To be of value a theory must predict as well as explain the phenomena after the fact. The self-esteem theory postulates that all behavior is mediated by the individual??Ts attempt to protect the ??oself??? within the social milieu.

This theory is a developmental one emanating from an Adlerian approach in which self-esteem is seen as the main psychodynamic mechanism underlyinq all drug use and abuse.

The self-esteem concept develops out of Adler??Ts Individual Psychology, more precisely the Psychology of Self-Esteem, in which the underlying motive of human behavior is the preservation of the concept of the ??oself??? (Ansbacher and Ansbacher 1956).

The preservation of the concept of ??oself??? is the most important variable in understanding the initiation, continuation, and cessation of drug use, and further explains why the rehabilitation process frequently results in relapse.

The theory will not only account for the initiation into drug use (the social milieu) but will determine the course the pattern will take (vis-avis self-esteem) in terms of continuation, cessation, and/or relapse.

The etiology of drug use does not lie in the personality of the individual (addiction proneness) or in family constellations (drug use as a behavioral model), but in availability, social acceptability, and social pressure.

It must be noted that the type of dependency is conditioned by the culture. Dependency on amphetamines, for example, could not have existed before their discovery in the early 1900s, medical use in the 1930s, and post-World War II street use.

Alcohol (as a social drug) was the main drug of abuse until the post-World War II period in the United States, and marijuana was the drug of abuse in India. Today, these two countries are in a state of social change, and the youths of both countries are becoming users and abusers of socially unacceptable drugs--marijuana in the United States and alcohol in India (Cohen 1969).

Thus, the culture determines the types of drugs available, while social pressure and social acceptability further determine the type and pattern of use. Social pressure may lead one both into and out of drug abuse.

This has become evident in some of the street gangs in New York City, where youths would become addicted to heroin because of peer pressure and then would later cease as a result of the same pressure.

A similar situation was true in Vietnam, where many of the soldiers who became addicted to heroin were subsequently cured of their addiction. The reasons for relapse will be discussed later.

The theory incorporates several of Adler??Ts key concepts. Self-esteem does not emerge full blown at birth but is developed slowly during the socialization process. The foundation is developed early in life and is present at the time the prototype of the personality is formed.

This does not mean, however, that self-esteem cannot be changed positively or negatively later, since the individual is very much responsive to social pressure. The concepts which will be elucidated in this paper are (1) inferiority-superiority, (2) social interest, (3) goal orientation, and (4) lifestyle.

In the context of this discussion, the development of self-esteem and the social milieu will be looked at to explain how social pressures affect the individual.

INFERIORITY AND SUPERIORITY

Paramount to Adler??Ts Individual Psychology are the concept(s) of inferiority and superiority. All children begin life in an inferior position, and much of their early socialization consists of learning to cope with feelings of inferiority.

Exposed to an adult milieu, they perceive themselves as small and weak, inadequate and inferior. Learning to cope with these inferiority feelings, which dominate the behavior of all individuals to a lesser or greater degree, becomes the basis for goal orientation.

The uniqueness of human beings stems from their means of dealing with these feelings, their style of life. Coping mechanisms are developed in accord with individual choices (as Tillich says, ??oMan is his choices.???) or goals, which can only be understood in relationship to lifestyle and social milieu.

The feelings of inferiority reflect the extent to which the individual perceives himself/ herself as able or unable to obtain goals. The ability to attain goals is the result of psychological, biological, and sociological factors, while the technique chosen to deal with inferiority is the result of a person??Ts lifestyle.

On the other hand, expressions of superiority can become a compensatory mechanism in which the individual??Ts overt behavior becomes a mask for inner feelings of inferiority.

SOCIAL INTEREST

Foremost in the development of a healthy personality is the development of social interest, because it is only through social participation that the individual can deal with feelings of inferiority and develop high self-esteem.

