Becoming a prescription pill smoker: Revisiting Becker
| Author | Jeffrey T Parsons,Brooke E Wells,Brian C Kelly,Mark Pawson |
| DOI | 10.1177/1748895816677570 |
| Published date | 01 July 2017 |
| Date | 01 July 2017 |
| Subject Matter | Articles |
https://doi.org/10.1177/1748895816677570
Criminology & Criminal Justice
2017, Vol. 17(3) 340 –355
© The Author(s) 2016
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DOI: 10.1177/1748895816677570
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Becoming a prescription pill
smoker: Revisiting Becker
Mark Pawson
CHEST, New York, USA; CUNY Graduate Center, USA
Brian C Kelly
CHEST, New York, USA; Purdue University, USA
Brooke E Wells
CHEST, New York, USA; Widener University, USA
Jeffrey T Parsons
CHEST, New York, USA; CUNY Graduate Center, USA; Hunter College, USA
Abstract
The academic literature detailing escalations in pre-existing substance use practices is primarily
understood through a biomedical lens, which situates drug escalation as a result of increases in
biological markers like drug tolerance and dependence. This article seeks to frame the escalation
of prescription drug misuse within a paradigm that situates drug use as a dynamic and interactional
learning process shaped by set and setting. The data drawn upon for this article are derived from
41 qualitative interviews of young adults (aged 18–29 years) socially active in nightlife scenes who
reported engaging in smoking prescription painkillers, sedatives, or stimulants. Results highlight
how theories of drug use as a deviant behavior that is socially learned can be stretched beyond
explaining patterns of initiation to also address the escalation of pre-existing drug use behaviors
as users’ transition from one route of administration to another.
Keywords
Deviance, drug escalation, prescription drugs, social learning
Corresponding author:
Mark Pawson, Department of Sociology, City University of New York Graduate Center, 365 5th Ave,
New York, NY 10016, USA.
Email: mpawson@gc.cuny.edu
677570CRJ0010.1177/1748895816677570Criminology & Criminal JusticePawson et al.
research-article2016
Article
Pawson et al. 341
Introduction
The prevalence of prescription drug misuse among young adults in the United States has
surpassed all other forms of illicit drug use except marijuana (McCabe et al., 2006;
SAMHSA, 2014). Despite the surge in popularity of misusing prescription drugs, exist-
ing research focusing on this phenomenon presents few theoretical explanations to better
understand nuanced aspects of this drug trend (Ford, 2008). As prescription drug misuse
has become increasingly normalized among US youth (Quintero, 2012) alternative forms
of consumption have replaced oral misuse as more obvious forms of deviance. This arti-
cle frames the escalation of prescription drug misuse – in the form of pill smoking – as a
socially learned form of deviance whose uptake is informed by a process in which this
particular route of administration comes to be conceptualized as a desirable form of con-
sumption among youth.
Although sociological and criminological scholarship no longer accepts the notion
that individuals are predisposed to drug use due to character flaws or moral failings, the
academic literature detailing escalations in pre-existing substance use practices is pri-
marily understood through a biomedical lens, which has its own implications for under-
standing drug use. More specifically, it situates drug escalation to be a result of increases
in biological markers like drug tolerance and dependence. We provide an alternative
perspective that grounds the transition within a social process through a reconsideration
of Becker’s (1953) classic work on initiation into drug use.
The Biomedical Model of Drug Escalation and Route of
Administration
Much of the biomedical model of drug addiction frames patterns of drug use in terms of
positive and negative rewards or reinforcements within the brain (Koob and Volkow,
2010; Le Moal and Koob, 2007). A cornerstone of the biomedical model of addiction
indicates that repeated exposure to a drug changes brain cells and circuits and decreases
positive reinforcement derived from its use in a way that results in pathological incen-
tives to escalate drug use (Ahmed and Koob, 2005). In other words, neurochemical
changes in the brain that produce drug tolerance and dependence require the evolution of
one’s drug habit to maintain the euphoric rewards from its use (Volkow et al., 2012).
These changes have been identified as a part of the hedonic allostasis model of addiction,
which considers escalations in drug use practices as part of the process of becoming
addicted to a particular drug (Koob and Volkow, 2010). According to this view, “escala-
tion of drug consumption marks the transition from drug use to drug addiction” (Ahmed
and Koob, 2005: 473).
Within the biomedical model, transitions in route of drug administration are typically
framed as escalations in drug use resulting from increases in reinforcing effects provided
through the new route of administration. The route of administration influences the speed
at which drugs are delivered to the brain and the faster the speed of delivery the greater
the rate of reinforcement (Volkow et al., 2000). Of particular interest to this study, previ-
ous research has identified drug inhalation as a more robust reinforcer than oral, intrana-
sal, and even intravenous use (Volkow et al., 2000). Subsequently, a transition to smoking
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