What leads a person to use drugs and alcohol?
Peer pressure? Depression? Genetics? Through various personal and educational experiences, we develop ideas about what does and does not lead to addiction. These beliefs are wide-ranging and rarely encompass only one facet of a person's life. In the research conducted for my master's thesis, I utilized cognitive anthropological methods to conceptualize and visualize how undergraduates at the University of Alabama think about the etiology of addiction. A group of undergraduate students participated in a free-listing exercise and identified 28 factors that they believed increased an individual's risk in developing a substance use disorder. These included factors that stemmed from a person's social or family life, as well as to psychological problems that could lead an individual to self-medicate with drugs/alcohol. Further, students identified innate, biological characteristics of the person or the substance and hedonistic causes that could influence an individual's likelihood of continuing to use drugs.
How do these beliefs relate to the tendency to stigmatize people with addiction?
This collection of ideas about the causes of a particular mental illness are referred to as "folk psychiatry" or "ethnopsychiatry," and these have been shown to be guiding factors behind public attitudes of individuals with mental illness. I found that among undergraduates at the University of Alabama, there are two guiding ideologies for understanding addiction: the Medical and the Moral. Those who adhered to the Medical model prioritized the Self-Medication and the Biological factors when explaining addiction, while those who adhered to the Moral model preferred the Social and Hedonistic causes for explaining why a person would develop substance use disorders. I found that those who adhered to the Medical model stigmatized significantly less than individual's with the Moral model.
Are there cross-cultural differences in these causal beliefs?
In the summer of 2017, I conducted pilot work in the city of Ribeirão Preto, SP, Brazil. Much like in the US, university students in Brazil are at extreme risk of developing problematic substance use behaviors, so I am particularly interested in how they think about and understand addiction. The sample consisted of students who attended either the University of São Paulo - Ribeirão Preto or Paulista University. Many of the factors identified by the American sample were present in the Brazilian sample, and residual agreement analysis identified two perspectives that at first glance are similar to the medical and moral perspectives found in the American sample. One group of people emphasized the Self-Medication and Familial risk factors (termed the Psycho-Familial perspective) and another group emphasized the Social and Hedonistic risk factors (termed the Moral perspective)
Is there a similar relationship between between perspective and attributed stigma in Urban Brazil??
Yes and No. There is a significant relationship between how individuals understand substance misuse risk and the extent to which they stigmatize someone with substance use disorders, but it was in the opposite direction of the American sample. Individuals who overemphasized the Self-Medication and Familial risk factors stigmatized more than individuals who overemphasized the Social and Hedonistic risk factors. There are several explanations for this, each tying to the differences in the cultural meaning of the social and familial causes. Brazilians viewed the social causes as situational and temporary -- that is, it’s what young people do and therefore, substance use is something that’s easy to grow out of. In contrast, when Americans believed that individuals primarily used substances because they needed them to self-medicate either physical or psychological problems, these individuals weren’t seen as dangerous, but rather, deserving of help. They had the potential to get better – they weren’t bad people for using substances, they just needed proper treatment. But, the Brazilian “Psycho-Familial” emphasis was more firmly tied into an individual’s home and family life. And, often, these circumstances are seen as impossible to escape from. Therefore, it’s these people that are dangerous, because they’re less likely to change.
Do individuals with substance use disorder interpret these factors in the same way?
In order to test whether there is a relationship between GP understandings and TG internalized beliefs, I performed non-metric multi-dimensional scaling on all 29 of the rating task items. Essentially, this analytic technique converts differences between individual response profiles to physical distance in two-dimensional space. Individuals that appear closer together on the MDS plot collectively rated all of the risk factors similarly, while those that appear further away had significant differences in the ways that they performed the rating task.The young adults cluster at the center, forming a cultural core of understanding, and patients gradually disperse from that core model in various directions. This suggests several things. First, it demonstrates that there are not 2 separate cultural models for the two sample types. Rather, the GP form the core of the model and the patients vary from this model in alternative ways. While there are differences in the ways that members of the general public understand substance misuse risk, there are far more differences in terms of the ways that the patients come to internalize and believe in the influence of particular risk factors. The graph demonstrates visually that the young adults provide a representation of a “core model” that the patients are moving away from in different ways. In other words, the patients are not starting from scratch, but rather are beginning from the shared cultural model and then using their personal experience to guide their shifts away from or towards the center of the cultural model.