Within the Adlerian paradigm, lack of social interest is always present in a neurotic person. Humans are social animals, and most conscious behavior is spent in contact with other individuals in the normal pursuit of work, play, and raising a family.

The fundamental conditioning technique during the socialization process centers around praise and blame. Praise is good for the ego and helps in the development of self-esteem when it is given for socially useful actions.

When the mother??Ts rewards are given for actions which are socially useless or in such a pampering fashion that the individual only gets rewards for exemplary behavior, feelings of self-worth and good selfesteem do not develop.

Good social interest can be developed only as a result of otherdirectedness, i.e., a concern for others. Other-directedness is a primary phenomenon that is healthy in conjunction with socially useful goals.

GOAL ORIENTATION

Goal orientation is very important to self-esteem theory, because success and failure can only be understood subjectively and not objectively; outward symbols of success must be understood in terms of the individual??Ts own perceptions.

Those who, to others, seem to have the world by the tail may see themselves as failures (e.g., Marilyn Monroe). In this respect, Adler says, In this psychological schema there are two approximately fixed points: the low self-estimation of the child who feels inferior, and the over-life-sized goal which may reach high as god-likeness.

Between these two points there rest the preparatory attempts, the groping devices and tricks, as well as the finished readiness and habitual attitudes. (Ansbacher and Ansbacher 1956, p. 245) Insecurity in childhood causes the individual to set high goals and to develop compensatory safeguarding measures: ??oIf I didn??Tt have this headache, I would have done better??? or ??oIf I hadn??Tt drunk so much last night but had studied, I would have done better on my exam.???

The individual may well resort to drug abuse as a coping mechanism. Individuals are constantly striving for superiority; all behavior is an effort to achieve success (positive situations) and to overcome obstacles (negative situations). Motivation is a goal-directed drive; lack of motivation is a symptom, not the cause, of neurotic behavior.

To cope with over-life-sized goals and low self-esteem, the individual may turn to drug abuse.

LIFESTYLE

Adler defined lifestyle as ??othe wholeness of his individuality??? (Adler 1933). the guiding line of the personality. He originally called it ??oLebensplan??? (life plan), then ??oLebenstil??? (lifestyle), and finally, style of life.

He further says, In other words the child must have formed a guiding line (Leithinie), a guiding image (Leithbild) in the expectations thus best to be able to orient himself in his environment and to achieve satisfaction of his needs, the avoidance of displeasure, and the attainment of pleasure. (Adler 1912, p. 33)

Max Weber (1974) was the first to use the concept of lifestyle to refer to a way of life of a subculture--a group-guiding principle. Adler used it to refer to the individual??Ts guiding principle. Thus, lifestyle refers to the individual??Ts orientation toward social behavior--the guiding line of the personality, the core around which the personality revolves.

Lifestyle is the whole which unifies the parts. It is the uniqueness of humans that made Adler call his theoretic development individual psychology, stressing this uniqueness. Every person is the same as every other, and every person is different from every other: Culture is the unifying principle.

There are two forms of deviant lifestyle--pampered and neglected. A pampered lifestyle results from an overprotective mother who takes all responsibility for her child??Ts behavior, preventing the child from developing a feeling of self-worth from his or her own accomplishments.

Here rewarding success does nothing to establish a feeling of self-worth. Approval and reward are seen as coming only from superior performance. Love is perceived as a response to this performance rather than as a feeling for himself or herself as a person, producing very weak selfesteem.

The counterpart of the pampered lifestyle is the neglected lifestyle of the impoverished environment, in which the individual receives almost no attention and is left to his or her own devices. The patterns of drug abuse as coping mechanisms may vary between these two polar situations, for example, heroin addiction among ghetto youths and marijuana abuse among middle-class college youths (Steffenhagen 1974).

Today we see marijuana abuse among lower class youths and heroin addiction increasing among the middle/upper middle-class youths, showing that the type of abuse is a function of the zeitgeist as well as the availability of the drug, which may account for the kaleidoscopic nature of the present drug scene.

