It is important to consider the social conditions of persons with
disabilities who choose to abuse drugs. Hirschi's social control theory
may illuminate the sociology of addiction for persons with disabilities.
The purpose of this article is to examine the meaning of Hirschi's
theoretical thesis for persons with disabilities, with particular
attention given to the concepts of attachment, commitment, involvement,
and beliefs. Specific Implications for rehabilitation counseling practice
and research will be provided.
The rehabilitation literature is replete with studies which suggest a
high incidence of substance abuse among persons with disabilities. For
example, Stude (1990) estimated that the rate of drug abuse among
rehabilitation clients may be as high as 40%. Further evidence exist which
suggests that persons with disabilities are twice as likely as the general
population to abuse substances (News in Mental Health Nursing, 1993). In
response to the reports of prevalence, several authors have emphasized the
need to develop services to treat persons with disabilities who abuse
drugs (Frieden, 1990; Perez & Pilsecker, 1989). Despite the importance
of estimating prevalence and establishing treatment modalities, greater
understanding of the psychological and sociological factors which motivate
persons with disabilities to abuse substances is needed.
Few studies have offered explanations for the conditions which lead to
the abuse of substances among persons with disabilities. Alston (1992)
explained how Beatrice Wright's (1983) suppositions on psychosocial
adjustment to physical disability can be used to illuminate the issues
involved in adaptation to drugs for persons with disabilities. Johnson,
Gray, and Ososkie (1991) explored sexual dysfunction as a correlate of
drug abuse among rehabilitation clients. Moore and Polsgrove (1989)
explored how disenfranchisement, inadequate self-control, and
sensation-seeking can serve as risk factors of substance abuse for persons
with disabilities.
The aforementioned studies were primarily psychological in nature.
There is a dearth of information concerning the sociological factors which
may influence substance abuse among persons with disabilities. It is
important that we consider the social conditions of persons with
disabilities who choose to abuse drugs. Hirschi (1969) developed a
theoretical approach called "social control" which can be used to
illuminate the sociology of addiction for persons with disabilities.
Social control theory focuses on the sociological forces that can prevent
people from participating in deviant behavior. Deviance can be defined as
beliefs, values, and/or behaviors which are inconsistent with acceptable
social norms and presents harmful consequences for the individual and/or
the public (Hirschi, 1969, 1977). Given the legal decrees against illicit
substances, societal contempt and legal penalties for abuse of approved
substances, and the inclusion of substance-related disorders in the
Diagnostic and Statistical Manual of the American Psychiatric Association
(American Psychiatric Association, 1994), it is safe to state that society
regards drug abuse as a form of deviance.
Several authors have explored the significance of Hirschi's (1969,
1977) theory for interpreting deviance among nondisabled persons (Agnew,
1991; Empey and Stafford, 1991; Jensen and Rojek, 1992; Junger-Tas, 1992).
However, there is an absence of literature which explains how the theory
can be applied to understanding addiction among persons with disabilities.
Therefore, the purpose of this article is to examine the meaning of
Hirschi's theoretical concepts for persons with disabilities who are
abusing substances. First, the elements of social control identified by
Hirschi will be described. Second, a discussion of how the weakening of
these elements can lead to alcohol and drug deviance among persons with
disabilities will be offered. Lastly, specific implications for
rehabilitation counseling practice and research will be provided.
Social Control Theory
Intrinsic to Hirschi's (1969, 1977) theory of social control is the
assumption that persons will engage in delinquent behavior when their
"social bond" to society is weakened. Hirschi's concept of "social bond"
is comprised of the following four elements: (1) attachment, (2)
commitment, (3) involvement, and (4) beliefs. Attachment refers to the
symbiotic linkage between a person and society. According to Hirschi,
individuals with strong and stable attachments to others within society
are presumed to be less likely to violate societal norms. Conversely, an
individual with weak attachments is assumed to be unconcerned about the
wishes of others, and thereby inclined to deviate from social
expectations. Thus, if one is attached to one's family, friends, and
community institutions (e.g., church), one is less likely to deliberately
engage in behaviors which would harm or distress the attachments. Although
persons with strong family and community attachments can potentially abuse
drugs, Hirschi hypothesized that they are more likely to contemplate their
decision and avoid deviant behavior because of probable consternation from
valued attachments.
