INFORMAL SOCIAL CONTROLS AND THEIR INFLUENCE ON SUBSTANCE USE

This paper analyzes the influence of informal controls that operate in social groups on consumption of alcohol, tobacco, other drugs, and food. A literature review provides evidence of five major informal controls-cultural recipes that describe what substances should be used in what amounts to achieve what effects; learning to use through association with others who teach people what, when, why, how, where and with whom to use; sumptuary rules specifying eligibility requirements for use; sanctions that reinforce the learning of substance use conventions and norms; and everyday social relations that make it expedient for people to use in some ways and, inconvenient to use in others. The potency of -informal controls has some implications for formal policies intended to regulate consumption of substances.

*Deborah Maloff is a research associate for the committee on Substance Abuse and Habitual Behavior, National Academy of Sciences. She is also a Ph.D. candidate in the Department of Sociology, George Washington University. Her research interests have been in criminology and social policy.

*Judith Rodin is Associate Professor of Psychology at Yale University. She is co-author of Obese Humans and Rats and author of numerous publications on the relationships between environmental stimuli and internal regulatory mechanisms. Her research has centered on obesity and feeding behavior.

*Howard S. Becker is Professor of Sociology at Northwestern University. He is the author of Outsiders and coauthor of Boys in White. and Is presently completing a book on the sociology of the arts. He is also co-editor of a forthcoming book on photography and social science.

*Arlene Fonaroff, former Senior Research Associate. NRC Committee on Substance Abuse and Habitual Behavior, is currently Public Health Officer, Office of Environmental and Health Affairs, The World Bank; and holds adjunct faculty appointments in Psychiatry and Human Behavior and Human Ecology. George Washington University. Her major Interests are in sociocultural/behavioral epidemiology.

*This paper was prepared for the Committee on Substance Abuse and Habitual Behavior. Assembly of Behavioral and Social Sciences. National Reserach Council. The authors wish to thank the Committee for its help and support. The expressed views of the authors are personal and are not necessarily those of the institutions with which they are affiliated.

When we talk about addiction or habitual substance use, we usually ask why people take "so much" of a substance when it is clear that less would be better or, in some instances, that none at all would be better yet. That question presupposes that we know the optimum amount, but differences of opinion about how much is optimum lead to much of the argument over these matters. A more neutral question allows us to avoid the moral elements of the problem and attach our questions to a larger body of social science thinking: how do people "decide" how much of a given substance they will take and when? (We put "decide" in quotes to indicate that the decision may be made without conscious reflection.)

Put this way, the question is reminiscent of Durkheim's famous question in Suicide. The analogy warrants a digression. Durkheim wanted to show the importance of the "social variable" in human affairs and thought that nothing would be more convincing than to demonstrate that suicide, the most private of acts, actually was rooted in social life. He did that by showing that the suicide rate varied with features of social organization: single people killed themselves more frequently than married people, urbanites more frequently than rural residents, Protestants more frequently than Catholics. In each case, he argued, the second member of the pair was more deeply involved in a web of social life while the first led a more individuated existence.

But what mechanism led from decreased involvement in social life to suicide? Durkhelm suggested, as the explanatory variable, that participation in highly organized social life led people to accept socially defined limits on desires. Many of the things people desire are of such a character that they can be consumed in very large quantities. There is no physical limit to the amount of jewelry or rich clothing one might have. Even when there is some physical limit-time alone limits the number of cigarettes one can smoke, although the amount of nicotine might be upped by using other means of administration-no one ingests as much of the substance as is physically possible. What stops them?

This question has as many answers as there are disciplines that investigate human behavior. The sociological answer is that people stop short of the maximum possible consumption of anything because their social groups set limits beyond which a reasonable member would not go. Recognizing that these limits are commonly accepted, group members internalize them as reasonable guides to their own behavior, often imbuing them with moral as well as practical force. This interpretation allowed Durkheim to explain suicide as something people do when they are so removed from social influences that they can find no way to limit their desires; one response to the pain of the ensuing insatiable desire is to kill yourself. Durkheirn could also thus explain a puzzling anomaly in suicide rates: rates went up not only in times of economic depression but also during economic booms. In both boom and bust the violent shift in people's economic situations nullifies the force of previously influential social norms. Neither the person who has lost everything nor the one who has incalculably more than had ever been anticipated can appeal to what they had hitherto known as the "right way to do things" to organize their consumption.

Although both Durkheim's logic and, especially, his data regarding variance in 'suicide rates have come under severe attack, we can begin with the premise that people control their consumption of various items by referring to the established norms which regulate how much of that sort of thing people like them usually consume or ought to consume. Since Durkheim's time various investigations (especially into the use of drugs) have broadened our conception of the ways membership in social groups can influence people's consumption patterns. We know both that there are sizable variations in amounts and schedules of use by such social variables as class, ethnicity, age, sex and geographic location and that there are a variety of ways that membership actually impinges on the process of use.

It should be clear that we are not here discussing the question of substance "abuse." That term invariably embodies a judgment that some amount or kind of use is immoral, unwise or unhealthy. Those judgments, inevitably, are debatable, whether they involve pitting the ethical system of one group or society against that of another, or judging people's actions by the code of their own group. We prefer to deal with the likely outcomes of one or another way social groups influence substance use and leave to the readers the problem of deciding which outcomes ought to be guarded against or prevented, and which ones ought to be promoted.

Our strategy here is to compare what is known about use of alcohol, tobacco, other drugs, and food, to see more clearly how participation in social groups enables people to know how much of a substance is "enough," or "too much," to be used. We assume that people differ with respect to psychological variables influencing substance use and biological susceptibility to substances, and that substances do have substantial pharmacological effects. We want to describe the influence of socio-cultural factors (specifically, informal social controls that stem from group membership) on patterns of consumption.

In using the terms, "formal" and "informal" social controls, we refer to the difference between rules created and enforced by the state and its agencies and subsidiaries (such as schools and law enforcement agencies) and by such private governments as the managements of corporations (who make quasi-governmental rules for their employees), on the one hand; and the informal rules and other guides to behavior created in micro-environments by groups which have no clearcut code or mechanisms for enforcement (such as families, friendship groups, teenage cliques, and the like). The operations of large scale social institutions-the government, the industries (legal and illegal) which manufacture and distribute substances, the advertising and media industries, and the medical and legal professions (considered as corporate bodies), all create the conditions in which people, acting in their everyday microenvironments, produce and respond to informal controls. (For a general approach to some of these questions see Spradley, 1978. In relation to the food industry, see Aronson, 1978.)

To summarize the results of our review of the literature on informal controls, we find that social groups develop cultural recipes, formulae describing what substances can be used in what amounts to achieve desired results. People learn to use substances by learning these recipes and developing a taste for the effects they make possible, all this through association with others who teach them what, when, why, how, where, and with whom to use. Sumptuary rules specify who is eligible to use what substances for what purposes and, secondarily, who will learn which recipes, and positive and negative sanctions reinforce these provisions. Finally, the everyday workings of ordinary social relations make it expedient for people to use substances in some ways and inconvenient to use them in others.

Cross-cultural data from anthropological, sociological and psychological research involving a variety of substances illustrate each of these phenomena. The Durkheimian strategy suggests the major questions we will raise throughout. What kinds of people engage in what kinds of social interaction around the use of these substances? What kinds of information, ideas, theories, knowledge, and feelings about what kinds of substances circulate among the parties in these relationships? What rules govern appropriate use and the penalties for inappropriate use? What are people's conceptions of how things are ordinarily done so that doing them differently would be troublesome, and what are their notions of the best ways to achieve desired results?

How do people know how much is enough? One answer is that in every social group, cultural recipes describe how to use certain substances to attain desired results-that is, cultural recipes tell people what, how much, when, and how to use in order to become healthy, socially uninhibited, high or whatever other result is desired. (See Harding and Zinberg, 1977; Zinberg, et al., 1977; Zinberg, et al., in press.) When people take a substance in the belief that it will produce a particular result, the cultural molding of perception makes it likely that they will experience that very result. So substances tend to produce the results for which people use them, thus confirming the cultural predictions as to how and why they should be used.

