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Contrary to what is commonly assumed, psychoactive drugs do not produce fixed and predictable psychological effects that are dependent purely on their chemical properties.
In fact, the way that a drug affects a person depends on two additional factors to the biochemical actions of the substance. Firstly, the ‘person’, or ‘set’, a variety of individual characteristics such as a person’s personality, their expectancies of how the drug will affect them, and their emotional state.
Secondly, the ‘social context’, or ‘setting’, the influence of the physical and social setting within which drug use occurs. Whilst the expression ‘drug, set and setting’ is commonly used in the field, we will use the expression ‘drug, person and social context’ in this article.
In this and the following two articles, we consider this interaction in relation to three different aspects: the drug experience, development and maintenance of addiction, and recovery. You will be able to download a pdf document of the three parts combined.
The drug experience
Few people have difficulty in understanding that different individuals in the same social setting react in different ways to alcohol. Moreover, variations in social setting can lead to differences in the observed effects of people drinking alcohol.
Someone who is drinking alcohol in a loud, raucous setting comprising many people drinking excessively is much more likely to feel and act drunk than someone who is drinking the same amount of alcohol amongst a similar-sized group all sitting down quietly drinking alcohol.
The same level of general understanding about the role of the person and their social context is not evident in relation to other drugs, despite what has been shown in research studies.
For example, if people are given a fixed dose of amphetamine for the first time in the same research laboratory, only a proportion of people experience pleasurable effects of the drug: a significant remainder experience anxiety.
Moreover, anecdotal reports reveal marked variations in the subjective experiences of people who use heroin for the first time, which cannot be readily explained by differences in the amount used or variations in drug purity.
The effects of a drug are partly dependant on the personality of the person. For example, extraverts succumb much more readily than introverts to the intoxicating effects of alcohol. The user’s beliefs (or expectancies) about drugs are also an important determinant of the drug effect.
In one research study, a group of subjects was given a sleeping tablet and told by the experimenter that it would make them sleepy. Another group was given the same tablet and told that they did not know what effect it would have, whilst a third group was given a placebo and told it would make them feel sleepy.
Those subjects who were given the active drug and told that it would make them sleepy showed the greatest drowsiness. The other two groups showed the same level of drowsiness. Thus, in this study, the experimenter’s suggestions were as effective as the drug.
The importance of factors such as beliefs, attitudes and expectancies is also illustrated by the classical research of Howard Becker with cannabis users.
The majority of people who first try cannabis do not get high. They may feel a little strange but they are not sure how to interpret the changes they are experiencing. They may even feel sick or become concerned about how they feel.
When they converse with others about what they experiencing, they may be told about specific details of the cannabis experience they had not noticed before, or had noticed but not realised it was part of being high or stoned. The next time they smoke the drug they are better prepared to know that they are stoned.
This learning of the drug experience is also apparent with other drugs. Young people who try their first cigarette or their first drink of alcohol rarely find the experience enjoyable, but they later begin to enjoy the experience. Many heroin users spend an initial period learning to interpret the effects of the drug.
This stuff is critical to understanding the impact of drugs on individuals and communities. We really should cite Zinberg’s work here – particularly “Drug, Set and Setting – the basis for controlled intoxicant use” (1984 Yale University Press).
I agree, Zinberg’s stuff is great! I’ll be quoting a lot of the classical literature in later writing.
As someone who has in the past been psychologically addicted to speed and addicted addicted to alcohol (for a long period to both). I realised on reading this article and from my own experieces that to really and fully overcome these thing that a complete change of lifestyle is the best option more often than not moving to a completely different area if possible
I have worked as a facilitator to relapse prevention groups on a volunteer basis for some 18 months and what came to mind on reading this is that sometimes the only way to get over high risk situations and triggers is not to live in them. You see so many cases of people getting clean then moving back home and relapsing.
Uncle John