Commitment refers to the investment an individual has in social
activities and institutions (Hirschi, 1969). Hirschi's commitment
construct is based on the premise that there is an association between
level of commitment and propensity for deviance. Thus, an individual who
has invested time, energy, and resources into conforming to social norms
and expectations (e.g., pursuing educational goals) are less likely to
deviate than someone who has not made such an investment. Hirschi asserted
that individuals heavily invested in commitments have more to lose (e.g.,
interruption of career path) than those who are moderately invested or
uninvested. Consequently, deviant behavior such as alcohol and drug abuse
are less appealing to individuals with strong commitments.
Involvement is the third element of Hirschi's (1969) concept of social
bonding. Hirschi postulated that large amounts of structured time spent in
socially approved activities reduces the time available for deviance.
Thus, an individual who is actively engaged in conventional endeavors
(e.g., employment) simply has less time and opportunity to engage in
deviant activities such as drug abuse. However, an unemployed or
underemployed per, son has several hours more a day of free time in which
to become enticed and involved in deviance. Hirschi contended that
involvement such as being a parent or maintaining a job fosters discipline
and regiment, and the discipline and regiment encourages a resolve to
resist deviance such as substance abuse.
Hirschi's (1969) last element of social bonding relates to an
individual's level of belief in the moral validity of shared social values
and norms. In American society, certain values (e.g., monogamous sexual
conduct) are espoused as norms. Hirschi suggested that persons who
strongly believe in the these norms are less likely to deviate from them.
However, those who question or challenge the norms have a greater
propensity to behave in a deviant manner. The belief system concerning
alcohol and drug use in American society can be complicated and confusing,
Though social drinking is accepted, driving while under-the-influence is
considered deviant behavior. Likewise, the use of prescription medication
tends to be socially sanctioned. Reasonable medication for illness and
pain is a belief that is encouraged and accepted in our society. Moreover,
the legal and medical professions have established guidelines for what is
considered a reasonable amount of medication. According Hirschi's logic,
adherence to the belief and guidelines decreases the probability of
deviance. However, substance abuse occurs when individuals exaggerate the
belief and ignore the medical and legal rules.
Disability and Social Control Theory
Application of Hirschi's (1969) social control theory to rehabilitation
requires an understanding of how the social conditions of disability
results in greater vulnerability to substance abuse. Several authors have
described a variety of factors (e.g., negative public attitudes,
structural barriers, inadequate transportation) which may contribute to a
weakening of social bonds for persons with disabilities (Deloach &
Greer, 1986; Marinelli & Dell Orto, 1984; Wright, 1983). Many factors
of social isolation for persons with disabilities can be explored in the
context of Hirschi's four elements of social bonding. More specifically,
Hirschi's elements can be used to hypothesize how social isolation and
weak bonds can place persons with disabilities at higher risk for deviant
behavior such as drug abuse.
Attachment -- Faulty perceptions of disability can lead to weak social
attachments for rehabilitation clients. Wright (1983) asserted that
persons with disabilities may be socially devalued. Consequently, they may
find their prospective status as an accepted member of a social network
(e.g., bridge club, bowling league) threatened due to the negative
attitudes (e.g., view of persons with disabilities as pitiful and
helpless) of nondisabled persons. Moreover, persons with disabilities may
be shunned by others in their community because they are perceived as
different or strange (Wright, 1983). Rather than confront frequent
negative social interactions, the person with the disability may choose
social isolation to cope (Deloach & Greer, 1986).
A potential outcome of continual social isolation is depression and
loneliness, and a behavioral correlate of depression and loneliness can be
alcohol and drug abuse (Clayton, 1992). Consequently, the perceived
absence of interest and empathy from family, friends, and community may
encourage drug deviance in rehabilitation clients. Social attachments with
society may be regarded by the person with the disability as already
distressed. Thus, concern for the reaction of significant others to
alcohol and drug deviance becomes less of a constraint.
Commitment -- The employment and college enrollment rates of persons
with disabilities is low in comparison to nondisabled persons (Bowe,
1992). Thus, there is greater likelihood that persons with disabilities
will be less invested personally and financially in educational and career
goals. It is important to note that lower output in socially expected
activities by persons with disability is not solely the result of
individual apathy and initiative. Rather, factors such as discriminant
hiring practices, inadequate job and academic accommodations, and poor
economic conditions contribute to the low representation of persons with
disabilities on worksites and in classrooms.