People have used substances in order to achieve a variety of ends, including: to prevent illness, to pin strength and energy, to treat an illness, to cure insomnia, to cure a hangover, to have a sense of belonging, to gain status, to facilitate social intercourse, to aid in coping, to reduce inhibitions, to stimulate mental activity or clear thinking, to celebrate special events, to "have fun," to become euphoric, as an aphrodisiac, and as part of religious or magic rituals.

Some of these uses-such as drinking coffee to start the day, taking an aspirin to relieve a headache, or taking heroin to avoid withdrawal-are considered necessary for routine everyday existence, to enable one to function "normally." Others-such as taking LSD to "alter one's consciousness" or drinking wine to relax inhibitions at a party--alter the person in some way so that special activities can be performed or enjoyed.

Here are some examples of recipes for substance use for this variety of purposes:

2. Substances may be used to treat illnesses or other undesirable physical or emotional states. If illness does occur, Santa Lucians administer hot substances to treat such cold illnesses as pulmon (i.e., respiratory ailment) and fresco substances for such hot illnesses as inflamation or fever (Cosminsky, 1977). Alcohol, like food, is also used for its medicinal benefits. In 19th century Ireland, alcohol was a universal cold medicine to "keep the cold out of the stomach" and to cure stomachaches, insomnia, fainting, and hangovers. Whiskey was a recommended cure-all for young men in low spirits (Bales, 1949). Hot toddies are contemporary favorites in England and Scotland to ease head colds and coughs, and U.S. physicians sometimes prescribe alcohol for elderly people and others. Popular folklore suggests that men can increase their sexual capabilities by eating oysters and other special foods.

3. Substances may be used for social recreational purposes. In the U.S., people use alcohol, cocaine, marijuana, and a variety of other legal and illicit drugs for relaxation or "to have fun." High school students have reported that among the purposes of drinking are "to be gay" and "to get high" (Straus and Bacon, 1953).

4. Substances may facilitate the performance of special activities or events. In their review of Human Resources Area File data on 247 nonliterate societies, Blum et aL (1969) found that hallucinogens are used most often for mind-modifying or religious purposes. Navahos use peyote, for example, as an important vehicle for participating in religious and ceremonial events (Aberle, 1966).

5. People may use substances in order to "belong" or "fit in." Over two-thirds of the respondents in Maxwell's (1952) study of drinking in the U.S. reported that they drank because "it seems the thing to do" or "on some social occasions because it would help me to fit in better with the others."

A review of cross-cultural definitions of the purposes for which substances are used reveals a tremendous diversity. Substances used for one purpose in one society may be used for a different purpose in another environment. Jamaicans, for example, believe ganja (marijuana) maintains health, and use it as a tonic to treat certain illnesses, to enhance appetite and relaxation, and even to build strength and energy (Rubin and Comitas, 1976). But in the U.S. marijuana is used primarily to relax and to "have fun" rather than to treat illness or to give the user energy. Similarly, Edwards, in his discussion of "cultural plasticity'' describes how one tribe may use as an energizer the same drug another tribe uses as a tranquilizer (Harding and Zinberg, 1977). This suggests that the purposes and outcomes of use are not dependent solely upon the pharmacological properties of the substance, but are influenced by socio-cultural factors as well.

Cultural recipes that describe to users the effects or benefits of using a substance have profound impacts on the user's experience. As Becker (1963) points out in his study of marijuana use in the U.S., the presence of "symptoms" is not enough for people to experience being high. Rather, they must learn to recognize the "symptoms" and to connect them with use of the drug. Through interaction with experienced users, the novice learns to find pleasure in the experience, and to define the "symptoms" as enjoyable.

It is in this sense that "set" and "setting" have their profound influence on drug effects. Cultural recipes dispose people to use substances in order to have one or more of the many results the pharmacological properties produce, by telling them that this is what they can expect. Their expectations, as many studies have shown, mold their perceptions (Aberle, 1966; Becker, 1963 and 1974). In fact, the expectations created by cultural recipes can even produce measurable physiological changes. O'Brien's (1977) studies of conditioned drug effects demonstrate that, even in the absence of heroin, expectations of heroin effects can influence self-reports of "high" or euphoria, and such autonomic changes as pupillary constriction, decrease in respiratory rates, or increase in skin temperature. These learned responses resemble the placebo effect, which suggests that drug effects can be learned. O'Brien's experiments also demonstrate that pre-injection rituals and expectations of drug effects increase both subjective response and autonomic changes following a test dose of a narcotic.

Cultural recipes also prescribe when, where, and with whom a substance should be used in order to achieve desired states. In the U.S. alcoholic beverages, generally used for social purposes, are appropriate at the cocktail hour, but not in the morning. Similarly, one may appropriately drink at home but not at a business meeting, and with others but not alone. In contrast, one may eat nutritious food necessary for health maintenance at any time of day, alone or with others, but not in such locations as church or school.

We can classify occasions of use as "ordinary" or "no n-ordi nary," depending upon the purpose of use. Ordinary occasions are associated with a normal, healthy, physical and emotional state. "Fitting in" with others may also be related to ordinary occasions for use, since fitting in, or belonging, may be necessary to maintain a functioning, normal existence. Thus, we eat three meals a day-breakfast in the morning, lunch at midday, and dinner in the evening-not only to keep ourselves healthy, but also to follow the particular pattern that enables us to fit in with others. Similarly, Italians drink in an "ordinary" way: Lolli (1958) found that 70 percent of the Italian men and 94 percent of the Italian women in his study drank exclusively and routinely with meals, believing this a healthful practice as well as a valued custom.

On "non-ordinary " occasions people use substances for special purposes: to treat an illness, to celebrate an event, to "have fun" or to prepare oneself for a special task or activity. The Andean peoples of Bolivia and Peru, for example, treat alcohol as a sacred substance, reserved for such social occasions and rituals as baptisms, betrothaIs and marriage. They almost always use it in a social setting, rarely alone (Carter, 1977). Many societies consider family or community festivities and celebrations appropriate occasions for drug use. Bunzel (1940) found that the people of Chichicastenango, Guatemala, confine their consumption of alcohol to market days and festivals. These drinking parties typically became occasions for the relaxing of social inhibitions, in contrast with the extreme decorum observed at other times. In England and Wales, people usually use alcohol to "have fun." Customary drinking habits include frequent visits to public houses, bars, or other places where people "go in for a drink." Rowntree and Lavers (1951) estimated that, in 1949, more than 80 million visits per week were paid to public houses, which serve as important centers of social life.

People sometimes use substances to "fit in" on non-ordinary as well as on routine occasions. They may use substances in special group rituals to participate as a member of the group, rather than to experience substance effects. For example, people who ordinarily prefer not to drink may drink champagne at weddings just to fit in.

Cultural recipes describe how to use substances, including the route of administration and the rituals surrounding use. Recipes tell people which methods-eating, smoking, or injecting-are appropriate and what paraphernalia to use.

Recipes prescribing the correct manner of use often provide users with the most practical, effective, and expedient ways of attaining what they want to attain. For example, people learn to smoke marijuana in groups, in which the joint is passed from one person to another, thus enabling the users to adjust the intensity of the high (Harding and Zinberg, 1977). Similarly, although it may be eaten, marijuana is usually smoked, which enables users to experience more immediate effects and to gauge how much more is needed to become high. They have less control over the intensity of the effects when marijuana is ingested.like marijuana, most substances are associated with one predominant mode of administration. Heroin, for example, is most often injected, the technique which produces the strongest and most immediate effects.

Rituals surrounding use also reflect the purposes of use. Brandt (1950) describes the peyote ritual of the Kiowa-Apache in which the user holds the button in his right hand, motions toward the fire several times, puts the button in his mouth, and then rubs his hands over his head, arms and legs, especially in places where there is sickness or pain, the ritual emphasizing the curative powers of peyote.