SOCIAL MILIEU

Sutherland??Ts (1939) differential association theory of deviance is directly applicable to our Adlerian model. Adler was keenly aware of the role of society in shaping the individual??Ts behavior.

Differential association has a direct impact upon the form deviance will take, given low selfesteem. Sutherland postulates that deviance is learned and that the internalization of such behavior is a function of duration, frequency, intensity, and priority of deviant associations.

It becomes clear in the college milieu that the more time an individual spends within a drugusing group, the more likely he or she is to use drugs. Becker and Strauss (1956) clearly indicate the role socialization plays in this situation. I mentioned previously how heroin use became a problem in Vietnam.

Boredom and social stress, which led to a need for a social release of tension, and the acceptance of heroin by the peer group were sufficient criteria for the development of a drug problem without any need for neurotic coping mechanisms.

This is an example of individuals with relatively high self-esteem becoming drug abusers as a result of the social milieu. The relevance of this to the rehabilitation process will be discussed in detail later. Peer pressure during adolescence is particularly powerful. The need for acceptance, while always an important drive, is especially strong during this formative period, and helps to account for the heavy drug use in the youth subculture.

The pressure is not always overt or obvious but may be covert or subtle: The fact that an activity may be the agent around which the group coalesces may provide the impetus for experimentation. In the case of marijuana, differential association is particularly important since the individual must associate with users in order to try the drug and then to obtain a supply. Both the preference resulting from association and the necessity prevail.

SELF-ESTEEM AND DEVIANCE

As I have said, who will become a drug user or abuser cannot be explained on the basis of any single psychodynamic factor but must take account of the social milieu. Our postulate is that an individual with low self-esteem will become a prime target for drug abuse as a result of the prevalence of drug information--true or false--provided by the mass media.

Behavior accompanying low self-esteem can best be explained by the following model: The behavior need not occur singly, but can also occur in combination. Gross multiple-drug users in college show more emotional disturbance than the nonusing population (McAree et al. 1969, 1972), indicating neurosis coupled with drug abuse.

In 1974 I further postulated that drug abuse (and neurosis) may also move toward the occult, in which case the drug use may continue or be replaced by the occult support. Participation in the occult may provide an immediate source of power as a coping mechanism or may provide a form of group self-esteem (Lieberman et al. 1973).

In the lower class, low self-esteem may take the forms of neurosis, drug abuse, and delinquency. In this milieu, drug abuse and delinquency are a much more likely pair than drug abuse and occultism. The occult appeals largely to the intellectually curious, especially college students. In both social classes, we may find drug abuse and suicide pairing together.

Alcoholics are much more likely to commit suicide than are nonalcoholics: Drug abuse is seen generally as an expression of the pampered life style. Its function is to safeguard low self-esteem; enabling individuals to shirk responsibility, while blaming others and outer circumstances, providing excuses, and enabling them to maintain excessively high goals without expending energy. (Steffenhagen 1974, p. 249)

It is important to realize that while low self-esteem is postulated as the underlying psychodynamic mechanism for drug abuse, it is not a sufficient or necessary condition for initiation. The social milieu can also provide the impetus (differential association plus existence of the drug).

The initiation into drug use may then stem from the social milieu, but the abuse of the nonaddicting drugs would be associated with low self-esteem. Further, although a cessation may be superimposed by the social structure, relapse would be likely to occur in the case of low self-esteem.

As in the example of Vietnam and heroin, the impetus came from the social situation--drug use continued as long as the social situation remained constant, whereas when the situation changed cessation occurred.

We have two possible outcomes: (1) the individuals with good self-esteem remained drug free whereas (2) those individuals with low self-esteem were likely to relapse since an already tried neurotic coping mechanism was within their repertoire.

I also postulate that self-esteem is important in determining the effect that stress will have upon the individual. A person with low selfesteem will respond much more negatively to stress than a person with high self-esteem.