However, less investment and commitment could potentially translate
into a negative attitude (e.g., "I don't have much to lose anyway.") about
life matters. Consequently, deviant choices such as alcohol and drug abuse
may be viewed by persons with disabilities as less risky (Hirschi, 1969).
Heinemann (1990) reported that employed persons with disabilities are less
likely to use valium, cocaine, alcohol, or marijuana. Heinemann's findings
give credence to Hirschi's notion that concern for loss of investment can
deter deviant behaviors.
Involvement -- There are strong similarities in meaning between
Hirschi's (1969) elements of involvement and commitment. Whereas
commitment emphasizes time, energy, and self-investment in conventional
behaviors, involvement focuses on the idle time available when one is not
committed. Due to detachment from social institutions, many persons with
disabilities are not engrossed in conventional activities (e.g., going to
school or maintaining a marriage and raising a family). They more
frequently engage in unstructured and unplanned activities such as
"hanging out around the house" rather than structured activities such as
participating in a school function (sports, music, a club) or working a
part-time job (Greer, 1986).
According to social control theory (Hirschi, 1969, 1977), individuals
possess unfulfilled needs or desires for excitement (e.g., sex).
Furthermore, Hirschi asserted that everyone would pursue these desires
constantly if time permitted. Periods of recreation are generally the
moments that we pursue desires of excitement. However, preoccupation with
conventional activities such as employment or parenthood limit our time
for recreation as well as define parameters of acceptable levels of
excitement. Since persons with disabilities are also desirous of
excitement and have more opportunity for leisure, they may be particularly
susceptible to deviance such as alcohol and drug abuse. Inordinate free
time may allow for persons with disabilities to more easily and readily
satisfy natural motivations for sensation seeking. Absence of involvement
in common daily activities eliminates a primary source of restraint from
deviant behavior for persons with disabilities.
Belief -- Hirschi's (1969, 1977) element of belief has significant
relevance for persons with adventitious disabilities. Prior to the onset
of disability, the moral belief system of the person, family, and friends
are oftentimes consistent with social norms. In other words, there is
respect for and obedience to rules and regulations of society such as
appropriate usage of legal substances and non-usage of illegal substances.
However, a modification and softening of the belief system may accompany
the onset of disability. Family and friends may believe that a person with
a disability is more entitled to use drugs because of the perceived loss
of personage and independence surrounding the disability (Corthell &
Brown, 1991). Thus, family members and friends of the person with the
disability may encourage rather than discourage the consumption of
substances. Feelings of guilt and pity can lead family members and friends
to compromise their beliefs and values when it concerns the person with
the disability (Wright, 1983). As suggested by Hirschi (1969, 1977), the
compromising of societal values and norms can produce deviance. Ford and
Moore (1992) described a case of moral compromise involving parents with
previously strict values allowing the child with the disability to smoke
marijuana in the home. According to Ford and Moore, the parents considered
the compromise an allowable privilege since their son was under tremendous
stress concerning the disability. When the person with the disability is
given special treatment by family and friends because of the disability,
enabling of alcohol and drug abuse occurs.
Implications for Rehabilitation Counseling Practice
Hirschi's (1969, 1977) constructs of social control are applicable to
the prevention and treatment of substance abuse in persons with
disabilities. It should be emphasized that the application of Hirschi's
theory does not discount or contradict customary rehabilitation
approaches. Instead, the suggested applications supplement standard
service provision by providing a broader framework in which to view the
abuse of alcohol and drugs by persons with disabilities. Since Hirschi's
constructs are reciprocal, the following suggested applications have
overlapping features.
Alston and Turner (1994) asserted that individuals exist in a systemic
context, and the most immediate context is that of the family system.
Consequently, a successful adjustment to any changes (e.g., substance
abuse) that stem from a disabling event will certainly involve the family
(Alston & Turner, 1994). The assertions of Alston and Turner are
particularly pertinent to the notions of attachment postulated by Hirschi
(1969, 1977). Rehabilitation professionals should utilize scales such as
the Family Environment Scale (Moos & Moos, 1986) to assess the
client's perceived level of family attachment and cohesiveness. If weak
attachments are identified, rehabilitation professionals can gain
permission from the client to interview family members in order to
pinpoint areas of disunity and disjointedness. During the interview, the
rehabilitation professional can emphasize the importance of input and
social feedback from the family as a means of restraining deviance such as
alcohol and drug abuse in the client. Lastly, a bridge to reattach the
client with the family can be established through therapeutic strategies
such as planned family outings and scheduled family conferences.
