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Addiction

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paper 44

REASONS FOR USE, ABSTENTION, AND QUITTING

ILLICIT DRUG USE BY AMERICAN ADOLESCENTS:

A Report Commissioned by the Drugs-Violence Task Force

of the National Sentencing Commission

Lloyd D. Johnston

2

REASONS FOR USE, ABSTENTION, AND QUITTING

ILLICIT DRUG USE BY AMERICAN ADOLESCENTS:

A Report Commissioned by the Drugs-Violence Task Force

of the National Sentencing Commission

Monitoring the Future Occasional Paper 44

Lloyd D. Johnston, Ph.D.

Institute for Social Research

The University of Michigan

1998

i

TABLE OF CONTENTS

LIST OF TABLES....................................................................................................................... iii

LIST OF FIGURES .................................................................................................................... iii

INTRODUCTION.........................................................................................................................1

METHODS....................................................................................................................................1

STAGES OF DRUG INVOLVEMENT.......................................................................................2

THE CONNECTIONS BETWEEN DRUGS AND CRIME......................................................4

REASONS FOR DRUG USE, ABSTENTION, AND QUITTING ...........................................6

Self-Reported Reasons for Use............................................................................................6

Self-Reported Reasons for Abstention.................................................................................8

A THEORY OF DRUG EPIDEMICS .......................................................................................14

The Growth Phase..............................................................................................................16

Awareness ..............................................................................................................16

Access ....................................................................................................................16

Motivation to use ...................................................................................................17

Reassurance about the safety of a drug..................................................................20

Willingness to violate laws and predominant social norms...................................20

The Maintenance Phase .....................................................................................................21

The Decline Phase .............................................................................................................21

The Relapse Phase .............................................................................................................23

SUMMARY AND CONCLUSIONS..........................................................................................26

REFERENCES............................................................................................................................27

ii

LIST OF TABLES

Table 1. Long-Term Trends in Annual Prevalence of Various Types of Drugs

for Twelfth Graders................................................................................................15

Table 2. Motivations for Using Drugs ................................................................................17

LIST OF FIGURES

Figure 1. Covariance Over Time in Interpersonal Aggression, Property Crime,

and Drug Use at the Aggregate Level, Twelfth Graders ....................................... 3

Figure 2. Marijuana: Self-Reported Reasons for Use, Twelfth Graders 91-94 ..................... 5

Figure 3. Cocaine: Self-Reported Reassons for Use, Twelfth Graders 91-94 ...................... 7

Figure 4. Marijuana: Reasons for Abstentin and Quitting ...................................................10

Figure 5. Cocaine: Reasons for Abstention and Quitting .....................................................12

Figure 6. Crack: Reasons for Abstention and Quitting ........................................................19

Figure 7. Marijuana: Trends in Perceived Availability, Perceived Risk of Regular Use,

and Prevalence of Use in Past Thirty Days, Twelfth Graders ..............................23

Figure 8. Cocaine: Trends in Perceived Availability, Perceived Risk of Regular Use,

and Prevalence of Use in Past Thirty Days, Twelfth Graders ..............................25

Reasons for Use, Abstention, and Quitting

1

INTRODUCTION

This paper is an abbreviated text of a lengthy invited presentation to the Drugs-Violence

Task Force of the National Sentencing Commission in the spring of 1995. The author was asked

to address the topic of why some people use drugs while others avoid using them, and that will

be the primary focus of this Occasional Paper. However, that issue is only one in the broader

array the Task Force considered, so the first part of this paper addresses the interface between

drugs and crime, which is at the heart of the Task Force’s mission. The complex issue of causes

follows that.

METHODS

The data for this report were obtained from the Monitoring the Future study (Johnston,

O’Malley, & Bachman, 1995). The study is subtitled “A Continuing Study of the Lifestyles and

Values of Youth,” because of its broad content; we cover a great many issues besides drugs,

including crime and victimization. We survey young people as they enter adulthood, that is, high

school seniors at the end of their secondary education. There are now four additional

populations in the study, two of which have been added fairly recently. The population on which

we have the longest time series, and on which I focus in this report, is the 12th graders, on whom

we now have twenty years of survey data. Each survey is representative of all 12th graders for

that year in the coterminous United States in public and private high schools. The samples of

seniors are large, ranging around 16,000 located in approximately 135 high schools per year.

From the sample in each graduating class, we take a smaller group of 2,400 and follow them

over subsequent years. In this way, we eventually develop a very good national sample of

college students, since virtually all college students come from high school. Although the

college student sample is small (about 1,500), I think it is quite accurate. We also have a

sizeable sample of young adult high school graduates. For trend purposes, the “young adult”

segment reported on here is limited to ages 19 to 28, although some of the high school students

we have followed are now in their late 30s. There are about 7,000 respondents per year in the

young adult sample of 19- to 28-year-olds. All of the follow-up surveys are conducted by mail,

with modest payment to respondents. These are highly cost-efficient because of the low-cost

method of data collection and high response rates. In the first year of follow-up in the early

cohorts, roughly 80 to 85 percent responded; at the ten year follow-up, the response rate was

about 70 percent.

Because initiation into drugs frequently occurs at younger ages, and because many

intervention programs are targeted at younger ages, eighth graders and tenth graders were added

to the annual in-school surveys in 1991. Each grade is an independent sample and the

methodology parallels the methodology used in the 12th grade surveys. In the 8th-, 10th-, and

12th grades, self-administered questionnaires are given to classrooms of students by University

of Michigan personnel. Similar self-administered questionnaires are mailed to the follow-up

samples, with a $10.00 (and earlier $5.00) payment. All questionnaires take 30 to 40 minutes to

complete.

Occasional Paper No. 44

2

STAGES OF DRUG INVOLVEMENT

In developing an understanding of drug use, and the reasons for it, it is useful to know

something about the sequential nature of drug involvement. First, involvement tends to follow a

typical sequence (Kandel, 1975; Yamaguchi & Kandel, 1984a, 1984b). People do not just start

smoking marijuana or using heroin--that is very rare. The sequencing tends to follow a pattern,

which is not invariant, but 80 to 90 percent of all the youngsters we look at who use drugs fit this

kind of pattern. They start either with alcohol or tobacco and usually go on to the other one.