Although cultural recipes often seem related to practical ways of attaining desired results, they may also be arbitrary. For example, illegal methadone, in contrast to heroin, is usually taken orally, in part because the liquid methadone dispensed by clinics is not always injectable, and in part because methadone is received in a context in which the oral route is "the natural way of using it" (Agar, 1977). Even when there is a practical reason for using a substance in a certain way, users may be unaware of those practical concerns, and merely follow conventions for the sake of conformity; marijuana users may not know that the way they use marijuana allows them to adjust the intensity of the high.

The culturally defined limits on how much is enough are often quite broad, depending upon the nature of the substance, the purposes for which it is used, and the behavior one displays when "under the influence." At a cocktail party in the U.S. one may have as many drinks as one likes so long as one's behavior remains appropriate to the occasion, or, drink almost unlimited cups of coffee without social censure. Cultural limits thus vary within, as well as among, groups.

Recipes for ordinary occasions. To maintain themselves in a normal, healthy functioning state, most Americans eat three meals a day. Some take a vitamin pill every morning for health maintenance and some routinely drink a few cups of coffee in the morning so that they can "wake up" and work more efficiently. Some societies use alcohol routinely on ordinary occasions for similar "maintenance" function. In lower Normandy, France, no one would think of ending a meal without a cup of brandy (Mouchot, 1955). In Peru, alcohol is consumed routinely by children in small quantities to "open the appetite, clear the head, kill microbes, etc." (Simmons, 1962).

Recipes for treatment. People learn how much of a substance to take, or what not to take, in the event of illness or other undesirable states. North Americans often take large doses of orange juice for the common cold. A common recipe for treating a hangover in the British Isles, reported by Stivers (1976) is taking a drink the day after a night of drinking; "a hair of the dog that bit you." Other recipes for treatment may require the withdrawal of certain substances. For example, Guatemalan Indians and many West Indian societies regard the withdrawal of foods as an essential treatment for childhood diseases (Reed, 1966; Fonaroff, 1968).

Recipes for special events. The use of as large amounts as possible is sometimes prescribed in connection with non-ordinary occasions. In rural Aymara, where drunkenness is a valued, almost sacred state, an individual can down as many as 100 shots of alcohol during a one to eight day bout. Drinking bouts usually accompany public rituals, rites of crisis (related to illness, misfortune or healing), and rites of passage. Between these rituals and rites, the populace is totally sober (Carter, 1977).

"Hard drinking" is often a valued goal for social and recreational purposes. In rural Greece, for example, men drink large quantities while "holding their liquor," to "have fun" and prove their manliness and honor. Since the ability to drink large quantities is tied to reputation, men become "inventive non-drinkers." They may hide their glasses, pretend that empty glasses are full, and use other ruses to give the appearance of consuming more than they do (Blum and Blum, 1969). Stivers (1976) and Bales (1949) report the same emphasis on hard drinking for social purposes among the Irish, who see drinking as a means of gaining respect-among one's peers and showing friendship for one's drinking partners.

Some groups define more moderate limits as appropriate for even recreational purposes. Jews have had low alcoholism rates, despite the use of alcohol in such non-ordinary events as traditional rituals, rites de passage, and observances of the Sabbath. Snyder (1962) found that Jewish college students perceived pressures toward moderate drinking and sobriety from their Jewish peers, but saw the non-Jewish milieu as a source of pressures to drink to excess. Many students surveyed defined sobriety as a Jewish virtue and drunkenness as a Gentile vice.

Recipes for accomplishing certain activities. Specific amounts of some substances are prescribed for accomplishing certain tasks or performing certain activities. Participants in American Indian peyote rituals facilitate spiritual experiences by eating a minimum of four peyote buttons, with an average of 12-20 a night (LaBarre, 1969). Peruvian Indians use enough coca to sustain themselves on long journeys along narrow mountain paths. Journeys are even measured in terms of the "cocada" (about 45 minutes), the length of time one chew of coca will sustain a traveler (Carroll, 1977).

Recipes for belonging. The amount of a substance people use may be influenced primarily by the desire to belong to a social group that uses specified amounts of the substance. Spradley (1973), in his account of public drunkenness in urban Skid Row areas, notes that social drinking offers a sense of belonging for homeless men. The bars they frequent serve as churches, clubs, employment agencies and, most of all, places to find friendship.

Studies of drug use among U.S. college students also indicate that patterns of use are associated with the lifestyle of the students' social group. Groves (1974) found that one of the best predictors of people's marijuana use was simply what school they attend, which implies that schools require certain patterns of use in order to "fit in."

We see how effective cultural recipes ordinarily are when they break down or are no longer recognized as legitimate, as in times of rapid social change due to urbanization or ethnic invasion. As Durkheim suggests, people cannot depend upon group norms for guidance when social situations are drastically disrupted.

Transition from rural to urban life in India provides an example of the breakdown of traditional norms for using alcohol. People's departure from rural agricultural communities weakens traditional restrictions against drinking, resulting in high alcohol consumption in the large cities (Chopra et aL, 1942). The industrial population accounts for about one-quarter of the total alcohol drinks consumed in India. Bales (1949) describes similar alcohol control problems among the Hopi and Zuni of Western New Mexico after the arrival of the Spanish settlers. Although these Indians used alcohol in a ritual manner in their aboriginal state, liquor brought in by the Spaniards caused so many problems that it was used for a period and then rejected entirely. The Indians could not successfully control their use of the Spanish liquor.

MacAndrew and Edgerton (1969) argue that the Indians learned their "changes-for-the - worse" after alcohol use from white men. Many tribes had institutionalized drinking in earlier and calmer times, but white traders provided examples of changes-for-the-worse behavior. The deterioration of traditional Indian values may explain the Indians' acceptance of drunkenness as a disinhibitor, there by allowing for changes-for-the-worse.

Prohibition in the U.S. provides another example of the breakdown of cultural recipes. Once drinking was prohibited, those who violated the law, continuing to drink, did so in an atmosphere in which previous informal controls and rules for appropriate use were no longer valid. People went to speak-easies not just to drink, but to get drunk (Zinberg and Fraser, 1978).

The diversity of cultural recipes across cultures raises questions about how these recipes, prescribed patterns of substance use, originate. Why does one culture follow one set of prescriptions and taboos, while another culture learns a different set of recipes? Rozin (1975) suggests the existence of "institutionalized nutritional wisdom" in the food habits that people have adopted: the practice of cooking food has practical adaptive functions-killing bacteria, making food more digestible, retarding decay, etc.-although the original rationale for cooking may be that warm, cooked food simply tastes better. The choices and combinations of foods used traditionally by cultures also express nutritional wisdom. Mexican peasant cuisine makes use of corn and beans which provide protein in the absence of meat and provide a better amino acid balance than either alone. The corn is usually ground with lime and cooked as a tortilla, which supplements a diet otherwise low in calcium (Rozin, 1975).

People may persist in nutritionally wise conventional food habits without being conscious of the adaptive functions of the foods they eat. Spices are "justified" biologically as sources of micronutrients, but it has not been proven that people use them for health reasons. Rather, researchers think spice use may have arisen because it masks the taste and smell of spoiled food, and provides variety in the diet (Rozin, 1975). Also, many widespread food habits have no apparent biological advantages and may even be harmful to a culture. Rozin (1975) suggests that cuisine-based unwillingness to accept new foods can have serious health consequences in times of famine, as in the unwillingness to eat wheat during the 1943 Bengal rice famine.

Availability may also explain how cultural substance use patterns emerge. The foods people eat are generally related to climatic and land use variables, to the availability of naturally occurring plants and animals and domesticated species which can be conveniently raised (Rozin, 1975). Access and availability have a tremendous influence on drug use patterns, as well.

People usually learn to use substances through interaction with other users. They may simply observe people they admire and respect using these substances in an environment that suggests that use is an appropriate activity. Or "others "-Usually parents, siblings or peersdeliberately teach the learner that certain benefits will follow if a substance is used in a particular way.

