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This is to certify that the

dissertation entitled

THE PSYCOSOCIAL DEVELOPMENT OF PREFERENTIAL
ABUSERS OF HEROIN OR COCAINE
BASED ON ERIKSON'S DEVELOPMENTAL THEORY

presented by

SHAUN LaBLANCE

has been accepted towards fulfillment
of the requirements for

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Major professor

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THE PSYCHOSOCIAL DEVELOPMENT OF PREFERENTIAL
ABUSERS OF HEROIN OR COCAINE BASED

ON ERIKSON'S DEVELOPMENTAL THEORY

BY

Shaun LaBlance

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
College of Education
Department of Counseling, Educational Psychology

and Special Education

1988

F4

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K1 1

THE PSYCHOSOCIAL DEVELOPMENT OF PREFERENTIAL
ABUSERS OF HEROIN OR COCAINE BASED
ON ERIKSON'S DEVELOPMENTAL THEORY

BY

Shaun LaBlance

The study was designed to examine the psychosocial
developmental differences which underlie the abuse of heroin
or cocaine.

Erik Erikson's theory of psychosocial development
provided the bases for the research. Erikson's theoretical
assumptions were transposed into hypotheses regarding the
developmental characteristics of male heroin abusers and
male cocaine abusers. Heroin abusers were hypothesized to
have developmental impairments associated with. Erikson's
first stage--Trust vs. Mistrust. Cocaine abusers were
hypothesized as having unresolved developmental issues
related to Erikson's second stage--Autonomy vs. Shame and
Doubt. An overall hypothesis that cocaine abusers would
achieve a Jhigher' mean level of’ development than heroin
abusers was considered.

Subjects were administered a 13-item demographic
questionnaire and the Assessment of Adult Adjustment
Patterns (AAAP). The AAAP is an objective, self-report
instrument that operationalizes Erikson's theory of

psychosocial development.

Shaun LaBlance

A total of 76 males were recruited as research
subjects, 38 were heroin abusers and 38 were cocaine
abusers. The subjects were classified by their stated
preference for either of the drugs and by how they met the
DSM III criteria for substance abuse.

The data analysis indicated that (1) heroin abusers had
developmental issues related to unsuccessful resolution of
Erikson's first stage; (b) cocaine abusers had core
developmental issues arising out of their lack of resolution
of Erikson's second stage. However, analysis indicated that
they had not resolved stage 1; and (c) the main finding was
that the AAAP was unable to discriminate between heroin
abusers and cocaine abusers.

An alternative explanation for the results could
support a modification of Erikson's model to a "life-spiral"
model. A person labors with a stage and there is a repeat,
albeit in somewhat different terms of the issues of all
previous stages. The AAAP was not a sophisticated enough
measure to detect the differences between the initial
working through of developmental tasks and the subsequent
reworking.

Another alternative explanation for the results could
be that the cocaine abusing sample was representative of a
"low" functioning group of cocaine abusers instead of a

representative sampling of cocaine abusers in general.

To those who mean the most-—Mary and Pat

iv

ACKNOWLEDGMENTS

I wish to express my sincere appreciation to the
following:

Dr. William Farquhar--Thank you for being my guide in a
manner of caring that is becoming rarer to find.

Dr. John Powell——Thank you for being there for me and for
serving as a person worthy of admiration and
emulation.

Dr. Gary Stollak--Thank you for making learning an
enjoyable and meaningful experience.

Dr. Gary DeRath--Gil, I cannot adequately describe my
appreciation for all that you have done for me, and
what you mean to me.

To Community Mental Health for the subjects and to all
who shared in the struggle.

Anyone who has completed a major project like this
understands that the greatest toll is extracted from
those closest to the author--his family. The stress,
anxiety, and immense soul searching created tensions and
weariness that we all shared. This has unified,
strengthened, and educated all of us. We are far, far
better for this experience, and I love you dearly--Mary

and Pat.

Table of Contents

Page
LIST OF TABLES ......... . .......................... viii
Chapter
I . THE PROBLEM. ................................... 1
Need for the Study ........................... 3
Purpose of the Study ........ .. ............. ..4
Overview of the Theory .................... ...5
Hypotheses... ............................ ...15
Overview .................. . ................. 28
II. REVIEW OF THE LITERATURE........ .............. 30
Physiological Perspective ................... 3O
Psychodynamic Overview ...................... 38
Psychological Perspectives .................. 53
III . METHODOLOGY ................................... 83
Definitions...... ......... . ................. 83
Selected Population ............... . ....... ..86
Sample.... ............. ..... ....... . ....... .86
Measure.............OOOOOOOOOOOOOOOO ....... .95
Assessment of Adult Adjustment
Patterns (AAAP)... ..... ..... ............ 95
Assessment of Adult
Adjustment Patterns........... ....... ... 97
Procedures for Data Collection. ...... .... 105
Research Design............................105
Testable Hypotheses. ...... . ........ . ....... 106
AnaIYSiSOOOOOOOOOOO.....OOOOOOOOOOOOOOOO...106
Summary........... .......... ...............109

vi

Chapter Page
IV. RESULTS OF THE DATA ANALYSIS............ ..... 111

Hypothesis About Heroin Abusers' Mean

Score Performance on AAAP Stage 1........111
Hypothesis About Cocaine Abusers Mean

Score Performance on AAAP Stage 1.. ...... 112
Hypothesis About AAAP Stages

Discriminating Between Cocaine

Abusers and Heroin Abusers...... ....... ..114

Demographic Variables...... ..... .........114

Summary................ ....... . .......... ..116

V. SUMMARY AND CONCLUSIONS ..................... .118

Summary of the Study. ...... . ............ 118

Discussion... ... ........................ .124

Hypothesis 1-—Heroin Abusers ............. 124

Hypothesis 2-—Cocaine Abusers. ......... . 127

Overall Hypothesis. ... ..... . ....... .. 128
Alternative Examination of the

Results ....... . . ..... ............. 129

Limitations of the study...................137

Implications for Future Research... ....... .138

APPENDICES.. ....................................... 141

REFERENCES ......................................... 163

vii

LIST OF TABLES

Table Page

3.1 Key Demographic Variables for Heroin
and Cocaine Admissions to the
Comprehensive Substance Abuse Treatment
Programs for October 1986 to November

1987...... ...... . ..... ............... ...... 87
3.2 Age of Subjects ............................ 89
3.3 Race of Subjects ........................... 89
3.4 Marital Status of Subjects ................. 90
3.5 Annual Income of Subjects...... ............ 91
3.6 Rating of Parents' Social Standing ......... 92
3.7 Rating of Emotional Well Being ............. 93
3.8 Reason for Taking Drug of Preference.......93
3.9 Age of First Usage of Drug of Preference

by Drug of Preference............ .......... 94

3.10 Length of Preferential Drug Usage in
YearSOOOOOOOOOOOOOOOO. OOOOOOOOOOOOOOOOOOOOO 95

3.11 Stage and Scale Statistics for the
Assessment of Adult Adjustment Patterns....98

3.12 The Factors Emerging from the Assessment
of Adult Adjustment Patterns...............99

3.13 Reliability Coefficients for the Stages...100

3.14 Mean, Standard Deviation for the Eight
Stages of the AAAP.................. ...... 103

viii

Table Page

3.15 Comparison Between the Normal and
Psychiatric Samples on the Ego Stage
Scales of the Assessment of Adult

Adjustment Patterns............. ........ ..104
4.1 Student's T-Test for Heroin Abusers

on AAAP Stage 1..................... ...... 112
4.2 Student's T-Test for Heroin Abusers

onAAAPStage1.0.0.00000000000000000000.0113
4.3 Student's T-Test for Cocaine Abusers

on AAAP Stage 1 ..... .. .................... 114
4.4 F Test Comparisons Between Male Cocaine

Abusers and Male Heroin Abusers on

AAAP Stages 1-8 ........................... 115
4.5 F-Test Comparison Between Cocaine

Abusers and Heroin Abusers on the

Variable of Age... ..... ....... ............ 116

ix

CHAPTER I

THE PROBLEM

Although the use of drugs or substances to alter
consciousness is a widespread, and in some cases an
ancient, cultural practice, it has been only in
relatively recent times that psychological theories and
theorists have expanded their viewpoint to consider an
examination of the individual using the drug, rather than
the drug itself. Even with this adjustment, McKenna and
Khantzian (1980) noted that

the tendency to view all drug dependent individuals
as deviants has detracted from a more careful
assessment of their psychological vulnerabilities
and the part that. drugs play in the jpersonality
organization of these individuals and their attempt
to adapt to their environment.

Historically, Brill (1980) indicated that

much of the thinking about drug addicts . . .

emanated from the psychoanalytic framework. In

psychoanalytic thinking, drug addiction has been
linked at various times with. "impulse neuroses,"

"perversion," "compulsive neuroses," "character
disorder , " and at times with the manic-depressive
cycle. Drug addicts were viewed uniformly as

persons with oral-narcissistic fixations emanating
from a very early point of their psychosexual
development.

Researchers have tended to describe all drug addicts as

if they have had exactly the same kind of family

1

constellations and the same uniform traits--such as
self—defeating impulses, oral fixations, narcissism, a
weak ego, poor frustration tolerance, an intolerance to
pain, and a rigid archaic superego. The fathers of drug
addicts were typically seen as dejected and
inconsequential persons, and the mothers were described
as seductive and devouring.

However, just more than a decade ago, researchers
began to recognize that the drug abuse literature did not
adequately account for the specificy of drug abuse. Some
researchers acknowledged that with the increased
proliferation of many potent pharmacological agents, with
such distinct pharmacological and psychological effects
from one another, that it was important to focus
investigations upon the personality dynamics which
underlie the preferential use of a specific drug.
Milkmen (1974) noted

that the origins of specific drug abuse may be in

the nature of the drug induced altered ego states.

These may capture a series of similar experiences,

the origins of which appear to exist in specific

phases of child development. A particular drug may
thus facilitate a specific regressive solution to
conflict and may, therefore, be preferred.
Spotts and Shontz (1982), in one of the few
investigations on the developmental antecedents of drug
abusers, reached similar conclusions. They noted that
once a person elects to use drugs, his ultimate

choice of substances is systematically related to
the core problem that he is attempting to resolve;

drugs temporarily produce something akin to a
desired ego state, but without the pain, struggle,
and assumption of personal responsibility that
genuine individuation requires; the critical matter
is not which drug a person takes but the level at
which his core developmental problems occurred and
the developmental status the person achieved in
spite of them.
What has not been accomplished, and what Spotts and
Shontz (1982) allude to, is a research investigation on

drug abusers using the theory of Erik Erikson (1963).

Need for the Study

The need for this study is primarily derived from
the fact that the drug abuse literature provides mainly
theoretical discussions of the psychosocial development
of drug abusers. There has been a paucity of research on
the psychosocial development of heroin abusers and
cocaine abusers. Erik Erikson's (1963) theory of
psychosocial development offers an innovative format for
understanding the developmental experiences of heroin
abusers and cocaine abusers. Until recently, however,
there has not been a standardized means to assess the
psychosocial development of individuals that could
demonstrate the requisite reliability and validity for
all eight stages of Erikson's psychosocial developmental
model. The Assessment of Adult Adjustment Patterns
(AAAP) has shown promise in providing a dependable and
accurate measure of Erikson's theory of development

(Farquhar, Wilson, & Azar, 1982). This study attempts

to make a unique contribution to the drug abuse field,
since there has not been a published study of the
developmental impairments of heroin abusers and cocaine
abusers using the Eriksonian developmental model.

The recent widespread use and abuse of cocaine and
heroin has reached epidemic proportions. Frank and
Lipton (1984) and Serban (1984) have gone to great
lengths to express their concern. about the increasing
number of heroin abusers. Likewise, Gwyne (1982); Kozel,
Crider, and Adams (1982); Grabowski and Dworkin (1985);
and Spotts and Shontz (1984) have all noted the amazing
growth in cocaine use. With the increased use and abuse
of both heroin and cocaine, it is even more imperative
that researchers direct their attention toward an
understanding of’ the jpsychosocial developmental
experiences of heroin abusers and cocaine abusers. The
results of this study will have major implications for
the psychotherapeutic interventions by professionals.
This study could provide a whole new spectrum of
possibilities that have heuristic value implementing
innovative research on the developmental issues of

heroine abusers and cocaine abusers.

Purpose of the Study
The purpose of this study is to examine the

psychosocial development of male heroin abusers and male

cocaine abusers using Erik Erikson's model of
psychosocial development. The major focus of this study
will be placed upon clarifying the level of psychosocial
developmental impairment and the core conflicts that need
to be resolved by groups of heroin abusers and cocaine
abusers. The use of AAAP will also provide an
opportunity to substantiate further the psychometric
properties of this scale on. well-defined pathological
populations, i.e., male cocaine abusers and male heroin

abusers.

Overview of the Theory
Kagan (1971) stated that "understanding how a
structure develops aids in the understanding of how the
structure functions in its mature form." Imperative to
this understanding is a thorough assessment of an
individual's psychosocial development.

Erikson's Developmental
Perspective

 

Crane (1980) indicated that

among the advances in the psychoanalytic theory of
development, none has been. more substantial than
those made by Erik H. Erikson. Erikson has given us
a new, enlarged picture of the child's tasks at each
of Freud's stages. And beyond this . . . so that
the theory encompasses the entire life cycle.

Erikson (1950, 1963) based his theory of
psychosocial development not only on his many years of

experience as a practicing psychoanalyst, but also on his

field studies of the personality development of
individuals in two Native American societies. His
observations have been systematized into a developmental
theory, in which there are postulated eight stages of
psychosocial development spanning the entire life cycle.
The crucial characteristic of Erikson's theory is that it
offers a conceptual explanation of the individual's
development by tracing the unfolding of the genetically
social character of the individual in the course of
his/her encounters with the ever-expanding social
environment at each of the eight stages of development.
Erikson (1963) acknowledges that
there are many formulations of what constitutes a
"healthy" personality in an adult. But if we take
up only one--in this case Marie Jahoda's definition,
according to which a healthy personality actively
masters his/her environment, shows a certain unity
of personality, and is able to perceive the world
and himself/herself correctly--it is clear that all
of these criteria are relative to the child's
cognitive and social development.
In concert with this definition, Erikson has formulated a
theory of psychosocial development in which each of the
eight stages represent a choice for the individual based
on the effects of’ maturation, experience, and social
institutions on the growing individual.
Erikson (1959) outlines the lasting contributions to
the personality development of the individual which

results from the interplay between parental and societal

influences and demands, and the needs and capabilities of

the individual at any' given stage: of .libidinal
development and beyond, spanning the whole life cycle.
The individual's capabilities at any given stage are
studied in terms of the maturation of various
apparatuses, from reflex response to motility. From this
interplay, there derives, at the gradual conclusion of
each developmental stage, certain lasting gains that
basically involves the achievement of’ certain
orientations of the individual toward the world, to other
people, and toward himself/herself. These achievements,
if development is optimal are: (a) in early infancy, a
development of a sense of basic trust, rather than a
sense of mistrust; (b) in later infancy, when anal—
muscular maturation has occurred, a growing sense of
autonomy, rather than a sense of shame and doubt; (c) in
early childhood, the period of greatest locomotor
development, a developing sense of initiative, rather
than a sense of guilt; (d) in the middle years of
childhood, the latency period, a sense of industry,
rather than a sense of inferiority; (e) in adolescence, a
sense of identity (consisting of certainty and a sense of
belonging regarding career, sex role, and a system of
values), rather than a sense of role confusion; (f) in
early adulthood, the development of intimacy (the
mutuality with a loved partner, whom Erikson notes is of

the opposite sex, with whom one is able to regulate the

cycles of work, procreation, and recreation), rather than
a sense of isolation; (g) in middle adulthood, the
development of generativity (establishing and guiding the
next generation” including'jprocreativityy productivity,
and creativity), rather than a sense of stagnation; and
(h) in late adulthood, a sense of integrity-~a basic
acceptance of one's life as having been inevitable,
appropriate, and meaningful-~rather than a sense of
despair--a hidden fear of death.

Erikson (1959) states that

in describing growth and its crises as a development

of a series of alternative basic attitudes, we take

recourse to the term "a sense of . . ." they are

ways of conscious experience, accessible to

introspection (where it develops); ways of behaving,

observable by others; and conscious inner states

determinable by test and analysis.
"A sense of . . .," also denoted Erikson's belief that it
is the relatively successful or unsuccessful resolution
of each crisis stage that leaves the individual with a
residual attitude or orientation toward himself/herself
and the world. Later psychosocial stages cannot
successfully or optimally be dealt with by the
individual, unless the preceding crises have been
reasonably well resolved.

Erikson postulated that at each psychosocial stage,
a central conflict or crisis arises as a result of new

and different developmental tasks that need to be
mastered. The eight stages of development with the

approximate age levels and descriptions of the central

crisis are briefly described in the following section.

I. Trust vs. Mistrust (Hope) Age: 0-18 months

The degree two which children learn to trust the
world, other people, and themselves depends, to a great
extent, upon the reliance that they can place on the
consistency, predictability, and reliability of their
primary caretaker's actions. When the parents are
consistent and dependable, children develop a sense of
trust in their parents and the environment. A sense that
they can count on others to relieve their pains of being
wet, cold, or hungry. Children consider themselves
trustworthy when they are able to cope with their own
urges. Healthy development occurs when there is a
favorable ratio between trust and mistrust; the former
should outweigh the latter. This principle holds true
for the other stage as well. Mistrust is the result when
inconsistency is the rule, rather than the exception.

II. Autonomy vs. Shame and Doubt (Will)

Age: 18 months to 36 months.

During a time of contradictory impules--holding on
one moment and expelling the next--the child is primarily
trying to exercise a choice. A child learns autonomy as
holding on and letting go are practiced without

destructive consequences. Erikson defines the conflict

10

as that of autonomy vs. shame and doubt. Autonomy comes
from within: biological maturation fosters the ability
to do things on one's feet, to use one's hands, and so
on. Shame and doubt occur from an awareness of social
expectations and pressures. Shame is the feeling that
one does not look good in other's eyes. Doubt and
indecision results from the child's decisions being

constantly thwarted.

III. Initiative vs. Guilt (Purpose) Age: 3-5 years

On resolving the crises of autonomy and possessing a
feeling that you are your own person, the crucial
question becomes what can you do on your own. Initiative
connotes forward movement. The child, with a sense of
initiative, makes plans, sets goals, and perseveres in
attaining them. Initiative is developed as children are
given the freedom and encouragement to initiate motor
play, and when their endless questions are answered.
Initiative is learned as the child contemplates and
initiates activity without experiencing feelings of guilt
or fear of punishment. In the child's play, pleasure is
evident in conquering and being aggressive. Coping
mechanisms to deal with the environment manifest
themselves through the child's controlling the
environment by over-aggressiveness and/or manipulation of

others or through. behaviors of' flight and *withdrawal.

11

The child internalizes social prohibitions--a guilt
producing superego—-keeping dangerous impulses and
fantasies in check. Although the superego is necessary
for socialized behavior, it stifles the bold initiative
of the former stage. Overrestrictive parents and
superego results in children giving up their ambitions
altogether.

Iv. Industry vs. Inferiority (Competence)

Age: 5-12 years

In this stage, children master important cognitive
and social skills. Children eagerly apply themselves to
learning the useful skills and tools of the culture.
Recognition is won by producing things. The traits of
perseverance and diligence result in competency. Erikson
(1964) described competency as the "free exercise of
dexterity and intelligence in the completion of tasks,
unimpaired by infantile inferiority." The positive
resolution of this stage is, according to Erikson (1959),
"the sense of being able to make things and make them
well and even perfectly," while the negative resolution
is a sense of not being able to cope with the world of
inanimate things and of not being able to compete with
one's peers. The danger is an excessive feeling of

inadequacy and inferiority.

12

V. Identity vs. Role Confusion (Fidelity)
Age: 12-18 years

 

During this stage, the central issue comes from the
question, "Who am I?" The adolescent's primary task is
establishing a new sense of ego identity--a feeling for
who one is, and one's place in the larger social order.
The adolescent begins to focus on the roles that they
play and the occupations that they imagine themselves
entering. The peer group identity assumes major
importance in this stage. In a rush to find some
identity, a group identity and clear-cut images of good
and bad in the world surfaces. Accomplishments help to
develop a sense of identity. Options, alternatives, and
commitments help to rework prior identifications and form
a new identity for the adolescent. Role confusion
results when adolescents are not certain about their
dominant personality characteristics, and do not have a
firm sense of the continuity between the remnants of

their childhood and anticipated adulthood.

VI. Intimacy vs. Isolation (Love) Age: 18-30 years
Intimacy refers to the ability to give of oneself to
another without the fear of losing one's identity in the
process. Intimacy is only possible once a reasonable
sense of identity has been established. The individual
risks being hurt (isolated) in an attempt to establish

genuine mutuality with a member of the opposite sex.

13

Learning intimacy results in feelings of' ‘warmth,
closeness, and oneness with a chosen partner and the
world. Erikson (1963) notes that "true intimacy means
that two people are willing to share and mutually
regulate all important aspects of ‘their lives." 'The
young adult, who does not have a reasonable sense of
identity, is apt to isolate himself/herself from intimate
interactions with parents, friends, and others due to the
fear and anxiety of ego loss. The choice of a partner is
the most significant positive occurrence in this stage.

VII. Generativity vs. Stagnation (Care)

Age: 30-45 years

Generativity is marked by the creation and care for
children, as well as the production of things and ideas
through work. Erikson emphasized more of the former than
the latter. When generativity is lacking, the result is
stagnation and impoverishment of the personality.
Erikson (1959) felt that in such cases "pseudo—intimacy"
results or people regress to "begin to indulge themselves
as if they were the one and only child." Erikson noted
that, especially in the United States, our values
emphasize independent achievement to such an extent that
people can become too exclusively involved in themselves
and their successes and neglect the responsibilities of

caring for others.