Widely recognized as a next step in drug-use progression is marijuana use, but less widely

recognized as an early step is the use of inhalants, which are used mostly among younger

adolescents. In fact, until this past year, inhalants were the most widely used illicit drug among

eighth graders--even higher than marijuana, however because marijuana use has risen sharply, it

has overtaken inhalants in prevalence of use. For various reasons the use of inhalants has not

received much attention. Inhalant use involves legal, inexpensive, easily available drugs

(household products in the main) affording all youngsters ready access at virtually no cost. They

believe inhalant use is safe, although it is not at all. Such use is probably an important early

indicator of youngsters who are going to get into trouble and I think we need to do more to

address this indicator and to educate youngsters about the inherent dangers of such use.

After these important initial steps into illicit drug use, youngsters may next try any of a

number of other illicit drugs including LSD, cocaine, amphetamines (for many years one of the

most widely used classes of drugs), and/or any of the controlled psychotherapeutic drugs.

Finally, after that intermediate step, a smaller number begin to use crack and/or heroin. Most of

the young people who use either of these drugs already have used one or more drugs in the

intermediate group. Fortunately, not all youngsters complete this sequence of involvement.

Most stop at alcohol or tobacco use and many stop at marijuana use.

There is gradual, and to some degree age-graded, involvement with drugs. The pattern of

progressive involvement is correlated with youngsters’ perceptions of how dangerous the drugs

are. (See Johnston et al., 1995.) Also related to the progression, I believe, is the perceived

deviance of the behavior. It is not very deviant to use alcohol and tobacco in a society which

widely extols their virtues, although it is somewhat deviant for a youngster to do that. It is more

deviant to cross the line into illegal drug use and even more so to use so-called harder drugs.

And finally, heroin has always been seen as the most deviant of all.

For any particular drug, there also are different stages of involvement. These stages

move through experimentation, occasional use, regular use, and on to addiction for some drugs.

And of course, the motives for the different degrees of involvement are somewhat different

(Yamaguchi & Kandel, 1984b). In this paper, I will focus on the earlier stages in the

involvement cycle, because in our studies few respondents are addicts. It is clear that the

psychopharmacological properties of drugs become more and more important to the

reinforcement pattern as an individual becomes more involved. Neurological change may occur,

and a drug can become necessary in order to be normal neurologically. It should be noted that

these different stages are quite different in their degree of relationship to crime, as will be

discussed next.

Figure 1

COVARIANCE OVER TIME IN INTERPERSONAL AGGRESSION, PROPERTY CRIME,

60

AND DRUG USE

AT THE AGGREGATE LEVEL

12TH GRADERS

40

20

0

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aggression index mean (1-5 scale)

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Occasional Paper No. 44

4

THE CONNECTIONS BETWEEN DRUGS AND CRIME

Several different kinds of connections between drugs and crime can be distinguished.

The first is that people do criminal things while under the influence of a drug. They may engage

in assaultive or other aggressive acts. That is certainly true for alcohol: By far the most

aggression which occurs under the influence of drugs, occurs with alcohol. It is relatively less

true for most of the illicit drugs. Those illicit drugs that may lead to such behavior are the

stimulants—cocaine, crack, amphetamines—where heavy use can cause a paranoid syndrome to

develop and with that, aggressive acts resulting from the pharmacological properties of the drug.

But most drugs, and certainly marijuana, do not seem to lead to aggressive behavior as a result of

their pharmacological properties.

And, of course, in the advanced stages of involvement, violent acts may be associated

with supporting the habit—the second connection with crime. When an addict’s desire for the

drug is very high, he often will do whatever is necessary to get it: stealing from his family,

stealing from friends or employers, shoplifting, etc. But as these property crimes continue,

aggression may be used in muggings to get a purse, robberies, and so forth. So addiction

represents an important factor in criminal behavior, although it relates primarily to property

crime.

Crime associated with dealing a drug is a third, very important part of the drugs-crime

connection. There has always been some violence of this sort, but the advent of cocaine and

crack seemed to shift the amount and brutality of the violence to a higher level. Fourth, a new

problem has emerged, which now is becoming quite serious. It is derivative from our policies

about drug users and drug dealers. The use of minimum mandatory sentencing has overcrowded

prisons with non-violent offenders and, as a result, is forcing other types of offenders

back onto the street earlier than they would have been otherwise. This may well result in an

increase in violent crime.

Finally, it should be noted that, while non-drug-related delinquent or criminal acts tend to

be highly correlated with drug use, much of this association is due to a more general common

determinant which might be called “deviance proneness.” We have shown that most of the

variance in drug use and other deviant behaviors can be explained by this common factor

(Osgood, Johnston, O’Malley, & Bachman, 1988) although some variance in drug-using

behaviors remains to be explained by determinants specific to them. In fact, in an earlier chapter

we raised the question of whether any of the levels of drug involvement, short of addiction,

actually contributed to a person’s involvement in either property crime or interpersonal

aggression (Johnston, O’Malley, & Eveland, 1978). Based on a panel study of a national sample

of young men from roughly ages 16 to 24, we found little evidence that it did, although

delinquency levels were predictive of adolescent drug use. Whether these earlier findings would

generalize to today’s young people is another question, however.

Figure 2

MARIJUANA: SELF-REPORTED REASONS FOR USE

12TH GRADERS 91-94

PERCENT OF USERS IN PAST YEAR

0 20 40 60 80

FEEL GOOD/GET HIGH

EXPERIMENT

HAVE GOOD TIME W FRNDS

RELAX /RELIEVE TENSION

BOREDOM

GET AWAY FROM PROBLEMS

SEEK INSIGHT

ANGER/FRUSTRATION

INCR OTH DRUGS EFFECTS

FIT IN WITH GROUP

GET THROUGH THE DAY

I AM HOOKED

DECR OTH DRUGS EFFECTS

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Occasional Paper No. 44

6

The Monitoring the Future Study provides quite another type of data to examine the

relationship between drugs and crime. Using the data from seniors over the period 1976 to 1994,

we can show that, while the proportion involved with illicit drugs varied widely over time—first

increasing and then decreasing substantially—the indices of property crime and interpersonal

aggression, measured on these same samples of seniors, varied rather little (see Figure 1). In

other words, there was no correlation between their trends. If the trend lines for individual drugs

were charted (see Johnston et al., 1995), they also would show no cross-time correlation with the

levels of delinquency, again raising the question whether drug use short of addiction really

contributes in a causal way to other illegal behavior (with the exception of drug dealing, which

was not covered in the delinquency indices).