Beyond family attachments, healthy relationships with drug free friends
are crucial as restraints to deviance. The rehabilitation professional can
assist the client establish friendships by introducing them to social
networks such as disability support groups and clubs (e.g., wheelchair
basketball). Stable attachments with friends can buffer feelings of
isolation and reinforce social feedback from the family.
The social bonding elements of commitment and involvement compliment
the goals of rehabilitation services. For example, Hirschi's (1969, 1977)
notions concerning commitment to and investment in conventional activities
by the individual are exemplified in the Individual Written Rehabilitation
Plan (IWRP). Because the IWRP requires considerable personal investment
toward accomplishing the objectives of adjustment and the goal of gainful
employment, it can serve to counter urges of deviance such as alcohol and
drug abuse. Thus, the rehabilitation professional must continually stress
commitment, concentration, and goal attainment to the client.
To neutralize deviance that may occur as a result of the client being
disengaged and uninvolved outside of the rehabilitation office, the
rehabilitation professional can coordinate participation in structured
activities. Programs such as job clubs will consume time that might
otherwise be spent contemplating and succumbing to thoughts of deviant
behavior. Other activities such as working with disability advocacy groups
and editing a newsletter should help to restrain substance abuse because
of the concern that obligations will be neglected if time is spent
sensation seeking.
To address deviant client behaviors emanating from noncompliance with
socially accepted beliefs, the rehabilitation professional can utilize
individual and group counseling techniques (Egan, 1990; Corey, 1981). The
values of the client concerning alcohol and drug abuse can be explored for
societal comparison and clarification. Although exercises on value
clarification can be conducted during individual counseling, group
counseling with others who share similar challenges may be particularly
valuable. Within a group counseling context, clients could receive
feedback on how their alcohol and drug usage is inconsistent with the
values of larger society.
Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) programs are
designed to address all four elements of Hirschi's notions on social bond.
Persons with disabilities who attend AA and NA are provided with an
instant attachment to a social network comprised of members who share the
common goal of stopping their substance abuse. Daily participation in AA
and NA can serve to reconnect substance abusers to their community, while
giving them regular meetings and 12 steps of spiritual growth in which to
become committed and involved. Moreover, a belief system which is
compatible with many societal norms (e.g., belief in a higher power) is
espoused in the 12 steps of AA and NA.
Conclusion
Much of the existing literature concerning the drug usage behavior of
persons with disabilities is atheoretical. It is contended in this article
that Hirschi's (1969, 1977) social control theory has usefulness in
helping to explain some of the potential sociological sources of alcohol
and drug abuse among persons with disabilities. As suggested by Greer
(1986), substance abuse among persons with disabilities is a complex and
multifaceted phenomenon that must be considered in a larger social
context. Given Wright's (1983) assertion that disability status can lead
to social isolation, Hirschi's hypothesis that weaker social ties (bonds)
with society encourages deviant behavior is particularly pertinent to the
prevention and intervention of substance abuse among rehabilitation
clients.
Although sufficient anecdotal experiences exist to support Hirschi's
(1969,1977) theory, empirical data is needed to definitively demonstrate
its significance for persons with disabilities. For example,
investigations which measure the level of association between the
constructs of social control theory and the incidence of drug abuse for
persons with disabilities is warranted. In a study of marijuana use among
adolescents, Murray (1986) operationalized and established measures for
Hirschi's (1969, 1977) elements of social bonding. Alston (in press)
operationally defined and designed scales to assess frequency and pattern
of drug usage relevant to persons with disabilities. Researchers are
encouraged to review these two studies for guidance in designing
investigations to explore the relevance of Hirschi's theory for persons
with disabilities.
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Received: October 1994
Acceptance: December 1994
Reginald J. Alston University of Illinois at Urbana-Champaign
Debra Harley
Karen Lenhoff University of Kentucky - Lexington
Reginald J. Alston, Ph.D., Associate Professor, Division of
Rehabilitation Education Services, University of Illinois at
Urbana-Champaign, 1207 South Oak Street, Champaign, Illinois 61820.