14

VIII. Ego Integrity vs. Despair (Wisdom)
Age: 45 and up

 

In this stage, one must look back over one's life
and wonder whether life was worthwhile. If he individual
has successfully completed the seven prior stages, a
sense of integration and wisdom develops. This results
in a calm and reasonable acceptance of life's triumphs
and disappointments. In this stage, the negative
resolution means that one: must confront the ‘ultimate
despair--the feeling that life was not what it should
have been, but now time has run out, and there is no
chance to try an alternative lifestyle. ‘Frequently,
disgust hides despair. This stage is really the inner
struggle of, "Was my life, as I face death, a meaningful
one?"

Erikson (1964) believed that

aLl of the aspects of development are in principle

present all of the time, but as the person develops,

he or she becomes ready to experience and to manage
the critical conflicts within specific cultural
contexts and to incorporate the resolution of these
normal crises into his or her personality.
Erikson (1968) delineated what he meant by crises are not
"connoting a threat of catastrophe but as a turning
point, a crucial period of increased vulnerability and
heightened potential, and therefore, the ontogenetic

source of generational strengths and possible

maladjustment."

15

Specific to this proposal, it should be noted that
Erikson devoted only brief attention to the drug abuser
in describing this theory of development. In an orthodox
psychoanalytic manner, Erikson (1963) described the
infant's oral phase of psychosexual development, and his
feelings that the drug abuser had a fixation on this
stage which causes the individual to seek a restoration
of the pleasurable feelings of infancy. To achieve these
pleasurable feelings, the drug abuser resorts to
"incorporation by mouth or skin of substances that will
satiate him." Even with only this meagre reference to
drug abusers, Erikson's theory of psychosocial
development presents viable concepts and an innovative
format to understand the psychosocial developmental
issues and differences of heroin abusers and cocaine

abusers.

Hypotheses

Developmental Issues and
Heroin Abusers

 

Erikson (1959) related that the first stage of his
developmental model--Trust vs. Mistrust--is an
"incorporative stage." This stage is one in which the
infant is relatively receptive to whatever is offered.
The process central to the successful resolution of this

stage is the attainment of the mutuality with the

l6

caregiver--developing a social attachment to another
human being. As the infant begins to perceive the
caregiver as a separate and permanent person, the
development of a sense of trust or mistrust becomes the
poignant issue. In "optimal" development, the caregiver
needs to be perceived by the infant as a source of
security, a person who will encourage further exploration
and facilitate the meeting of the infant's biological
needs. If such interactions are not experienced, the
infant develops a sense of mistrust in others and the
world. Included in the experience of these interactions
are the unavoidable pain, delay in satisfaction, and the
inexorable weaning which combine to make this stage
prototypical for the development of a sense of
abandonment and helpless rage. The sense of abandonment
and helpless rage arises out of the perception of feeling
that the parent or caregiver is unpredictable,
unreliable, and may not be there when needed. Indeed,
one cannot trust one's needs will be met.

Erikson (1959) was concerned about this lack of
mutuality in the mother-infant relationship. He wrote

that

one cannot be sure what (a failure in mutual
regulation) does to a baby; but it certainly is our
clinical impression that in some sensitive
individuals (or individuals whose early frustration
was never compensated for) such a situation can be a
model for radical disturbances in their relationship

17

to the "world," "to people," and especially to lover
or otherwise significant people.

Chein et al. (1964) in their research. on adolescent
opiate addicts developed this theme further by noting
that

a prominent feature of the family situatiOn of the
adolescent opiate addict . . . is the peculiarly
close relationship between the addict and his
mother. It is not a closeness of warmth or mutual
regard so much as it is clinging and feeling of
being bound together . . . it seems to us that there
is a strong need on the part of the mothers to
maintain their sons in a weak, dependent position
for their own security.
Other researchers, most notably Savitt, 1963; Hendin,
1974; Khantzian. et a1., 1974; and Spotts and Shontz,
1982, have described radical disturbances in the heroin
addict's personal relationships and attribute their
observations that only a few addicts are capable of
tolerating close, mutual relationships, as stemming from
this disturbed relationship between the addict and
his/her mother.

An extension of this theme is Erikson's belief that
the amount of trust derived from the earliest infantile
experience does not seem to depend upon the quantities of
food or demonstrations of love, but rather on the quality
of the maternal relationship. With the research
indicating that the narcotic addict's relationship with
his/her mother being very disturbed, it is not surprising

that Cappel and Caffrey (1974) and Unger's et al. (1978)

18

research found that opiate abusers were significantly
lower in trust than the other comparison groups.
Rado (1963) noted that in order to understand
narcotic addicts,
we must penetrate the deepest strata of the mind,
formed during the earliest stages of ontogenetic
development. At a certain stage of neuro—muscular
maturation, the infant becomes capable of carrying
out little intentional acts with his body, hands,
and feet. Enchanted by his, he now fancies that he
can do everything. Describing his feelings in our
words, we can only say that he believes in his own
omnipotence. This illusion, the product of
unwarranted generalizations, is the young organism's
first self-image--it's primordial self.
As the individual grows and experiences frustration and
disillusionment, it is a return or regression to this
sense of omnipotence that is sought out. Chein et al.
(1964) supports this view by noting that the narcotic
addict easily regresses to this state of primary
narcissism. Although somewhat simplistic, if there are
consistent delays in obtaining satisfaction, inconsistent
caregiving--including aspects of handling, playing,
paying attention to, and so forth, and a large number of
unavoidable pains——the infant develops frustrations that
lead to a sense of abandonment, of helpless rage, and
mistrust in others and the world. These unresolved
frustrations and conflicts will remain until the
subjective experience: of’ heroin--rekindles the sought-

after sense of omnipotence and dampens the rage and

resentments toward the untrustworthy world (Zimmering et

 

19

al., 1952; Weider & Kaplan, 1969; Milkman & Frosch, 1973;
Khantzian, 1974).
Erikson (1959) acknowledges that
in the psychiatric literature, we find frequent
references to an ”oral character," which is a
characterological deviation based on the unresolved
conflicts at this stage. Whenever oral pessimism
becomes dominant and exclusive, infantile fears,
such as that of ”being left empty," or simply "being
left," and also of being "starved of stimulation,"
can be discerned in the depressive forms of "being
empty and at being no good." Such fears, in turn,
can give orality that particularly avaricious
quality, which in psychoanalysis is called "oral
sadism," that is, a cruel need to get and to take in
ways harmful to others.
Kaufman (1974) has emphasized that "behavior such as low
frustration to tolerance, viewing others only as
providers of supplies, manipulativeness, extractiveness,
self-destructiveness, and impaired reality testing
historically has been taken as evidence of the addicts
oral character structure." Ina relation to the feelings
of being empty and of being no good, Khantzian (1978) and
Kaufman (1974) support the idea that the heroin addict
feels cut off, hollow and empty, as Erikson has
described, and that it is for this kind of individual
that the heroin experience provides an absence of
conflict, a dampening of rage, a peacefulness of being
filled up, and an opportunity to engage in the
pleasurable fantasies of omnipotence. The cruel need to
get and to take becomes harmful to the addict under the

guise of pleasure.

20

Erikson (1959) indicates that "in adults, the
impairment of basic trust is expressed in a basic
mistrust. It characterizes individuals who withdraw into
themselves in particular ways when at odds with
themselves or others." Having already developed some of
the issues regarding the development of basic mistrusts
in addicts, it is important. to) cite the research. of
Spotts and Shontz (1982) that lends support for the idea
that heroin addicts indeed withdraw from the world in
peculiar ways. Spotts and Shontz noted that the heroin
abusers in their study

were all leading narrow and constricted lives, and

were all isolates who were cynical and distrustful

of others. Few could tolerate close or mutual
relationships. They avoided intense emotionality.

The chronic opiate users would rather withdraw from

the problems of life than attempt to conquer them.

Chein et al. (1964) summed up the narcotic addict's
developmental issues quite aptly by stating that the

narcotic addict

though matured in years, he has yet to successfully
manage the developmental hurdles of infancy (the
acquisition of what Erikson has called "basic
trust") and that, unlike the infant before him the
tasks of achieving self-acceptance and trust in
others, the addict is already carrying the psychic
scars of his own failure and of the social world
that has failed him.

It was the contention in this study that the heroin
abuser has unresolved developmental conflicts and issues
resulting from the unsuccessful resolution of Erikson's

first stage of development--Trust vs. Mistrust.

21

Developmental Issues and
Cocaine Abusers

 

Erikson (1959) in outlining his developmental
sequence, noted the second stage of his theory as
Autonomy vs. Shame and Doubt. This stage is described as
the child's movement toward autonomous functioning. The
learning to "let go" is an extension and abstraction
paralleling the general physical development of the
child. In Western societies, it parallels the task of
learning sphincter control over bowel movements. What is
central and important in this stage is .not the anal
"pleasure" and its frustrations, but rather, the clash of
wills between the very young child--attempting to express
his/her newly sensed freedom in such crude ways as not
going to the toilet—-and the imposition of parental
authority. Erikson attributes a great deal of importance
in this stage to the jparenting agents, who may show
respect and positive regard for the child's blossoming
autonomy, while vigilantly acting to protect the child
against failure experiences that produce shame and doubt.
In the optimal experience, the respect, positive regard,
and vigilance communicates to the child a recognition of
the separateness between parents and child, allows for
the availability of self-worth that is nonconditional,
and facilitates the child's recognition of his/her own
self-worth. When this particular approach is not the

22

consistent style of interaction between the parent and
child, active shaming (either overt or covert) and/or
exposure of the child's shortcomings occurs and the child
experiences a sense of inferiority or badness that seems
to be all pervasive. This sense off inferiority arises
out of the feeling that one is not able to live up to
parental expectations. Weigel (1974) supports this
position by suggesting that active shaming by the parents
prompts the child to feel that he/she is different and
bad because of his/her shortcomings. This causes the
child to hold himself/ herself responsible, not because
of the doing or the not doing of a particular act, but
because one is a certain way. This gives rise to shame
and doubt in the child. Negri (1974) substantiated
Weigels' stance and elaborated further on how parents may
evoke shame in the child. Negri noted that shame can
arise from the active shaming on the part of the parents,
through ridicule or showing contempt. Shame may also
arise out of the parent's indication of disappointment in
or dislike of the child as a person, as well as the
child's sexual or nonsexual impulses. Additional shame
may arise from the inadvertent disregard for the child's
immediate needs. These different routes can set the
stage for a child to view himself/herself as unworthy of
response or regard and can engender an introjected rage

resulting from the perceived parental withholding of "at

23

oneness," closeness, and affections. Therefore, the
child develops a sense of shame and doubt. Spotts and
Shontz (1923) described the cocaine abuser in their study
as having developed such shame and doubt. They stated
that the

low level (dosage wise) abusers we studied are

insecure persons, troubled by self-doubts and

feelings of inadequacy; they are easy going people
who avoid conflicts and intense emotionality.

Cocaine helps them to feel more self-assured,

enhances social relationships, warms and enlightens

a dreary day or provides a brief escape from an

otherwise dull existence.

In essence, cocaine helps the abuser to overcome the
pervasive feelings of shame and doubt.

Erikson (1959) described shame as an experience of
complete self-consciousness, complete exposure, and an
awareness of being whole visible--both in one's external
being and for one's internal life and thoughts; all of
one's badness is visible whether the audience is real or
imagined. Shame and doubt arises out of an awareness of
societal expectations and pressures that are not adhered
to or lived up to. Shame is the feeling that one does
not look good in another's eyes and doubt stems from the
realization that one is not so powerful after all and
that others can control and perform actions much better.
Erikson suggests that experiencing shame includes rage at

oneself because failures and/or inadequacies have been

exposed to or by significant others. Grinker (1955)

24

succinctly summed up this kind of experience by noting
that in the same experience, a clear message is received
stating that "I am not as good as he is or as they
expect me to be, therefore, I hate myself." Lynd (1958)
conceptualized shame in a very similar manner, by noting
that shame is
a wound to one's self-esteem, a painful feeling or
sense of degradation excited by the consciousness of
having' done something 'unworthy' of' one's previous
idea of one's excellence. Also, a peculiarly painful
feeling of being in a situation that incurs the
scorn or contempt of others.
On an historical note, Fenichel (1945) viewed shame as
arising from the loss or lack. of bladder control in
childhood. The child's failure is exposed to others and
thus the experience of shame is equated with the
experience of being looked at ". .. . to be looked at is
to be despised," which gives rise to a defensive posture
of ". . . if you do this or that, you may be looked at an
despised." Spotts and Shontz (1982) provided an
acknowledgment of this kind of painful experience in the
lives of chronic cocaine abusers when they stated that
the typical cocaine user almost broke free from the
maternal control but still carries wounds from this
battle with the Terrible Mothers. In childhood,
when this man reached out for tenderness and
compassion, the embarrassment and humiliation he
experienced was a source of pain. Consequently, he
vowed to become a strong, self-sufficient warrior
who needs to lean on no one.
In their earlier research, Spotts and Shontz (1980) noted

that the abusers of cocaine are "counter dependent

25

individuals who are wary, sensitive to slights,
suspicious, and distrustful of others . . . (they seem to
believe that in cocaine, they have found a shortcut to
happiness and fulfillment." Cocaine seems to provide
these individuals with a way to avoid feeling the shame
and doubt and provides an illusion of autonomy.

Fenichel (1945) when describing the concept of
shame, counterposed it with ambition. The purpose of
ambition is the conquering or overcoming of shame. In
the cocaine abuser, Gay et al. 91973), Sabbag (1976), and
Spotts and Shontz (1980), have all indicated that the use
of cocaine may be popular because of the fact that it
reinforces the qualities in life that. most Americans
admire; namely, initiative, drive, optimism, and the need
for achievement. Cocaine seems to allow the individual
the illusion of overcoming the shame and doubt, the
feelings of inadequacy and rage, and therefore, the
cocaine abusers can be seen as a productive individual
possessing the attributes that are admired in our
society.

Levin (1967) states

the essential threat in shame . . . is that of
rejection (which may be communicated through
criticism, scorn, abandonment, etc.). Since

acceptance (or respect) by a person is the
antithesis of rejection, the wish to gain acceptance
can be equated with the wish to avoid rejection.
One can postulate that when acceptance (or respect)
is obtained, the individual normally experiences

26

feelings which are the opposite of shame. Such

feelings might be referred to as "pride," "honor,"

"self-esteem," etc.
Levin felt that shame may be seen as arising out of the
fear of loss of life, to the point that "many of the
people who have intense shame are very shy and try to
keep a certain distance from others as a means of
protecting themselves against the intense shame which
they feel under certain conditions of self-exposure."
Several important issues regarding cocaine abusers arise
out of Levin's contentions. The first issue is noted in
Spotts and Shontz's (1980, 1982) in that cocaine abusers
"select careers in which supervision and control by
others is minimal." In this case, the rejection, the
contempt, and the scorn from others is kept to an
absolute minimal level. The second point is that some
cocaine users reported that cocaine enhanced their social
relationships, with the cocaine dampening their feelings
of shame, the individuals could bridge the distance that
they normally felt toward others. Thirdly, cocaine
abusers have related that cocaine enhances their sexual
relationships. The cocaine abuser seems to find that the
use of cocaine allows them the delusion of having
overcome their shyness and the distance that they feel
from others as well as prolonging sexual intercourse

(Spotts 8. Shontz, 1980). In the sexual experience, the

cocaine abuser may desperately attempt to please others,

27

in hopes that they might be able to regain the love that
they missed as a child. At the same time, the individual
may fear that the "letting go" into a true union with
another without the use of cocaine will be overwhelming
and devastating to their brittle sense of self.
Relationships are approached out of a need for closeness,
however, the cocaine abuser must recoil out of a fear of
exposure based on earlier shamed needs, fears of
insatiability (a likely resultant of the early
experienced lack of fulfillment of some basic needs),
and fears regarding the expression of early experienced
rage at parental nonresponsiveness. The expression of
needs and impulses have been connected to pain,
frustration, lack of fulfillment, shame and doubt and
ultimately the loss of the other through rejection and
abandonment. Cocaine seems to provide the illusion of
having overcome these fears.

Levin (1967) relates that shame acts to insure the
attainment of parentally prescribed behaviors and values
and the repression of the impulse or need. The initial
fear of the child or infant is in losing the positive
regard of the parents through rejection (i.e., criticism,
ridicule, scorn, abandonment, etc.), for not living up to
the parental expectations. A response to this fear of
rejection is the use and abuse of cocaine with the

subsequent illusion of mastery or sense of mastery that

28

it provides. With cocaine, the individual appears to be
striving toward achieving the parental expectations of
actively pursuing the American Dream.

Spotts and Shontz (1982) felt that their sample of
cocaine abusers spanned the Eriksonian stages of
Autonomy, Initiative, and Industry. It. will be the
contention of this study that the cocaine abuser is
mainly engulfed in their struggle for independence—-
autonomy. Cocaine abusers will have core developmental
conflicts and issues resulting from the unsuccessful
resolution of Erikson's second stage of' development-—

Autonomy vs. Shame and Doubt.

Overview

With the problem presented and the hypotheses
stated, two important topics remain before the reader can
evaluate the results of this study: a literature review
and the methodology. In Chapter II, the literature
relevant to this study is presented. This included a
brief overview of the physiological effects of heroin and
cocaine, the major psychodynamic theorizing about
substance abuse, and specific jpsychodynamic theorizing
about heroin abuse and cocaine abuse.

In Chapter III, the methodology used in this study

was described. This included characteristics of the

 

29

sample, the measure, hypotheses, design, and statistical
analyses.

In Chapter IV, the result of the statistical
analysis of the study's hypotheses were presented.
Chapter V was devoted to summarizing the research,
discussing the findings, and their implications for

further research.

CHAPTER II

REVIEW OF THE LITERATURE

After an extensive review of the literature in such
disciplines as psychology; medicine, social. work,
education, sociology, and the addictions, quite a few
research articles relative to this study' were found.
Since most literature reviews could extend ad infinitum,
it was the goal of this literature review to present only
the major theorizing and research investigations.
Operating with such a framework, the literature review
was organized so that the reader will be familiar with
(a) a brief overview of the physiological nature of
heroin abuse and cocaine abuse; (b) an overview of the
major psychodynamic theorizing and investigations on the
bases for substance abuse; and (c) the psychological

research specific to heroin abusers and cocaine abusers.

Physiological Perspective
An in-depth discussion of the physiological and
pharmacological actions and effects of cocaine and heroin
is well beyond the scope of this study. However, a basic
understanding of their effects and actions is of vital

importance to the drug abuse researcher.

30

31

Heroin

Heroin is a member of the class of drugs designated
as narcotics (from the Greek——narkoun, meaning to deaden
or benumb). Narcotics are more pr0perly known today as
opioids, a collective designation for both natural
opiates (opium and its derivativeS) and synthetic
opiates. Narcotics are described in the pharmacological
literature as central nervous system depressants.

Narcotics act mainly upon the central nervous and
digestive systems. They are used today for much the same
medical purposes as they have been for hundreds of years,
mainly to relieve pain, control diarrhea, and suppress
coughing.

While narcotics can suppress coughing, they also
stimulate other involuntary responses, such as nausea and
vomiting. Their ability to reduce the movement of food
through the intestines makes these drugs the most
effective means yet discovered to treat diarrhea.
Narcotics will constipate users who employ them for other
purposes. Most narcotic abusers will report problems
with constipation.

In addition to their analgesic properties,
narcotics, such as heroin, produce euphoria, and it is
the quality of the narcotic high that makes heroin such a
seductive and powerfully reinforcing drug of abuse.

Heroin creates a sense of warmth and well being, peace,

32

and contentment, feelings of strength and energy. Major
problems and every day irritations fade. Anxiety and
depression lessen. The world becomes more pleasant. The
heroin high exerts a powerful hold. And as the saying
goes, "It's so good, you don't even want to try it once."

Mothner and Weitz (1984) note that

the first semisynthetic narcotic, diacetylmorphine,

was cooked by boiling morphine with acetic

anhydride, in 1874 at St. Mary's Hospital in London.

But it was nearly a quarter century before the

German pharmaceutical firm Bayer marketed the drug,

under the trade name Heroin, as a cough suppressant.

The jphysiological and pharmacological effects and
actions of heroin, in depressing the functions of the
central nervous system, are manifested by the following:
(a) calming or relief of tension and anxiety; (b)
drowsiness, sedation, sleep, stupor, coma, or general
anesthesia; (c) increase of' pain threshold; (d) mood
depression or apathy; and (e) disorientation, confusion
or loss of mental acuity (Nowlis, 1969).

The route of administration of heroin is usually
through injecting it, either subcutaneously (beneath the
skin) or intravenously ("mainlining" it directly into a
vein). Heroin is rarely taken orally, due in the most
part, because it is a highly inefficient route of
administration. There are a growing number of heroin

users now smoking street heroin.

Mothner and Weitz (1984) note that

33

the effects of smoking can be similar to intravenous
injection in tmiggering heroin's orgasmlike "rush,"
the euphoric peak of the drug experience. The rush
fades in a matter of minutes, and is replaced by a
prolonged period of lethargy. The "nod," which can
last six to twelve hours and is marked by a sense of
overall contentment and the absence of anxiety and
appetite.

When heroin is taken on a regular basis, tolerance
develops over time, and therefore, increasingly larger
doses are necessary to experience the rush and euphoria.
In time, the compulsive heroin user experiences fewer and
fewer of the pleasurable effects from the drug. However,
usage must be continued--and even increased--to avoid the
discomfort of withdrawal. The withdrawal symptoms begin
with uncontrollable yawning, a runny nose, and a cold
sweat. In the classical heroin withdrawal, symptoms will
include .nausea, vomiting, intestinal spasms, diarrhea,
and muscular pains. There is alternatively shivers and
sweat and an inability to remain still. There can be
extreme anxiety and intense drug cravings. The symptoms
usually diminish within two weeks, depending upon the
degree of tolerance.