REASONS FOR DRUG USE, ABSTENTION, AND QUITTING

In Freudian psychology, the term “overdetermination” means that a behavior has multiple

causes. It is very clear that this applies in the case of drugs. There are different ways to look at

those causes. One can simply ask users, “Why is it you use this drug?” We have done that for

many years, and some of the results from those surveys will be presented below. Certainly there

are some global determinants of drug use (like willingness to be deviant), but there are also many

specific determinants for the individual drugs. I think one of the things we can do as a society is

change the proportion of people who are willing to consider using any of the illicit drugs. A

second level of explanation and analysis deals with the question of why whole epidemics come

and go, in terms of proportion who are willing to use any drugs, and in terms of the proportion

willing to use any particular drug. While use of one drug is going up, use of another can be

going down—they behave individually. Like fads, certain drugs fade in and out of popularity

for a host of reasons. I think we have a good idea of what some of those reasons are, and they

will be discussed here. I will begin, however, with the motivations young people themselves

report for their use of particular drugs.

Self-Reported Reasons for Use

In an earlier article on self-reported reasons for use (Johnston & O’Malley, 1986), we

came to a number of general conclusions about the reasons high school seniors offered for their

use of the various illicit drugs. First, those reasons differ considerably by drug. They often

relate, as you would expect, to the known pharmacological effects of the drugs. That is, one uses

an “upper” for different reasons than a “downer.” Second, the profile of reasons differs,

depending on how involved the youngster is in the use of a particular drug. Youngsters who are

in the beginning stages of drug use, will say “to experiment, to see what it is like.” After that

comes “to have a good time with my friends”—a social reason, as well as “to get high.” Those

in the heavier user groups increasingly mention psychological coping as the underlying reasons

for their use—“to get through the day,” “to relieve boredom,” “to deal with anger and

frustration,” etc. (Of course, there are only certain types of reasons that people are capable of

reporting: There may be others that they are not aware of or do not want to report. Those will be

discussed in a later section.)

4

EXPERIMENT

FEEL GOOD/GET HIGH

HAVE GOOD TIME WITH FRIENDS

GET MORE ENERGY

STAY AWAKE

BOREDOM

RELAX /RELIEVE TENSION

GET AWAY FROM PROBLEMS

ANGER/FRUSTRATION

INCREASE OTHER DRUGS EFFECTS

SEEK INSIGHT

GET THROUGH THE DAY

I AM HOOKED

DECREASE OTHER DRUGS EFFECTS

FIT IN WITH GROUP

Figure 3

COCAINE: SELF-REPORTED REASONS FOR USE

12TH GRADERS 91-94

PERCENT OF USERS IN PAST YEAR

0 20 40 60 80 100

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Occasional Paper No. 44

8

For the present paper I have used recent survey data to conduct updated analyses of selfreported

reasons for use. Again, it is gathered from high school seniors using a closed-ended

answer format in which the respondent is asked to check “What have been the most important

reasons for your using marijuana or hashish? (Check all that apply.)” Figure 2 provides the

answers given by respondents, drawn from the classes of 1991 through 1994 combined, who said

that they had used marijuana at least once in the prior 12 months. The 15 reasons have been

listed in rank order.

First, note that respondents mention many reasons—thus they add up to far more than

100 percent. “To feel good and get high” has a very high mention for marijuana use, and “to

have a good time with my friends” is mentioned by two-thirds of respondents who had used in

the past year. For marijuana, much of the motivation is celebratory, social behavior. Many

youngsters often use in a social setting, such as teenage parties. Some, in fact, half, say they use

it to “relax” or “relieve tension.” Many of the psychological reasons receive relatively low

mentions from marijuana users overall; however, daily users of marijuana mention psychological

reasons more often: “to get away from my problems,” “seek insight,” “deal with anger or

frustration.” As can be seen from its low ranking, “to fit in with a group” is not a widely claimed

reason (though this may come more from its low social desirability) and “because I am hooked”

is mentioned by only a few percent of recent users.

Figure 3 presents comparable data for cocaine. “To experiment” gets an even higher rank

for cocaine than it did for marijuana, possibly because a higher proportion of the cocaine users

are at an early stage of involvement, since cocaine generally has a later age of onset than

marijuana (Johnston et al., 1995). Cocaine is the only drug in our study for which active use

grows with age, into the 20s. Fewer respondents say “to have a good time with my friends”

because cocaine is less of a party drug and more a drug one uses to “feel good or get high”–the

second ranked reason after experimentation. “More energy” and “staying awake” are mentioned

by fair proportions, and, of course, these reasons stem from the specific psychopharmacological

properties of cocaine. Finally, psychological coping motives tend to trail off in the mentions,

again, in part, because relatively few respondents at this age have progressed into heavier use.

Self-Reported Reasons for Abstention and Quitting

It is also possible to ask respondents why they do not use, and we have done that. The

respondent is instructed, “Here are some reasons people give for not using marijuana, or for

stopping use. Please tell us which reasons are true for you. (Mark all that apply.)” Only

respondents saying that they have not used in the past twelve months are asked these questions,

and of them, respondents who say they “probably will” or “definitely will” use in the next 12

months are excluded. The results for marijuana are presented in Figure 4. Two kinds of nonusers

are distinguished: the “abstainers” (i.e., those who have never used) and the “quitters”

(defined as past users who have not used in the prior 12 months). Again, data from 1991 through

1994 have been combined to increase the sample size, because this question appears on only one

of our six questionnaire forms. Clearly, abstainers provide more reasons for their abstention than

quitters give for their quitting. However, the rank order given to the various reasons tends to be

fairly similar for both abstainers and quitters, though for almost every reason the abstainers are

Reasons for Use, Abstention, and Quitting

9

less likely to cite the reason. Notice that the two most commonly mentioned reasons for

abstainers are concerns that they might damage themselves psychologically and/or physically.

These beliefs about the risk of harm have proven to be very important determinants of drugusing

behaviors—a point returned to below.

