Commentary on “Understanding Addictive Vulnerability”

While exploring Khantzian's well-presented case as to why people become addicted, I became uncomfortable with the inference that all who become addicted use their drug(s) of choice to adapt to inner conflicts, psychopathology, or emotional pain or to control deficits in emotional regulation. The suggestion is of drug use as responding to a “drive” or compulsion outside the person's ultimate control— and this suggestion fails to square with a large segment of the literature on the topic of addiction. What of the more hedonically motivated goals of “having fun” and “rebellion”? These are strong and common motives for use (e.g., Jessor & Jessor, 1977), and while some might claim that they represent forms of psychopathology, they could only do so by pushing the boundaries of “pathology” to extraordinary limits. In addition, a focus on motivational theories of addiction takes us soon into the area of decision making (Sutton, 1987; West, 1989) and raises the question of social or subcultural norms, availability, expectancies, peer pressure, and reinforcement as influences upon our choices (Bandura, 1971, 1986; Orford, 1985). I feel these warrant more attention than the psychodynamic perspective allows.

There are many reasons to suggest that drug use may be maintained, not by physiological benefit and the removal of withdrawals (in part, addiction theory), nor by intrapersonal gain or self-medication (e.g., enhanced self-confidence, reduced anxiety), but by reinforcing friends and situations (sociallearning theory), achievement of self-selected goals (reinforcement), or pursuit of goals and the individual's motivational structure (e.g., Cox & Klinger, 2002). For example, Mischel (1977) notes that the interaction between personal disposition and the environment accounts for more variance in behavior than does either factor alone, or both together. Behavior is not caused only by either inner forces or external influences,