Mothner and Weitz note that

there is some agreement among scientists studying

opiate receptors in the brain that the production of

endorphins (the body's own morphinelike chemicals)
seems to drop off when narcotics are regularly being
supplied from outside the body . . . with no heroin
and little endorphin to reach their receptors and
trigger "slow down" signals, a number of centers in
the brain start transmitting at an accelerated rate.

Communication speeds up through all their networks.
The autonomic nervous system, which controls such

34

involuntary functions as breathing and digestion,
begins bombarding its outposts with garbled messages
that bring on such withdrawal symptoms as nausea,
cramps, diarrhea, and a runny nose.

Cocaine

Cocaine belongs to the class of drugs designated as
stimulants. Stimulants have the general effect of
increasing functional activity through the stimulation of

the central nervous system.
Mothner and Weitz (1984) state that

what some users seek from cocaine is relief from

depression . . . others use the drug to sharpen
their performance on the job or in the social scene
or during sex. And cocaine can, indeed, upgrade

performance by increasing energy, creating a wide—
awake-and—with-it-feeling and masking depression.
Everything appears sharper and clearer with coke;
confidence rises and problems seem simpler.
In essence, things really do go better with cocaine.
Spotts and Shontz (1980) related that "the details
of the physiological and pharmacological actions and
effects of cocaine are currently matters of some debate."
Four years later, this sentiment was echoed by Jone's
(1984) statement that one ". .. . might assume that the
scientific knowledge of cocaine is relatively complete,
it is not." With this thought in mind, a brief survey of
current knowledge about the physiological and

pharmacological actions and effects of cocaine is being

presented.

35

There seems to be general agreement among
researchers that cocaine stimulates the central nervous
system from above, downward. Its effects begin in the
cortical cells of the brain (Ritchie, Cohen, & Dripps,
1970), and are associated with euphoria, garrulousness,
excitation, restlessness, and a feeling of heightened
physical and mental powers.

Cocaine is a short-acting stimulant that is unique
in its dual ability to deaden feelings while constricting
the blood vessels. Cocaine is the most potent of all
sympathomimetic agents, and can induce rapid elevation of
heart and respiration rates, as well as blood pressure
(Post, Kotin, 8. Goodwin, 1974). Heavy use can produce
euphoria, anorexia, and insomnia; anxiety; agitation and
confusion; depression; visual, auditory, and tactile
hallucinations; and acute psychosis, with paranoia and
delusions (Gay et al., 1973; Spotts & Shontz, 1980;
Wesson & Smith, 1977).

In general, stimulants work, at least in part, by
causing the release of neurotransmitters (chemicals that
stimulate neighboring neurons), such as norepinephrine,
from nerve cells. Some stimulants mimic the functions of
transmitters like norepinephrine through a direct effect
on the nerve cells themselves. Specific to cocaine,

Shuckit (1984) reports that

36

cocaine's effects occur through a variety of

mechanisms, including the blocking of initiation or

conduction of peripheral nerve impulses

(contributing to its local anesthetic effect),

direct stimulation of the CNS, and blockage of

catecholaimine uptake (norepinephrine more than
epinephrine) at nerve terminals.

In its predominant effects, Schuckit relates that
cocaine has a biphasic effect on CNS actions--lower doses
tend to improve motor performance, with higher doses
causing a deterioration, possibly with subsequent severe
tremors and even convulsions. Additional CNS effects
include nausea and possible emesis, dilated pupils, and
an increase in body temperature, probably reflecting both
direct actions on the brain and indirect actions through
muscle contractions. There is a decrease in fatigue.
The cardiovascular effects are also biphasic--lower doses
tend to produce a decrease in heart rate via actions on
the vagus nerve while higher doses produce both an
increased heart rate and vasoconstriction, with a
resulting elevation in blood pressure. The actions on
the heart may produce arrhythmia both directly through
the effects of the drug and indirectly through
catecholamine release.

Since cocaine is absorbed at all sites of
application, there are a number of routes of
administration. In the United States, "most users take

cocaine intranasally, snorting into the nostrils, a

process technically called 'insufflation.' Cocaine is

37

readily absorbed by mucous membrane and easily reaches
the bloodstream this way" (Mothner & Weitz, 1984). When
cocaine is snorted, the maximum response is usually
achieved within the first ten minutes, with the euphoria
lasting usually not much longer than half an hour, sixty
minutes at the most.

Some users take cocaine orally. However, this route
of administration is rarely used due in a large part to
the peak effect being much slower--roughly an hour after
administration.

The smoking of cocaine has gained in popularity.
This route of administration involved a process of
smoking freebase. This is a highly efficient and heavily
reinforcing means of administration, and is almost as
rapid a route as injecting the drug intravenously. In
smoking freebase, cocaine has to be converted back to its
alkaloid form. This is usually achieved by boiling it
with baking powder or more explosive solvents, which
results in purifying the cocaine. The dangers involved
in this time-consuming process were underscored by
comedian Richard Pryor's near fatal 1980 accident.

Kinkopf (1986) notes that dealers have taken over
the process of preparing cocaine for smoking. The result
is "crack," a sliver of whitish, rocklike substance that

measures between 70 and 90 percent pure cocaine.

38

Cocaine can be inainlined, injected intravenously.
When injected directly into the bloodstream, cocaine
provides a maximum rush to the central nervous system
within minutes and a nerve-jangling rush (much like the
freebase experience) within seconds of administration.
Because cocaine constricts the blood vessels, cocaine is

rarely ever injected subcutaneously or intramuscularly.

Psychodynamic Overview

The early psychodynamic formulations about the
personality development of substance abusers were
grounded in the prevailing psychoanalytic model of that
time. Sigmund Freud never devoted a paper to addiction,
and his references to addiction were little more than
asides in papers devoted largely to other matters. One
of these asides is Freud (1897) in his letters to Fleiss,
which provided a brief glimpse of his view of substance
abuse. Freud wrote that ". . . masturbation is the one
great habit that is a 'primary addiction' and that the
other addictions, for alcohol, morphine, tobacco, etc.

., only enter life as a substitute and a replacement
for it."

Crowley (1939), in providing a comprehensive review
of the literature on alcoholism and drug addiction, noted
that the "clinical papers frequently mentioned other

aspects of the addiction problem, sadism and masocism for

39

example. However, their theoretical sections emphasized
the libidinal elements just as the general trend of
analytic theory." On a specific note, Crowley stated
that it was "not until 1926, did any paper attempt the
problem of addiction as a whole. . . . Theoretical papers
dealt almost exclusively with libidinal elements, mainly
oral erotic." Crowley was referring to Rado (1926).
Rado attempted to examine drug effects in light of
Freud's (1920) concept of a protective shield or stimulus
barrier. Freud considered that such a barrier was
operative against external stimuli only and as such was
powerless to defend the ego against internal excitations.
Rado (1926) thought that the painkilling, sedative and
hypnotic drugs made up for this deficiency by supplying a
central artificial shield as a "second line of defence."
The result is that the psychical apparatus is spared the
helplessness and the psychic pain through the use of a
drug which diminishes the sensory input. Regarding
stimulants, Rado suggested that they act on the
inhibitions and tensions arising from the conflicting
claims on the ego by the instinctual demands and superego
prohibitions by loosening the bound cathexes so that the
conductivity of the system is increased.

Rado's (1933) writing represents a revision of the
"classical" explanation of addiction. He suggested that

although it was destructive in its effect, drug usage

40

might represent an individual's attempt to cope with
difficult emotional states. Rado's theorizing had the
significant effect of viewing drug addiction as a
psychological problem for the first time. He argued,
". . . that it is not the drug but the individual's
impulse to use it that makes an addict." Crowley (1939)
emphasized the historical nature of this shift by stating
that
the question is about the singleness of the impulse
rather than the variety of drugs used. Rado

discussed the question of why the addict must
continue to seek out the pleasure effect even though

it. means self-injury and self-destruction» ‘When
human beings are frustrated, they react by what Rado
calls a "tense depression." Relief of this

depression by a drug is very impressive, so that the
pharmacogenic pleasure effect may produce a sense of
elation. During this "tense depression," the ego
wants to get back to the stage of infantile
omnipotence in which self-esteem may be enjoyed
without coping 'with reality. This is magically
obtained by taking the drug.
As the elation from the drug passes, there is a return to
the original state with the exception that the addict has
a greater fear of reality and guilt form escaping from
it. This sets up a cyclical pattern of "tense
depression" that leads to drug taking, which results in a
transient elation followed by a new "tense depression"
with the added features of fear and guilt and once again
the craving for the elation necessary to maintain self-
regard. Rado called this cyclical pattern

"pharmacothymia." Rado stressed that the "pharmacothymic

41

regime" was set up by "defects in ego development, lack
of satisfying early object relations, the lack of
affectionate and meaningful object relations, and by an
artificial technique used to maintain self-regard and
satisfaction." Hendin (1974) related that the early
psychodynamic studies of addiction, such as Rado's,
placed all types of drug craving into a single disease or
disorder characterized as an impulse disorder in which
"the ego is subjugated by an archaic need for oral
gratification."

The next major theorizing about drug addiction
occurred when Fenichel (1945) hypothesized that drug
addiction was a regression to orality and represented an
attempt to find a substitute for the maternal object.
Fenichel supported Rado's earlier suppositions by
emphasizing that ". . . the origin and nature of
addiction are not determined by the chemical effect of
the drug but by the psychological structure of the
patient." He noted that addicts represent the most
clear-cut type of "impulsives." Fenichel affirmed that
the same urges that govern other pathological impulses
are operative in a addicts, namely, the need to get
something that its not merely sexual satisfaction, but
also provides security and self-assertion, and as such,
essentials to the person's very existence. IFenichel

recognized the need to differentiate between addicts and

42

temporary drug users. He made this distinction by noting
that for the addict ". . . the drug effect is used to
satisfy-—archaic oral (sexual) longings, the .need for
security, and a need to maintain self-esteem."

Fenichel (1945) noted that in drug addiction, there
is a "short circuiting" that occurs in the biological
system, so that the normal pleasure-pain principles no
longer function. He stated that an

analysis of drug addicts shows that genital primacy
tends to collapse in those persons whose genital
primacy has always been unstable. In analysis, all
kinds of pregenital wishes and conflicts may reveal
themselves in a confusing manner. The final stages
are: more instructive than the confusing pictures
that appear during the process. The eventual
"amorphous tension" actually resembles the very
earliest stage in libidinal development, before
there was any organization at all, namely, the oral
and cutaneous tendencies are manifest in those cases
where the drug is taken by mouth or by hyperdermic
injection, the syringe, it is true, may also have

genital symbolic quality; the pleasure,
nevertheless, is secured through the skin and is a
passive-recepitve one. More important than any

erogeneous pleasure in drug elation, however, is the
extraordinary elevation in self-esteem. During the
drug’ elation, erotic: narcissistic satisfaction
visibly coincide again. And this is the decisive
point.
For Fenichel, addicts are "fixated to a passive-
narcissistic aim."

Gerard and Kornetsky (1954) represents one of the
finest in—depth studies on addicts. Using an analytic
frame of reference, they studied the general, social, and
psychiatric characteristics of 32 male adolescent addicts

from the United States Public Health Services Hospital in

43

Lexington, Kentucky' 'These subjects were given a
comprehensive psychiatric interview, as well as a
complete psychological testing battery consisting of the
Rorschach, Thematic perception Tests, the Wechsler-
Bellevue, Draw—a-man, and the Bender-Gestalt Test. The
results from 'the interview' and the independently
formulated interpretations of the projective tests
indicated that all of the subjects were seriously
maladjusted. Gerard and Kornetsky felt that the opiate
drugs fulfilled several adaptive functions, namely, (a)
the addict can avoid awareness of his intrinsic source of
discomfort, and therefore, rationalize that the drugs
force one to act out hostile feelings and impulses as
well as support their delusional and/or distorted
perceptions and expectations of interpersonal
relationships by living a life of deceit,
manipulativeness, and suspicion; (b) drug usage
diminished overt psychiatric symptomatology; (c) the
opiates helped to control the anxiety in interpersonal
relationships by allowing the addict to be able to
participate more adequately in normal adolescent
activities--i.e., dancing, dating, or going our with the
gang; (d) the regressive, oral satisfaction at the "high"
was valuable for the emotionally disturbed individuals
who are not able to find adequate satisfaction in

recreation, work, or interpersonal relationships. Gerard

44

and Kornetsky found "no essential relationship between
drug addiction and socio-economic groups." Gerard and
Kornetsky (1955) studied 55 male adolescent opiate
addicts in a controlled group. The results indicate that
becoming an opiate addict is a highly individualized
process which can be understood only in the context of
the individual's personality structure, past life
experiences , and present interactions with the
significant figures of his familial and peer group. Both
of the Gerard and Kornetsky studies lend support to
Fenichel and Rado's theorizing by emphasizing the
personality structure of the addict and the use of drugs
in an adaptive capacity.

As the focus of psychodynamic theory began to
include concepts from ego psychology, a number of new
formulations emphasizing ego organization and character
structure were added to the addiction literature. As
Fenichel (1945) heralded in this transition, it was
Savitt (1954) who provided a good presentation of the
concepts. Savitt presented an ego psychology framework,
when from his somewhat meagre sampling, he stressed the
following etiological factors contributing to drug
addiction: "(1) early disturbances in the development of
the ego; (2) ego weakness; (3) ego splitting; and (4)
immaturing of the ego." Savitt related that "the mother-
child relationship appears to be crucial," since the

45

infant can't develop any confidence or hope that will
allow him/her to tolerate present frustrations in
anticipation of future gains. In a later paper, Savitt
(1963) reaffirmed his belief by stating that it is
"vicissitudes of early ego development and later ego
maturation which facilitate and encourage regression that
appears to play a dominant role in predisposing an
individual to other development of a crippling morbid
craving."
Rado's (1956, 1957) work represents support for this
new direction in conceptualizing addicts. In a
reexamination of drug addiction based on his added
experience and the point of view of adaptional
psychodynamics, Rado (1956) stated that from. Ihis
experience
certain individuals are unable as young children to
make the adjustment and transition from "the
narcissistic system" to the realistic regime of the
ego; from the blissful state of self-loving with the
omnipotent ego fancying itself as the center of the
universe, where its commands and overdemands are
equally fulfilled to the first contacts with the
pains and frustrations of reality.
The first blow to self-esteem and the attempts to
incorporate the frustrating love-object and subsequent
hostility against the love—object results in a "tense
initial depression." This "tense initial depression" may

last according to Rado for years in various conflictual

variations until the day when the analgesic, hypnotic,

46

and elatant effect of drug(s) is discovered, erasing
reality and temporarily reinstating the narcissistic
omnipotence. But, the pharmacological effect is short-
lived, and there is a sobering reawakening in which the
original "depression" is accentuated and compounded by
the guilt feelings for escaping from reality. The
"pharmacothymic regime" that he first described in 1933
is established and the vicious cycle with the inevitable
alteration of mood is played out. Rado now emphasizes
that the "pharmacothymic regime" displays a
disorganization of psychosexual development in the
individual.

Rado (1957), in considering the dependence on
narcotics, emphasized the importance of regression and
defects in development as being the key concepts to
understanding narcotic dependent individuals. Ike stated

that

under the revised system of psychoanalytic thought,
dependence on narcotic drugs is regarded as a
malignant form of miscarried repair, artificially
induced by the patient himself . . . and to explain
the remarkable reaction, we must penetrate into the
deepest and oldest strata of the mind, formed during
the earliest stages of ontogenic development. The
narcotic superpleasure may be viewed as a
developmental derivative of alimentary orgasm.

Rado felt that the individual, who is about to develop a
narcotic drug dependence, is one who has had a long
history of intolerance to pain, coupled with "strong but

often overcompensated needs."

47

In the sixties, the work of Chein, Gerard, Lee, and
Rosenfeld (1964) marked a significant shift in the
psychoanalytic literature. By studying the adolescent
addict in the ghetto, rather than the adult addict in
the analytic office, they provided some new perspectives
on which to build a better understanding about drug
addiction. Chein et al. placed major emphasis on the
individual's attempt to use drugs adaptively to cope with
the overwhelming adolescent anxiety associated with
anticipated adult roles in the absence of adequate
preparation, models, and prospects. Chein et al.
followed, for a large part, the view that preexisting
personality disturbances and consequent psychosocial
maladjustment results in the development of drug
dependence. They argued for the necessity of specific
social factors and the individual's experience of drug
use as psychologically or socially helpful, useful, or
adaptive as a precondition (determining) factor in
addiction, instead of the widely accepted psychological
deviance stance. Seldin (1972) reviewed the research of
Chain et al. and felt that their work supported his
contention that for young male addicts, the critical
factor is the degree of family emotional health. This
critical factor emphasizes the importance of the
individual's relationship with his mother as being

crucial. From a family therapy point of view, Seldin

48

indicated that the family process for the addict is seen
as inconsistent, overindulging, as well as overdenying.
This process seems to be determined arbitrarily by the
mood swings of the parents, and by parental standards
that are not always stressed. Seldin (1972) also
reviewed the literature from the various disciplines
studying the visible male addict and found that these
research investigations emphasized the addicts immature
personality development.

Hartmann (1969) reported the findings of a study
group of the American Association of Child
Psychoanalysis, that was formed to investigate the use of
drugs by adolescents. The study group suggested that
some of the points that Rado (1933) had made seemed to
apply to the current adolescent drug—using population.
The group stated that:

1. There is a basic depressive character with early
wounds to narcissism and defects in ego
development.

2. There is an intolerance for frustration and pain
with a constant need to change a "low" into a
high." This may come from an early lack of
satisfying object relations.

3. There is an attempt to overcome the lack of
affectionate and meaningful object relations
through. pseudocloseness and fusion.‘with. other
drug takers during their common experience.

4. The artificial technique of maintaining self-
regard and satisfaction with drugs, of avoiding
painful affects, and alleviating symptoms
results in a change from a reality-oriented to a
pharmacothymic—oriented regime. This leads to
severely disturbed ego functions and ultimately
to conflict with reality. Eventually, the drug
taking becomes a way of life.

49

Krystal and Raskin (1970) indicated that the
psychological preconditions that disposed an individual
to seek and become dependent upon drugs, as a
developmental problem in the differentiation of affects.
In their book, they have placed the preconditions in
early infancy and in the defective development of the
requisite skills necessary for the successful management
of affective states. The drugs help the individual to
avoid and/or manage the painful affective states.

In the late 1960's and into the 1970's, research
investigations began to focus on the preferential use of
drugs. Weider and Kaplan (1969) concluded from their
experience that different drugs induce different
regressive states that resemble specific phases of early
childhood development. They stated that "the user
harbors wishes or tendencies for a particular regressive
conflict solution which the pharmacology of a particular
drug may facilitate . . . the repeated experiences of
satisfaction establishes preference for the specific
drug." Weider and Kaplan lend support to Fenichel's
(1945) statement that

the problem of addiction reduces itself to the

question of the nature of the specific gratification

which person's of this type receive or try to
receive from their chemically induced sedation or

stimulation and the conditions that determine the
origin of the wish for such gratification.

50

Frosch (1970) offered further substantiation for Welder
and Kaplan's contention by stating that

having once experienced a particular drug induced
pattern of ego functioning, the user may seek it out
again for defensive purposes as a solution to
conflict or for primary delight. This seeking out
of a special ego state will be related to the
individual's previous needs for the resolution of
conflict or anxiety. If a particular drug induced
ego state resolves a particular conflict, an
individual may seek out that particular drug when in
that particular conflict situation. This will
result in a preferential choice of drug.

Milkman (1974) summarized his research by stating

that

the origins of specific drug abuse may be in the

nature of the drug-induced altered ego states.

These may recapture a series of similar experiences,

the origins of which appear to exist in specific

phases of child development. A particular drug may
thus facilitate a specific regressive solution to
conflict and may, therefore, be preferred.

Khantzian's (1975) research suggested that an
individual "selects" one as opposed to another drug in an
attempt to cope with specific problems in the internal
and external environment, which without the drug's effect
would be unmanageable or unbearable.

Wurmser (1972) related that in the compulsive drug
user, the drug usage is only the tip of the iceberg--an
indicator of all the deeper troubles he is beset with.
Although. speaking specifically about. opiate: addiction,
Wurmer (1974) felt that opiate addiction was a response
to, or an attempt, to cope with preexisting

psychopathology. This supported Kohut (1971) who noted

51

that "the drug . . . serves not as a substitute for a
loved or loving object or for a relationship with them,
but as a replacement for a defect in the psychological
structure."

In the study most relevant to this proposal, Spotts
and Shontz (1982) researched the developmental
antecedents of chronic drug abusers. Their overall goal
was to obtain comprehensive information about drug
effects, drug use, and the personality characteristics of
chronic drug abusers. This research was the result of
inferences derived from a six-year project that examined
the life histories, drug experience, and use patterns,
psychological adjustment, and personality characteristics
of selected chronic users of cocaine, amphetamines,
opiates, barbiturates, and sedative—hypnotics. Subjects
were selected for the study on the premise that the
structure, dynamics, and motivations underlying drug
abuse would be more readily discernible in an in-depth
study of those individuals than in a more traditional,
but superficial, large-scale survey of heterongenous
users. Participants were selected to produce groups that
were matched for age, sex, intelligence, socioeconomic
status, and lifestyles. Their compilations indicate that
the five groups of chronic drug abusers were ordered
along a continuum of psychological maladjustment ranging

from barbiturate, sedative-hypnotic abusers--representing

52

the greatest amount of psychological maladjustment, to
opiate abusers, to amphetamines, to cocaine abusers, to
nonusers--representing the greatest degree of
psychological adjustment. This continuum is
representative of the schemata for development, with
barbiturate, sedative-hypnotic abusers having the lowest
level of development, to nonusers having the highest
level of development. This research was based on the
theories of development of Jung, Neumann, Edinger, and
Campbell. The key implication of Spotts and Shontz's
(1982) research is as follows:

once a person elects to use drugs, his ultimate

choice of substance is systematically related to the

core problem. he is attempting to resolve; drugs
temporarily produce something akin to a desired ego
state, but without the pain, struggle, and
assumption of personal responsibility that genuine
individuation requires; the critical matter is not
which drug a person takes but the level at which his
core developmental problems occurred and the
developmental status the person has achieved in
spite of them.
Spotts and Shontz (1982) also noted "that chronic
substance abusers cannot be reached therapeutically
unless they fight through the psychological crises that
remain unresolved from their earliest years."