Interestingly, in light of the fact that one of the leading reasons given for use is wanting

to get high, one of the leading reasons for non-use for both quitters and abstainers is the

opposite—they do not want to get high. “Afraid of becoming addicted” is mentioned by

considerably more abstainers than quitters, and the disparity is even greater for “it’s against my

beliefs,” which is important to the majority of abstainers but to less than a quarter of the quitters.

Quitters are less likely to cite as reasons that they “don’t like users” or that their “friends don’t

use.” However, quitters are much more likely to characterize marijuana smoking as “not

enjoyable,” which was mentioned by about 40 percent of the quitters but by less than 20 percent

of the abstainers. This makes sense considering that true abstainers have never had first-hand

experience to determine whether it was enjoyable. Also note that concerns about “loss of

ambition” were mentioned by 30 to 40 percent of each group. Among daily marijuana users, we

have found that loss of energy has been mentioned as a consequence of use by some 40 percent

(Johnston, 1981). Many young people seem to be aware of this possibility.

“Fear of arrest” is mentioned by less than half of both the abstainers (48 percent) and the

quitters (about 40 percent). Nevertheless, it is a concern for some. Lack of availability on the

other hand, was mentioned by less than 10 percent of either group, substantiating our claim made

elsewhere (Johnston et al., 1995) that marijuana is almost universally available to this age group.

Concerns about cost (“too expensive”) were salient for only about a quarter of each group.

These findings suggest that the nation’s primary long-term strategy of supply control has not

worked very well.

Figure 5 presents a set of data for powder cocaine similar to the one we have just been

examining for marijuana. The answer format is slightly different for powder cocaine; instead of

being asked to check all the reasons they felt were important for their non-use, respondents were

asked to choose the degree of importance of each reason on a three-point scale: “not at all

important,” “somewhat important,” and “very important.” The proportion marking “very

important” is displayed in Figure 5.

Again, the cocaine abstainers give more reasons for their non-use, but not dramatically

more, than the quitters. In contrast to marijuana, the “fear of addiction” ranks at the top–almost

all respondents mention it, and that is true of quitters as well as abstainers. Concerns about

physical and psychological harms rank very high for cocaine, as well as for marijuana. This

reflects a big change. During the late 1970s and early 1980s, when cocaine use was burgeoning

in United States, it was seen as a “safe” drug because experts publicly stated that it was not

addictive or deadly. Many people believed them: Clearly not anymore. It took time for

experience to cumulate and for people to see the outcomes. That it “might lead to stronger

drugs” is also a concern of the great majority. “Fear of arrest” is mentioned by many more

respondents as a reason for not using cocaine than was true for marijuana.

Figure 4

MARIJUANA: REASONS FOR ABSTENTION AND QUITTING

l2TH GRADERS, 91-94

COMBINED

PSYCH DAMAGE

PHYSICAL DAMAGE

DON1

AFRAI

- FEEL LIKE HIGH

D OF ADDICTION

AGAINST BELIEFS

PARENTS DISAPPROVE

LEAD STRNGER DRUGS

LOSS OF CONTROL

my0 OF ABSTAINERS (N&331 4)

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0% OF QUITTERS (N=1465) 0 60 100

c

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Figure 4 (Cont’d)

MARIJUANA: REASONS FOR ABSTENTION AND QUl’TllNG

12TH GRADERS,

91-94 COMBINED

DON’T LIKE USERS

MIGHT GET ARRESTED

FRIENDS DON’T USE

LOSS OF AMBITION

BOY/GIRLFRND DISAP

AFRAID OF BAD TRIP

TOO EXPENSIVE

NOT ENJOYABLE

NOT AVAILABLE

my0 OF ABSTAINERS (N&-61 4)

0% OF QUITTERS (N=1465)

PERCENT GIVING REASON

0 20 40 60 80 100

~48

t

0 60 100

LEAD

Figure 5

COCAINE: REASONS FOR ABSTENTION AND QUITTING

12TH GRADERS,

91-94 COMBINED

AFRAID OF ADDICTION

PHYSICAL DAMAGE

PSYCHOL. DAMAGE

LOSS OF CONTROL

TO STRONGER DRUGS

MIGHT GET ARRESTED

LOSS OF AMBITION

DISLIKE USERS

AGAINST BELIEFS

PERCENT GIVING REASON

0 20 40 60 80 100

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my& OF ABSTAINERS (N4036)

0% OF QUITTERS tN=l99) I

t;

Figure 5 (Cont’d)

COCAINE: REASONS FOR ABSTENTION AND QUITTING

12TH GRADERS,

91-94 COMBINED

PERCENT GIVING REASON

0 20 40 60 80 100

PARENTS D,SAp,,RO,,E

BOY/GIRL,-RI,-,,,, ,,,SA,,,,RO,,E

88

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NOT ENJOYABLE ~~~~~~185

I

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my0 OF ABSTAINERS (N&5036)

0% OF QUITTERS (N=199) 0 20 60

Occasional Paper No. 44

14

One of the striking things about the results in Figure 5 is how many of these reasons are

mentioned as very important by the majority of both groups—usually the great majority. In fact,

the only exception is the reason “not available”; while mentioned by over 60 percent of the

abstainers, “not available” was mentioned by less than 50 percent of the quitters. “Too

expensive” is mentioned by roughly 80 percent of both groups for powder cocaine, much higher

than for marijuana. This multitude of highly endorsed reasons for not using is consistent with

the fact that in recent years only a few percent of this age group have been using cocaine. In

1994, the annual prevalence rate among high school seniors was 3.6 percent, compared with 31

percent for marijuana (see Table 1).

Figure 6 presents comparable data from both quitters and abstainers of crack cocaine use.

(Incidentally, the question on crack use immediately preceded the question on powder cocaine

use in the same questionnaire form. The marijuana question on reasons for not using, which has

been in the study much longer, is on a different form.) It should be noted that the data on crack

quitters are based on only 105 cases. In general the findings are quite similar to those for powder

cocaine except that the disparities between the answers from abstainers and those from quitters is

a little larger for crack.

