In order to better understand substance use/abuse, there are two (2) concepts that are far too under-discussed: 1) set; and, 2) setting.

Set is the user’s state of mind while using.  For example, if a person has just learned that she was published in a magazine, her marijuana “high” will probably be “better” than the woman whose longterm boyfriend just dumped her.  The user’s state of mind is a critical component of the reaction the substance will invoke/enhance.

Setting is the physical environment where the substance is used.  If someone uses heroin in his bathroom all the time, then uses the same dose in someone else’s living room, there’s a good chance that the heroin will have a hugely different impact on him.

The combination of set and setting accounts for many overdoses with which I’ve been familiar.  For example, I know someone who went to Las Cruces from Alburquerque, took his heroin stash with him, and died because his regular dose was too strong in the unfamiliar place.  The reason that set and setting are so important is that, like Pavlov’s dog, the body and brain produce various chemicals (like adrenaline) that allow the body to react in almost ritualistic fashion with the substance.  Change the routine, and the body/brain may not “prepare”accordingly.

Therefore, set and setting are crucial in understanding substance use/abuse, but are far too under-studied and under-discussed.  I do hope to increase awareness of these concepts as I develop my Addiction Recovery Psychology.