Learning occurs more easily in a comfortable setting, where people learn to associate positive experiences or feelings with food or drug use. Not only are they taught to define food or drug reactions as pleasurable, but those intimates who have encouraged substance use reward it with approval or acceptance. Similarly, people learn taboos by association with others who disapprove the use of certain substances and teach the would-be user of likely negative consequences. Negative sanctions reinforce taboos against, for example, eating ham in a Kosher home.

The kinds of substance use practices people learn depend on who teache , s them
those practices. Specifically, parents, or other authority figures usually teach people
to like and use substances approved by "conventional" society, while peer groups
teach them to use illicit substances, or substances disapproved for their age status.

Parental and Family Influence

The literature provides ample evidence that parents introduce their children to substances used and accepted by the dominant culture. Simmons (1962) describes the way a Peruvian community serves liquor to young children as a tonic; as already noted, it is thought to improve the appetite and kill bacteria, among other healthful benefits. In this community, almost all adult males drink so that children have many opportunities to observe drinking and to learn about it by example. Children usually receive their first drink at familial birthday celebrations, while the introduction of "heavy drinking" comes under the tutelage of fathers or other older male relatives. Bunzel (1940) describes a similar situation of parental influence among the Guatemalan Indians of Chamula. From early infancy, children are habituated to alcohol right along with mothers' milk. At fiesta time, everyone in the village, from the youngest child to the oldest women, drinks enormous quantities and is, to some degree, intoxicated.

Families often introduce people to tobacco smoking too. Damon's (1973) study of smoking in seven preliterate societies (four in Melanesia and three in sub-Saharan Africa) found that 44 percent of the smokers in all seven groups were initiated into smoking by family members (and another 27 percent by friends). In Jamaica, where the use of ganja is commonplace (particularly among the lower classes), parents introduce children to ganja tea, believed to have medicinal qualities. While ganja smoking is primarily a peer activity, ganja tea drinking is intergenerational, adults providing tea for minors (Rubin and Comitas, 1976).

The family socializes children to conventionally approved food habits. Rozin (1975) describes the exposure of a Mexican peasant child to the odors and tastes of tortillas, beans, and the sauce made of tomato and chili peppers. Growing up in a home that uses these foods and seasoning, "The child will experience features of these foods in the mother's milk, as well as in the odors of the home" (p. 294), and thus becomes familiar with the characteristic smells and tastes of its culture.

People sometimes use drugs because of their association with popular or folk heroes, whom the user knows only by reputation. Siegel's (1977) interviews with 85 cocaine users showed that they often found cocaine appealing because of its rarity, high price, and association with certain legendary figures. (See also Sandoval, 1977.) Winick, in his 1959 study of 409 jazz musicians, identified one of the factors influencing them to use marijuana as the use of drugs by several well-known modern jazz musicians. Drugs use was thus part of the image younger musicians emulated. Winick also refers to the "drug climate" in some bands, created by the attitudes of the band leader and other band members. In this environment, marijuana use became a norm.

Peer Group Influence

In addition to parents, or other adults who provide models for young people to
imitate, the peer group influences taste acquisitions, particularly for illicit drugs.
Blum's (1969) survey of 200 American adults found that, while parents introduce
their children to beer, wine, and spirits, peer groups influence adolescents to use a
wider range of substances: beer, wine, spirits, tobacco, marijuana, amphetamines,
narcotics, and other illicit drugs. Accounts of learning to use marijuana (Becker,
1953; Goode, 1970;,Harding and Zinberg, 1977) stress the importance of peers who
are experienced users, and who teach the novice how to use the drug, what
reactions he or she will have, and how to interpret these reactions. To the new
users, curiosity and mystery surround the first experience, seen as a kind of
milestone in their lives. The experience of first use is typically a "ritualized affair"
in a "secure setting" (Harding and Zinberg, 1977). Friends and familiar
environments help learning occur more efficiently.

Hollingshead (1949) reports that adolescents in Elintown learn to use tabooed substances (alcohol and tobacco) in the clique environment. If one's clique smokes and drinks, one learns to smoke and drink. Although some of Elmtown's adolescents had been allowed to drink with their families, they usually had their first drinks away from home with "best friends." Clique drinking among boys continued throughout high school. Among girls, the clique appears to have had a lesser influence; a girl smoked on a date only if her boyfriend smoked. This suggests that females learn to use drugs from male peers rather than from female peers, which is borne out by studies of marijuana use (Schaps and Sanders, 1970) and heroin use (Rosenbaum, unpublished). (See also Becker, 1974.)

Kandel's (1974) analysis of drug use among secondary school students in New York state provides further evidence of the role of friends in introducing adolescents to drug use. She found that the overall influence of parental drug use on adolescent illegal drug use is small, although marijuana use is correlated with maternal drug use and with maternal and paternal alcohol use. Best friend's self-reported use is more highly correlated with adolescent marijuana use. The effect of peers is thus far larger than the effect of parents. In fact, Kandel's data suggest that marijuana use, rather than any other school, religious, or recreational activity, is the single most important activity or characteristic friends have in common, other than such demographic characteristics as sex, age and race. Drug users are also more likely than nonusers to say that they learned most of what they know about drugs from their peers rather than from parents, teachers, or the media.

Interviews with heroin users (Powell, 1973 and Brown et al., 1971) also indicate that "friends and environments" influence whether or not a person uses heroin. The ritual of use helps maintain one's identity as part of a particular group.

A number of studies in the U.S. (McArthur et al., 1958; Salber et al., 1963; Blum et al., 1969) have reported tobacco use as a peer group phenomenon. These studies also show that parental and sibling smoking increase the likelihood of smoking and thus support the conclusion that people learn to smoke through exposure to smokers.

The media carry negative as well as positive messages with regard to drug use. In addition to anti-drug advertising campaigns, many television programs portray drug users in an unfavorable light. We do not know whether these messages reduce drug use or, on the contrary, glamorize and call attention to it. It is particularly difficult to measure media effects with regard to illicit drug use. Although some research shows that anti-smoking publicity has helped to reduce the number of smokers (Warner, 1977), teenage smoking has increased despite the anti-smoking campaign, and other studies find that media messages only strengthen existing tendencies (O'Keefe, 1971). Many researchers have concluded that the complexities of the issues involved have prevented accurately gauging media impact, and doubt that adequate data can ever be obtained (Liebert and Schwartzberg, 1977).

Learning to use substances, then, and learning the rules that accompany proper use is a process that involves input from familiar, respected, or pervasive sources. These sourceswhether parents teaching children to eat eggs for breakfast, teenagers teaching their best friends to roll marijuana cigarettes or television commercials encouraging beer drinkingtransmit knowledge about what is desirable to use, the way substances should be used, appropriate settings for use, benefits of use, etc.

The conflict between official control systems and people's micro-environments is especially clear when we consider the way large-scale institutions shape micro-environments. The substance use practices people learn from "drug sub-cultures" are to some extent a function of the existing control apparatus. For example, the heroin subculture in the U.S. and the very character of the heroin experience arise from the illegality of the drug, which in turn influences its cost, the "hustle" necessary to obtain the drug, and other features of heroin addiction.

SUMPTUARY RULES

Sumptuary rules specify who is eligible to use what substances with respect to such matters as age, sex, ethnicity, or socioeconomic status. (We do not always find direct statements of rules prohibiting substance use by occupants of particular statuses, and have sometimes made the argument indirectly, from evidence of non-random distributions of use.) These are other bases for eligibility as well-festive drinking in Tahiti and Bora Bora was traditionally confined to married adults (Lemert, 1964). Occupational status may also determine who is eligible to use substances: Carroll (1977) reports that, in Bolivia, coca is distributed to relay messengers, soldiers and court orators as an energizer, to facilitate performance of their duties.

Eligibility requirements based on broad social categories such as age, sex and class are often combined or overlapping. For example, adult and adolescent males, but not young boys, are allowed to drink in Samoa (Lemert, 1964), and sex-specific rules for drinking behavior vary by social class in the U.S. (Cahalan et al., 1969).