A THEORY OF DRUG EPIDEMICS

Aside from the question of why particular people use particular drugs in any given

historical period, there is the question of why there are such wide shifts over time in the

proportions using any illicit drug (as illustrated in Figure 1) or in the proportions using specific

illicit drugs (as illustrated in Tables 1 and 2). In discussing the reasons given by today’s high

school students for using or for not using, I already have alluded to the fact that some of these

motivations, and underlying beliefs, have changed substantially over time. While individual risk

factors and protective factors may be very useful for differentiating who is more or less likely to

use drugs at any given time, they have not proven particularly helpful in explaining large swings

in the proportions of the population using drugs (see Bachman, Johnston, & O’Malley, 1990;

Bachman, Johnston, O’Malley, & Humphrey, 1990).

Based on our observations of the American epidemic of illicit drug use, we have

developed an empirically-derived theory of drug epidemics (Johnston, 1991). It distinguishes

phases in an epidemic of widespread illicit use of drugs and posits factors of importance to the

development of each phase. These factors are certainly among the reasons why people do or do

not use drugs.

The initiation or growth phase of a drug use epidemic is when the proportion of the

population involved in illicit drug use grows from near zero percent to some significant fraction

(for example, during the late 1960s through the 1970s). In this epidemic it climbed to two-thirds

of American young people by the end of high school (Johnston et al., 1995). The next phase is a

maintenance phase: Some of the forces that gave rise to initiation or growth recede (the Vietnam

War is a classic example of such a factor) but the epidemic continues. For example, cocaine was

as prevalent in 1986 as it was in 1980. Then there is a decline phase: A substantial drop in use

Table 1

Long-Term Trends in Annual Prevalence of Various Types of Drugs for Twelfth Graders

Approx. N =

Any Illicit Drug

Any Illicit Drug Other

Than Marijuana

Marijuana/Hashish

Inhalants

Inhalants, Adjusted

AmyVButyl Nitrites

Hallucinogens

Hallucinogens, Adjusted

LSD

PCP

Cocaine

Crack

Other Cocaine

Heroin

Other Opiates

Stimulants

Crystal Meth. (Ice)

Sedatives

Barbiturates

Methaqualone

Tranquilizers

Alcohol

Been Drunk

Cigarettes

Smokeless Tobacco

Steroids

cla3s cp C$a,ss cl$s cl$s cl$s ys cla$s cl$s ck&ss cl$s cl.. cffs cl$s cb”f”” cla$s cl$s cla3s cl$s c;y

‘93-‘94

1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 change

9400 15400 17100 17800 15500 15900 17500 17700 16300 15900 16000 15200 16300 16300 16700 15200 15000 15800 16300 15400

45.0 48.1 51.1 53.8 54.2 53.1 52.1 49.4 47.4 45.8 46.3 44.3 41.7 38.5 35.4 32.5 29.4 27.1 31.0 35.8 +4.8sss

26.2 25.4 26.0 27.1 28.2 30.4 34.0 30.1 28.4 28.0 27.4 25.9 24.1 21.1 20.0 17.9 16.2 14.9 17.1 18.0 +0.9

40.0 44.5 47.6 50.2 50.8 48.8 46.1 44.3 42.3 40.0 40.6 38.8 36.3 33.1 29.6 27.0 23.9 21.9 26.0 30.7 +4.7sss

- 3.0 3.7 4.1 5.4 4.6 4.1 4.5 4.3 5.1 5.7 6.1 6.9 6.5 5.9 6.9 6.6 6.2 7.0 7.7 +0.7

- - - - 8.9 7.9 6.1 6.6 6.2 7.2 7.5 8.9 8.1 7.1 6.9 7.5 6.9 6.4 7.4 8.2 +0.8

- - - - 6.5 5.7 3.7 3.6 3.6 4.0 4.0 4.7 2.6 1.7 1.7 1.4 0.9 0.5 0.9 1.1 +0.2

11.2 9.4 8.8 9.6 9.9 9.3 9.0 8.1 7.3 6.5 6.3 6.0 6.4 5.5 5.6 5.9 5.8 5.9 7.4 7.6 +0.2

- - - - 11.8 10.4 10.1 9.0 8.3 7.3 7.6 7.6 6.7 5.8 6.2 6.0 6.1 6.2 7.8 7.8 0.0

7.2 6.4 5.5 6.3 6.6 6.5 6.5 6.1 5.4 4.7 4.4 4.5 5.2 4.8 4.9 5.4 5.2 5.6 6.8 6.9 +O.l

- - - - 7.0 4.4 3.2 2.2 2.6 2.3 2.9 2.4 1.3 1.2 2.4 1.2 1.4 1.4 1.4 1.6 +0.2

5.6 6.0 7.2 9.0 12.0 12.3 12.4 11.5 11.4 11.6 13.1 12.7 10.3 7.9 6.5 5.3 3.5 3.1 3.3 3.6 +0.3

--- - - - - - --- 4.1 3.9 3.1 3.1 1.9 1.5 1.5 1.5 1.9 +0.4

- - - - - - - - - - - - 9.8 7.4 5.2 4.6 3.2 2.6 2.9 3.0 +O.l

1.0 0.8 0.8 0.8 0.5 0.5 0.5 0.6 0.6 0.5 0.6 0.5 0.5 0.5 0.6 0.5 0.4 0.6 0.5 0.6 +O.l

5.7 5.7 6.4 6.0 6.2 6.3 5.9 5.3 5.1 5.2 5.9 5.2 5.3 4.6 4.4 4.5 3.5 3.3 3.6 3.8 +0.2

16.2 15.8 16.3 17.1 18.3 20.8 26.0 20.3 17.9 17.7 15.8 13.4 12.2 10.9 10.8 9.1 8.2 7.1 8.4 9.4 +l.O

--- - - - - - --- -_-_ 1.3 1.4 1.3 1.7 1.8 +O.l

11.7 10.7 10.8 9.9 9.9 10.3 10.5 9.1 7.9 6.6 5.8 5.2 4.1 3.7 3.7 3.6 3.6 2.9 3.4 4.2 +0.8s

10.7 9.6 9.3 8.1 7.5 6.8 6.6 5.5 5.2 4.9 4.6 4.2 3.6 3.2 3.3 3.4 3.4 2.8 3.4 4.1 +0.7s