Spots and Shontz (1982) suggest that their findings
should be compared with research findings using the
theory of Erik Erikson (1963), which covers the entire
life span. Dunnette (1975) indicated that "the

psychosocial theory of Erik Erikson may well be

53

applicable for explaining and possibly predicting drug
use, particularly among young people."

In spite of the theorizing and the research studies
that have begun to consider the developmental problems or
issues exhibited by chronic substance abusers, there has
not been a published report using a paper and pencil
measure to determine the level of psychosocial
developmental impairment in chronic substance abusers.
Nor has there been research on chronic substance abusers

using an Eriksonian developmental perspective.

Psychological Perspectives

Over the past decades, addiction researchers and
theorists have attempted to describe common personality
characteristics among individuals dependent upon drugs.
These investigative efforts have provided generalizations
and suppositions which seem applicable to most types of
drug abusers. The drug abuse literature, however, does
not distinguish between the personality characteristics
of individuals as involved in specific kinds of substance
abuse (heroin and cocaine in this proposed study).
Milkman (1974) made an excellent observation. when he
indicated that "there is now a sufficient backlog of
theoretical. material to begin testing’ hypothesis with
regard to specific mind influencing agents." This

observation holds true for today, for if one accepts the

54

research findings of Rosch, 1970; Milkman, 1974;
Khantzian, 1975, 1978, 1980; and Spotts and Shontz, 1982,
that indicate that specific drug abuse is based on the
preferential choice of a drug as an attempt to cope with
specific problems that remain unresolved from the drug
abusers earliest life. One is confronted with the
question. of’ how heroin. abusers differ' in 'their
psychosocial development from cocaine abusers? Regarding
the unresolved problems from early childhood, which
psychosocial development tasks or issues are
characteristically unresolved by the abusers who prefer
heroin or cocaine?

Kurland and Mule (1978) lend credence to this
exploration of the psychosocial development of the heroin
abusers and cocaine abusers, by noting that "the choice
of a specific drug derives from the mutual interaction of
the psychodynamic meaning and pharmacogenic effect of the
drug with the particular conflicts and defects in a
person's structure throughout his development."

The Phenomenology of
Heroin AEuse

 

Zimmering, Tooland, Safrin, and Wortis (1952) whose
investigation was one of the first studies to delineate
some of the personality characteristics of adolescent

heroin addicts. Their results have importance to this

55

pr0posed study. In: their study of 65 adolescent heroin
addicts, they found the following:

They (adolescent heroin addicts) have a very close
empathic relationship with the mother or mother
surrogate. They are frequently the mother's
favorite; the father is usually out of the picture
because of death, separation, or lack of emotional
rapport. . . . Their interpersonal relationships in
general are tenuous and readily given up. . . . All
of the boys showed profound work and school
inhibitions, a fear of new situations and tasks
calling for active mastery, and difficulty in
initiating aggressive activity. . . . All of the
boys described a similar subjective experience under
the influence of heroin, consisting of (a) a
disappearance of anxiety and a feeling of euphoria
with a sensation of buoyancy or floating, (b)
increased self-esteem and self-confidence with a
feeling of positiveness in a situation, (c)
fantasies of omnipotence in the possession of great
wealth and power. . . . They resent the intrusion of
an any reality that challenges these illusions of
omnipotence and as a consequence isolate themselves
in order to preserve them. . . . The can adjust more
easily to tasks and situations demanding passive
attention and alertness than to those that require a
more concentrated effort and independent ideation of
a creative nature. . . . There is a trend toward
dependent thinking and judgment. . . . A general
constriction of interest which results in an
inability to absorb adequately what is offered
through the school and cultural environment. .

Drive and energy tend to be inhibited .or
misdirected.

Zimmering et al. (1952) felt that narcotic addiction
can be considered one style of handling problems and fits
the needs of this type of individual.' This type of
individual

perceives his activities so dangerous that he has a
strong need to inhibit all of his aggressiveness and
sexual impulses. He can find peace only under the
influence of the drug. When sexual appetite is
gone, and all aggressive activity is suspended.
Then can he engage in his pleasurable fantasies of

56

omnipotence. Even in these fantasies, there is an
absence of conflict, of active achievement, and of
sex.

Gerard and Kornetsky (1954) studied addicts at the
U.S.P.H. Hospital in Lexington, Kentucky, the researchers
found "no essential relationship between drug addiction
and socioeconomic group." The gross aspects of family
structures in which addicts were reared were "variable."
Mothers were reported to be: excessively controlling and
strict (40%) or excessively indulgent, nondisciplinary
(48%), and/or seductive (24%). Fathers were reported to
be: absent, deserted, separated, or divorced (60%), or
actively punitive, moralistic (30%), or paranoid and
controlling (20%). Of the relationships between parents,
70% were reported to be poor, with father seen as a weak
and ineffectual figure, held in contempt by the mother
and children. Gerard and Kornetsky conclude that "the
least qualified generalization which could be made about
the families of these patients, is that they were of the
types which psychiatric experience suggests are
productive of serious difficulties in adjustment."

Given that an individual's mode of coping with
life's problems is learned and engendered by his familial
experience and surroundings, Savitt (1963) presented a

family approach to studying addicts. He notes that

57

addicts to heroin were grossly neglected and unloved

by their mothers. . . the infants were not
physically unattended but the postnatal, as well as
prenatal, emotional climate was a tense and

discordant one, and one or both of the parents were
ambivalent about having the child.

This supported Gifford's (1960) comments that
the predisposition to addiction . .. . has a special
interest, because the need to reduce reality
perceptions, abolish time sense, and withdrawal from
human contact suggests an early period when object
relations existed only in terms of gratification and
the infant required a specific substance but an
undifferentiated person, and all sensations from the
environment were experienced as unpleasurable.
For Savitt, the connection exists in that "like the child
who alternates between hunger and sleep, the addict
alternates between hunger for a drug and narcotic
stupor." The elation produced by narcotics has received
the major focus rather than the sleep or stupor that
follows 11b. The transient euphoria preceding the stupor
may be related both to the decreased pressure of the
drives, libidinal and aggressive, and to the sense of
gratification of needs-satiation. The user "seeks
desperately to fall asleep as a surcease from anxiety,
and the drug provides the obliteration of consciousness.
Well expressed in the vernacular, the addict 'goes on the
nod.‘
Savitt felt that
the person who needs to inject the drug
intravenously requires more rapid. protection 'than
those who are gratified by the oral—incorporation of

need-satisfying drug supplies. Unless tension is
completely obliterated, he is left in a situation

58

akin to the undifferentiated state of the neonate,
which Freud (1936) describes as the period in which
the infant, not yet able to bind tension, is flooded
with stimuli against. which there: is no adequate
apparatus of defense.
The heroin addicts that Savitt experienced seemed to be
in just such a chronic state of intolerable tension until
they found release in heroin.

Wider and Kaplan (1969) related in a similar manner
that for the addict, the narcotic produces

a state of quiet lethargy . . . (is) . . .
conductive to hypercatheting fantasies of
omnipotence, magical wish fulfillment and self-
sufficiency. A most dramatic effect of drive
dampening is experienced subjectively as satiation
may be observed in the loss of libido and aggression
the appetites they serve.

Wider and Kaplan suggest that this style of coping
is reminiscent of the Narcissistic Regression Phenomenon
described by Mahler (1967), as an adaptive pattern of the
second half of the first year of life. It occurs after
the specific tie to the mother has been established and
is an attempt to cope with the disorganizing quality of
even her brief absences. It is as if the child must shut
out affective and perceptual claims from other sources
during the mother's absence.

This particular formulation is consistent with
Fenichel's (1945) statement that addicts are "fixated to
a passive-narcissistic aim." The psychodynamic

perspective, the term "narcissism" is used in a number of

contexts. "Primary narcissism" is seen as a failure in

59

the inner awareness and acceptance of the separateness or
differentiation between self and the object world: the
"self" is unbounded and the infant is therefore never
aware of him/herself as such. In the newborn, some
degree of primary narcissism is assumed to be the normal
state of affairs. The infant only gradually develops a
sense of separateness from the caregivers. Under good
conditions, the infant leans slowly and without much pain
that he/she is indeed quite separate; that he/she cannot
make unlimited demands on the caregiver's attention or
interest; that the caregivers have only a limited
capacity to give; but that the caregivers are still
trustworthy and lovable persons nonetheless. The
earliest attachments to others are rooted in this lack of
differentiation even as the infant begins to realize that
he/she is, in fact, not unbounded. The caregiver is
experienced as an extension or part of the infant. The
infant seemingly has but to wish or cry out, and these
extensions will do whatever is necessary to relieve the
distress. The infant develops a sense of omnipotence.
Since the infant is not aware of external objects as
such, he/she cannot attribute pleasure and pain,
gratification and frustrations to others as causal
agents; affective states are conditions of being and can
be perceived reflexively. Being is wonderful or being is

hateful.

60

As the infant develops, the self becomes more
bounded. There is a differentiation that occurs between
self and nonself. In this development, the infant enters
the phase of "secondary narcissism." The infant's
relationships are appropriately modified—-the caregivers
are experienced differently--they are no longer perceived
as extensions; rather, they become instrumentalities. If
the infant fails to make an effective transition to this
type of relationship, i.e., to an acceptance of
separateness and to the formulation of relationships with
others who are consistently seen as different and
separate—-leaves the infant subject to certain
maladaptive consequences. 'The infant never quite
succeeds in perceiving others in terms of their objective
properties. When they fail him/her, the ensuing rage is
not focused simply on the frustrating object; it is, at
least partially, directed at the primordial
undifferentiate self, at the fact of existence. When
they satisfy his/her .needs, there: is a corresponding
unbalanced and unfocused elevation of mood which embraces
the inadequately perceived others in its glow, but which
also cannot achieve recognition of the qualities of
others that have made the desirable outcome possible or
which can give due credit for services rendered. Such a

person cannot make any realistic appraisal of his/her own

61

qualities, and therefore, cannot deploy the resources
necessary for the attainment of his/her ends.
As Chein et al. (1964) noted,

the adolescent addict has typically progressed well
into ‘the second stage, but. has .not. outgrown. and
easily regresses to the first. Although his
involvement with the outside world, in the sense of
establishing sympathetic and empathic relationships
with peers and adults, is meager, one figure does
occupy a prominent place in his psychic life--his
mother. He has little love for her, in the sense of
warm sympathetic, responsible concern for the
welfare of another person which features the
gratification of many infantile impulses. In part,
and in a more basic sense, it is a relationship with
an undifferentiated portion of himself/herself, with
the hated, feared, and unloved mother from whom he
has not yet fully distinguished himself and who is

still a part of himself or whom he himself still
remains a part.

Hence, the Narcissistic Regressive Phenomenon that
Weider and Kaplan (1969) referred to, where objects are
need fulfilling sources of supply. The oral zone and the
skin are the primary focus for satisfaction and self-
esteem is dependent on supplies of food and warmth. The
narcotic drug represents these supplies. Addicts are
described as being intolerant of tension and cannot
stand pain or frustrations.

Milkman and Frosch (1973) noted that in being
intolerant of tension and not being able to stand pain or
frustration, the heroin abuser seeks to avoid these
confrontations with his environment. Milkman and Frosch

stated that

62

the major preoccupation of the heroin abuser is
survival. The heroin addict perceives the
surrounding environment as hostile and threatening,
and maintains equilibrium via withdrawal and passive
expressions of hostility. The heroin abusers
thinking is described as concrete and personalized,
and the defensive structures are more primitive and
fragile than the comparison groups of amphetamine
abusers.

Milkman and Frosch noted that "the heroin addict who
characteristically' maintains a 'tenuous equilibrium ‘via
withdrawal and repression, bolsters these defenses by
pharmacologically inducing a state of' decreased motor
activity, under-responsiveness to external situations and
reduction of perceptual intake." With this reduction of
responsiveness to the environment, the authors provide an
explanation that is consistent with Freud's (1936)
comment, in that the addict is responding very similarly
to the infant who is overwhelmed by external stimuli and
actively seeks to shut it out.

Khantzian (1974) made a valuable contribution to the
literature about narcotic addicts by studying the
interrelationship between use of narcotics as a means of
self-medication and the narcotic addict's underlying
problems centering mainly around aggression. The main
point of this dissertation is that the major motivation
for narcotic use is not the search for pleasure, but
rather, the suppression or muting of various forms of

severe unpleasure. Based upon his extensive professional

experiences with narcotic addicts, Khantzian hypothesized

63

"that a significant portion of these individuals become
addicted to opiates because they discover that the drug
acts specifically to reverse regressive states by
attenuating, and making more bearable dysphoric feelings
involving aggression, rage, and depression." A muting of
the aggression and rage occurs through the use of
opiates. In the course of responding to carefully
obtained drug histories, Khantzian found that narcotic
addicts provided ample descriptions of the dysphoric
states of bodily tension and restlessness, anger, rage,
violent feelings, and depression, all of which were
relieved by heroin. He states that "with almost
monotonous regularity, the patients used terms such as
'relaxed,‘ 'mellow,‘ 'calming,‘ and emphasized a total
body response, to describe the effects . . . when they
first began to use such drugs."

Hendin (1974) has published an excellent article
dealing with college students on heroin. This paper
contains valuable case descriptions. Hendin views heroin
use as a buffer against the anxiety about closeness,
sexual and emotional intimacy, stemming from a very
disturbed relationship with the heroin user's mother, but
Hendin also adds that heroin has a dampening effect on
rage (they "hide their rage behind a passive facade" (p.
248)). Hendin notes that in the willingness of heroin

users to do what is potentially so destructive that two

64

central themes, of despair and invulnerability seem to

intertwine.

Heroin is essentially a drug of despair. It has the
effect of . . . making everyone unimportant, of
turning human involvement into an. only ancillary
experience. No groups of students I have seen, with
the exception of severely suicidal students, have
been hurt so deeply and so early in life.

The immense despair of heroin users

is reflected (in the) increasing fear and
abrasiveness bound up in human relationships, a
sense that to be free, one must give up on the very
possibility of closeness. In using heroin to
achieve this withdrawal, these students achieve the
illusory freedom and illusory invulnerability of the
isolate and the emotionally dead.

Khantzian, Mack, and Schatzberg (1974) focused on
the use of heroin to cope, stating that

the central problem for most people who become
addicted to opiates is ‘that. they' have failed to
develop effective symptomatic, characterologic, or
other adaptive solutions in response to
developmental crises, stress, deprivation, and other
forms of emotional pain . . . the drug is their
characteristic or characterological way of adopting
and dealing with their inner world of feelings and
emotions and the real world around them.

In the clinical material presented in the study, the

authors note that

the loss of a girlfriend, a sense of failure in
social relations, painful self-consciousness among
peers in adolescence, worries about success and
achievement, anticipated inability to live 'up to
parental expectations, loneliness, psychosomatic
pain, feelings of rage, violent impulses, and many
other forms of emotional distress and bodily
tensions are relieved and made more manageable
through the use of narcotic drugs.

65

Khantzian et al. (1974) relate

that it is not uncommon to hear many addicts and
others insist that the reasons they repeatedly and
avidly return to using opiates is that they have not
escaped from those same societal influences that
originally caused their problem. What tends to be
overlooked in such a broad, over-simplified
generalization is how these societal influence and
intrafamilial factors can produce early ego
impairment that leaves a person less equipped to
deal with later developmental challenges and adult
stresses.

Kauffman (1974), in conducting a study consisting of the
psychodynamic interviews of' college students who were
heroin addicts, noted the following' psychological

factors:

frequent masturbatory fantasies about mother as well
as overt sexual attraction to her were common in
male addicts. . . . Heroin was frequently used to
neutralize murderous aggressive fantasies. For
several, the act of injecting heroin represented a
type of sexual gratification. Heroin frequently
provided a primitive homeostasis which helped
reconstitute a feeling of total bodily

disintegration . . . . behavior such as low
frustration tolerance , viewing others only as
providers of supplies, manipulativeness,

extractiveness, self—destructiveness, and impaired

reality testing historically has been taken as

evidence of the addicts oral character structure.

The characterological traits occur in all opiate

addicts regardless of social class.

With this supportive evidence that narcotic addicts
have residual developmental issues stemming from a very
early stage in their development, it is not surprising
that empirical data suggests that opiate abusers are low
in trust. Emikson's first developmental stage is trust

vs. mistrust“ Capel and Caffrey (1974) compared the

66

attitudes of heroin addicts with those of other deviants
and nondeviants comparison groups. Although the study
was not directly centering on the issue of trust alone,
their research suggested that the heroin abusers were
more distrusting than the other comparison groups. Capel
and Caffrey's (1974) findings were further substantiated
by the investigative work of Ungerer, Harford, Kleinhaus,
and Coloni (1978). Ungerer et al. investigated trust in
opiate abusers using the Rotter Interpersonal Trust
Scale. This instrument measures the generalized
expectancy that he oral or written promises of others are
reliable or trustworthy. The authors compared the level
of interpersonal trust in opiate abusers, and comparison
groups consisting of the abusers of other drugs, college
students, and noncollege students. The findings indicate
that opiate abusers were significantly lower in trust
than the other comparison groups. The authors suggested

that

one possible explanation is that low trusters are
predisposed to opiate use. Perhaps low trust
results in heightened anxiety, and the low trusters
find the anxiety-reducing effects of' opiates
rewarding . . . another explanation is that heroin
dependence decreases interpersonal trust.

Ungerer et al. (1978) found support for their findings in
the quote by Kamstra (1975), when he observed that:
heroin . . . always seems to involve a lack of

trust. Perhaps its the nature of the drug itself;
anything that creates such a need in the body, a

67

need that has to be satisfied at all costs, is
inherently dangerous.

Gallagher (1973), in a study concerned with certain
personality variables characteristic of heroin addicts,
found significant differences between the heroin addicted
groups and the nonaddicted comparison group, on two
demographic variables relevant to the study. The data
"indicates that the addicted group showed a higher
frequency of not growing up with their true fathers," and
that the demographic information "supports the fact that
the heroin addicted population more often do not grow up
with their true mothers than the non-addicted group."
Although these findings are, to a certain degree,
contrary to other research findings, the ramifications
upon development are extensive, due to the significant
role that the mother and father plays in developmental
theory as well as the psychoanalytic approach to
psychotherapy.

Milkman (1974) represents one of the first research
studies to focus on the preferential abuse of a substance
as opposed to another. Milkman studied the ego
functioning of the preferential abusers of' heroin or
amphetamines. The results were based on interviews in
which the subjects were examined with Bellak and
Hurvich's Interview and Rating Scale for Ego Functioning.

The data indicate that the heroin abuser's thinking is

68

more concrete and personalized, regression is to an
earlier level, the defensive structures are more
primitive and fragile, and that the heroin addict has
less "global ego strength" than the amphetamine abuser.
Other findings indicate that:
The heroin addict is concerned with survival and
self-maintenance. . . . Clinical and statistical

impressions of the heroin abuser suggests an
individual of quasi-stable sense of identity (based

mainly on) feedback from outside sources. When
external signals and cues are absent, identity can
become poorly integrated . . . . Their general

impression of the heroin abuser is one in which he
is detached from people under stress and is
moderately striving for nurturant relationship, of a
highly dependent nature, leading to stormy and
strained attachments. . .. . Clinically, the heroin
abuser appears to be relatively primitive in his
defensive structure. Repression and denial are
massively deployed and withdrawal is a predominant
mode. under stress, repression is easily disrupted
and the emergence of anxiety and depression are
readily observed. Defensive functioning may become
minimal, as evidenced by recurrent outburst of inner
and outer directed aggression.

Milkman summarized his investigation by stating that
the origins of specific drug abuse may be in the
nature of the drug induced ego states. These may
recapture a series of similar experiences, the
originals of which appear to exist in specific
phases of child development. A particular drug may
thus facilitate a specific solution to conflict and
may, therefore, be preferred.

Khantzian (1978) noted that the rigid character
traits and alternating defenses employed by narcotic
addicts were adapted against underlying needs and
dependency in order to maintain a costly psychological

equilibrium. He stated that

69

the defenses (and the associated character traits)
are employed in the service of containing a whole
range of longings and aspirations, but particularly
those related to dependency and nurturance needs.
It is because of massive repression of these needs
that such individuals feel cut off, hollow and empty
and that the addict's inability to acknowledge
and pursue actively their needs to be admired and to
love and be loved, leave them vulnerable to
reversion to narcotics.
Khantzian (1980) provided a further elaboration on this
point by noting that "in my experience, many of the self-
destructive aspects of drug dependence represent failures
in ego functions involving self-care and self-
protection." Self-care functions originate and are
established in the early phases of human development.
They become internalized as a result of and through the
ministrations of the caring and protective role of the
parents, particularly mother. If optimal, children
gradually incorporate a capacity to care for themselves
and to protect against and anticipate harm and danger.
Extremes of indulgence and deprivation may do injury to
the individual's developing ego and sense of self around
vital functions of self-preservation and care, and may
leave individuals vulnerable to a whole range of hazards
and dangers, not the least of' which is the use of
dangerous drugs. Khantzian also felt that because of the
lifelong preoccupation of heroin addicts with aggression,

that heroin is used specifically as an anti-aggression

drug.

70

Wurmser (1978) lends support to Khantzian's

contentions by noting, in his excellent book on the

psychodynamic aspects of compulsive drug use, that

narcotics calm . . . intense feelings of rage,
shame, and loneliness and the pain and anxiety
evoked by these overwhelming feelings. These
affects are usually derivatives of’ pervasive
conflicts about the limitations of life: rage and
shame are reactions to the massive disappointment
and disillusionment in regard to their own grandeur;
the intolerable sense of loneliness and hurt is the
result of a longing for a symbiotic bond with a
need-fulfilling, powerful other person who would
give in to all demands.

