By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Set and Setting change perceptions of drug use.
Set and setting, the impact of places and mood on drug user’s experiences plays a large role in the way alcohol and drugs affect the user’s mood and behavior.
Not everyone who takes the same dose of a drug has the same experience. One person who drinks becomes angry and another happy. The time and place of drug use influence the way in which a drug user or problematic alcohol drinker may be affected by their particular drug of choice.
We need to understand these influences to explain why two different people may describe their experience of using a drug in very different ways. The same person may also experience one drug differently at different times. Here are some ways set and setting may alter the drug user’s perceptions.
Set – Mindset matters.
What you expect a drug to do is likely to be the result you get. Well sort of. First the why and then the why not.
Two drinkers each consume the same amount of the very same alcoholic beverage. One becomes angry and combative and the other becomes happy and mellow. Why? Isn’t a drug a drug?
The effects of alcohol and other drugs have on people vary with the mood they have when they consume that drug. If someone drinks because they are angry they are more likely to become increasingly angry. The alcohol’s disinhibiting effects allow them to take action, express that anger in ways they would not express it if they were sober.
A happy person, expecting to become happier while drinking, will find that is exactly what happens. Again disinhibited they may act on that celebratory mood, dance on the table or kiss a stranger but believing that alcohol will make them happy they will become happier.
Sometimes, at least partially, drug user’s expectations will override the actual effects of the drug. Mindset also has to do with the reasons for using a drug.
When you take a medication to control the pain you are less likely to develop a problem than when you use a drug to change the way you feel emotionally. See physical pain may go away or you may become used to it. But using a drug or alcohol to change the way you feel increases the risk that you will use more and more until eventually that drug no longer makes you feel better but you need it just to feel normal.
Drinking or drugging to change the way you feel is one of the riskiest ways to use substances. Why? Because it works so well. Once you begin using drugs and alcohol to change the way you feel you risk becoming dependent on that drug to change the way you feel.
Setting – where you use a drug matters.
The effect of setting is often underestimated. This leads to strong disagreements about the nature of drug use and addiction.
A patient takes a drug in the hospital. Say they are given morphine for pain. Despite substantial doses over a number of days most people who receive pain medication in a hospital setting do not go on to become addicted.
If that same person were to purchase the very same quantity of this same drug in an alley, there is a high likely hood that addiction would result.
Some religious groups use wine as a part of their service. People rarely behave inappropriately as a result of that one drink at church. But let that same person have a glass of wine late at night in a bar and there is a chance, maybe a good one, that they will behave in a way that they do not normally act.
Drugs, legal and illegal, become a part of the ritual during which they are used. If your ritual is to get high, use all the drugs you can, and act violently, that is what you will do. If you believe a small quantity of wine will increase your feeling of religious connection that too will occur.
Both set and setting are tied to placebo and nocebo effects. The way in which you perceive a drug’s use and its effects influence the experience you have.
People who are drinking non-alcoholic drinks but believe they have been given drinks containing alcohol begin to act as though they were becoming disinhibited. They may slur their speech, stagger, and become loud and boisterous. They may get louder, joke more and do things that in other settings they would be embarrassed to do. The belief that they were drinking alcohol has altered their behavior.
That does not mean that the effects of drugs or alcohol are purely mental. Give those people who had been drinking a non-alcoholic beverage, but thought it contained alcohol, a reaction-time test, and they will suddenly sober up and do just fine.
The converse is that people who drink a lot and develop a tolerance may feel they are not drunk at very high blood alcohol concentrations and with tremendous loss of coordination. While they may think they are fine, those who drank a lot will fail a sobriety test in the lab or in the field.
In any discussion of drug use and abuse, we need to keep in mind the psychological as well as the physical effects of those drugs. Where people use, the setting, and what they are thinking when they use, the mindset, may affect their perceptions of the drug and the risk of developing an addiction or other problems with usage.
Set and setting may alter the way the experience feels but that does not mean that the mind is strong enough to undo the effects of substances. You can think your way into addiction but you can’t think yourself sober. Being clean and sober takes action also.
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