5.1 4.7 5.2 4.9 5.9 7.2 7.6 6.8 5.4 3.8 2.8 2.1 1.5 1.3 1.3 0.7 0.5 0.6 0.2 0.8 +0.6s

10.6 10.3 10.8 9.9 9.6 8.7 8.0 7.0 6.9 6.1 6.1 5.8 5.5 4.8 3.8 3.5 3.6 2.8 3.5 3.7 +0.2

84.8 85.7 87.0 87.7 88.1 87.9 87.0 86.8 87.3 86.0 85.6 84.5 85.7 85.3 82.7 80.6 77.7 76.8 76.0 - -

72.7 73.0 +0.3

----- - - --- - -_-_ - 52.7 50.3 49.6 51.7 +2.1

------------_________

------------_-__-_-__

- - - - -_--- - - -__ 1.9 1.7 1.4 1.1 1.2 1.3 +O.l

NOTES: Level of significance of difference between the two most recent classes: s = .05, ss = .Ol, sss = .OOl. I-’ indicates data not available.

SOURCE: The Monitoring the Future Study, the University of Michigan.

Occasional Paper No. 44

16

occurs for an individual drug or the overall epidemic. Finally, as the last couple of years have

illustrated, there can even be a relapse phase when use starts to rise again. There seems to be a

cyclical nature to this, although it’s not inevitable, and it is one that can be influenced. The

remainder of this paper will deal with factors explaining changes in the levels of drug use within

and across these phases.

The Growth Phase

In this theory of drug epidemics, I argue that there are five necessary conditions for an

epidemic to grow. One condition is awareness: People have to know that a substance will have

some psychological effect in order to use it for that purpose. Most young people who grew up in

the 1950s and early 1960s did not know about marijuana, cocaine, and LSD: These drugs were

not in their repertoire of known alternatives. Youngsters today are aware of a smorgasbord of

drugs, reflecting an important change in the social environment. A second condition is

accessibility: If people cannot get a drug, they cannot use it. Awareness may eventually drive

access by creating a demand for the drug, in turn eliciting a supply system. A third condition is

motivation to use drugs: Do the perceived positive payoffs outweigh the negatives for using. We

have been dealing with this factor in the previous discussion of self-reported reasons for use, but

I want to discuss it here from another perspective. The fourth condition, I propose is some

reassurance about the safety of using a drug: Because people have a natural tendency to protect

themselves, especially physically, and they recognize that taking a chemical into their body has

the clear potential of being dangerous, they require some reassurance that the drug is safe.

Finally, because virtually all of these drugs are illegal, people must also be willing to violate the

predominant social norm and laws against using illegal drugs—the fifth condition. Each of these

five conditions will be discussed separately.

Awareness. In the late 1960s awareness of the psychoactive potential of many drugs,

including marijuana, LSD, amphetamines, and speed, evolved. Over the intervening years, an

awareness of many other drugs has developed; for example, some youngsters figured out that the

over-the-counter drug, Robitussin™, would give them at a bit of a “buzz.” It had been available

for some time before anyone discovered its psychotherapeutic effects.

The media play an important role in spreading such awareness, though not usually an

intentional one. They help raise awareness, and potentially stimulate motivation by explaining

why people use the drug. Raised awareness can be semi-permanent change, because the

knowledge gets passed on from cohort to cohort, generation to generation.

Access. Access is another necessary condition for the expansion of a drug epidemic.

Increased awareness may increase the access by simply causing people to seek a source for the

drug. Certainly, too, increased use creates greater access, especially among young people,

because for many of them the “dealers” are simply friends from whom they buy their drugs. If a

fair number of young people use drugs, then a great many of them have some friend who uses

and who potentially provides them access. Thus, access radiates through friendship networks.

Table 2

MOTIVATIONS FOR USING DRUGS

l ACHIEVEMENT OF PLEASANT MOOD STATES

l (HIGH, MELLOW, FUNNY, HAPPY, POWERFUL, AT ONE WITH THE UNIVERSE, ETC.)

l AVOIDANCE OF UNPLEASANT MOOD STATES

l (DEPRESSION, ANXIETY, ANGER, BOREDOM)

l ACCEPTANCE IN A PEER GROUP

l CELEBRATION AND COMMUNAL EXPERIENCE

$ l SYMBOLIC EXPRESSION

l DEFIANCE OF PARENTS, OTHER AUTHORITIES (AGE-GRADED NORMS)

l ALIENATION FROM “THE SYSTEM” OR THE CULTURE

l SOLIDARITY WITH A PEER GROUP

l SOLIDARITY WITH A SOCIAL MOVEMENT

l BEING “LIKE” AN ADMIRED ROLE MODEL

l PERFORMANCE ENHANCEMENT

l SEXUAL PERFORMANCE AND ENJOYMENT (MARIJUANA, COCAINE, QUAALUDES)

l ENHANCED WORK CAPACITY (COCAINE, AMPHETAMINES)

l STAYING AWAKE AND ALERT (COCAINE, AMPHETAMINES)

l PERSONAL INSIGHT AND CREATIVITY (LSD, MDMA)

Occasional Paper No. 44

18

If the demand is there, the supply will emerge and be maintained. Indeed, I have

arguedthat no matter how many countries stop growing illicit drugs, how many border seizures

of illegal drugs are made, or how many drug dealers are arrested on the street, an endless number

of suppliers will emerge to fulfill demand in order to reap the enormous profits to be made.

That, I think, is the Achilles heel to the supply-side reduction approach. It is simple economics:

If there is large-scale demand with high profits, the elements in the supply system continue to

emerge. We can fill the prisons, build more, fill them, and so on, as we have been doing. Supply

and suppliers will keep emerging. We will not solve this country’s drug problem as long as we

think about it only, or even primarily, as a supply-side problem. That does not mean we can let

criminal networks flourish and flout the law, clearly we cannot. However, for the last decade

law enforcement officials have said that all that they can do is a holding action. Demand must be

reduced to resolve the drug problem.

The development of a supply network is a semi-permanent change: It is not easy to close

down a supply and distribution system quickly once established. Once a distribution system is

in place, it can readily add drugs. Again, the fastest and surest way to control drug use in the

population is to close down demand.

Motivation to use. Motivation to use is posited as the third necessary condition for an

epidemic to emerge. Table 2 presents a broad range of motivations, including ones that go

beyond those respondents can, or will, report. Thus, this list goes well beyond the self-reported

reasons discussed above.