Eligibility requirements are also coupled with rules regarding appropriate occasions for use. Britons, particularly in the North, feel strongly that women should not enter public houses unless there is a special room set apart for them (Rowntree and Lavers, 1951). Similarly, women in the U.S. are more likely than men to drink at home and on weekends or holidays, rather than away from home and during the week (Maxwell, 1952). Hollingshead (1949) reports that the girls of Elintown snubbed and gossiped about by other girls who smoked "on the street", while boys were not subject to the same standards. Since the women's liberation movement in the U.S., these sex-specific rules are likely to have changed.

Age

Age is frequently a requirement for substance use. Adults allow children to use substances only for limited purposes: to prevent or treat illness, but rarely to facilitate work or "get high." The food habits of a culture, on the other hand, are quickly transmitted to very young children.

The use of many substances is frequently put off until adolescence or later, even if the child observes it from infancy. In the U.S., tobacco smoking incidence figures rise steadily across the 13-18 year age range (Williams, 1971). Similarly, children seldom drink coffee and alcohol, although they may repeatedly witness their parents using them. These and other "unpalatable" substances, for reasons that are unclear, become acceptable gradually as the child approaches adulthood. Rozin (1975) suggests that the initial negative response to the substances is overcome by the desire to attain adult status by eating and drinking what adults eat and drink. It may also be that children simply are not expected to need to achieve the purposes usually associated with these substances.

In addition to substances visible in the home in childhood, adolescents use other substances to which they are introduced by peers, particularly illicit drugs. Studies of heroin addicts in the U.S. have found the age range at first use to be from early to late adolescence: 14 (Proctor, 1971), 17 (Brotman and Freedman, 1968), 18-20 (Newmeyer, 1973), etc.

Some substances, used for the first time in adolescence, are rarely used by middle-aged or older adults. Calhoun (1975) found that the college students in his study of six U.S. suburbs used marijuana and hallucinogens much more frequently than did the adults. Heroin use in the U.S. is also most common among young adults and decreases in incidence with the onset of middle age. In general, it appears that illicit substances in the U.S. are most likely to exhibit this age distribution. While in some sense no one is eligible to use illicit substances, children and the elderly are less likely to participate in those social groups that allow their use (e.g., Winick, 1972).

Sumptuary rules sometimes identify kinds of substance use specifically appropriate for the elderly. Clinard (1962) reports that while drunkenness is not permitted in British pubs, "old timers" are given more freedom in this respect than others.

Sex

Sex-specific prohibitions and taboos regarding substance use occur frequently. The Tiv of Nigeria forbid women to eat pork (Mead, 1955). In some Latin American communities, men resist enriched corn or macioc meal because they believe it 'will cause impotence (Read, 1966). Further, there may be sex-specific rules for use even when both men and women are eligible to use; in the U.S., boys learn to "drink like a man" while girls learn to "eat like a lady."

The literature provides numerous illustrations of drugs used exclusively hymen. In Samoa (Lemert, 1964), most men drink beginning before the age of 15, but no drinking is observed among women. Similarly, Weil (1977) found that among the Cubeo Indians of the Amazon basin the women prepare coca leaves for men, who use coca every day from adolescence to old age, but women and children never use it themselves.

While there are few indications of drugs used by women and forbidden to males, there are some substances used predominantly by women but not prohibited to either sex (e.g., valium in the U.S.).

Sex specific rules are often associated with the reproductive cycle. The Zulu, for example, forbid milk to pregnant, lactating or menstruating women (Lee, 1957). In the U.S., pregnant women are encouraged to eat nutritious foods and to avoid such drugs as alcohol and tobacco.

The Jamaican lower classes smoke ganja more than the middle classes (Rubin and Comitas, 1976). Those who aspire to upward social mobility use ganja less, to avoid the stigma attached to ganja users by "respectable" community members.

In the U.S., class is associated with differential patterns of drinking. Inhabitants of Vansburg, Michigan (Stone, 1962) perceived the difference between "standing drinkers" and "sitting drinkers" as a characteristic class difference. The middle classes evaluated drinking accompanied by "spontaneous affective behavior" negatively, while certain taverns associated with the working class represented expressive drinking, where people are allowed to get "drunk and disorderly."

Societies enforce sumptuary rules, and other guidelines for substance use behavior by using positive and negative sanctions to reward those who use in a way appropriate to their social position, at the right times and in the right amounts; and to punish those who diverge from commonly held notions of appropriate substance use. The state and other official bodies typically use formal sanctions, while informal groups rely on such informal means as approval and disapproval, in the form of the awarding or withholding of prestige, rank, acceptance, admiration, disrespect, ostracism or ridicule.

Formal sanctions vary among societies depending upon the sanctions available to the ruling body. The U.S. government rarely uses formal sanctions to reward approved behaviors. Rather, they use such punishments as fines, prison sentences or official warnings for illicit drug use or for improper use of legal drugs. Informal sanctions tend to parallel formal sanctions. For example, the American community as a whole, following the lead of the law, tends to disapprove the use of heroin, the use of tobacco among minors, and the public display of drunkenness, regarding people who do these things as immoral, as well as unwise. Conversely, controlled drinking and non-use of illicit drugs is generally approved. However, within the U.S., the threatened formal sanctions of society-at-large and subcultural values and sanctions regarding substance use sometimes clash. A heroin user may gain prestige among his or her peers and enjoy being part of the "chemical elite" (Proctor, 1971), despite the threats of punishment from law enforcement agencies.

Clearly, formal sanctions are only available to a society's policy makers and enforcers. Informal sanctions have multiple sources, similar to the sources who teach people the rules for appropriate use. Children are subject to informal sanctions from parents, other authority figures, and peers, while adults are sanctioned primarily by their peers. In groups that deviate from the standards of the dominant culture, positive sanctions from peers and the rewards and benefits attributable to the substance used seem to offset the negative sanctions threatened by official institutions.

Many aspects of substance use are subject to sanctions. The quantity used, the way one behaves while "under the influence," as well as the circumstances under which substances are used are all culturally prescribed and reinforced by sanctions. Those who use the prescribed amount of a substance (which at an extreme, may be none at all) in prescribed ways will be approved and accepted by their peers, while those who use too much or too little of a substance in an improper manner with improper outcomes, will be disapproved by their peers and may be subject to formal punishments.

Informal negative sanctions are sometimes applied to people who fail to use enough of a prescribed substance. Field (1955) reports that drinking is a sign of manliness among Soviet manual workers, and those who do not join in are accused of being "weak sisters."

Controlled use or abstinence. Groups which value controlled use or abstinence reward that behavior and show disapproval of those who use substances to excess. The Chinese traditionally view heavy drinking as a disgrace and, when they become drunk, they try to "awaken" themselves by drinking hot tea (Moore, 1948). Similarly, during Prohibition in the U.S., public attitudes often associated sobriety with virtue and the use of alcohol with vice. Those who disapproved drinking believed that no one would be able to control his use successfully so that total abstinence was the only reasonable goal (Zinberg and Fraser, 1978).

Behavior "under the influence. " People often evaluate and sanction the effects of substance use as well as use itself, e.g., drunken comportment (behavior under the influence of alcohol). While drunkenness is shameful in some cultures, many other societies reward drunken behavior. Drunken men were usually treated with care and affection in 18th century Ireland (Bales, 1949). Similarly, in the Guatemalan village of Chamula, drinking is a necessary part of every social contact, and people assume a protective and conciliatory attitude toward a drunken man (Bunzel, 1940). Other societies in which no stigma is attached to the drunkenness of eligible users include the Samoans (Lemert, 1964), the Tarahumara of Mexico, and the Camba of Bolivia (MacAndrew and Edgerton, 1969). In many of these societies, drunkenness is a matter of Pride and is positively reinforced so long as it is limited to prescribed behaviors. The Mohave of Southern California and Arizona (Price, 1975) do not appreciably change their behavior when intoxicated, continuing to behave in a "quiet and reasonable manner." In contrast, drunkenness sometimes provides an opportunity for people to engage in otherwise forbidden activities. In Oaxacan 'villages, drunks have great social license-to shout insults, intrude uninvited into social gatherings, and behave in other normally unacceptable ways (Dennis, 1975). Among the Tarahumara, drunkenness allows people to engage in violence or extramarital sexual activity without sanction (MacAndrew and Edgerton, 1969).

