Set and Setting: How context determines the nature of drug use.

I’d like to expand on some thoughts I offered in my previous article on methamphetamine. In particular, I suggested that the most important thing to know about users is not that they use methamphetamine, but the particular pattern and context of their use.

This is similar to a popular sentiment among modern day psychonauts, first popularized by the otherwise highly problematic Harvard lecturer turned ‘LSD guru’, Timothy Leary – namely that the character of a psychedelic experience depended crucially, not on the chemical itself, but on the set and setting of the user. Set refers to “the preparation of the individual, including his personality structure and his mood at the time.” Setting “is physical — the weather, the room’s atmosphere; social — feelings of persons present towards one another; and cultural — prevailing views as to what is real.” These two concepts are immensely valuable to all psychedelic users, but it turns out this is true of all drugs; a fact which is still highly underappreciated by just about everyone.

I’ve been reading Dr. Carl Hart’s excellent memoir, ‘High Price’, which explores these concepts as they related to drugs like “crack” cocaine, and heroin, particularly crack. In it, he recounts his first experience of smoking cannabis, which was quite similar to my own. He did not believe he was high – a lot of people don’t when they first smoke. He cites sociologist Howard Becker’s research which shows that many people do not at first enjoy the experience, precisely because it is so alien – they have to be essentially taught to enjoy it. Only “when they had smoked multiple times with other users who taught them how to detect and appreciate the sensory distortions and other effects,” did Beckers subjects begin to interpret them positively. In other words, the experience of being high is not purely physiological, but social, as well. It varies significantly depending on experience, prior knowledge, and preparation. This knowledge is a powerful tool for harm reduction.

Becker’s paper, published in the American Journal of Sociology, serves as a useful example of the way knowledge, contextualization, and social interaction influence drug use – the character of this use, its consequences (positive or negative), and often the meaning people construct around this use. It describes the “sequences of changes in individual attitude in experience” which occur when a person learns to smoke and enjoy cannabis.

Firstly, as was Dr. Hart’s experience, some people ‘don’t get high’ their first time. One explanation is that they do not have sufficient knowledge to consume the drug effectively. One of the fifty users he interviewed explained that you need to inhale deeply, and hold it in momentarily, and this is often explained to young smokers before they manage to get high. Further, as I mentioned, they need to be taught to recognize and appreciate the effects. Thus, Becker suggests that being high “consists of two elements: the presence of symptoms“ and “the recognition of these symptoms and their connection by the user with his use of the drug.” This is all part of the users set (or mindset) with regards to cannabis use, and it is a powerful influence on the role of this use in their life. Again, this knowledge is a powerful tool for harm reduction (recall that it applies to all kinds of drug use, not just cannabis).

Finally, he must learn to enjoy it. The effects of cannabis are arguably ambiguous, neutral. Regular users have probably discovered that it can be highly pleasurable in some settings, and a nightmare in others. Listening to music with friends is a pleasant setting for smoking weed, but family dinners are a nightmare (setting, at play). Enjoyment may, and I think usually does, come naturally if weed is first consumed in the right context and with sufficient prior knowledge. If one knows how to consume the drug, understands that it heightens the appreciation of music, and attempts to use it for this purpose, they will not find it difficult.

But to move beyond the historical curiosity and abstract insights of Becker’s 1953 essay, which includes the word ‘dig’ with ‘enjoy’ in square brackets next to it, we should try to apply the theories of Hart, Leary, and Becker to the real world.

The most obvious application is that which Leary coined the phrase ‘set and setting’ for, and for which purpose it was quickly and widely adopted, namely in the guidance of psychedelic experiences. He expounded this idea in his ‘Manual Based on The Tibetan Book of the Dead’, published in 1964. This book was read far and wide through the sixties and beyond. In my opinion, Leary was a quack, but it should be said that he established himself as a trustworthy and open minded source of wisdom to young people thereby enabled himself to disseminate advice to a very large portion of the demographic to which this advice applied. Sadly, much of it was bad, but his exhortation to be mindful of set and setting was invaluable and undoubtedly influenced many positive experiences. I wonder just how well the hippie generation truly understood this advice, however – the large number of ‘bad trips’ at Woodstock was almost universally attributed to “bad LSD,” which rests on precisely the assumption Dr. Hart’s book refutes: that the chemicals themselves are the primary determinants of the experience of drug use. They jumped immediately to the conclusion that someone had ballsed up the recipe for LSD and made it somehow negative, failing to observe that the largest concert yet thrown, in a sea of half a million people, with a severe shortage water, is probably not the best setting for mass amateur LSD use.

I believe, perhaps naively, that this theory is more widely and more intelligently understood today than it was in 1969, however. I credit this advancement to the advent of the internet, which has revolutionized communication in our society. I mention often that I volunteer for an online harm reduction community. That community is TripSit, which begun as an ostensible 24-hour IRC (text chat) hotline for people having ‘bad trips’, and has since grown into a vibrant harm reduction community educating users on the safe consumption of any and all of the incredible range of drugs people sometimes use Totally aside from my own involvement, these people do incredible work. They are a source of 24-hour assistance to anybody embarking on psychedelic experiences. They foster intelligent discourse, and popular education. Set and setting are very well understood by the perhaps two or three hundred regular users, and over the years has been taught to thousands more passers-by. This is an invaluable service. In addition, though this is very much a non-political essay, I will note that given a legal market for drugs, psychedelics could be sold with digestible literature along the lines of the numerous educational materials Tripsit has been working hard to create. The ultimate value of these techniques (this application of the theories outlined earlier) is to initiate novice users and equip them to have positive and fruitful experience with psychedelic drugs.

In addition, our newfound understanding of the importance of setting or context to the nature and experience of drug use helps obliterate many fundamental misunderstandings about drug use which are still the predominant view of society at large and which are often the source of the hysteria from which prohibition derives its support. For example, we have long assumed that addiction results either from properties innate in the drug, or from properties innate in the user. We know now that neither of these are an adequate explanation of addiction. Rather, addiction stems primarily from context. Mistreatment and neglect in childhood are one context in which addiction is likely to arise. Poverty and subjugation are another. By and large, people are not addicted because of any physiological predisposition to addiction, or any irresistable psychopharmacological inducement, but because drugs hold obvious utility to them in the specific context of their lives.

These facts are expounded upon very articulately by Gabor Mate, and I suggest anybody concerned with these issues seek out his work. He works as a physician, primarily with people on the extreme end of drug addiction, most of whom are addicted because of suffering in their life. They use heroin to self-medicate PTSD, for example, and for which purpose it is highly effective. The reality of society is that for “social, economic, and long-term historical reasons, some children have much more difficulty than others,” and furthermore there is widespread child abuse. For each adverse childhood experience, whether sexual, physical, or emotional abuse, the death or imprisonment of a parent (which is currently happening at incredible rates for simple drug use), that child’s risk of addiction goes up exponentially…all of which means that “in this society we punish people for having been abused in the first place and then turning to drugs.”

These insights into the importance of context to the nature of drug use are invaluable. They will go along way, in coming years, towards reducing problem use and caring for those who become addicted. Now that we understand the significance of context, we can seek to change the contexts we force people into. These insights shed light on the failings of many misguided attempts at treatment, such as AA, and furnish a most damning critique of prohibition. This understanding is absolutely fundamental to the addressing the issue of drugs in our society.

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