Achieving pleasant or euphoric mood states (being high, mellow, funny, happy, powerful,

one with the universe) clearly constitutes part of the perceived benefits of use. And, as discussed

earlier, these differ from drug to drug. Avoiding dysphoria or unpleasant mood states is another

important motivation and, for drugs that have this effect, it is an important part of their

reinforcement value. In my opinion, the more psychologically needy are more susceptible to

serious drug involvement precisely because they get more such reinforcement. If a drug removes

some kind of pain, that provides more reinforcement than if the person were not experiencing as

much pain in the first place. Of course, as a person’s involvement with a drug increases, the

drug itself may create the additional physical pain of withdrawal, becoming an additional

powerful motivator for continued use.

Seeking to fit in with a peer group can be another important reason to use. I think it is

often a subtle--almost a self-imposed--kind of peer pressure, rather than outright taunting or

daring. Celebration and communal bonding with the group also can be important for some

drugs, particularly for alcohol and marijuana. Symbolic expression can provide a strong

motivation to use. For every generation the defiance of parents can be a motivation. Drug use

can also prove symbolic as a part of social movements. During the Vietnam era the use of both

marijuana and LSD carried not only the symbolism of communal bonding with the

counterculture, but also active rejection of adult society’s values. At the present time there is no

social movement that has adopted certain drugs as part of its ritual and symbolism, but that could

happen again. If it does, it could prove to be a powerful catalyst for use.

CRACK: REASONS

12TH GRADERS,

91-94 COMBINED

0

Figure 6

FOR ABSTENTION AND QUITTING

PERCENT GIVING REASON

20 40 60 80 100

PHYSICAL DAMAGE

AFRAID OF ADDICTION

PSYCHOLOGICAL DAMAGE

t; LOSS OF CONTROL

LEAD TO STRONGER DRUGS

MIGHT GET ARRESTED

DISLIKE USERS

LOSS OF AMBITION ~~~~~~~~~~~~~~~~189

..................................................................................................................................................... .......... ........................................................................ ........................................................................................................................................

I

PARENTS DISAPPROVE

my0 OF ABSTAINERS (Nz6369)

0% OF QUITTERS (N=lO7)

96

95

95

34

Figure 6 (Cont’d)

CRACK: REASONS FOR ABSTENTION AND QUllTlNG

12TH GRADERS,

91-94 COMBINED

PERCENT GIVING REASON

0 20 40 60 80 100

DON’T FEEL L

s

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,-R,,-,,,,S DON’T “SE ~% ~~,:~~~~~~~~!~:~,:; j:~~:8~:~~~-*~l~~~~~~~~:~~~~ ~~~8~ 4~