The author indicates that there are several theoretical

possibilities of how the pharmacogenic effect of

narcotics comes about:

the
five

Either the drug increases the thresholds of
decompensation from .narcissistic. conflicts; or it
decreases the intensity of these conflicts by
elevating the sense of omnipotence and self—esteem;
or it functions directly as an artificial dampener
on overwhelming affects, as denial.

Wurmser felt that the importance of narcotics lay in
latter function of reducing, or even eliminating,
basic overwhelming effects.

Disappointment was the first, but most elusive and
transient, rage the most prominent affect.
Typically this narcissistic rage was close to
murderous or suicidal dimensions. When the ideal
self or the ideal world had collapsed, only total
devastation remained. Shame was the third, as an
outcome of the conflict between the limited,
disappointing self and the grandiose ideal self.
Hurt (loneliness, rejection, abandonment), the
fourth basic emotion in these patients, was the
outcome of the experience that the other person
(mother, father, girlfriend, boyfriend) proved not
to be as great and redeeming, as all-giving as
expected; the experience that anything short of

71

total union with this person total isolation and
rejection, the shattering of the symbiotic illusion
which was sought and often found and confirmed
externally and concretely.

wurmser notes that

there is no question that these patients all
suffered very massive traumatization throughout
their childhood, mostly in the form. of grossest
violence and crassest seduction and indulgence . . .
these patients experienced massive external
conflicts of overwhelming dimensions, and going on
from early childhood right through adolescence.

Spotts and Shontz (1982) focused on the
developmental experience of addicts when they
investigated the developmental antecedents of chronic
drug abusers. The authors interviewed chronic drug
abusers and the results of these interviews were then
placed within a Jungian developmental framework. The
results are consistent with the other investigations
regarding opiate abusers. Specifically, the authors

state

that in the early lives of chronic opiate users, the
transformations . . . which permit the ego to break
free and establish a secure, separate identity--were
mismanaged, blocked, or only partially completed

the failure or partial success of the opiate
user's separation from the maternal figure is
suggested by the frequent findings that‘ these
individuals continue to live with mother long after
reaching adulthood.

Spotts and Shontz attempted to define the typical
opiate character. However, they indicated that

although no typical opiate character emerged, these

men were all leading narrow and constricted lives,

and were all isolates who were cynical and
distrustful of others. Few could tolerate close or

72

mutual relationships. They avoided intense
emptionality . . . chronic Opiate users would rather
withdraw from the problems of life than attempt to
conquer them.

They reported that

these men did not feel at home in the world at
large, showed little interest in the tasks of
adulthood (work, sexuality, marriage, family, etc.),
seemed unable to cope with these in any persistent
fashion, and reacted with ego constriction and
withdrawal. Though bound to the present, chronic
opiate users seemed repeatedly drawn to the past so
remote that it is only referenced in religion,
mysticism, and myth.

In. support for their findings, Spotts and Shontz
noted that

other investigators have commented on the regressive
character of the opiate experience. Rado (1933,
1963) describes opiate addiction as a situation in
which the ego returns to a state of infantile
narcissism in which all wishes are immediately
gratified. Savitt (1963) contends that the addict's
impulses to use drugs originate in their need to
fuse with the mother. Thus, the heroin injection
(mother's breast food) relieves tension and
depression, and restores the integrity of the ego,
but at a primitive and infantile level. However,
one interprets the opiate experience, it is clear
that the men studied feel an intense longing to
withdraw from the world and periodically surrender
themselves to a state which, from their own
descriptions is not unlike that of the Babe at the
Maternal Breast.

Blatt, Rounsville, Eyre, and Wilbur (1984) provided
supportive evidence for the early impairment in the lives
of opiate addicts by stating that "opiate addicts are
more chronically addicted individuals who frequently
appear to be struggling primarily with intensely painful

problems of self-worth . . . their memories of early

73

childhood are filled with negative images of both
parents."

The research literature places primary focus on the
opiate addicts--heroin abusers' problem of adjustment as
emanating from the early phases of development. There
are consistent themes of:

1. The need for immediate gratification.

2. Establishing as a sense of omnipotence.

3. A need to inhibit aggressiveness.

4. Experiencing the environment as hostile or
unpleasurable--to the point that the child must shut out
the stimuli from the environment and that the resultant
rage, shame, despair needs to be dampened and that heroin
achieves this result for them.

5. That significant other cannot be trusted to
provide them with the protection so desperately desired.

6. That the addicts relationship with their parents
was very tenuous and strained.

There is not an attempt to blame the parents for the
problems of adjustment because individual's do not react
to their parents as they really are, but to parental
images--unconscious images--that are heavily influenced
by fantasies and archetypal contents. Nevertheless,
there is a need to recognize the existence of certain
modal patterns of adjustment for heroin addicts that find

their origins in the early developmental years based on

74
the interaction. of' parental, constitutional, societal,
and environmental factors.

The Phenomenology of
Cocaine Abuse

 

The psychological perspective on cocaine abuse has
become a concern in the research literature over the past
ten years. The increased use and abuse of cocaine has
resulted in investigations that attempt to provide a
better understanding of the cocaine abusers underlying
problems. Unfortunately, there has been a paucity of
investigations, and most of the significant work has been
done by Spotts and Shontz (1980, 1982, 1984).

Byck (1974) noted that

strangely enough, there has been almost no recent

research into the effects of cocaine on man . . . if

a search is made for articles about cocaine's

psychopharmacological effects, no papers are to be

found at all. A recent edition of the

Pharmacological Basis of' Therapeutics (1970) does

not give a single reference in the literature to

document the central effects of cocaine in man.

One of the reasons for this lack of research might
lie in the fact that cocaine has always been a mercurial
drug. A century ago, it became popular overnight and
lost favor just as quickly.

One of the most interesting footnotes in the history
of cocaine is that Sigmund Freud wrote five papers on

cocoa and cocaine in the mid to late 1880's. These

papers have been published as the Cocaine Papers:

75

Sigmund Freud (Byck, 1974). Gay et al. (1973) indicated
that cocaine was isolated in 1860. One of the early,
enthusiastic supporters of its use was Sigmund Freud.
Between 1884 and 1887, Freud wrote five papers on cocoa
and cocaine, suggesting the therapeutic value of the
drug, ranging from its use as an aphrodisiac to a cure
for morphine and alcohol addiction. Musto (1968) related
that Freud believed that cocaine was a "magical drug,"
and Freud described cocaine as an instrument of
unbelievable curative power. Although Freud never
publicly retracted his broad endorsement of cocaine, he
eventually acknowledged its danger, and conceded that
cocaine had failed as a cure for morphine addiction.
Freud discontinued his work with cocaine in 1887, and
subsequently; eliminated this period from .his
autobiography.

One of the first articles published that focused on
the cocaine user was Seevers (1939). In this article,
Seevers provides a brief glimpse of the type of
individual who chooses to use cocaine. He states that
the individual choosing to use cocaine may be a
phlegmatic, egocentric individual with a subjective
awareness of inferiority.

The next major thrust toward understanding the
cocaine user appeared in the early 1970's. Gay et al.

(1973) commented that "the pharmacological action of

76

cocaine reinforces the highest aspirations of American
initiative and achievement by providing the user with
greater energy and optimism." Their observation has been
supported by Sabbag's (1976) suggestion that "cocaine's
growing popularity in the United States may be a function
of the fact that it reinforces the qualities that have
come to be admired as truly American: initiative, drive,
optimism, the need for achievement, and the embrace of
power." To further substantiate this point, Spotts and
Shontz (1980) described the subjects in their study in
the following manner:

all participants are products of American culture,

perhaps to an extreme. All want to escape from the

world unless they can achieve what they regard as
the ultimate in success--acquiring wealth and

admiration through aggress ive self-assertion ,

winning the war of life by competing harder than

anyone else.

Although the researchers have described
characteristics which might well be found in people who
use other drugs or no drugs at all, it is noteworthy that
the descriptions have been of individuals who preferred
cocaine because it allowed them to compete for the
American dream and to possibly be admired for their
productivity.

Spotts and Shontz (1980) represents the first in-
depth study on the users of cocaine. Although this

investigation has been criticized for its small sample

size, it provides valuable information about the chronic

77

users of cocaine. This study is based on interviewing
and testing of nine men who used and preferred cocaine
over all of the other available drugs. The subjects were
interviewed and given a battery of dimensional,
morphogenic, and sociopsychological measures. Each
subject was treated as an expert who could provide rich
empirical and clinical detail with regard to both the
personal characteristics of cocaine users and the
situational context of their cocaine use. The authors
note that "the data from the subjects were combined to
provide a broad picture of men using cocaine in America
today."

The findings "indicate ‘unequivocally that. cocaine
produces euphoric effects, a sense of enhanced well-being
and for some individuals increased self-confidence." In
noting the different responses due to dosage level, the

authors found that

while most low-dose users felt that the drug
enhanced social relationships, heavy users reported
that the drug provided the opposite effect. When
taking cocaine, they found it necessary to restrict
social contacts, withdraw, and isolate themselves,
because of the intense paranoia that the drug
produced.

In addition to difference, low dosages may enhance
sexuality, but higher dosages seem to decrease interest
in sexuality. However, "there was general agreement
(among subjects) that cocaine can prolong sexual

intercourse . . . but the sexual effects depend on the

78

amount of dosage." These findings seem to support the
hypothesis that "cocaine can become a substitute for sex
sex may be a pale and lifeless competitor for the
user's attention."
In regard to the cognitive effects of cocaine's use,
Spotts and Shontz found that

there was an agreement that when using cocaine, the
participants felt an enhancement of physical
strength and a sense of certainty that they could
accomplish anything—-"you feel like you could gnaw
through steel" . . . "I not only felt like I could
do more work, I did more work! I could do triple
what everyone else was doing."

All of the subjects reported increased mental lucidity
and acceleration of mental activity.

Regarding characterological effects, the authors

reported that

when it comes to cocaine, all the persons in these
studies have weak will power. . . . In fact, there
seems to be an inverse relationship between level of
cocaine use and capacity for self-discipline. Those
who take less cocaine seem to be more at the mercy
of their environment than those who take more. The
latter are characterized by their determination to
impose themselves upon their surroundings, to make a
mark on their world.

Spotts and Shontz indicates that of the men who
participated in the study,
the majority are strong, willful, manipulative, and

action oriented; they are counter dependent
individuals who are wary, sensitive to slights,

suspicious, and distrustful of others. . .. . Most
of these people took cocaine to gain access to the
boundless energy, self-confidence, ebullient

optimism, ego-enhancement, and aggressiveness the
drug reportedly provides. These characteristics are
highly valued in America, where they are touted

79

hourly in commercials and espoused in novels,
movies, and dramas on T.V. It could therefore be
proposed that the: men in these studies selected
cocaine because it seemed to provide an easy way to
fulfill the American dream. Our participants seem
to believe that in cocaine they have found a
shortcut to happiness and fulfillment.

The recurring life themes noted in this study

centered around

a preoccupation with independence, social isolation,
and denial of passivity. The men seemed fearful of
normal dependency relationships and are intent on
making sure that they are self-sufficient enough to
need no other human beings. . . . Each person in
these studies seems to have used the drug for the
heightened distinctiveness of self-identity, self-
confidence, and sense of mastery that it provides.

Spotts and Shontz (1982) studied the developmental
antecedents of chronic drug abusers. The authors
interviewed chronic drug abusers and drew inferences
regarding their ego development. In describing the
typical cocaine user, the authors indicate that most of
the men in their study had established their adult
identity and seek self-completion. However, they still
retain the scars from their unresolved developmental
issues. Spotts and Shontz state that

the typical cocaine ‘user almost broke free from

maternal control but still carries wounds from the

battle with the Terrible Mother. In childhood, when
this man reached out for tenderness and compassion,
the embarrassment and humiliation he experienced
from the maternal figure taught him to have or
express such feelings was a source of pain.

Consequently, he vowed to become a strong, self-
sufficient warrior who needs to lean on no one.

80

The key to understanding this type of individual centers
around the intense counterdependence. The cocaine user

equates dependence with submission and intimacy with
vulnerability, and he sees expressions of weakness
as conditions that set the stage for domination by
others. This is evident in the fact that cocaine
users select careers in which supervision and
control by others is minimal.

The cocaine user is focused upon the "fears of dependency
and helplessness, momentos from the Mother of Childhood."

In describing the core conflict confronting the
cocaine user, Spotts and Shontz noted that

the core ego conflict of chronic stimulant users
occur after the paternal affect image has
differentiated. To the chronic users, the Father is
positive in emotional tone, but is a source of
competition: someone to be overcome in the battle
for ecstatic union with the affect image of a mother
. . . the men who choose cocaine strive to possess
her in her most passionate and ecstatic form.

In their research, Spotts and Shontz related that the
chronic cocaine user's core conflict is at Stage III of
their model which they indicate is reasonably close to
Erikson's fourth stage of development (industry vs.
inferiority). However, the authors indicate that

people with core difficulties in the early phases of
Stage III tend to be so enmeshed in their battle for
independence that they give little attention to the
future. Freedom alone is the goal, and it seems a
sufficient incentive for continuing the struggle.
Those with problems later in this stage have
attained sufficient competence and independence to
formulate life dreams and goals.

81

This is an indication that from an Eriksonian framework
that the chronic cocaine user spans the stages of
Autonomy to Industry (2 to 4).

Spotts and Shontz (1984) in a report that describes
some important psychological factors associated with
heavy, chronic use of cocaine, describe "findings that
are integrated with other facts to produce a theory of
why some persons are drawn to heavy, chronic use of
cocaine; to describes persons at risk for heavy use of
the drug. . . ." The authors report that the

low-level, users we studied are insecure persons,
troubled by self-doubts and feelings of inadequacy;
they are easy going people who avoid conflicts and
intense emotionality. Cocaine helps them feel more
self-assured, enhances social. relationships, *warms
and enlightens a dreary day, or provides brief
escape from an otherwise dull existence . . ., heavy
users . . . are intensive, achievement oriented men
who are determined to be self-sufficient, they are
strong but isolated loners who equate. dependence
with submission, intimacy with vulnerability, and
expressions of weakness as setting the stage for
defeat at the hands of others. . . . Most are
economically successful; all resent. authority' and
seek out occupations where supervision is minimal.

The authors related that in treating heavy cocaine

users through psychotherapy,

the most obvious manifest problem is the
counterdependence. . . . Heavy cocaine users do not
trust people; they strive to achieve complete
independence through competitive success and
domination . . . the second problem is an intense
anger that is externally oriented but not directed
at any specific object. Anger serves a dual purpose
in these men's lives. It supports their struggle
against the ‘world and justifies their antagonism
toward other people. It is also a response to the
frustration they feel when their attempts to achieve

82

self-sufficiency fail. :rt recharges their energies
and gets them to try even harder for success next
time. The third problem tends to appear only after
the user begins to realize the futility of his
efforts of conquest. This is the problem of
despair, and it is reflected in feelings of defeat,
helplessness, bitterness, and disappointment.

The three problems noted result from and feed into
the first underlying theme which is betrayal. The heavy
user feels betrayed when "their infantile belief in the
divinity of the mother image" is shattered and "they also
feel betrayed by their fathers, who were too weak to
prepare their sons adequately to deal with the world at
large."

The research literature places primary focus on the
cocaine abusers' problem of adjustment as arising from
the phase of psychosocial development related to
independence. There are a consistent themes of:

1. An awareness of inferiority.

2. Of being admired for one's productivity.

3. That cocaine enhances self-confidence.

4. A preoccupation with independence.

5. That significant others need to be pleased.

There is a need to recognize the existence of
certain. core developmental issues that are associated

with cocaine abuses and that these issues seem to have

their origins in the second stage of Erikson's theory.

CHAPTER III

METHODOLOGY

In Chapter III, definitions, sample, measures,
procedures, design, testable hypotheses, and analysis

procedures are presented and discussed.

Definitions

Research in the area of substance abuse has been
complicated by a variety of overlapping definitions and
terms. Smart (1974) summed up the problem quite well
when he noted that "conceptual clarity has never been
prominent in. the field of' alcohol and drug research.
Terms such as addiction, dependence, habituation, drug
abuse, drug misuse, and the like are used sometimes
differently, sometimes interchangeably."

Although terms may have a variety of meanings
depending on one's perspective, all interpretations of
substance abuse seem to imply some problem related to
mind-altering chemicals being taken on a regular basis.
Huberty (1975) provided a good definition when he stated
that substance abuse occurs when

the substance becomes physiologically habituating
(creating a biological need for the drug) or

83

84

psychologically habituating (creating an emotional
need for the drug). In either case, the substance
abuser's daily thoughts and activities are focused
primarily on getting money for the drug, obtaining
the drug, and actually consuming it. This may be
done to the full or partial neglect of one's social
and familial responsibilities. An individual's
potential to grow emotionally, interpersonally,
socially, and financially is short—circuited by
one's striving for the drug. This is not to imply
that the substance abuser is unable to function from
day to day. It is to say that drug taking is
primary in one's life and that other
responsibilities and goal directed behavior is of
secondary importance, leading to some degree of
impaired functioning in one's life.

In the Diagnostic and Statistical Manual of Mental
Disorders, Third Edition (DSM III), the American
Psychiatric Association (1980) uniformly“ classified
substance use disorders. For the sake of operational
uniformity, all subjects in this research will be
assessed as to their preferential substance of abuse
based on the DSM-III classification. The DSM III
nomenclature defines substance abuse as having the
following components:

1) A pattern of pathological use;

2) Impairment in social or occupational functioning
due to substance use;

3) Minimal duration of disturbance of at least one
month.

These components of substance abuse are further
delineated in the DSM III according to the following

criteria:

A pattern of pathological use. Depending upon the
substance, this may be manifested by: intoxication

85

throughout the day, inability to cut down or stop
use, repeated efforts to control use to certain
times of the day, continuation of substance use
despite a serious physical disorder that the
individual knows is exacerbated by the use of the
substance for adequate functioning, and episodes of
a complication of substance intoxication (e.g.,
alcoholic blackouts, opioid overdose).

Impairment in social or occupational functioning
caused by a pattern of pathological use. Social
relations can be disturbed by the individual's
failure to met important obligations to friends and
family, by display of erratic and impulsive
behavior, and by inappropriate expressions of
aggressive feelings. The individual may have legal
difficulties because of' complications of the
intoxicated state (e.g., car accidents) or because
of criminal behavior to obtain money to purchase the
substance. (However, legal difficulties due to
possession, purchase, or sale of illegal substances
are highly dependent on local customs and laws, and
change over time. For this reason, such legal
difficulty on a single occasion should not be
considered in the evaluation of impairment in social
functioning for diagnostic purposes.) Occupational
functioning can deteriorate if the individual misses
work or school, or is unable to function effectively
because of being intoxicated. When the impairment
is severe, the individual's life can become totally
dominated by the use of the substance, with marked
deterioration in physical and psychological
functioning.

Duration: Abuse as used in this manual requires the
disturEance last at least one month. Signs of the
disturbance need not be jpresent continuously
throughout the :month, but should be sufficiently
frequent for a pattern of pathological use causing
interference with social or occupational functioning
to be apparent (DSM III, 1980, p. 164).

In this research, the duration of the disturbance
will be for a period of at least six months instead of
the one month provided for in the DSM III criteria. The
DSM III criteria was used in this study because the
research was approved and well under way before the DSM

III—R was introduced for general usage.

86

Selected Population

The population for this research consisted of male
preferential abusers of heroin or cocaine, who were
admitted to the Comprehensive Substance Abuse Treatment
Programs of the Clinton-Eaton-Ingham Community Mental
Health Board. An explicit population. description is
included (see Table 3.1). It. is projected that. the
reader will be in a position of generalizing the results
of this study to other populations that have similar

relevant attributes.

Sample
The sample consisted of 76 substance abusers: 38
heroin abusers and 38 cocaine abusers. All of the

subjects were capable of informed consent for
participation in the research project. The subjects met
the following requirements for inclusion into the study:

1. Admissions to the drug treatment programs of the
Clinton—Eaton—Ingham Community Mental Health Board.
Admission were either self-referrals or court ordered for
treatment.

2. A stated preference for either heroin or
cocaine.

3. Met the DSM III classification for heroin or

cocaine abuse.

87

Table 3.1

Key Demographic Variables for Heroin and Cocaine

 

Admissions to the Comprehensive Substance Abuse Treatment

Programs for October 1986 to November 1987.

 

 

Variable Cocaine Abusers Heroin Abusers
Number admitted 103 83
Mean age (range) 27.66 (18-47) 35.47 (23-55)
Race--Caucasian 60 53
Black 36 26
Hispanic 7 3
Other 0 1
Marital Status
Never Married 65 36
Married 19 25
Separated 13 2
Divorced 6 20
Education—-Mean Years 11.74 12.18
Income
$0 -$ 4,000 41 24
$ 4,001-$ 6,000 18 11
$ 6,001-510,000 12 15
510,001-515,000 12 6
515,001-525,000 9 8

$25,001 11 13

88

4. Have impairment of social or occupational
functioning greater than six months duration.

5. Have minimal exposure to previous drug
treatment.

6. Have an absence of psychosis.

7. Volunteer for the study.

8. Be drug free at the time of the test
administration.

The determination of the drug preference and
duration of drug abuse was based on:

1. Subject self-report of preference.

2. Interviews conducted by the jprofessional drug
rehabilitation staff.

3. Report from an a attending physician (where
possible.

The sample of cocaine abusers in the study ranged in
age from 10 to 40 with a mean of 24.58. The heroin
abuser group had a mean age of 34.26 with a range from 21
to 45 years. Both groups were predominately Caucasian
(68.4% cocaine; 78.9% heroin). There was only one
Hispanic, and he was a cocaine abuser. Blacks accounted
for the remaining subjects (28.9% cocaine; 21.1% heroin).
This information can be found in Tables 3.2 and 3.3.

