Self-image, Medicine, and Drug Use

Kurt W. Back and Deborah A. Sullivan

The problems associated with drug use can range from a physician's attempt to obtain a patient's acceptance of a regime of prescribed medicines to the prevention of frivolous or even dangerous drug abuse. The variation among individuals in their use of drugs depends on both their willingness to be changed and their acceptance of a chemical means of inducing this change. Some types of drugs are more socially acceptable than others. In fact, one could propose a spectrum of drugs which includes, at one end, those prescribed to treat acute infectious diseases or physiological disorders and, at the other end, those prohibited drugs used for "recreational" purposes. Motivation for the use of a drug may depend on the specific situation or the specific effect of the drug to be used. However, a predisposition to use or not to use drugs in any situation also may explain some of the variation in drug use patterns among individuals.

Previous studies (Brehm and Back, 1968; Brehm and Davis, 1971), have shown that the use of drugs is related to general personality tendencies, such as a "great desire to be changed, devaluation of the self-image, belief in the beneficial influence of somatic means, and even a positive reaction and curiosity about the effects of physical agents" (Brehm and Back, 1968). A questionnaire, devised to investigate this area, led to the identification of five factors which represent several different personality traits related to a preference for drug use, particularly the use of drugs with strong psychological effects such as opiates, energizers, and hallucinogens.

These previous studies principally include young subjects who were conscious of stimulating or recreational drug use. Moreover, the drugs listed in the questionnaire were mainly psychotropic, mood-changing drugs, and the setting of the data collection may have encouraged the subjects to interpret "drugs" in this sense. In the current study we focus on middle-aged and elderly subjects and shift the attention more toward drugs used for medicinal purposes, thereby looking at the general conditions of drug use.

Method

The data are derived from a multidisciplinary study of middle-aged and elderly population (Duke Second Longitudinal Study). This research uses data collected in two separate parts of the program. One source is the medical history section of the physical examination, where the respondents were asked to check the amount of drugs and medicines which they had taken in the preceding year. This list includes both prescription and nonprescription drugs and those used for specific physical ailments, as well as those used for general onerous conditions. In addition, the use of alcohol and tobacco was checked. Table A—1 shows the extent of use of the different drugs. They are classified into those which deal with specific ailments (medicines), with nonspecific complaints (medicinal drugs), and with nonmedical social use (social drugs).

Table A—1. Extent of use of different kinds of drugs.

The rest of the data are taken from the social history questionnaire. Besides the thirty-five statements that yielded the drug-use personality factors in the previously mentioned studies, a number of standard personality scales are used. These include the sick-role index (Mechanic and Volkart, 1961), the internal-external scale (I-E scale) (Rotter, 1966), the positive-negative affect indices (Bradburn and Caplovitz, 1965), and a series of semantic differentials. In these semantic differentials the concepts "myself," "how I would like to be," and "how I appear to others" are rated on seven bipolar scales. The Euclidian distance between these concepts (the square root of the means of the squared difference between the scale scores) gives an impression of the discrepancies between the three concepts. The distance between "myself" and "how I would like to be" is termed selfevaluation, that between "myself" and "how I appear to others" is termed persona, and that between "how I wpuld like to be" and "how I appear to others" is termed ideal persona.

Results

Factors

Five factors emerge from the principal components analysis of the thirty-five statements related to sickness and drug use among the middle-aged and elderly sample (table A—2). Items related to a dissatisfaction with oneself (e.g., seeing oneself as too nervous, anxious, self-conscious, or tired) and a desire for some physical action to overcome personal limitations dominate the first factor. As in previous studies, this factor is labeled "insecurity." The second factor accounts for 10.5 percent...