Drug & Alcohol Effects: drug, set and setting.

Drug properties, individual psychology and the context of the drug use are all important factors which influence drug effects. 

Psychoactive drugs (including alcohol) have predictable and stable effects on individuals. If you wish to be more sociable and the life and soul of a party have a drink of alcohol if you wish to encourage creative thought then simply inhale a steady dose of cannabis. Grab that quiet retiring friend and share an incredible boost with that well-known confidence giver - cocaine. 

Of course, the above points are wrong – very wrong. ‘The idea that specific drugs have fixed and predictable effects which are the same from person to person is extremely widespread, but it remains a fallacy’ (Gossop 2000, P16). Unfortunately though simple attributions of drugs, like these, saturate our society and encourage an ignorant but understandably stereotypically view of drugs. 

The reality regarding drug effects is that what we objectively perceive (and subjectively feel) is the culmination of an incredibly complex and multifaceted process. Zinberg (1984) argued that to understand what impels someone to use an illicit (and licit) drug, and how that drug affects the user, three determinants must be considered: The drug (the pharmacological action of the substance itself); The set (personality, attitudes and expectancies, physical condition of the user); and, The setting (the influence of the physical and social setting within which the use occurs). Each will be examined in turn, together with relevant research and then attempts will be made to provide a logical summing up of how these factors impact collectively on the effects of drug-taking.

The simplest classification system that may be used to organise psychoactive substances is by their rudimentary effects (McBride, 2002). Stimulants (i.e. cocaine, amphetamine, nicotine) generally wake you up, give you the subjective sense of more energy. Depressants (i.e. alcohol, benzodiazepines) calm you down, make you drowsy and even put you to sleep. Hallucinogens (i.e. Lysergic Acid Diethylamide, Psilocybin) alter your perception of the world; distort your experience of things.  

However, this basic system of classification is not adequate, and it as been routinely pointed out that even substances with similar structures can have differing (even opposite) effects on the individual (McBride, 2002), alluding to the role individual differences and context (or ‘set’ and ‘setting’, Zinberg, 1984) play in drug effects. 

We can also provide information of individual mechanisms of action for particular drugs. All psychoactive drugs affect the brain or the central nervous system (CNS). The effects of some of the drugs categorised above are mediated through several different endogenous chemical substances (neurotransmitters) acting through a vast complex of intercellular communications that strike a balance between excitatory (acting) and inhibitory (preventing) function. Certain drugs can increase the release of a neurotransmitter, resulting in enhanced synaptic levels of the endogenous substance, an increase in postsynaptic receptor activity and, therefore, a greater functional effect. Amphetamine, for example, is known to increase the release of the neurotransmitter dopamine. Cocaine, however, is known to prevent the re-uptake of dopamine. If we take alcohol, the most widely used psychoactive substance in the world after caffeine (Gossop, 2000), we know that is acts upon gamma-aminobutyric acid (GABA) and in turn, affects the production of dopamine in the CNS. 

This micro-level view of the effects of drugs is an ever-expanding area, but while this is not the place for a detailed discussion, what we can extrapolate are important principles of how drugs can affect us at a biological level. Further drug properties/factors which can influence the effect of drugs is most obviously the amount of the drug (the dose, and the number and timing of such doses);  the site of administration into the body to its target organ(s) or tissue(s) (i.e. the route), for example, a drug taken intravenously will have a quicker and stronger effect upon the individual than a drug swallowed and thus entering the system via the stomach (leading also to the rate of absorption); the rate of distribution around the body; the rate of metabolism; and finally the rate of elimination. Furthermore, individual physiology contributes to such processes. Gender (Gossop, 2000), genetic predisposition (Badaway, 1996), and hereditary (Heath, 1995) have all been shown to affect the effects of drugs (and the propensity for addiction). 

It seems that a person’s personality type can influence the effect of drugs (Otter and Martin, 1996). Introverts are much more resilient to the effects of depressants (i.e. alcohol) than extroverts, while the opposite is true when it comes to stimulants (i.e. cocaine). It has been shown that the same dose of a sedative can affect more than 95 per cent of extroverts, while less than 10 percent of introverts (Gossop, 2000). This surprising phenomenon is incongruent with the basic classification of drugs based on their effects mentioned earlier. 

The beliefs and expectations a person holds regarding a drug can have a significant effect on its effect. Everybody has some idea of what will happen when they use a particular (or a combination of) drug(s). These beliefs may be based upon health messages portrayed by others and the media (Zinberg, 1984), through observation of the effects the drugs have had on others (‘vicarious modelling’, Bandura, 1977) or themselves in the past (‘Expectancy theory’, Tolam, 1932), and importantly the person’s belief of their ability to change the behaviour of a drug is important. (‘Self-efficacy’, Bandura, 1977). 