The cocaine abuser group responded that they were
primarily never married (58.9%) at the time of data

collection, with 39.5% of heroin abusers responding in a

89

Table 3.2

Age of Subjects

 

 

 

Sample No. Mean Standard Duration Range
Cocaine 38 24.58 6.22 19-40
Heroin 38 34.26 5.67 21-45
Table 3.3

Race of Subjects

 

 

 

 

 

Cocaine Heroin
Race '
No. % No. %
Caucasian 26 68.4 30 78.9
Black 11 28.9 8 21.1

Hispanic 1 2.7

 

90

similar manner. Further information about the subject's

marital status can be found in Table 3.4.

Table 3.4

Marital Status of Subjects

 

 

 

 

Cocaine Heroin

Marital
Status

No. % No. %
Never Married 22 57.9 15 39.5
Married 6 15.8 9 23.7
Separated 4 10.5 1 2.6
Divorced 6 15.8 13 34.2

 

The mean number of years of education for the
cocaine abuser group was 12.0, with 78.9% completing 12
or more years of education” 'This compares with. the
heroin abuser sample having a mean of 12.58 years of
education with 86.8% completing 12 years or more of
education.

A sizeable percentage of the cocaine abusers (57.9%)
in this study reported having an income of less than
$4,000 for the preceding 12 months, with 86.9% reporting
an income of less than $1,000. The heroin abuser group

reported 42.1% having income less than $4,000, while

91

65.8% had an income of less than $10,000. Table 3.5

expands upon this information.

Table 3.5

Annual Income of Subjects

 

 

 

Cocaine Heroin
Income '
No. % No. %

$ 0 — 4,000 22 57.9 16 42.1
$ 4,001- 6,000 5 13.2 4 10.5
$ 6,001-10,000 6 15.8 5 13.2
$10,001-15,000 2 5.3 3 7.9
$15,001-20,000 l 2.6 3 7.9
$20,001—30,000 5 13.1
$30,001+ 2 5.3 2 5.2
Total 38 100.0 38 100.0

 

Both groups rated their parents' social standing on
a 9-point Likert scale. The cocaine abusers reported a
mean of 5.16 with a standard deviation of 1.10, while
heroin abusers indicated a mean of 4.84, with a standard
deviation of 1.44. The cocaine abusers predominately

reported their parents' social standing as middle class

92

(81.6%) and 76.3% of *the .heroin abusers reported the

same. The results are depicted in Table 3.6.

Table 3.6

Rating of Parents' Social Standing

 

 

 

 

 

Cocaine Heroin
Scale ’
No. % No. %
Lower 4 10.5 7 18.4
Middle 31 81.6 29 76.3
Upper 3 7.9 2 5.2
Total 38 100.0 38 100.0

 

Both groups rated their sense of emotional well being on
a 9-point Likert scale. Cocaine abusers had a mean of
5.26, with a standard deviation of 1.80. Heroin abusers
had a mean of 5.37, with a standard of 1.32. Table 3.7
graphically illustrated that only 28.9% of the cocaine
abusers and 21.1% of the heroin abusers rated their
emotional well being as happy.

Subjects were asked to indicate the reason that they
used their drug of preference. Cocaine abusers
overwhelmingly responded that they were looking to speed

themselves up (94.7%). Heroin abusers predominately were

93

Table 3.7

Ratingof Emotional Well Being

 

 

 

 

 

 

Cocaine Heroin

Scale °

No. % No. %
Unhappy 7 18.5 3 7.9
Average 20 52.6 27 71.0
Happy 8 28.9 8 21.1
Total 38 100.0 38 100.0
looking to slow themselves down (60.5%). The results are

depicted in Table 3.8.

Table 3.8

Reason for Taking Drug of Preference

 

 

 

 

Cocaine Heroin
Reason '
No. % No. %
Slow myself down 2 5.3 23 60.5
Speed myself up 36 94.7 15 30.5

 

Finally, the age at first use of the preferential
drug was determined for both groups. Cocaine abusers had

a mean age of first use of cocaine of 21.95 years old,

94

while heroin abusers had a mean age of first use of
heroin of 25.08 years of age. Table 3.9 expands on this
information. Both groups' length of usage for their drug
of preference was determined. Cocaine abusers had a mean
length of cocaine usage of 5.58 years, and heroin abusers
had a mean length of heroin use of 9.18 years. Table
3.10 provided further information about length of usage

of preferential drug.

Table 3.9

Age of First Usage of DrtLq of Preference by Drug of

 

 

 

Preference

Age Cocaine Heroin
13-15 6 1
16—18 10 5
19-21 10 8
22-24 5 9
25-27 5 11

28-30 2 4

 

95

Table 3.10

Length of Preferential Drug Usage in Years

 

 

 

Number of Years Cocaine Abusers Heroin Abusers
1-2 4 2
3-4 16 8
5-6 8 5
7—10 8 11
11-15 1 7
16-20 1 4
20+ -- --
Measure

Erik. Erikson's theory' of' psychosocial development
has been an impetus for research investigations and
clinical applications. Several attempts have been made
to make it amenable to empirical assessment.

Assessment of_Adult Adjustment
Patterns (AAAP)

 

The AAAP was developed by Farquhar, Wilson, and
Parmeter (1977), as an objective, self-report instrument
based on Erikson's theory of psychosocial development.
Its rigorous test construction and its attempts to
measure all eight of Erikson's stages makes it unique

among Eriksonian assessment techniques currently reported

96

in the literature (Azar, 1982; Farquhar, 1983). It
consists of 320 items which measure mastery or nonmastery
of each of the eight stages, as well as the inclusion of
two validity scales to check for deviant responding (F
Scale) and attempts to present oneself in a favorable
light (Social Desirability Scale).

The format of the AAAP requires that subjects rate
themselves on a 4-point scale ranging from (1) definitely
true of me to (4) definitely not true of me.
Intermediate points are labeled (2) true of me and (3)
not true of me. Mastery or nonmastery for each of the
eight stages are measured by the AAAP as individual items
are assigned weighted values with regard to whether they
represent resolution or not of particular developmental
stages. Responding in the direction of resolution, a
specified percentage of the time for a given stage is
considered to represent mastery. The normative sample of
the AAAP was comprised of 322 staff and faculty from
Michigan State University. Azar (1982) found that this
sample mastered the eight stages in the following
proportions: Stage 1=66%; Stage 2=73%; Stage 3-=54%;
Stage 4:68%; Stage 5-76%; Stage 6-74%; Stage 7=46%; and
Stage 8=51%. His initial research approach had been to
use the 80% standard adapted from the mastery learning
model (Bloom, 1968). The mastery levels were

manipulated, however, in an attempt to have the scales

 

97

reflect an ascending order of mastery from Stage 1 to
Stage 8. The more traditional 80% mastery standard is
the one used in this study.

The developmental stages, as measured by the AAAP,
have quite high internal consistency (see Table 3.11).

The scales of the AAAP have internal consistencies
ranging from .85 to .95 using the Cronbach Alpha
coefficient. A factor analysis of the instrument
produced 23 factors that were consistent with Erikson's
theory, as well as having reliability coefficients
ranging from .68 to .92 with a mean of .84 (Azar, 1982).
See Table 3.12.

Assessment of Adult
Adjustment Patterns

 

 

Scale reliabilities. Reliability estimates for the
eight stage scales of the AAAP were computed for the
combined samples. The reliability coefficient for the
eight stage scales were consistently lower than those
reported by Azar (1982) for the normative group and by
Athy (1986) for a group of alcoholics. The greatest
discrepancy between reliability coefficients for this
study and Azar's normative group and Athy's alcoholic
sample occurred on the first three stages. (See Table
3.13 for a comprehensive presentation of the reliability
coefficients.) These early stages of psychosocial

development are the ones that this study hypothesized

 

98

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Table 3.12

The Factors Emerging from the Assessment of Adult

99

 

Adjustment Patterns

 

 

No. of Cron-
Erikson Stage Name of Factor Items bach's
N-354 Alpha #
1. Trust vs.
Mistrust Basic Trust 18 .88
2. Autonomy vs. Will to be oneself 23 .89
Shame and Solitude 11 .82
Doubt Holding on, letting go 13 .82
3. Initiative Self-punishment and
vs. Guilt Guilt 23 .86
Anticipation of
roles by parents 4 .81
4. Industry vs.
Inferiority Apply self to risk 26 .92
5. Identity vs. Trust in peers 16 .86
Identity Ideological thought 8 .79
Confusion Molding identity 13 .84
Fidelity tests 10 .79
6. Intimacy Commitment to
vs. affiliation 19 .90
Isolation Genital maturity 11 .83
Fusion with another 7 .68
7. Generativity Establishing and
vs. Self— guiding next
Absorption generation 17 .68
Charity 15 .84
8. Integrity Order and Meaning 17 .83
vs. Disgust Accepting one's
Despair life cycle 13 .80

 

Source: William Farquhar, Assessment of Adult Adjustment
Patterns (AAAP) Research Instrument:
Unpublished Report, 1983.

Report."

First

fli.i

100

Table 3.13.

Reliability Coefficients for the Stages

 

 

Stage Pgisent Athy's Azar's
udy Alcoholics Normative
l .66 .80 .88
2 .68 .83 .91
3 .51 .77 .87
4 .82 .93 .95
5 .71 .86 .90
6 .81 .86 .90
7 .80 .85 .89

8 .83 .85 .85

101

that heroin abusers and cocaine abusers would have the
greatest degree of difficulty with than their
nonsubstance abusing counterparts. Such internal
deviation may be indicative of a great deal of
instability in their psychosocial development as
suggested by the research literature and this study.

The demographics of the AAAP normative sample are in
marked contrast to the substance abusing samples used in
this study (Azar, 1982). Several dimensions of the
demographic presentations illustrate this points The
mean age of the normative sample was 41 years of age,
while the mean age of the substance abusing subjects in
this study was 29 years. The marital status of the
groups were different. 131 Azar's study, 76% of' the
subjects reported that they were married. This is in
distinct contrast to the 40% of the substance abusers in
this study who indicated that they had never been
married. Azar's normative group was composed of 12.2%
subjects reporting an annual income of less than $10,000
in comparison to 76% of the subjects in the present
studyu In assessing their personal life, Azar reported
that 70% of the normative sample indicated that they were
happy, while only 25% of the subjects in this study. The
normative sample was composed of quite a large number of
college graduates, 77.3% of its members reported having

attained at least a bachelor degree in stark contrast to

102

only 4% of the subjects of the present study. Table 3.14
provides a comprehensive presentation of scale statistics
for the present study, Athy's samples, and Azar's
normative sample.

Construct validity was established by comparing a
normal population with a psychiatric population. (The
means for each stage were significantly higher for the
normal population than for the psychiatric population
except for Stage 6, at a probability (.001 (Azar, 1982).
See Table 3.15.

The AAAP represents a comprehensive effort by
Farquhar and his research associates to develop a
reliable and valid instrument that may be used to
objectively measure all eight of Erikson's psychosocial
developmental stages. 'The present format is a
distillation of 2500 original items that were subjected
to extensive cross validation and item analysis (Azar,
1982; Farquhar, Wilson, & Parmeter, 1977). Studies using
it have been undertaken with college students (Valdez,
1983), handicapped college students (Scabbo, 1984), and
male alcoholics (Athy, 1986). It has proven to be a
reliable measure with these diverse samples and
recommendations have been. made for continued research
with it. This study is the first administration of the
AAAP to a sample comprised of heroin abusers and cocaine

abusers.

 

103

Table 3.14

Mean, Standard Deviation for the Eight Stages of the AAAP

 

 

Means Standard Deviation
Stage Present Athy Azar ‘
scale gtugy iiigg 333:4 P.S. Athy Azar
1. Trusta 52.96 63.48 54.01 9.5 9.8 7.33
2. Autonomy 83.97 97.96 108.56 8.05 11.6 11.59
3. Initiative 66.17 67.39 75.27 5.37 9.37 8.9
4. Industry 147.05 175.39 190.56 14.42 23.4 20.99
5. Identity 75.04 91.29 100.08 8.35 12.3 10.41
6. Intimacy 62.24 80.81 88.09 9.31 12.0 10.08
7. Generativity 75.36 76.76 84.57 9.15 11.26 10.77
8. Integrity 53.84 68.58 74.23 8.77 10.34 8.71

 

aThe normative study had 18 questions for Stage 1.
The subsequent studies had 25 questions for Stage 1. The
mean for the normative group would be approximately 74.4
if there were 25 questions.

104

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105

Procedures for Data Collection

The method for data collection was a follows:

1. Alert the various substance abuse treatment
components regarding the requirements for subjects
inclusion into the study.

2. Recruit subjects who meet the requirements by
explaining the study and providing information regarding
the risk and benefits that could reasonably be expected,
as well as their rights as subjects.

3. Have subjects sign the consent for participation
form.

4. Administer the AAAP and demographic
questionnaire.

5. Review the AAAP and demographic questionnaire
and return to the subject for completion if any missing
information was noted.

6. All protocols were coded to ensure
confidentiality.

7. A multichecking form was used to ensure that
clients were appropriate for inclusion in the study by

meeting the requirements.

Research Design
This study is descriptive in nature. While
causality is not within the scope of a descriptive study,
the proposed investigation will offer valuable

3 ‘UL‘... q ~

106

information on the relationship between psychosocial
development and the preferential abuse of heron or

cocaine.

Testable Hypotheses
The following research hypotheses are stated in
their alternative form. It is an implicit and accurate
assumption that their null hypothesis will be initially
tested.

Null Hypothesis 1: Heroin abusers will have a mean
score on the AAAP that does not exceed the
mastery level of Stage 1 (Trust vs. Mistrust).

Null Hypothesis 2: Cocaine abusers will have a mean
score that does not exceed the mastery level of
Stage 2 (Autonomy vs. Shame and Doubt) on the
AAAP.

Null Hypothesis 3: The mean scores on the AAAP
stages 1-8 will be lower for heroin abusers than

cocaine abusers.

Analysis
The statistical analysis procedures to be used in
testing the hypotheses of the study were chosen for their
ability in analyzing the data for significant differences
between and among groups. The probability level for

significance was set at .05.

 

107

Hypothesis 1 will be tested using the analysis of
variance procedure to test for significant differences
between cocaine abusers and heroin abusers on the eight
stages of the AAAP. The analysis of variance procedures
require that the following statistical assumption are
met:

1. Normality

2. Homogeneity of variance

3. Independence of observations

In the present study, the assumption of normality is
addressed by the Central Limit Theorem. This theorem
states that the greater the sample size, the more likely
the sampling distribution will approach a normal
distribution. The cocaine abuser sample size of 38 and
the heroin abuser sample size of 38 could be suspect, but
fortunately, the F—test is considered to be robust with
regard to violations of the normality assumption. The
assumption of homogeneity of variance requires that cell
sizes for each category to be equal or nearly equal.
This is the case for both samples in the present study.
The study has 38 cocaine abusers and 38 heroin abusers in
each cell. Furthermore, it should be noted that the
analysis of variance procedure is also robust to the
violation of the homogeneity of variance assumption. The
independence of observations assumption is insured by

each subject completing the measures used without

. .....-

 

108

collaboration or discussion with others. Assignment to
sample groups is based on the operational definition of
the abuse of cocaine or heroin.

Hypotheses 2 and 3 will be tested by student's (one
tailed) t-test of a single mean against a calculated
theoretical value. The assumptions underlying the use of
the t-test are:

1. Independent random sampling

2. Normality

In the present study, the independent random
sampling requirement is met by considering the
consequitive admissions to the various drug treatment
programs as being representative of the larger group of
heroin or cocaine abusers, and is therefore, treated as a
random sampling. The assumption of normality is met by
the Central Limit Theorem. The theorem states that when
the sample size becomes sufficiently large, the sampling
distribution will approach a normal distribution. The
sample size in the present research meets the criterion
of the Central Limit Theorem. The t-test usually
provides a relatively accurate evaluation of experimental
hypotheses even when its assumptions are violated
(Boneau, 1960).

The mastery percentages for the .AAAP stage
performance were based on an 80% standard of responding

in the direction of resolution.

 

109

The influence of relevant demographic variables was
also considered using the analysis of covariance

procedures.

Summary

The study presented was designed to delineate the
psychosocial developmental characteristics of male
cocaine abusers and male heroin abusers as manifested on
the Assessment of Adult Adjustment Patterns (AAAP).
Developmental differences between cocaine abusers and
heroin abusers on the AAAP were explored.

Samples of 38 male cocaine abusers and 38 male
heroin abusers were administered the AAAP, along with a
short demographic questionnaire. Data analysis involved
the use of analysis of variance procedures in testing for
significance between and among sample groups on the AAAP
and Student's t-test used to test specific hypotheses
about the theoretically calculated level of psychosocial
development impairment of sample groups. Cocaine abusers
were hypothesized as having developmental impairments
that results in not mastering Stage 2 (Autonomy vs. Shame
and Doubt) on the AAAP and heroin abusers were
hypothesized as having developmental impairments that
results in not mastering Stage 1 (Trust vs. Mistrust) on
the AAAP. Cocaine abusers were hypothesized as having

mean scores on the AAAP stages 1-8 that were greater than

 

110

the heroin abusers mean scores. Demographic variables

were also examined.

 

CHAPTER IV

RESULTS OF THE DATA ANALYSIS

In the following chapter, the results of the data
analysis are presented. Each hypothesis is restated in a
testable form. The results of the analysis are then
given, followed by a statement of whether or not the
hypothesis was accepted or rejected. A separate section
focuses on the significance of the demographic variables
and their influence on the data analysis.

Hypothesis About Heroin Abusers' Mean Score
Performance on AAAP Stage 1

Hypothesis 1: The mean score on Stage 1 of the AAAP
for Heroin Abusers will be equal to or greater
than a score of 80, indicating mastery of Stage
1.

Alternate Hypothesis 1: The mean score on Stage 1
of the AAAP for Heroin Abusers will be less
than a score of 80, indicating a lack of
resolution of Stage 1.

The results of a t-test (Table 4.1) allowed for the
rejection of the null hypothesis. The alternative
hypothesis could be accepted as it was significant in the

111

 

112

predicted direction (p < .0005). The observed sample
mean deviates significantly for the specified a priori

value as predicted.

Table 4.1

Student's T-Test for Heroin Abusers on AAAP Stage 1

 

Stage Scale N t-obtained Critical Value p

 

1. Trust 38 -10.15 Approx. 2.704 p<.0005

 

Hypothesis About Cocaine Abusers Mean Score
Performance on AAAP Stage 1

Hypothesis 2: The mean score on Stage 2 of the AAAP

 

for Cocaine Abusers will be equal to or greater
than a score of 115, indicating' mastery of
Stage 2.

Alternative Hypothesis 2: The mean score on Stage 2
of the AAAP for Cocaine Abusers will be less
than a score of 115, indicating a lack of
resolution of Stage 2.

The null hypothesis was rejected and the alternative

hypothesis accepted as predicted. The observed sample
mean deviates significantly from the a priori value.

Tables 4.2 illustrates the results of the t—test.

.‘q

 

113

Table 4.2

Student's T-Test for Heroin Abusers on AAAP Stage 1

 

Stage Scale N t-obtained ~ Critical Value p

 

2. Autonomy 38 —9.13 Approx. 2.704 p<.0005

 

It was hypothesized that Cocaine Abusers would show
a lack of resolution on Stage 2 of the AAAP and within
that hypothesis was the assumption that Cocaine Abusers
would show mastery on Stage 1 of the AAAP.

Hypothesis: The mean score on Stages 1 of the AAAP
for Cocaine Abusers will be equal to or greater
than a score of 80, indicating mastery of Stage
1.

Alternative Hypothesis: The mean score on Stage 1
of the AAAP for Cocaine Abusers will be less
than a score of 80, indicating a lack of
resolution of Stage 1.

The results supported rejecting the null hypothesis

and supported the alternative hypothesis. Table 4.3
provides the results of a t-test on the mean score on

Stage 1 of the AAAP for Cocaine Abusers.

 

114

Table 4.3

Student's T-Test for Cocaine Abusers on AAAP Stage 1

 

Stage Scale N t-obtained Critical Value p

 

1. Trust 38 -9.43 Approx. 2.704 p<.0005

 

Hypothesis About AAAP Stages Discriminating
Between Cocaine Abusers and Heroin Abusers

Hypothesis 4: There will be no difference between
the mean scores of Cocaine Abusers and Heroin
Abusers on the AAAP Stages 1 through 8.

Alternative Hypothesis 4: The mean scores on the
AAAP Stages 1 through 8 will be significantly
higher for Cocaine Abusers.

The results of the one-way analysis of variance
(Table 4.4) did not allow rejection of the null
hypothesis. The alternative hypothesis was rejected as
no significant difference was found between Cocaine

Abusers and Heroin Abusers.

Demographic Variables

 

The demographic infbrmation pertaining to both
cocaine abusers and heroin abusers was presented in
Chapter II . Chi—square analyses revealed that the two

sample groups were significantly on the variables of "I

 

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115

 

 

 

 

 

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116

take my drug of preference to (a) slow myself down; (b)
speed myself up," (p < .00001). Analysis of variance
procedures showed significant differences on the variable

of age. The results of the analysis of variance for age

is depicted in Table 4.5.

Table 4.5

F-Test Comparison Between Cocaine Abusers and Heroin

 

Abusers on the Variable of Age

 

 

Sample N X SD DF F P
Heroin 38 34.26 5.67

1 23.97 (.00001
Cocaine 38 27.58 6.22

 

An analysis of covariance was performed on the data,
to consider the interaction of age and drug of preference
upon mean stage scores, as well as the main effects of
age and drug of preference.

The results of the analysis of covariance procedure
indicated that age and the interaction effects of age and

drug of choice were not significant.

117

Summary

The results of the analysis of data were presented
in Chapter IV. All hypotheses formulated for the study
were restated in testable form. The results of the
analyses were given followed by a statement of whether or
not the hypothesis was accepted or rejected. In
addition, several other analyses were performed to
examine closely the demographic variables and how they
might influence the mean scores for the cocaine abuser
and heroin abuser groups. In the next chapter, the study
is summarized, the results discussed, and conclusions

drawn.