In the case of the pampered lifestyle the individual may function adequately as long as he or she has the support system provided by the family but may quickly resort to neurotic coping mechanisms when this support system is removed--such as by the death of parents or by merely going away to college.

CONCLUSION

The following paradigm is offered: Self-esteem + Lifestyle + Personality + Goal orientation + Primary group + Social milieu = Behavior

Self-esteem--high or low

Lifestyle--pampered or neglected

Personality--normal or neurotic (includes inferiority and social interest)

Goal orientation-- realistic or unrealistic

Primary group--supportive or unsupportive

Social milieu--excess of definitions for conformity or deviance

These are not mutually exclusive categories, since they all interrelate, and the lifestyle of the parent is superimposed upon the child. Selfesteem is posited not as the apex of the personality but the foundation.

The theory postulates that the psychodynamic mechanism underlying drug abuse is low self-esteem. Self-esteem develops through experiential behavior involved in mastery, the ability to master situations and achieve one??Ts goals.

Low self-esteem may result either from setting goals too high or from not achieving realistic goals because of a lack of confidence in the ability to attain them. The latter situation may happen when a parent or a significant other does everything for the child, never allowing him or her to develop talents for mastery.

William James??T formula, success over pretentions equaling self-esteem, reflects this situation (James 1890, p. 310).

This is not solely a result of intrapsychic processes but also of the social order. Goals are set by the individual (the individual??Ts uniqueness), but they are provided by the social system.

According to Merton (1938), success as defined by the American credo is largely equated with the attainment of money. This is further evidenced by the fact that America is a secular/materialistic culture, as opposed to a religious/spiritual culture (Roszak 1975).

The American credo provides the basis for the goals (which sociologists frequently call aspirations), but the social structure does not always provide the means (expectations) for attainment.

However, although many forms of deviance cannot be explained solely within the framework of this perspective, e.g., marijuana use among the youths of today, nevertheless we must look to the social milieu for part of the answer.

Even when the goals prescribed by the culture are not readily attainable due to social deprivation, low self-esteem is not inevitable. The individual may be able to lower goals appropriately so that attainment is possible, and thereby achieve satisfaction and develop a feeling of self-worth.

All behavior is goal directed or goal striving--it is the energizing state of the organism. Since all behavior becomes goal striving, individuals evaluate themselves in terms of their perceptions, their evaluation of themselves in terms of achievements.

High self-esteem is achieved when the evaluation is good and socially useful; when the evaluation is bad or on the socially useless side of life, low self-esteem results.

Thus, it becomes apparent that self-esteem is the key variable underlying drug abuse. If individuals feel inadequate (inferior), they feel a need to protect their poor self-image, frequently through compensatory mechanisms which create further problems in interpersonal relations and add to the feelings of inferiority.

Our theory also helps us explain why Alcoholics Anonymous (AA) and Synanon are only rehabilitative 1 and not curative. It is generally accepted that alcoholics are never cured but remain functional only as long as they remain active in AA, and a similar condition seems to prevail for the members of Synanon and even Weight Watchers.

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1 By rehabilitation I mean that the individual is returned to a state of ??onormal??? functioning but not cured of the pathology, which can become reoperative due to trauma.
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It is our contention that this can be easily explained within the self-esteem theory, because both of these organizations do nothing to build individual self-esteem but, rather, build a form of group self-esteem resulting from and depending on group support cohesion (as the pampering mother).

All of these organizations provide a socialization function, and the individual is socialized to remain problem free only within the framework of the group. With the self-esteem theory we can explain nonuse, social use, and abuse of drugs as well as why various therapeutic models are or are not successful.

It is possible that an ex-AA member may remain sober, but this can be explained within the context of the support system or unique circumstances where the drug as a coping mechanism loses its function as a self-esteem protecting mechanism.

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From N.I.D.A. Monograph 30 - Theories on Drug Abuse: Selected Contemporary Perspectives.  [Page for pdf download, which includes diagrams and reference list.]