Acceptable drunken comportment may also vary within a society, depending on the social context. In the traditional wine ceremony of the Papago Indians, people sing and are peaceful, but secular drinking is accompanied by aggressiveness (Price, 1975). Similarly, among the Kuma of New Guinea the use of a wild mushroom eaten all year long, produces "mushroom madness" only during certain seasons. Madness is a periodic expression of behavior normally disapproved, but there continue to be socially defined limits to behavior. Open aggression toward kinsmen is strongly disapproved even during mushroom madness (de Rios, 1973).

The ordinary routines of everyday life make some ways of using substances less troublesome than others, because doing things that way "fits in" with what others are doing best. People find it expedient to use substances in some ways, and inconvenient to diverge from conventional patterns. Ease or convenience, then, reinforces learned patterns of substance use and is a potent form of social control in its own right. Substance use practices that allow people to achieve desired states in the least troublesome ways vary by substance, setting, purpose of use, and by such user characteristics as sex, age, and class. It may be expedient to use some, none, or a lot of a substance depending on the substance, circumstances and conditions of use, and characteristics of the user.

People usually find it expedient to use substances in conventional amounts. Food, tobacco, and alcohol packaging all suggest how much is enough and how much is too much for use. Food portions served by restaurants determine a convenient amount to be eaten at a meal (Stunkard and Kaplan, 1977; Coll, et al., 1978). Similar packaging exists for illicit substances: a cokespoon holds 5-10 mg. of cocaine (Siegel, 1977); cigarette rolling papers hold limited amounts of marijuana.

However, one can frequently and not necessarily inconveniently buy and use more than one unit of a packaged substance. One can easily smoke and drink almost indefinitely despite the size of the cigarette or the drinking glass. Packaging may be most important in setting lower limits for how much is consumed; it would be wasteful and inconvenient to drink half a bottle of beer.

Conditions other than packaging set upper limits on how much of a substance one can conveniently use. For example, the emphasis on thinness in societies like our own makes it expedient to use limited amounts of food, since the obese person suffers many inconveniences. Seats in airplanes, buses and theaters are often too narrow. Clothing comes in limited sizes; wedding dresses are not made beyond size 10 and only a limited selection of styles are available for fat men and women (Strauss, 1966).

When others use. People find it expedient to use substances when other people do, on occasions designated as appropriate for substance use. At cocktail parties, we find it so expedient to drink that people who don't drink may hold a glass throughout the cocktail party in order to "fit in". It is similarly expedient to drink during community rituals in a variety of cultures. In some Latin American societies every public event or ceremony is marked by drinking.

People often rind it convenient to use substances at particular times of day; most people, for instance, eat certain meals at certain times. Lewin (1943) reports that in the U.S., people eat "according to the clock": a person waking at noon to go to work will eat foods appropriate for lunch, not breakfast. Particularly if one eats with others, it would be inconvenient to eat cereal for dinner. Restaurants usually do not even use the same menu at all times of the day.

As a sign of respect or politeness. In many societies, one can insult people by refusing food or drink. Among the Aymara, community leaders greeting community members are expected to invite them to partake of both coca and alcohol, and the offer should not be refused. Tribal "outcasts" are those who refuse to accept the "love" of their hosts by refusing to imbibe (Carter, 1977). Goldblatt et al. (1965) describe the eating habits of lower class Czechs, noting that there is a great deal of Sunday visiting during which people eat large quantities of food. Refusing second and third helpings at meals is considered impolite.

To facilitate another activity. Substance effects make it expedient to use substances at times when they facilitate planned activities, and to abstain when substance effects interfere with them. For example, U.S. drivers find it expedient to use coffee as a stimulant for long distance driving, but not before going to sleep. Damon (1973) found that the Bushmen of Botswana smoked tobacco in a rapid succession of deep inhalations to facilitate the "trance" state achieved during the medicine dance, their central ritual event.

Many substances interfere with ac tivities in which people must engage and are therefore inconvenient to use at certain times. Harding and Zinberg (1977) report that the marijuana users they studied agreed that they should not be high at work or at school. In the Peruvian community of Lunahuana (Simmons, 1962), drinking may occur on any occasion, at any time of the day, and anywhere, except in church where drinking would interfere with the required sobriety.

Eating speed may also be influenced by expedience. For example, people are likely to eat more quickly in fast food restaurants set up for quick meals, than in other kind of restaurants (Stunkard and Mazer, 1978).

Availability and Expedience

Substances are usually more available to people who are eligible to use. Availability also influences the differential convenience of using legal versus illicit substances. In the U.S., where alcohol is almost universally available, the majority of the drinking age population are considered light to heavy drinkers (U.S. Dept. of HEW, 1974). Illicit substances, relatively less convenient to obtain and use, are used to a lesser extent (e.g. Calhoun, 1975). Robins' (1973) study of 470 men who returned from Vietnam demonstrates that when substances were accessible and cheap, they were used relatively often. Most of the respondents reported that marijuana was always available in Vietnam and that at least half the men in their units used it regularly. Almost all men were personally offered narcotics and 43% reported that they had tried narcotics in Vietnam. After Vietnam, narcotics use declined, the two most important deterrents being risk of arrest and expense, both factors making use less expedient than it had been.

CONCLUSIONS AND, IMPLICATIONS

Our review of the way informal social controls affect substance use in a variety of settings suggests a number of conclusions and implications for public policy. We have also identified questions not yet adequately addressed by the research literature.

Research Needs

Purposes of use. The purposes for which people use substances appear to be a major explanatory variable when we look at different substance use patterns across and within cultures. Although some evidence suggests that these purposes of use are related to sociocultural factors, we need more comparative research on the role of cultural recipes in influencing individual reactions to substances. Further research is also needed to explore the extent to which conventions and recipes associated with substance use are practical means of achieving desired results. Similarly, to what extent are cultural recipes adaptive actions which "benefit" the users? To what extent can the origins of substance use patterns be traced to some sort of "community wisdom" regarding the effects of using a particular substance in a particular manner?

Learning to Use Within Multiple Environments. Individuals often learn to use substances within the context of a micro-environment that diverges from macro-environmental values and practices related to substance use. What characteristics of micro-environments can make them more effective in transmitting cultural recipes? To what extent, and under what circumstances do microenvironments reflect the values of macro-environments?

Differential Use Along the Life Cycle. Substance use practices vary within any given society depending upon user characteristics such as age, and sex. For example, in the U.S., heroin users are usually young adults or adolescents, but rarely middle aged or elderly, and women in many societies appear to be relatively immune to the use of particular substances. What mechanisms explain these differential patterns of use and how do these patterns vary across substances? To what extent are the purposes of use related to these patterns (e.g., are the young expected to achieve purposes different from those desired by adults?). What unique characteristics of adolescents, the elderly, women, and other population groups make them more or less likely to become involved with certain substances?

Expedience. It seems likely that expedience is one of the most potent informal social controls, yet we know little about it. How do cultural recipes and sumptuary rules become translated into social arrangements that make it expedient to adhere to these rules? In what situations does expedience cease to operate as an important control? (For example, people use heroin even when it is exceedingly troublesome to do so.)

Disapproved vs. Approved Substances. We know more about the role of both formal and informal controls in the case of the use of disapproved substances than in the case of approved substances. Research is focused on matters that are considered problems, not on matters that seem to be working well and causing no difficulty. Thus, we know more about controls on drugs and alcohol than about controls on food and cigarettes. We need to know a great deal more about the way people acquire eating preferences, schedules and habits, for instance, for these data would tell us what kinds of patterns might develop if we deregulated substances now affected by formal legislative controls.

Informal social controls usually embody the view of the immediate consumers of substances. Conversely, formal controls embody the views of officials and others responsible for maintaining an image of the society as doing well and in good shape, and who have to answer in some venue for the results of their policies. Informal social controls arise and are maintained through constant adaptation as they are applied situationally, while formal controls, once enacted, remain fixed with occasional formal revisions. Informal controls are thus more flexible.

