Fenna, Mix, Schaeffer, & Gilbert, 1971). Despite some minimal pharmacokinetic differences among people of different races, the observed differences appear to be more due to pharmacodynamics; that is, the influence of people vis-à-vis the drug (i.e., their traditions, taboos, expectations, and patterns of use) appears to exert greater influence than the drug vis-à-vis the people (e.g., rates of absorption and catabolism and flushing reactions). Pharmaco-dynamic factors related to culture and pharmacokinetic factors related to biological inheritance and environmental influences probably both play roles in the individual's experience with psychoactive substances.

As psychoactive substance use developed into substance abuse in many advanced civilizations, social and cultural means evolved to control usage. One method was law and law enforcement. Aztecs utilized this method in pre-Columbian times to limit the frequency and amount of drinking (Anawalt & Berdan, 1992). Later, in the post-Columbian period, England countered its "gin plague" with a tax on imported alcohol-containing beverages (Thurn, 1978), and its later "opium epidemic" with prescribing laws (Kramer, 1979). Another method has been religious stricture. Perhaps the first organized religion to prescribe abstinence from alcohol was Hinduism. Early Buddhist leaders counseled abstinence from alcohol as a means of quitting earthly bondage to achieve contentment in this life and eternal nirvana after death. Islam became the third great religion to adopt abstinence from alcohol, reportedly when a town was sacked as a result of a drunken nighttime guard. The gin plague in England spawned several abstinence-oriented Christian sects, despite the earlier status of wine as a Christian sacramental substance (Johnson & Westermeyer, 2000). The Church of Jesus Christ of Latter-Day Saints (the group popularly known as the Mormons) forbids any use of psychoactive substances, including caffeine and nicotine.

In addition to religion as a preventive measure, religion has also served as a therapy for psychoactive substance abuse. Native Americans and Latin Americans, plagued with high rates of alcoholism, have joined fundamentalist Christian sects as a means of garnering social support while resisting peer pressures to drink (Mariz, 1991). Many Native Americans have joined the Native American Church, in which peyote is a sacramental substance but alcohol is proscribed (Albaugh & Anderson, 1974).

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