The problem of drug use, like any social problem, is susceptible to various epistemological interpretations. It is a complex and multifactorial social problem for its causes and consequences and its components and implications. In this way, it can be viewed from different perspectives, each emphasizing certain aspects and proposing a particular approximate position.
The multiple elements involved determine the complexity of aspects that must be considered to understand and address this social problem fully. All drug use implies the presence of a person who makes a behavioral choice. Still, it also supposes a peculiar reaction of the organism before the action of a chemical substance, as well as social scenarios with many conditioning variables. We discuss a phenomenon with multiple implications: psychological, medical, biochemical, sociological, ethnological, legal, economic, political, educational, historical, ethical…
This complexity should invite us to contemplate the drug use problem without any reductionism or partial interpretation. However, the specific training of the researchers and professionals who deal with it has created different interpretive models –sometimes formulated in an irreconcilable way, unfortunately– which, in any case, also provide interpretative richness, provided that the researcher can maintain away from the reductionism as mentioned above since this will prevent exploring all the implications of the phenomenon.
In general terms, we can distinguish nine major interpretative contributions that we will analyze separately in this article: legal model, consumption distribution model, traditional medical model, harm reduction model, social deprivation model, model of socio-structural factors, model health education, individualistic psychological model and socio-ecological model. The latter is presented with a certain vocation for synthesis since it intends to collect the other interpretations’ relevant findings and propose overcoming its shortcomings and limitations. In any case, the socio-ecological perspective comes fundamentally from the social sciences, and, despite the vocation mentioned above for integration and overcoming reductionism, its explanation can only be understood by attending to the contributions of the other models. For this reason, we will systematize the characteristics of the aforementioned theoretical interpretations in this work to present a vision as exhaustive as possible of the problem of drug use.
However, before fulfilling the main purpose of this work, it is necessary to establish some basic questions about the concepts we will deal with to delimit them conceptually.
We will start from the classic definition of a psychoactive drug provided by the World Health Organization (WHO), which is understood as any substance that, when introduced into the body, modifies any of the functions of the central nervous system (Kramer and Cameron, 1975). In other words, a psychoactive drug will be a chemical substance capable of affecting the psyche, regardless of its sociological classification.
The Concept Of The Sociological Situation Of Drug
The preceding leads us to consider the concept of the sociological situation of drugs in industrialized societies and to differentiate three possibilities (Berjano and Musitu, 1987):
- Institutionalized Substances:
They maintain a status of controlled legality in their production, distribution, advertising, and consumption, in addition to receiving mostly uncritical evaluations from the social environment. This is the case with alcohol and tobacco.
- Non-Institutionalized Substances:
They maintain a status of illegality in the indicated items and receive mostly critical evaluations from the social environment.
- Institutionalized Substances With The Possibility Of “Diverted” Use:
Substances manufactured for medical purposes can be “diverted” from their original purpose to be consumed for recreational purposes.
The WHO highlights that tobacco and ethyl alcohols are the widely consumed psychoactive drugs in industrialized societies and those that are associated with the greatest public health problems, which is why they should not be separated from the generic consideration of drugs nor contemplated. to a lesser degree of harmfulness concerning non-institutionalized substances (World Health Organization, 2000).
It will also be necessary to differentiate concepts related to drug consumption levels and addiction. The term “use” refers to the ingestion of a substance by a person at a given time. It is, therefore, a generic concept and should be understood as such. Drug use will not always be addictive; the latter refers to a pattern of behavior definable in clinical terms, characterized by the prioritization of the consumption of a particular substance over other daily behaviors, by the appearance of withdrawal symptoms in the face of deprivation and by the impossibility of the person to control their consumption (American Psychiatric Association, 2002).
Addiction is not the only form of drug use related to health damage. Abusive consumption, even without necessarily being addictive, represents a type of health risk, both due to the morbidity associated with the toxicity of the substances and due to the interference that the psychoactive effect can exert on certain behaviors. Thus, it will be possible to differentiate between two forms of abusive consumption (Pons, 2007):
- Quantitative abusive consumption: the consumption of a particular substance in an amount and frequency that exceeds the tolerable limits for maintaining the health of the consuming person.
- Qualitative abusive use: using a particular substance associated with particular circumstances and regardless of frequency: driving, work use, child use, among others.