Drug, set and setting

Some of the most important research work which challenged and continues to challenge popular views of drugs, drug use and people who use drugs has been into the role played by set and setting. While the findings of the research are not contentious the full implications of the findings are still contested – not because of research that contradicts the findings but because of moral and ideological perspectives and alternative models of drug use (see disease model).

The argument for the ‘drug set and setting’ model is complex. Its origins are in the cultural changes of the 1960s and it was developed further in the Vietnam Veterans studies published in the 1970s. The idea is best laid out by Norman Zinberg in the 1980s.

In 1966. Timothy Leary, a psychiatrist, carried out experiments on the effects of DMT (dimethyltryptamine) a psychedelic drug, similar to LSD but shorter acting. This had a reputation for inducing intense, unpleasant experiences lasting typically around 30 minutes in both ‘recreational’ and experimental research settings. Leary proved that changing variables other than dose and route of administration, it was possible to support a positive experience in over 90% of his subjects. In a conducive environment – literally a room ‘completely covered, ceiling, walls and floor, by warm, colorful India prints’, for example (see citation below) and with a supportive induction to the experience and the company of people subjects trusted, people reported very positive experience of using the same drug which others had reported in other situations as unpleasant, even terrifying. Leary proposed that this proved that ‘set’ i.e. mindset – the state of mind of someone taking a drug and ‘setting’ the physical and social context in which they use the substance is key to the experience of using the drug. This is the common experience of people who use drugs and particularly the experience of people who use psychedelic drugs in which experiences can greatly differ.

Research by Norman Zinberg of Harvard University, described in his 1984 book Drug Set and Setting: The Basis For Controlled Intoxicant Use, challenges the notion of addiction as commonly discussed and described. Zinberg argues that problem drug use is a phenomenon caused not by the inherent characteristics of substances (see addictive; see dependency) nor by personal weakness or failure of individuals but by the mindset and the social setting of a person at the time that they use drugs.

Heroin use and dependency was common amongst US soldiers in Vietnam by the early 1970s. However, about 88% of the men ‘addicted’ in Vietnam did not relapse to problem heroin use after their return to the US. Zinberg showed that the power of the social setting applied to the controlled of use of drugs including heroin and that ‘controlled users’ existed. This suggests that notions of ‘addictive personalities’ and the ‘addictiveness’ of substances are not only simplistic but mistaken.