There is no simple relationship between the operation of formal or informal controls, on the one hand, and resulting morbidity and pathology, on the other. It seems likely that accurate information with respect to how to best achieve the most desirable substance effects and to avoid the most harmful ones, from various points of view, would probably be more advantageous to the user than inaccurate information. But there is no guarantee that official controls will either be based on or promulgate accurate information (Becker, 1974). Empirical investigation in each case of substance use must determine whether or not the people who create and enforce informal controls are more knowledgeable about substance effects, benefits and hazards than those who enforce and create formal controls.

Policies that rely on informal mechanisms. When we speak of policy implications we are talking about formal social controls, for we can hardly have a policy about informal controls. Almost by definition, we cannot legislate such matters as what young people will tell each other confidentially about their experiences with substance X. What we can legislate is what kinds of substances will be legally available, in what form, in what quantities, subject to what taxes, with what penalties for violation of the applicable regulations, and so on. We can have a policy about informal controls only in two senses: we can leave the regulation of substance use to informal controls and we can take actions that will have a second order effect on substance use. That is, we may discourage substance use by making rules that make it inconvenient to use the substance in certain ways. Thus, we might forbid the sale of soft drinks in school cafeterias or forbid the provision of ashtrays in various places. The laws regulating the hours during which alcohol may be purchased are designed to work this way. Similarly, while we cannot make a policy about what people tell each other about their drug experiences, we can make information available which could be passed on through those same channels. Presumably drug education works best when it operates through informal channels.

The characteristics of informal and formal controls lead us to suggest decreased regulation of illicit substances. There has been little reliance on informal control mechanisms in the past, yet these may be effective policy alternatives for controlling substance use and addiction.

REFERENCES

Aronson, Naomi
1978 "Fuel for the Human Machine: The Industrialization of Eating in America." (Unpublished dissertation, Brandeis University)

Aberle, David
1966 The Peyote Religion Among the Navajo. Viking Publications in Anthropology Number 42. New York: Wenner-Gren Foundation for Anthropological Research, Inc.

Agar, Michael
1977 "Into That Whole Ritual Thing: Ritualistic Drug Use Among Urban American Heroin Addicts." In Brian du Toit (ed.) Drugs, Rituals and Altered States of Consciousness. Rotterdam: A.A. Balkena.

Bales, Robert
1949 "Cultural Differences in Rates of Alcoholism." Quarterly Journal of Studies on Alcohol 6:480-99.

Becker, Howard S.
1963 Outsiders: Studies in Sociology of Deviance. New York: The Free Press. 

Becker, Howard S.
1974 "Consciousness, Power and Drug Effects." Journal of Psychedelic Drugs. 6 (1): 67-76.

Blum, Richard and Eva Blum
1969 "A Cultural Case Study: Temperate Achilles." In Blum et al. (ed.) Society and Drugs. San Francisco, CA: Jossey-Bass, Inc.

Blum, Richard and Associates
1969 Society and Drugs. San Francisco, CA: Jossey-Bass, Inc. 

Brant, Charles
1950 "Peyotism Among the Kiowa-Apache and Neighboring Tribes." Southwestern Journal of Anthropology. 6:212-222.

Brown, Barry et al.
1971 "Addicts' Reasons for Initiating and Withdrawing From Heroin." The International Journal of Addictions. 6 (4):635-645.

Bunzel, Ruth
1940 "The Role of Alcoholism in Two Central American Cultures." Psychiatry, 3:36187.

Cahalan, Don; Ira Cisin and Helen Crossley
1969 American Drinking Practices. New Haven, CT: College and University Press.

Calhoun, J. F.
1975 "An Examination of Patterns of Drug Use in Six Suburban Groups." The International Journal of the Addictions. 10 (3):521-538.

Carroll, Eleanor
1977 "Coca: The Plant and Its Use." In National Institute on Drug Abuse Research Monograph 13, Cocaine: 1977 . Washington, DC: U.S. Department of Heald- Education, and Welfare.

Carter, William
1977 "Ritual, the Aymara, and the Role of Alcohol in Human Society." In Brian du Toit (ed.) Drugs, Rituals and Altered States of Consciousness. Rotterdam: A. A. Balkena.

Chopra, R. N.; G. S. Chopra and 1. C. Chopra
1942 "Alcoholic Beverages in India." Indian Medical Gazette. 77:225-230.

Clinard, Marshall
1962 "The Public Drinking House and Society." In Pittman and Snyder (eds.) Society, Culture and Drinking Patterns. New York: John Wiley.

Coll, Milton; Andrew Meyer and Albert J. Stunkard
(no "Obesity and Food Choices in Public Places." (Unpublished paper).date)

Cosminsky, Sheila
1977 "Alimento and Fresco: Nutritional Concepts and Their Implications for Health Care." Human Organization. 36 (2):203-207.

Damon, Albert
1973 "Smoking Attitudes and Practices in Seven Preliterate Societies." In W. Dunn (ed.) Smoking Behavior: Motives and Incentives. Washington, DC. V. H. Winston & Sons, Inc.

Dennis, Philip
1975 "The Role of the Drunk in a Oaxacan Village." American Anthropologist. 77:856863.

de Rios, Marlene Dobkin
1973 "The Non-western Use of Hallucinogenic Agents." In National Commission on Marijuana and Drug Abuse, Drug Use in America: Problem in Perspective. Appendix Vol. 1. Washington, DC: U.S. Government Printing Office.

Field, Mark
1955 "Alcoholism, Crime, and Delinquency in Soviet Society." Social Problems. 3 :100108.

Fonaroff, Arlene
1968 "Differential Concepts of Protein-Calorie Malnutrition in Jamaica: An Exploratory Study of Information and Beliefs." J. Trop Pediat. 14 (2):82-106 (Monograph No. 4).

Gagnon,John
1977 "Environment and SeIf-Control in Substance Abuse." In Proceedings; Conference on Commonalities in Substance Abuse and Habitual Behavior. Committee on Substance Abuse and Habitual Behavior, National Research Council.

Goldblatt, Phillip; Mary Moore; and Albert Stunkard
1965 "Social Factors in Obesity." Journal of the American Medical Association. 192 (12):97-102.

Goode, Erich
1970 "Turning On: Becoming a Marijuana User." In Goode (ed.) The Marijuana Smokers. New York: Basic Books.

Groves, W. Eugene
1974 "Patterns of College Student Drug Use and Life Styles." In Josephson and Carroll (eds.) Drug Use: Epidemiological and Sociological Ap proaches. Washington, DC: Hemisphere Pub. Co.

Harding, Wayne and Norman Zinberg
1977 "The Effectiveness of the Subculture in Developing Rituals and Sanctions for Controlled Drug Use." In Brian du Toit (ed.) Drug, Rituals, and Altered States of Consciousness, Rotterdam: A. A. Balkena.

Hollingshead, August
1949 Elmtowns Youth. New York: John Wiley.

Horn, Daniel; Frederick Courts; Robert Taylor; and Erwin Solomon
1959 "Cigarette Smoking Among High School Students." Am. J. Publ. Health. 49:14971511.

Kandel, Denise
1974 "Interpersonal Influences on Adolescent Illegal Drug Use." In Josephson and Carroll (eds.) Drug Use: Epidemiological and Sociological Approaches. Washington, DC: Hemisphere Pub. Corp.

Kramer, Esther
1973 "A Review of Literature Relating to the Impact of the Broadcast Media on Drug Use and Abuse." In National Commission on Marijuana and Drug Abuse, Drug Use in America: Problem in Perspective. Vol. II. Washington, DC: U.S; Government Printing Office.

Kramer, John
1977 "The Dope Magazine; a New Cultural Phenomenon." In The EthnoPharmacology Society Newsletter. 1 (2).

La Barre, Weston
1969 The Peyote Cult. New York: Schocken Books.