Similarly, it is also a person’s perception of the physiological effects of a drug that can greatly influence their subjective/objective effects.  A Swedish study demonstrated that a user’s beliefs regarding the potential effect of a drug were powerful enough to change the user’s response to the actual pharmacological effect of the drug. (cited in Gossop, 2000).  Experimenter’s suggestions that a group taking a placebo would become tired produced as great sedation in a group taking a sedative. 

This is true of their perception of their emotional state before, during and after taking a drug. The label a person attaches to a feeling or physical state is an extremely important factor in how drugs can affect us. Two well-known studies (Schachter & Singer, 1962; Becker, 1953) have ingeniously demonstrated that the expectations and beliefs we have regarding a drug and its (expected) effects greatly influence the label we attach to the experience, and in turn the effect of the drug. If we are fully informed and accurately aware of the effects of a drug then we are less responsive to external cues when interpreting these effects. If we experience (cognitive) dissonance when feeling the effects of the drugs -  that is the effects we feel were not what we expected or we had no idea what to expect - then we are more likely to be influenced by outside cues and adopt an interpretation (or label) similar to that presented (i.e. sitting in a room with an exuberant confederate after a dose of adrenalin will create an exuberant subject if they were misled about the effects of the adrenalin – they attached a ‘label’ based upon the external cue and behaved similarly. If the subject was correctly informed of the effects of adrenalin then their ‘label’ was not affected by the external cue and therefore their behaviour did not match that of the confederate, Schachter & Singer, 1962). This phenomenological approach is natural in humans, we constantly search for meanings (Gestalt psychology) and if such meaning is yet to be defined then we may look externally to create it. 

The context in which drug-taking occurs brings with it major implications for the subjective/objective effects of such drugs. The potential for the setting in which a drug is used (and the people in it) to affect our beliefs, attribution and labelling of that drug (and then to influence the effects) has been mentioned. However, there are many more factors at a societal level which can influence.

Availability and access to drugs is a noteworthy point.  The drugs have to be there in the first place for them to be taken. When drugs become more available they are more likely to be used (McBride, 2002). Furthermore, when certain drugs become widely used (i.e. cannabis in contemporary times) due to availability and/or access then the elements of a person’s psychological ‘set’ (see previous) are open to change. If most of your friends start smoking cannabis, you will not only have greater access to the drug but you may well also find your previously held beliefs/attitudes changing with vicarious modelling, normalisation and other processes coming into play due to the increase in availability and access.

An individual’s social and environmental circumstances also can play an important part. Factors such as poverty, geography (closely linked to availability and access), employment, ethnicity, age, religion, social class and mental health all influence a person and make us what we are (Peterson, 2002), and how we react and behave and therefore can impact upon a drug’s effect.  

The cultural norms and mores of the day play a considerable role in determining how the effects of drugs are interpreted by an individual. Although alcohol-related deaths far outnumber drug-related deaths in Britain, we live in a drinking culture and alcohol is therefore socially sanctioned – members of society fail to be influenced by the many harmful effects and rather fear their children ‘doing drugs’. The social context defines what is a drug and what is not (Zinberg, 1984), or what is a harmful drug and what is not. These definitions impact upon policies, culture, and morality and of course individuals and their respective opinions and behaviour.

A study of American soldiers in the Vietnam War (Robins 1974) highlights many of the above mentioned factors. In 1971 it was estimated that nearly half of the troops enlisted and serving in Vietnam had taken opiates. The majority used them frequently and over a long duration. Now it may come as a surprise that given the high numbers of troops using opiates (and very high-quality opiates at that – they were in the “golden triangle’), the number that continued to use opiates (mainly heroin) upon their return to the U.S after discharge was about only 7 per cent. Of them, only 1 per cent felt they were addicted. 

Opiates are strongly physically addictive and habit forming. Why is it that such an incredibly large number of people managed to stop ‘just like that’, with little if no professional support if they were taking such an addictive drug? The answer mostly lies in social context. It was highly available, highly accessible, and was seen as normal – within that context, (and within those mores and norms at that time).  Upon return to their usual context then the situation changes and they adopt the behaviour, values and beliefs they formerly held. 

What is demonstrated with the above overview is that the effect of any drug is an extremely complex process. The properties of the drug, the psychology of the user, and the context in which the drug-taking takes place to share a symbiotic relationship. Sometime one will override the other and vice-versa but what can be said with certainty is that they all play an integral part.