8 7

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SUPPORTS CRIMINAL NETWORK

~~~~~~~~ 8 1

TOO EXPENS

NOT AVA,LABLE , ,

my0 OF ABSTAINERS (N&369)

0% OF QUITTERS (N=lO7) 0 20 40 60 80 100

Reasons for Use, Abstention, and Quitting

21

Modeling and imitating admired role models can be another reason for use. Members of

the entertainment industry (e.g., musicians, performers, athletes) have an important influence on

youngsters who want to be like them. Historically, the drug-using behavior of the people in

these role model statuses has fluctuated widely, and at the present time, I believe youngsters are

getting a mixed message from some of these role models, rather than the more unified message

they got in the late 1980s. Some of our data (yet to be released) certainly suggest that.

Performance-enhancement can be another promised benefit of a drug. Sexual

performance and/or enjoyment were among the alleged benefits for marijuana, cocaine, and

certainly for Quaaludes and the nitrite inhalants. The promise of increased work capacity through

endurance, or the ability to stay awake and alert, has helped sell stimulants like cocaine and

amphetamines. LSD promised personal insight and creativity, and similarly, MDMA (ecstasy)

was alleged to give people more insight into themselves.

In sum, a great many different types of motivations can play a role in spreading the use of

a drug—more than are covered in the self-reported use questions discussed earlier. Motivations

can differ with drug and historical period and at times by subgroup in the population.

Reassurance about the safety of a drug. Where do people derive reassurance about the

safety of a drug—one of the necessary conditions for an epidemic of use. Partly from

acquaintances and friends who are using the drug without obvious adverse consequences.

Experts also can play a role, and have. Timothy Leary, for example, was a psychology professor

at Harvard University, which gave him credibility as an expert on whether LSD could be

dangerous to the user. At one time psychiatrists were singing the praises of MDMA. A number

of academics served as expert “reassurers” on the safety of cocaine early in the cocaine

epidemic, and so on.

Of course, the real evidence about the adverse consequences of a drug may take a long

time to develop, so the self-proclaimed experts can reign for some time even if they are wrong.

They help provide the initial, necessary reassurance.

Willingness to violate laws and predominant social norms. During the 1960s and 1970s

a whole generation of young people expressed a willingness to violate laws and social norms

regarding drugs. It was a political and ideological act to do so, associated with the Vietnam war,

alienation from government, Watergate, and so on. Fortunately, we seldom have such huge

generational differences in ideology, but certainly there were in this epidemic (e.g., Johnston,

1973).

The legality of a given substance helps to establish norms about its use, which is why I

am very much against legalization. It sends a misleading message about what the norms are and

how dangerous the society-at-large thinks a drug is, whether or not there has been traditional use.

We have a tendency to disapprove drugs that we see as dangerous. For example, as the longterm

health risks of cancer, heart disease, etc., have been clearly linked to tobacco use, norms

about such use have changed dramatically.

Occasional Paper No. 44

22

The Maintenance Phase

The counterculture social movement receded in the 1970s because the Vietnam war was

over. An important catalyst that helped give rise to the drug-use epidemic, was gone; but the

epidemic continued. Why? I have already mentioned several factors which have been semipermanently

changed: awareness of a smorgasbord of alternatives that earlier generations did not

know about, and accessibility through an elaborated supply system. In addition, there was intercohort

role modeling. I use the word “cohort” rather than “generational” because older siblings

model and perhaps teach their younger siblings these behaviors. Each new cohort is aware of

what the slightly older cohort has been doing. Youngsters in middle or junior high school want

to be like the older kids.

There is also the potential for inter-generational role modeling, because we now have a

generation of parents who are very drug experienced themselves. Personally, I do not think this

is a very important force, because I think parents are much more conservative about drugs now

than they were as adolescents. However, that older generation may have conflicting feelings

about how to communicate with their own children about drugs, because they are worried about

being hypocritical, given their own past experiences with them. Instead of taking the risk of

being hypocritical, they are silent—and that may be an important generational change.

There are still other factors which help maintain an epidemic. Institutional support

mechanisms like NORML and High Times, for example, have evolved. There are other

publications and organizations which tend to be pro-drug, as well. NORML has a recruiting

table at many rock concerts, hoping to recruit the next generation of kids to be “pro-pot.”

Finally, new drugs are constantly being introduced, helping to stimulate new interest. If

the use of the more established drugs recedes because people become aware of their dangers,

there always will be new ones with new promises, new proponents, and new reassurances.

Ecstasy is a recent example. Ice another, although it did not catch on, largely I think, because it

emerged when crack was developing a very bad name as a dangerous drug, and ice was closely

associated with crack.

The Decline Phase

For more than a decade, beginning in the late 1970s, the American drug epidemic was in

a decline phase. During this phase fewer people initiated use and more users quit. The quitting

rate went up, especially for marijuana and later for cocaine (Johnston et al., 1995). However,

there is less evidence of a decline among addicted heroin and cocaine users. Such behavior is

harder to change by altering attitudes, beliefs, and norms, precisely because the users are

addicted. The criminal justice system provides a convenient catchment system for reaching and

intervening with many addicted users, and since treatment is the only policy-controlled way we

are likely to get them to stop using, we should be treating these addicted users in prison.

Figure 7

MARIJUANA: TRENDS IN PERCEIVED AVAILABILITY, PERCEIVED RISK OF

REGULAR USE, AND PREVALENCE OF USE IN PAST THIRTY DAYS

TWELFTH GRADERS

50

40

30

w

co

3

20

IO

0

AVAILABILITY

'76 '78 '80 '82 '84 '86 '88 '90 '92 '94

YEAR OF ADMINISTRATION

100

80

60

Occasional Paper No. 44

24

Our observation of the decline phase of the broad epidemic of illicit drug use strongly

suggests that perceived risk and peer norms have been critical to the downturn in drug use. This

has particularly been true for two key drugs—marijuana and cocaine (Bachman, Johnston, &

O’Malley, 1990; Bachman, Johnston, O’Malley, & Humphrey, 1988). While we have less

empirical evidence, I believe it also has been true for drugs like PCP, ice, and LSD. Figures 7

and 8 show the long term trends in seniors’ use of marijuana and cocaine. They also show the

trends in two possible explanatory factors—perceived risk and perceived availability. Figure 7

shows that the perceived availability of marijuana has remained almost constant over a 20-year

period, and therefore has little capacity to explain the large decline which began after 1979.

Perceived risk, on the other hand, rose dramatically over the very period that use fell.

Disapproval of use (figure not included) also increased substantially over the same period. This,

plus other substantive evidence, has convinced us that this decline was due to a change in

demand, resulting from the upswings in perceived risk and disapproval.

Figure 8 tells a similar story for cocaine. In fact, during the first few years of the

downturn in cocaine use, perceived availability actually continued to rise. Perceived risk, on the

other hand, moved sharply upward after 1986, and the reasons for quitting and abstention,

discussed earlier, show it is still a major deterrent to use. Other factors, such as levels of

religiosity, or conservatism, or delinquency have not shown significant power to explain the

declines in the use of these two drugs (Bachman et al., 1990; 1988).

The Relapse Phase

Of course, the capacity to start the cycle over again always exists, and beginning in 1991

we have seen evidence of that (see Figure 7). Marijuana use in particular, and illicit drug use in

general, have begun to rise again among American adolescents. Again, we have seen a change

in perceived risk, this time preceding the turnaround in use by a year, and in peer disapproval of

use, which we believe helps explain this relapse. We have added a new concept to our theory of

epidemics—“generational forgetting”—to help explain the relapse (Johnston, Bachman, &

O’Malley, 1994). By that, we mean that adolescents’ knowledge about the adverse

consequences of drugs begins to erode as a result of generational replacement. Newer cohorts of

youngsters have less drug use in their immediate environment, or portrayed in the mass media,

from which to learn vicariously about the adverse consequences of use. They also may be

getting less information through the news (which has had a dramatic drop in coverage of the drug

issue) or through the anti-drug advertising campaign (which also has suffered a fall-off in

coverage). If another generation of young Americans are to be spared having their own drug

epidemic, from which they will have to learn the hard way, society-at-large needs to do a better

job of conveying the hazards of drug use to this more naive generation.

Even if we fail to do that, I am not predicting an epidemic of the scale of the last one,

because for the moment we lack an historical event of the consequence of the Vietnam War.

However, legalization of some or all of the drugs would be a different kind of historical event

which could have dramatic repercussions. Because it is likely that legalization would reduce

considerably both perceived risk and disapproval, I would expect it to greatly increase the

proportion of young Americans likely to use currently illicit drugs. Within the framework of our

theory of drug epidemics, legalization would be predicted to have disastrous consequences.

Figure 8

COCAINE: TRENDS IN PERCEIVED AVAILABILITY, PERCEIVED RISK OF TRYING,

AND PREVALENCE OF USE IN PAST YEAR

TWELFTH GRADERS

50

40

AVAILABILITY

10 USE(12 MONTH)

.

100

80

60

40

20

0

'76 '78 '80 '82 '84 '86 '88 '90 '92 '94

YEAR OF ADMINISTRATION

Occasional Paper No. 44

26

SUMMARY AND CONCLUSIONS

In sum, whether people use drugs can differ as a function of the particular drug and the

degree of involvement with that particular drug. The perceived dangers of using a drug have

proven to be very important explanators of individual use and of use in the aggregate. So has the

normative environment of the peer group, which we have argued is influenced in part by the

perceived dangers of using a drug. Such norms also can be influenced by social movements in

which drug use plays a symbolic role, the most obvious example being the counterculture

movement during the Vietnam era.

Further, the process of generational replacement me



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