Lee, Dorothy
1957 "Cultural Factors in Dietary Choice." American Journal of Clinical Nutrition. 5 :166170.

Lemert, Edwin
1964 "Drinking in Three Polynesian Societies." American Anthropologist. 66:361-74.

Levy, Jerold and Stephen J. Kuntz
1974 Indian Drinking. New York: John Wiley & Sons.

Lewin, Kurt
1943 "Forces Behind Food Habits and Methods of Change." National Research Council Bull. 108. Washington, DC: National Academy of SciencesNational Research Council.

Liebert, R. M. and N. S. Schwartzberg
1977 "Effects of Mass Media." Annual Review of Psychology. 28:141-73.

Lolli, Giorgio et at.
1958 Alcohol in Italian Culture. Glencoe, ILL: The Free Press.

McArthur, C., E. Waldron and J. Dickinson
1958 "The Psychology of Smoking." Journal of Abnormal Social Psychology. 56:267-75.

MacAndrew, Craig and Robert Edgerton
1969 Drunken Comportment. Chicago, ILL: Aldene Publishing Co.

Maxwell, Milton
1952 "Drinking Behavior in the State of Washington." Quarterly Journal of Studies on Alcohol. 13:219-39.

Mead, Margaret
1953 Cultural Patterns and Technical Change. Paris: United Nations Education, Scientific and Cultural Organization.

Meyer, Alan; Lucy N. Friedman and Paul Lazarsfeld
1973 "Motivational Conflicts Engendered by the On-going Discussion of Cigarette Smoking." In W. Dunn (ed.) Smoking Behavior: Motives and Incentives. Washington, DC: V. H. Winston & Sons.

Moore, Merrill
1948 "Chinese Wine: Some Notes on its Social Use." Quarterly Journal of Studies on Alcohol. 9:70-9.

Mouchot, Gabriel
1955 "Letter from France." International Journal on Alcohol and Alcoholism. 1:75-84.

Newmeyer, John
1973 "The Watergate-Era Junkie: Observations on the Changing Face of Heroin Addiction in San Francisco." Unpublished paper. Haight-Ashbury Medical Clinic, San Francisco, CA.

O'Keefe, Timothy
1971 "The Anti-smoking Commercials: A Study of Television's Impact on Behavior." Public Opinion Quarterly. 35:242-248.

Powell, Douglas H.
1973 "A Pilot Study of Occasional Heroin Users." Archives of General Psychiatry. 28:586-594.

Preble, Edward and Thomas Miller
1976 "Methadone, Wine and Welfare." Unpublished paper presented at the Workshop on the Ethnography of Drugs and Crime, 1976.

Price, John
1975 "An Applied Analysis of North American Indian Drinking Patterns." Human Organization. 34 (1):17-26.

Practor, Mac
1971 "The Habit." International Journal of the Addictions. 6 (1):5-18.

Read, Margaret
1966 Culture, Health and Disease. London: Tavistock Publishers.

Robins, Lee
1973 The Vietnam Drug User Returnss, Special Action Office for Drug Abuse Prevention. Washington, DC: U.S. Government Printing Office.

Rosenbaum, Marsha
1978 Unpublished Research Reports.

Rowntree, B. S. and G. R. Lavers
1951 English Life and Leisure. New York: Longmans, Green.

Rozin, P.
1975 "Psychobiological and Cultural Determinants of Food Choice." Dahlem Workshop on Appetite and Food Intake.

Rubin, Vera and Lambros Comitas
1976 GanJa in Jamaica. New York: Anchor Press.

Salber, E.; R. Reed; S. Harrison and J. Green
1963 "Smoking Behavior, Recreational Activities and Attitudes Toward Smoking Among Newton Secondary School Children'' Pediatrics. 32 (5):911-918.

Sandoval, Mercedes Cros
1977 "Patterns of Drug Abuse Among the Spanish-speaking Gay Bar Crowd." In Brian du Toit (ed.) Drugs, Rituals, and Altered States of Consciousness. Rotterdam: A. A. Balkema.

Schaps, Eric and Clinton R. Sanders
1970 "Purpose, Patterns, and Protection in a Campus Drug Using Community." Journal of Health and Social Behavior. 2 (2):135-145.

Schneider, F. W., and L. A. Vanmastrigt
1974 "Adolescent-Pre-Adolescent differences in Beliefs and Attitudes About Cigarette Smoking." Journal of Psychology. 87:71-81.

Schwartz, Elaine; Sanford Feinglass; and Carol Drucker
1973 "Popular Music and Drug Lyrics: Analysis of a Scapegoat." In National Commission on Marijuana and Drug Abuse, Drug Use in America: Problem in Perspective Vol. II. Washington, DC: U.S. Government Printing Office.

Siegel, Ronald K.
1977 "Cocaine: Recreational Use and Intoxication." In National Institute on Drug Abuse Monograph 13, Cocaine: 1977. Washington, DC: U.S. Department of Health, Education, and Welfare.

Simmons, Ozzie
1962 "Ambivalence and the Learning of Drinking Behavior in a Peruvian Community." In Pittman and Snyder (eds.) Society, Culture, and Drinking Patterns. New York: John Wiley.

Snyder, Charles
1962 "Culture and Jewish Sobriety: The Ingroup-outgoing Factors." In Pittman and Snyder (eds.) Society, Culture, and Drinking Patterns. New York: John Wiley.

Spradley, James
1978 "Substance Use: Context, Meaning, and Informal Control." Unpublished paper presented at the Conference on Issues in Controlled Substance Use, Stanford, California, June 2.

Spradley, James
1973 "The Enthnography of Crime in American Society." In Nader and Maretzki (eds.) Cultural Illness and Health. Washington, DC: American Anthropological Association.

Stivers, Richard
1976 A Hair of the Dog. University Park, PA: Pennsylvania State University Press.

Stone, Gregory
1962 "Drinking Styles and Status Arrangements." In Pittman and Snyder (eds.) Society, Culture, and Drinking Patterns. New York: John Wiley.

Straus, Robert and Selden Bacon
1953 Drinking in College, New Haven, Conn: Yale University Press. Stunkard, Albert and 

D. Kaplan
1977 "Eating in Public Places: A Review of Reports of the Direct Observation of Eating Behavior." International Journal of Obesity. 1 :89-101.

Department of Health, Education, and Welfare
1974 Alcohol and Health. Second Special Report to the U.S. Congress. National Institute on Alcohol Abuse and Alcoholism. Washington, DC: U.S. Department of Health, Education, and Welfare.

Weil, Andrew
1972 The Natural Mind: A New Way of Looking at Drugs and the Higher Consciousness. New York: Houghton Mifflin Co.

Weil, Andrew
1977 "Coca Use in the Amazon Basin." In Proceedings of the Conference on Commonalities in Substance Abuse and Habitual Behavior. Committee on Substance Abuse and Habitual Behavior, National Research Council.

Whittaker, John
1962 "Alcohol and the Standing Rock Sioux Tribe." Quarterly Journal of Studies on Alcohol. 12:468-79.

Winick, Charles
1972 "Maturing Out of Narcotic Addiction." Bulletin on Narcotics. 14:1-7. 

Winick, Charles
1973 "A Content Analysis of Drug Related Network Entertainment Prime Time Programs 1970-72." In National Commission on Marijuana and Drug Abuse, Drug Use in America: Problem in Perspective. Vol. II. Washington, DC: U.S. Government Printing Office.

Zinberg, Norman; W. M. Harding and M. Winkeller
1977 "A Study of Social Regulatory Mechanisms in Controlled Illicit Drug
Users." Journal of Drug Issues. 7:117-133.

Zinberg, Norman and Kathleen Fraser
1978 "The Role of the Social Setting in the Prevention and Treatment of
Alcoholism." Accepted for publication in J. H. Mendelson (ed.) Diagnosis
and Treatment of Alcoholism.

Zinberg, Norman; Wayne M. Harding, Shirley M. Stelmack and Robert A.
Marblestone
(in "Patterns of Heroin Use." Annals of the New York Academy of Sciences. press)