 

CHAPTER V

SUMMARY AND CONCLUSIONS

This chapter is devoted to a summary of the study, a
discussion of the conclusions drawn from the data and
their analyses, and concludes with implications for

future research.

Summary of the Study

Erik Erikson's theory of psychosocial development
has provided innovative and systematic formulations from
which to study the development issues and differences
between male heroin abusers and male cocaine abusers.
Erikson's theory outlines the lasting contributions to
the individual's personality development that results
from. 'the interplay' between. parental. and societal
influences and demands, and the needs and capabilities of
the individual. The theory includes eight stages that
span the entire life cycLe. Each stage is viewed as a
crisis or a choice between alternatives. The relatively
successful or unsuccessful resolution of each stage
leaves the individual with a residual attitude or
orientation toward himself/herself and the world. The
successful resolution of prior stage(s) is presumed to be

118

 

119

necessary for the successful resolution of’ a current
stage. For the purpose of this study, Erikson's
theoretical assumptions were transposed into hypotheses
regarding the developmental characteristics of male
heroin abusers and male a cocaine abusers. Specifically,
heroin abusers were hypothesized to have developmental
impairments associated with Erikson's first stage--Trust
vs. Mistrust. The core developmental conflict for heroin
abusers arises out of the lack of consistency, on
predictability, and unreliability of their primary
caregiver. The effect of this style of interaction
between the heroin abuser and the caregiver is found in
the individual's inability to trust that his/her needs
will be met by others and the world. Heroin allows the
individual to cope with the world and difficult emotional
states.

Cocaine abusers were hypothesized as to having
unresolved developmental issues related to Erikson's
second stage of development--Autonomy vs. Shame and
Doubt. In their early attempts at autonomy, the cocaine
abuser engaged in a struggle of wills with their primary
caregiver. In losing the struggle, the cocaine abuser
tries to please others by living up to their expectations
and thus thwarting his/her ability to function
autonomously. A great deal of shame and doubt pervades

the life of the cocaine abuser.

120

An overall hypothesis stating that cocaine abusers
would have achieved a higher level of development was
considered.

The present study was descriptive, with the drug of
choice as the independent variable (two levels: cocaine
abuse, heroin abuse), and the scores on the Eriksonian
developmental measure (AAAP) as the dependent variable.

The cocaine abuser sample and the heroin abuser
sample was comprised of males who were receiving
treatment for their specific drug of choice in the
Comprehensive Substance Abuse Treatment Programs of the
Clinton-Eaton-Ingham County Community Mental Health
Board. A total of 76 males were recruited as research
subjects, with 38 males in the heroin abusing sample and
38 males comprising the cocaine abuser sample. The only
significant difference of note between the two samples
was the demographic variable of age. In general, the
male cocaine abusers in the study' were significantly
younger than the heroin abusers sampled.

Both cocaine abusers and heroin abusers were
administered a 13-item demographic questionnaire and the
Assessment of Adult Adjustment Patterns. The AAAP is an
objective, self-report instrument that is based on Erik
Erikson's theory of psychosocial development. It

attempts to measure the resolution or lack of resolution

 

121

of the eight stages. The AAAP has been proven to be a
reliable instrument with diverse samples.

Data analysis involved the use of Student's t-test
to determine significant differences between an observed
sample means and some particular a priori value. The
relationship between heroin abusers and the AAAP Stage 1
performance was examine using this procedure. The
relationships between cocaine abusers and the AAAP Stage
1 and Stage 2 performance were also examined using these
procedures. Analysis of variance procedures were used to
test the significant differences between. male cocaine
abusers and male heroin abusers on the mean scores of all
of the eight stages of the AAAP. The resolution
percentage for the AAAP was based upon an 80% criterion
of responding in the direction of resolution. Finally,
an analysis of covariance procedures were used to
determine the effect that age and drug of choice, as well
as the interaction of those variables might have had upon
the mean scores of the eight stage of development
measured by the AAAP. The influence of the relevant
demographic variables upon. AAAP stage ‘performance for
cocaine abusers and heroin abusers was examined with
analysis of variance procedures. The probability level
for significance was set at .05 for all analyses.

Hypothesis 1 related to the heroin abuser sample

mean performance score on AAAP Stage 1. Thus, Hypothesis

 

122

1 related to an expectation that heroin abusers would
have a mean performance score less than the resolution
criteria of 80%. The hypothesis was stated as follows:

Hypothesis 1: The mean score on Stage 1 of the AAAP
for Heroin Abusers will be equal to or greater
than a score of 80, indicating mastery of Stage
1.

Alternate Hypothesis 1: The mean score on Stage 1
of the AAAP for Heroin Abusers will be less
than a score of 80, indicating a lack of
resolution of Stage 1.

The null hypothesis was rejected, leading to the
conclusion that heroin abusers have developmental issues
and conflicts related to the developmental tasks
theorized by Erikson to be associated with the
development of trust and that are purported to be
measured by Stage 1 of the AAAP.

Hypothesis 2 related to the expectation that cocaine
abusers would have a mean score on Stage 2 of the AAAP
that was less than the mastery criteria of 80%. The
hypothesis was stated as follows:

Hypothesis 2: The mean score on Stage 2 of the AAAP

for Cocaine Abusers will be equal to or greater
than a score of 115, indicating mastery of

Stage 2.

 

123

Alternative Hypothesis 2: The mean score on Stage 2
of the AAAP for Cocaine Abusers will be less
than a score of 115, indicating’ a lack of
resolution of Stage 2.

The null hypothesis was rejected, leading to a
conclusion that cocaine abusers have developmental issues
and conflicts related to Stage 2--Autonomy vs. Shame and
Doubt--as theorized by Erikson and measured by Stage 2 of
the AAAP. However, in considering the mean score of
cocaine abusers for Stage 1 of Erikson's theory, the
following hypothesis was considered:

Hypothesis: The mean score on Stages 1 of the AAAP
for Cocaine Abusers will be equal to or greater
than a score of 80, indicating mastery of Stage
1.

Alternative Hypothesis: The mean score on Stage 1
of the AAAP for Cocaine Abusers will be less
than a score of 80, indicating a lack of
resolution of Stage 1.

The null hypothesis was rejected, leading to a
conclusion that cocaine abusers also have developmental
issues and conflicts related to Stage 1-—Trust vs.
Mistrust—-as theorized by Erikson and purported to be
measured by Stage 1 of the AAAP.

Hypothesis 3 related to cocaine abusers having a

higher level of development on all eight stage of

 

124

Erikson's theory as measured by the AAAP. This
hypothesis was not supported indicating that cocaine
abusers and heroin. abusers are ‘very similar' in. their
development.

The demographic variables showed significant
differences between the cocaine abuser sample and the
heroin abuser sample on the variable age. However, the
analysis of the main effects of age and drug of
preference and their interactional effect indicated that
these effects did not have a significant effect upon the

mean performance scores.

Discussion

Hypothesis 1--Heroin Abusers

Male heroin abusers manifested psychosocial
developmental impairments related to Erikson's first
stage—-Trust vs. Mistrust--as measured by the AAAP. The
focal point of Emikson's first stage is the quality of
the relationship that an individual has with his/her
primary caregiver. If the primary caregiver is perceived
as unpredictable, unreliable, and not being there when
needed, the child feels a sense of abandonment and
helpless rage. One cannot trust that one's needs will be
met. Erikson (1959) expressed concern about inconsistent
parenting by stating that ". . . such a situation can be
a model for radical disturbances in . . . (the child's)

 

125

relationship to the 'world,' 'to people,‘ and especially
to lover or otherwise significant people." Chein et al.
(1964) suggested that a sense of abandonment, helpless
rage, and mistrust in others and the world resulted in
immense rage and resentments that would need to be
avoided especially through heroin abuse. Edelstein
(1986) states that
. heroin is the most disapproved drug. So in
order to use it, one has to be a deviant, to be
angry at the world, to have a rage that a will often
break down all social inhibiting barriers to certain
forms of behavior.
Khantzian (1982) related that from his extensive
experience, the primary appeal of heroin resides in the
anti—aggression action of the drug. Khantzian stated

that

in my early work with narcotic addicts, I became
impressed quickly with. the addict's lifelong
experiences and problems with rage and aggression,
most often dating back to family and environmental

influences. . .. . I began to suspect that there was
a connection between the addict's rageful/
aggressive feelings and impulses . . . and their

attraction to opiates.

The findings of this study, that heroin abusers did
not master Stage 1 of Erikson's model as measured by the
AAAP, supports the conclusions of Cappel and Caffrey
(1974) and Ungerer' et .al. (1978) that. opiate abusers
score low in the variable trust.

This research confirms that research of Chein et a1.

(1964), who stated that the narcotic addict

 

126

though matured in years, he has yet to successfully
manage the developmental hurdles of infancy (the
acquisition of what Erikson has called "basic
trust") and that, unlike the infant before him the
tasks of achieving self-acceptance and trust in
others, the addict is already carrying the psychic
scars of his own failure and of the social world
that has failed him.
The residual scars from such early deprivations and
disappointments result in individuals finding peace,
contentment, a sense of omnipotence only while under the
influence of a drug (Zimmering et al., 1952).

The conclusions about male heroin abusers lacking in
trust, combined with Savitt's (1973) suggestion that
"addicts to heroin were grossly neglected and unloved by
their mothers . . . the emotional climate was a tense and
discordant one, and one or both of the parents were
ambivalent about having the child." Gallagher's (1973)
finding that the heroin abuser's parents were just not
available for the child has broad implications for the
treatment of heroin abusers. The main concern for
therapists in working with heroin abusers should be the
development of a therapeutic alliance. An alliance that
will allow the heroin abusers the opportunity to
experience a closeness that he/she has not experienced,

while ensuring them that they can trust the world and

trust themselves.

 

127

Hypothesis 2--Cocaine Abusers

The results of this study indicated that cocaine
abusers manifested developmental issues related to
Erikson's second stage--Autonomy vs. Shame and Doubt--as
measured by the AAAP. This conclusion is in keeping with
the hypothesis presented and supported by the literature
reviewed. However, the results also indicated that the
cocaine abusers in this study had not mastered Stage 1 of
Erikson's model--—Trust vs. Mistrust--as measured by the
AAAP. The failure of cocaine abusers to show mastery of
Stage 1 of the AAAP was surprising. A review of the
literature suggested that the core developmental issues
for cocaine abusers would be related to their struggle
for autonomy and evidenced in their need to overcome
feelings of inferiority, shame and doubt (Spotts &
Shontz, 1980, 1982; Seevers, 1939). One explanation for
the low Stage 1 performance score may be found in
Erikson's (1959) suggestion that later stages cannot be
successfully or optimally dealt with by the individual
unless the preceding crisis has been reasonably well
resolved. Therefore, within the context of Erikson's
model, cocaine abusers might have core developmental
issues related to shame and doubt while still
experiencing residual effects from not having resolved
Stage 1 as effectively as possible. Erikson (1963)

acknowledged that a basic sense of trust would provide

128

the child with an inner sense of goodness from which
autonomy could develop; without the trust, there would be
an inner sense of badness resulting in shame. Thus, in
retrospect the research should have expected cocaine
abusers to score low on Stage 2 of the AAAP, as well as
Stage 1--Trust vs. Mistrust. The conclusions of this

study lends confirmation to Erikson's theory.

Overall Hypothesis

The overall hypothesis stated in the null form was
that there would be no differences between the mean
scores of cocaine abusers and heroin abusers on Stage 1
through 8 of the AAAP. The literature review seemed to
support a rejection of this hypothesis in favor of
accepting that cocaine abusers would have higher mean
scores on the stages, however, the null hypothesis was
accepted.

The male heroin abusers and male cocaine abusers
mean scores on the Stages of the AAAP indicated a lack of
resolution of all eight stages. Erikson (1959) indicated
that there was a widely held "belief that the
establishment of a basic sense of trust in earliest
childhood makes adult individuals less dependent on mild
or malignant forms of addiction," the results of this

study provide support for his statement. The sample

129

groups were lacking in basic trust and had serious forms

of addiction.

Alternative Examination
of the Results

 

Alternative explanations for the results of this
study center on three main areas, namely, the theory, the
subjects, and the instrument. In this section, some of
the key issues that inight effect the results or the
interpretation of the results will be presented. It is
important to note that the discussions about the areas of
concern will and do overlap.

The basic question posed by this study was: "Can
the AAAP objectively measure and differentiate the
psychosocial developmental issues of heroin abusers and
cocaine abusers as suggested by the literature review?"
And, more particularly: "Do heroin abusers have core
developmental issues related to Erikson's Stage 1--Trust
vs. Mistrust?" and "Do cocaine abusers have developmental
issues related to Erikson's Stage 2--Autonomy vs. Shame
and Doubt?"

The overall results of this study suggest that
heroin abusers and cocaine abusers have similar
psychosocial developmental impairments. These results
are contrary to ‘the research. reports reviewed in. the
extensive literature review. In exploring alternative

explanations, quite a few possibilities arise. If one

 

130

accepts that the literature review provides an accurate
account of the different core developmental issues
related to cocaine abusers and to heroin abusers, then
the results support the idea that the AAAP is incapable
of effectively discriminating the psychosocial
developmental differences between heroin abusers and
cocaine abusers. However, further analysis of Erikson's
writings may provide a possible explanation for the
results without negating the findings in the literature
review. Euikson (1959) provides comments about Stage 2
that are worthy of further consideration in light of the
results of this study. Erikson stated that:
If outer control by too rigid or too early training
insists on robbing the: child of .his attempts to
gradually control his bowels and other functions
willingly and by his own free choice .. . . he will
be forced to seek satisfaction and control either by
regression or by fake progression. In other words,
he will return to an earlier, oral control, that is,
by sucking his thumb and becoming whiny and willful,
often using his feces (and later, dirty words) as
communication; or he will pretend an autonomy and an
ability to do without anybody to lean on, which he
has by no means really gained.
Erikson's statement may well provide an adequate
description of the cocaine abusers in this study.
Cocaine abusers may have failed to develop autonomy and
are experienced by researchers and clinicians as being
autonomous when what could be observed and documented in
a pseudo-autonomy or what Erikson calls a "fake

progression." Spotts and Shontz (1982) propose some

 

131

support for a fake progression by stating that "the
cocaine user almost broke free from the maternal control
but still carries the wounds from the battle." Could
such a battle and its subsequent scars result in such a
breach of trust in the primary caregiver that a "fake
progression" or pretend autonomy becomes the preferred
style of interaction. This possibility could then be an
alternative explanation.

Another possible explanation for the results may be
found in Erikson (1976). Erikson published a little
known essay entitled, "Reflections on Dr. Borg's Life
Cycle." The essay was a commentary on Ingmar Bergman's
film, Wild Strawberries. As Erikson analyzes Dr. Isak
Borg's thoughts and memories of his life as it unfolds
through the movie, Erikson strongly affirms a fundamental
modification of his life-cycle model. According to
Erikson, Dr. Borg does more than wrestle with the eighth
stage of his psychosocial development model--the
traditional conflict in the elderly between integrity and
despair. Erikson states that while Dr. Borg attempts to
come to grips with the psychological issues of this
stage, he simultaneously struggles with the psychological
issues from all the previous stages of the life cycle.
Thus, as Fitzpatrick and Friedman (1983) note, "Erikson
converts his life-cycle model (in which one stage is

completed or near completion and then followed by the

 

132

next) to a 'life-spiral' model (in which the person's
earlier developmental stages are never even partially
transcended or bypassed as he grows older)." The
psychosocial developmental issues a person wrestles with
in all stage of his life invariably recur as he wrestles
with. new issues at alter stages. IDevelopment is no
longer portrayed by Erikson as primarily a linear
progression but becomes a spiral in which multiple
interactions simultaneously link the past and the
present. As a person labors with a stage, he also
repeats, albeit in somewhat different terms, the issues
on all previous stages. Vaillant and Milofsky (1980)
presented a similar modification and support for
Erikson's new life—spiral model. Erikson (1982)
reaffirmed this life-spiral model by stating that
as each part comes to its full ascendance and finds
some lasting solution during its stage, it will also
be expected to develop further under the dominance
of subsequent ascendancies and most of all, to take
its place in the integration of the whole ensemble.
Within the framework of Erikson's reformulation, the
possibility exists that the jpsychosocial. developmental
differences between heroin abusers and cocaine abusers
noted in the literature review are accurate; however, the
AAAP is not sophisticated enough to discriminate between
the initial working through of a core issue and the

reworking that occurs at subsequent stage. Cocaine

abusers might have progressed adequately though Stage 1,

133

but in laboring with Stage 2, the reworking of trust is
detected by the AAAP responses.

The next area of concern, when attempting to develop
alternative explanations for the results of this study,
was the subjects. When considering the subjects, one is
reminded of the story of the blind men investigating an
elephant. Each grabbed hold of a different piece of the
elephant--the trunk the leg, the tail-—and each proceeded
to extrapolate beyond the available data. The subjects
questioned and tested in this research study were but
part of the bigger picture. of' addicts and addiction.
Kleber (1981) states that differences between addicts in
treatment and addicts in the community is the amount of
present symptomatology. The results of this study may
well be indicative of sampling a group: of "typical"
heroin abusers and a group of cocaine abusers
representing of "low" functioning cocaine abusers, a
group that has had serious psychosocial developmental
impairments in Stage 1. Perhaps if a "typically"
functioning cocaine abusing group were sampled, the
results would follow the path of the theory prediction.

The overall results of this study indicated that
heroin abusers and cocaine abusers were similar in their
psychosocial development impairments. The similarity
between the groups may"well have been the result. of

similar parental rearing patterns and familial

 

134

experiences. Spitz and Rosecan (1987) notes that as
research continue,
the sharp line of distinction between the families
of heroin abusers and cocaine abusers is rapidly
changing. There is greater overlap among the family
patterns than what was originally thought . .
especially in the use of denial, enmeshments, and
disengagements, boundary problems, inadequate role
definitions and difficulty with separation from the
family.
Seldin (1972) suggested that the critical factor for drug
addicts is the degree of emotional health available in
and through the family. Gallagher (1973) and Spotts and
Shontz (1980) offered similar suggestions. Emmelkamp
and Heeres (1988) lend further credence to the important
role of the family environment in the life of drug
abusers by stating "that the lack of emotional warmth and
rejection are dimensions that are most often associated
with drug abuse." Gerard and Kornetsky (1954) summed it
up best by noting that the "least qualified
generalization which can be made about the families of
drug addicts is that they were of the type which
Psychiatric experience suggests are productive of serious
difficulties in adjustment." These types of families and
the parental rearing practices may make children
Vulnerable to psychopathology in general, rather than

just one or a few specific forms of psychopathology

(i.e., addiction). The results of this study would

135

suggest that further examination of the rearing practices
and the family of origin is warranted.

With regard to subjects, Spotts and Shontz (1984)
noted certain differences between the low to moderate
users of cocaine and the heavy users of cocaine.

Heavy cocaine users do not trust people . . . the

second major problem of heavy cocaine users is an

intense anger that is externally oriented but not
directed at any specific object . . . the third
problem is despair, and it is reflected in feelings
of defeat, helplessness, bitterness, and
disappointments.
The authors felt that "the psychodynamic appeal of the
cocaine state . . . in suitably predisposed individuals,
is the power to attract deep-seated, proverbial
fantasies, and arouse infantile states." These heavy
users of cocaine spend their life yearning for paradise
in a world where chemical pleasure is the best that they
can find. Edelstein (1986) states that "in order to use
heroin, one has to be a deviant, to be angry at the
world, to have a range . . . which they cannot contain.
They seem to look for ways to avoid completely discomfort
and pain." Edelsten's statement considered with
Zimmering et al.'s (1952) suggesting that heroin abusers
have "fantasies of omnipotence . . . resent the intrusion
of any reality that challenges these illusions of
omnipotence," and Weider and Kaplan's (1969) assertion

that narcotics produce "a strong state of quiet lethargy

and is conducive to hypercatheting fantasies of

136

omnipotence, magic wish fulfillment and self-
sufficiency," results in the suggestion that heavy
cocaine abusers are described in a manner similar to
heroin abusers. The major implication for this study is
that a cocaine abuser sample may be composed primarily of
heavy cocaine abusers instead of a representative
sampling of all cocaine abusers.

The final area of concern is the instrument. If one
accepts that the literature review provides an accurate
account of the developmental differences between heroin
abusers and cocaine abusers then. possible alternative
explanations related to the survey exist. A study by
Gibson, Wermuth, Sorenson, Menicucci, and Bernal (1987)
found that substance abusers tend to deny negative things
about themselves and their families. The substance
abusers need for approval will skew self-reports.
Rounsaville et al. (1981) found that when reporting
psychological symptoms or family problems, drug abusers
tend to exhibit denial and defensiveness associated with
the need for approval. Capel and Caffrey (1974) and
Ungerer et al. (1978) commented on the suspiciousness
with which heroin abusers approach certain situations.
The suggestion is that the results of this study may have
been skewed due to the approval needs and/or the
suspiciousness that the subjects approached the answering

of the survey questions.

I

137

The results of this study could have been skewed by
the following:

1. the length of the survey--320 questions

2. the length of time necessary to complete the
survey

3. the questions for Stage 1, the pivotable stage
in this study, were located at the end of the survey
The first two points may have created fatigue, thereby

skewing the results for Stage 1.

Limitations of the Study

The major problem for the present research centers
on the fact that the samples used were samples of
convenience. Like most of the studies cited in the
literature review, samples drawn from populations of
opportunity severely limit one's ability to make broad
generalizations to other groups. Casky and Bell (1986)
note that "those addicts in treatment are likely to have
more serious addiction related problems." Addicts seen
in treatment in general represent a discrete
subpopulation of' the entire population of abusers so
generalizations must be limited.

The samples consisted of male Midwestern cocaine
abusers and heroin abusers. This fact makes the
generalizability of the conclusions of this study limited

to a select population.

138

The use of volunteers as subjects makes the
generalizations of the study restricted to volunteers
from the same type of population.

