Dr. Pittman, et al, discuss the role of social control, particularly through the legal and medical institutions, in determining the behavior of individuals toward the use of alcohol and other drugs. The authors define social control as a means of inducing compliance with norms. The degree of force used in social control may range from the minimal use of threat or ultimatum to more control by invoking fines, curfews or censorship of media, to more force, such as hurting or killing the individual.
The political institution, as represented by the legal system, plays a major role in reflecting society's basic attitudes towards drugs. Whether a drug will be criminalized, decriminalized, or legalized is determined by the governing images held toward that drug. Example, South Americans in the Andes have been chewing on the leaves of cocoa plants for centuries. Dutch researchers have presented papers which discuss the recreational use of cocaine by individuals Who do not become addicted. But in the U.S., the governing orientation of the mass public is that cocaine and its derivative, crack, produce instant addiction and are killer drugs. Alcohol, a drug widely accepted in Western society is criminalized in the fundamentalistic Islam societies of Iran and Libya.
Using alcohol as the example, Pittman outlines the general areas of state involvement as defining the who, what, where, and when of purchasing and consumption, as well as the cost and form of payment, and the unacceptable consequences of drinking. The legal institution is also concerned with the social consequences of drinking, which Pittman lists as drunkenness, alcoholism, vehicular, and other alcohol-related (criminal behaviors that occur when alcohol is ingested). American law has typically held that drinking, intoxication and alcoholism are not defenses against the commission of a crime.
In thc U.S., medical institutions have assumed increasing responsibility for alcohol control. For instance, the diagnosis and treatment of alcoholism are medical activities. Given their overlapping roles, the medical and political instituions can collide over alcohol and other drug issues. The authors cite the examples of pregnant addicts and liver transplantation for alcoholics as situations with shared concern. To what extent should the state regulate the lives of pregnant women who are alcohol or drug dependent? Pittman points out that the women who are most likely to have babies affected by alcohol and cocaine are non-white poor and have received limited prenatal care. He believes the lack of a national health insurance plan in the U.S. has made the situation worse. "Some law enforcement officials are now strong advocates of criminalizing the pregnant addict--sending her to jail rather than to a hospital."
Part of the 20th century rise to pre-eminence of the medical institution is the increase in responsibility for social control of alcohol. Prescriptions are a form of medical control of drugs. The physician is thus a major gatekeeper. There is no consensus in American society over the nature of alcohol and other drugs problems. The most obvious example is in the basic disagreement over whether these problems are caused by the agents or the hosts. Even when there is agreement on the nature of the problem, there is considerable disagreement over appropriate responses.
Finally, Dr. Pittman reminds us that attitudes about alcohol and other drugs are cyclical in the United States and Britain, and that the tension between the legal and medical institutions is one of the stimuli for change and evolution.
Pittman, David J, Staudenmeier, William J. Jr., and Kaplan, Abe, Alcohol and other drugs: the response of the political and medical institutions., British Journal of Addiction 1991: 86;967-75.
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