An important limitation of this study is the extent
to which other confounding variables were not controlled
for, especially "family" variables (parent's marital
status, type of parental child rearing style and
discipline while growing up, openness of communications
in the family, and parent's educational level) were not
considered. Although all subjects had completed at least
grade 8, intelligence was not controlled for.

Finally, the relative small sample sizes compared
with the number of variables suggests that the power of
the study was lower than it might have been had a greater

number of subjects been recruited for the samples.

Implications for Future Research
The types of study described would certainly have
more far-reaching implications if it were designed as a
longitudinal study. However, due to the time constraints
of a dissertation study, following the sample group of
individuals from adolescence to adulthood is impractical.
Therefore, the present study should be viewed as a pilot

study with the expectation of a longitudinal study being

done in the future.

 

139

As the study was a pilot, replication of the study
is suggested. Replication of the study with a larger
sampling is necessary in order to ensure that results
reported in the study are valid. Replication should
occur at the same site of the present study as well as
other substance abuse treatment centers to determine if
any differences exist due to locale.

Since the psychosocial development of male heroin
abusers and male cocaine abusers was examined, future
research. should study the psychosocial development of
female heroin abusers and female cocaine abusers.
Research with the AAAP needs to proceed with a variety of
populations.

Future research might be directed toward examining
the effect that various psychotherapies might have upon
the stage scores of the AAAP. A pretest—treatment-post-
test paradigm. This could help determine if the AAAP
could possibly serve as a measure of personal growth
through therapy.

A study directed toward the further delineation and
clarification of the developmental issues of heroin
abusers and cocaine abusers and what the first two stages
of the AAAP measure with regard to trust and shame. The
study would involve the use of a measure of trust, a

measure of shame, and the first two stages of the AAAP.

 

140

This research could be carried out with a variety of
populations.

Finally, a study using chronic substance abusers,
whereby the AAAP is compared with another measure of
Eriksonian psychosocial development needs to be

conducted.

APPENDICES

APPENDIX A

RESEARCH FORMS

141

CONSENT FOR PARTICIPATION FORM

I freely consent to take part in a scientific study
being conducted by Shaun LaBlance under the
supervision of William Farquhar, Ph.D.

I understand that the study being conducted is for
the purpose of examining patterns of psychosocial
development.

I understand that I am free to discontinue my
participation in the study at any time.

I understand that participation in this study will
not result in any direct benefits to me.

I understand that the information that I provide by
filling out these forms will be kept in strict
confidence. Only the researcher will have access to
the original forms and that only general results
will be reported, but none of those which identify
participants.

I understand that, upon request, I will receive a
report of this study's general results.

I understand that my participation or lack of
participation in this project will have no effect
upon receiving services from the Community Mental
Health Board.

 

 

Signature Date

 

142

AAAP SURVEY-FACT SHEET

Fill in completely, please.

1.

2.

10.

11.

Your age in years and date of birth

Your race: 1-Caucasian; 2-Black; 3=Hispanic;
4=Other

Your current marital status: 1-Never married;
2=Married; 3-Separated; 4-Divorced; 5-Widowed

How many years of formal education do you have?
(circle the number)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Education (highest level completed)

1=Grade School 4=Trade School 7-Ed.S.
2-Junior High 5-BS/BA 8-Ph.D.
3=High School 6=MS/MA

Income: (for the last 12 months)

1=Under $4,000 4-$10,000—15,000 7=$25,000-30,000
2-$4,000-6,000 5-$15,000-20,000 8=$30,000-40,000
3=$6,000-10,000 6=$20,000-25,000 9=Over $40,000

Rate your parents social standing:
1 2 3 4 5 6 7 8 9
lower middle Upper

Rate your sense of physical well being:
1 2 3 4 5 6 7 8 9
Unhealthy Average Healthy

Rate your sense of emotional well being:
1 2 3 4 5 6 7 8 9
Unhappy Average Happy

Rate your sense of satisfaction with personal
relationships:

1 2 3 4 5 6 7 8 9
Dissatisfied Average Satisfied

Which drug do you prefer: 1=Heroin; 2=Cocaine

 

12.

13.

143

Please indicate the primary reason for taking your

drug

of preference:

1-Enjoyment or pleasure, to get high, to feel good

2-To
3-To
4=To
5=To

6=To

be social and friendly

reduce anxiety, tension, nervousness, or stress
relieve boredom

relieve anger or irritability

improve performance

Overall, I take my drug of preference to:

1=Slow myself down

2=Speed myself up

 

144

ASSESSMENT
OF
ADULT
ADJUSTMENT

PATTERNS

William W. Farquhar
Fredrick R. Wilson

James A. Azar

 

145

ASSESSMENT OF ADULT ADJUSTMENT PATTERNS

A
MEASURE OF HOW ADULTS RESOLVE
BASIC DEVELOPMENTAL ISSUES

by

William W. Farquhar, Ph.D.
Fredrick R. Wilson, Ph.D.
James A. Azar, M.A.

With special assistance from:

Martha R. Anderson, Ph.D.
John A. Bellingham, M.A.
Elizabeth Parmeter, Ph.D.
Margaret B. Parsons, M.A.

Based on:

Erik Erikson's Epigenetic Developmental Model

Copright applied for

William W. Farquhar
Fredrick R Wilson

1983
East Lansing, Michigan

146

Directions

 

Please answer the questions in this booklet as honestly
as you can. The statements were designed to measure how
you view yourself, and how you view life in general. Be
as honest as you possibly can.

Work quickly, not spending too much time on any one

question. There are no right or wrong answers to these
questions.

Make your marks on the answer sheet next to the same

number that appears before the question. Please use a
number two pencil.

All items are to be rated:
(1) Definitely true of me
(2) True of me, more mostly true of me
(3) Not true of me, or mostly not true of me
(4) Definitely not true of me
Example:
1. I believe that people should save money.

ANSWER SHEET

Please ignore
1. (1) (2) (3) (4) (5) this response

'This person marked space number one on question one

indicating the belief that people should save money is
"definitely true of me."

NOW TURN THE PAGE AND BEGIN

 

10.

11.
12.
13.

14.

15.

16.

17.

18.

19.

147

I learn fast.
I generally attend community or school meetings.

I have gone door-to-door collecting signatures on a
petition.

I give blood (or would if not medically
prohibited).

My life is the result of choices I have made.

When I have to speed up and meet a deadline, I can
still do good work.

I generally feel pleased with my performance when I
talk in front of a group.

I like children.
I have difficulty in getting down to work.

If I want to, I can charm a member of the opposite
sex.

I make it a point to vote in all elections.
I check things out for myself.
When I argue, I use facts to support my position.

When the situation demands, I can do into deep
concentration concerning just about anything.

I publicly question statements and ideas expressed
by others.

People are more important to me than material
things are.

It's easy for me to know whether people really like
me.

I enjoy interacting with children.

I have volunteered my name as a witness at the
scene of a crime or an accident.

20.

21.

22.

23.

24.
25.

26.

27.

28.

29.

30.

31.

32.

33.

34.
35.
36.
37.
38.
39.

40.

148

I enjoy being sexually stimulated.

I have actually sought out information about my
school board members in order to form an opinion.

I do things for my community.

How many friends I have depends on how pleasing a
person I am.

I handle myself well at social gatherings.
I can work on ideas for hours.

I have "put myself on the line" in my relations
with others.

 

My social life is full and rewarding.

When things are not going right in my work, I
reason my way through the problems.

It is hard for me to keep my mind on what I am
trying to learn.

I am confident when learning a complicated task.

If I can't solve a problem quickly, I lose
interest.

I like problems that make me think for a long time
before I solve them.

I enjoy finding out whether or not complex ideas
work.

I like problems which have complicated solutions.
When I was younger, I wanted to run away from home.
I enjoy parties.

I feel self-confident in social situations.

I can work even when there are distractions.

I feel uneasy if I don't know the next step in a
job.

I can work under pressure.

41.
42.

43.

44.

45.
46.

47.

48.

49.
50.
51.
52.

53.

54.

55.
56.

57.

58.

59.

60.

61.

149

I feel that people are genuinely interested in me.
In times of trouble, I have friends I turn to.

It is hard for me to work on a thought problem for
more than an hour or two.

I learn well when someone gives me the problem and
lets me work out the details myself.

I have difficulty imagining how other people feel.
People like to work with me.

In times of crisis, I'm one of the first people my
friends call for help.

When I was prepared, teachers couldn't fool me with
trick questions.

I am dedicated to my work.

I my work, I show individuality and originality.
I am proud of my work.

My plans work out.

I get stage fright when I have to appear before a
group.

When I'm in a group, I feel confident that what I
have to say is acceptable.

I get caught up in my work.

I like to solve problems.

When I get hold of a complicated problem, I return
to it again and again until I come up with a
workable solution.

I get along with people.

The thought of making a speech in front of a group
panics me.

I feel inferior to most people.

For me to learn well, I need someone to explain
things to me in detail.

62.

63.

64.

65.
66.
67.
68.
69.
70.
71.
72.
73.

74.

75.

76.
77.

78.

79.

80.
81.

82.
83.

150

When I took a new course in school, I felt
confident that I would do all right.

I play around so much I have a hard time getting a
job done.

No matter what the task, I prefer to get someone to
do it for me.

I feel proud of my accomplishments.

I will probably always be working on new projects.
My judgment is sound.

People expect too much of me.

I feel useless.

I'm interested in people.

I enjoy doing favors for my friends.

I am always a loyal friend.

I do many things well.

I like to participate actively in intense
discussions.

When I sit down to learn something, I get so caught
up that nothing can distract me.

I know the children who live in my neighborhood.
I think about the big issues of life.

I like to discuss ways to solve the world's
problems.

When I decide to do something, I am determined to
get it done.

I like to answer children's questions.

I give clothing and other items to charitable
organizations such as the Salvation Army.

I lend things to my neighbors when they need them.

I work to make my community better for children.

84.

85.

86.

87.

88.

89.

90.

91.
92.
93.
94.
95.
96.
97.
98.

99.

100.

101.

102.
103.

104.

105.

151

I have gone door—to-door collecting money for
charity.

I see to it that my work is carefully planned and
organized.

I find it hard to keep my mind on a task or job.

I go at my work without much planning ahead of
time.

I am proud of the accomplishments I have made at
work.

Completed and polished products have a great appeal
for me.

I read a great deal even when my work does not
require it.

I have worked on a school committee.

I devote time to helping people in need.

I feel there is nothing I can do well.

I am active in community or school organizations.
Children bore me.

I can stay with a job a long time.

I like curious children.

Young people are doing a lot of fine things today.
I enjoy the times I spend with young people.
Children's imaginations fascinate me.

I have met the leaders of my community and have
formed my own opinions about them.

I keep my word.
I do not understand myself.

Because I have to be so different from situation to
situation, I feel that the real me is lost.

Children talk to me about personal things.

106.
107.
108.
109.

110.

111.
112.

113.

114.
115.
116.
117.
118.

119.

120.

121.

122.

123.

124.

125.

126.

127.

152

I am proud of my accomplishments.

I enjoy things that make me think.

I enjoy explaining complex ideas.

I get those things done that I want to do.

I am pretty much the same person from situation to
situation.

I do not expect people to be consistent.
I have very few good qualities.

Often other people determine the kind of person I
am.

My work is usually up to the standards set for me.
I am determined to be the kind of person I am.

I'm just not very good with children.

I am good at solving puzzles.

My happiness is pretty much under my own control.

I feel disappointed and discouraged about the work
I do.

I keep up with community news.

Once I have committed myself to a task, I complete
it.

I feel more confident playing games of skill than
games of chance.

I feel confident when learning something new that
requires that I put myself on the line.

I never have serious talks with my friends.

I like the way young children say exactly what they
think.

I like to participate in intense discussions.

I feel awkward around members of the opposite sex.

128.

129.

130.
131.
132.

133.

134.
135.
136.
137.
138.

139.

140.

141.

142.

143.
144.
145.

146.

147.

148.

153

I analyze my own motives and reactions.

I feel deep concern for people who are less well
off than I am.

People of the opposite sex think well of me.
I enjoy interacting with children.
I find it easy to introduce people.

My table manners at home are as good as when I eat
out in a restaurant.

I am a worthwhile person.

It is very important that my mate loves me.

My life is what I made it to be.

My basic state of happiness is dependent upon me.
I make my own decisions.

I can't stand the children who live in my
neighborhood.

It's pretty neat to be me.

I get a feeling for the meaning of life through
contemplation.

I have not deliberately said something that hurt
someone's feelings.

I like myself.
Compliments embarrass me.
I am self confident.

I am not irked when people express ideas very
different from my own.

Getting along with loudmouthed, obnoxious people is
impossible for me.

Even though I do not like the thought of it, my
death does not frighten me.

154

149. I have had experiences in life which were so
intense that they were almost mystical.

150. I feel good when others do something nice for me.

151. I am close to someone with whom I talk about my
feelings.

152. I have been so close to somebody, that it is not
possible to find adequate words to describe the
feelings.

153. I don't think I'll ever find someone to love.

154. My values change as I discover more about life and
the universe.

 

155. I ignore the feelings of others.
156. I would not care to be much different than I am.

157. I get a feeling for the meaning of life through
art.

158. My feelings about nature are almost sacred.

159. I am sometimes irritated by people who ask favors
of me.

160. With the person I am closest to, I share my inner
feelings of confidence.

161. I find myself thinking about things much more
deeply than I did in years past.

162. There have been times when I was quite jealous of
the good fortune of others.

163. I keep my word.
164. I cannot stand silence.

165. When someone says something critical about me, I
keep my composure.

166. The best times of my life were in the past.

167. Even when I am doing something I really enjoy, I
can never get totally involved.

168.

169.

170.

171.

172.

173.

174.
175.
176.

177 O

178.

179.

180.

181.

182.
183.

184.

185 O

186 O

187.

155

After a lot of hard struggling, I am comfortable
being me.

I enjoy privacy.

I have been so close to someone that our
relationship seemed almost mystical.

When I get angry at someone, I boil inside without
letting them know.

As far as I know about myself, once I choose a
mate, I do so for life.

For me to act on a sexual urge, I have to have
feelings for the other person.

I am sensitive to how other people feel.
When I am alone, silence is difficult to handle.
I learn from constructive criticism.

There have been occasions when I felt like smashing
things.

It's good to be alive.

I have been so close to someone, that at times it
seemed like we could read each other's mind.

I have no one with whom I feel close enough to talk
over my day.

I get a feeling for the meaning of life through
beauty.

I like to be by myself a pat of every day.

I have had experiences in life when I have been
overwhelmed by good feelings.

I trust the spontaneous decisions I make.

With the person I am closest to, I share my inner
anxieties and tensions.

I play fair.

I can make big decisions by myself.

188.

189.

190.
191.
192.
193.

194.

195.

196.

197.

198.

199.

200.

201.

202.

203.
204.

205.

206.

156

I am amazed at how many problems no longer seem to
have simple right and wrong answers.

I don't worry whether anyone else will like the
friend I choose.

I like being by myself.

I am a citizen of the world.

I am basically cooperative when I work.
It is very important that my mate likes to snuggle.

When I get angry at someone, it rarely wrecks our
relationship.

I can see little reason why anyone would want to
compliment me.

I am strong enough to make up my own mind on
difficult questions.

I am comfortable being alone.

I have a person with whom I talk about my deepest
feelings about sex.

The more I look at things, the more I see how
everything fits with everything else.

I find there are a lot of fun things in this world
to do alone.

Even though I am pretty much in touch with who I
am, I am always discovering new aspects of myself.

The inner wisdom of people never ceases to amaze
me.

I feel strongly about some things.

It is very important that my mate be thoughtful of
me.

I get a feeling for the meaning of life through
nature.

Life gets better as I get older.

207.

208.

209.
210.

211.

212.

213.

214.

215.

216.

217.

218.

219.

220.

221.
222.
223.

224.

157

When I get angry at someone, I tell them about it,
and it's over.

There is at least one person in my life with whom I
can talk about anything.

Whatever age I am always seems to be the best.

With the person I am closest to, I share my inner
feelings.

There have been times when I felt like rebelling
against people in authority even though I knew they
were right.

 

No matter who I'm talking with, I'm a good fl
listener.

If someone criticizes me to my face, I listen
closely to what they are saying about me before
reacting.

I have had an experience where life seemed just
perfect.

I am outspoken.

Circumstances beyond my control are what make me a
basically unhappy person.

I can take a stand.

I have a sense of awe about the complexity of
things in the universe.

I have had moments of intense happiness, when I
felt like I was experiencing a kind of ecstasy or a
natural high.

I can remember "playing sick" to get out of
something.

I give help when a friend asks a favor.
No matter what the task, I prefer to do it myself
I like to gossip at times.

If someone criticizes me to my face, I feel low and
worthless.

225.

226.

227.

228.

229.

230.

231.

232.

233.

234.

235.

236.

237.

238.

239.

240.

241.

242.

243.

158

I sometimes try to get even rather than forgive and
forget.

I do not intensely dislike anyone.

I like being able to change my plans without having
to check with somebody.

I see to it that my work is carefully planned and
organized.

My values are formed from many sources, and I
integrate them to give meaning to my life.

With the person I am closest to, I share my inner
feelings of weakness.

I seem to understand how other people are feeling.

I just can't be courteous to people who are
disagreeable.

When people express ideas very different from my
own, I am annoyed.

When I was young, there were times when I wanted to
leave home.

Being close to another person means sharing my
inner feelings.

I value the deep relationships I have formed with
the opposite sex.

I sometimes feel resentful when I don't get my way.

It is very important that my mate likes to touch me
and be touched by me (hold hands, hug, etc.).

I feel free to express both warm and hostile
feelings to my friends.

Being deeply involved with someone of the opposite
sex is really important to me.

How many friends I have depends on how pleasant a
person I am.

I am ashamed of some of my emotions.

I never like to gossip.

159

244. For me, sex and love are tightly linked together.

245. The closest I get to another person is to share my
opinions and ideas.

246. Reading or talking about sex stimulates me.

247. I get a feeling for the meaning of life through
music.

248. I have not found a person with whom I can be close.

249. As I look back at my past decisions, although I
wish I might have done things differently, I
realize those were the best decisions I could make
at the time.

250. My morals are determined by the thoughts, feelings,
and decisions of other people.

251. I act independently of others.

252. I wouldn't enjoy having sex with someone I was not
close to.

253. I go out of my way to avoid being embarrassed.

254. I rarely check the safety of my car no matter how
far I am traveling.

255. I have been punished unfairly.
256. Sometimes I deliberately hurt someone's feelings.

257. With the person I am closest to, I share my inner
feelings of tenderness.

258. I have had experiences in life when I have felt so
good that I have felt completely alive.

1. If I were one of the few surviving members from
worldwide war, I would make it.

2. People like me.

3. No one understands me.

4. My parents caused my troubles.

10.

11.

12.
13.

14.

15.
16.
17.
18.

19.

20.
21.

22.

23.
24.
25.
26.

27.

160

I takes a lot to frighten me.

There are questions that interest me which will not
be answered in my lifetime.

I must defend my past actions.

It's hard for me to say "no" without feeling
guilty.

I feel optimistic about life.
My free time is spent aimlessly.

Feelings of guilt hold me back from doing what I
want.

My word is my bond.
I admit my mistakes.

I worry or condemn myself when other people find
fault with me.

I am happy.

I believe people are basically good.

My feelings are easily hurt.

Whatever stage of life I am in is he best one.

When somebody does me wrong, I get so hung up on my
own feelings I can't do anything but brood.

When I feel tense, there is a good reason.
I like being able to come and go as I please.

I have taken time to help my neighbors when they
need it.

I worry about things that never happen.
I trust others.

I trust others.

I am basically an unhappy person.

My family understood me while I was growing up.

280

29.

30.
31.
32.
33.
34.

35.

36.

37.

38.

39.
40.
41.

42.

43.

44.
45.

46.

47.

48.

49.

161

Mostly I like to just sit at home.

I am happy with the pace or speed with which I make
decisions.

People hurt my feelings without knowing it.
I take the unexpected in my stride.

I frighten easily.

I eat balanced meals.

I find people are consistent.

My day-to-day frustrations do not get in the way of
my activities.

I think the best way to handle people is to tell
them what they want to hear.

I worry about my future.

It takes something of real significance to upset
me.

My mistakes annoy me, but do not frighten me.
Guilt is a feeling I seem to have outgrown.
I believe the best times are now.

I constantly need excuses for why I behave the way
I do.

When I feel worried, there is usually a pretty good
reason.

Basically, I feel adequate.
I like people who say what they really believe.

I learn things as fast as most people who have my
ability.

People respect my work because I do a good job.
I am picky about my food.

I don't need to apologize for the way I act.

50.
51.

52.

53.

54.

55.

S6.

57.
58.
59.
60.
61.

62.

162

I have a lot of energy.
I am calm.

No matter what the task, I prefer to get someone to
do it for me.

I am willing to admit it when I don't know
something.

I enjoy being sexually stimulated by someone I
don't know.

I am an even-tempered person.

If a clerk gives me too much change, I correct the
error.

I punish myself when I make mistakes.

My duties and obligations to others trap me.

I was raised in a happy family.

When it's time to go to bed, I fall asleep easily.
My parents treated me fairly.

I am a stable, dependable worker.

 

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Blatt, S. J., Rounsville, B., Eyre, S., & Wilber C.
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Boyd, R. D. (1964). Analysis of the ego-stage
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Boyd, R. D., & Koskela, R. N. (1970). A test of
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Corty, E., & Ball, J. C. (1986). What can we know about
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Crane, W. (1980). Theories of develo ent;-Concepts and
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Crowley, R. (1939). Psychoanalytic literature on drug
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Dunnette, M. D. (1975). Individualized prediction as a
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Edelstein, E. (1986). Psychology of drug abuse. In A.
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Emmelkamp, P., & Heeres, H. (1988). Drug addiction and
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Erikson, E. H. (1959). Identity and the life cycle.
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Erikson, E. H. (1963). Childhood and society (rev.
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