‘Cultural fraud’: the role of culture in drug abuse RICHARD M. ECKERSLEY National Centre for Epidemiology and Population Health, The Australian National University, ACT, Australia Abstract The research literature on the social determinants of health focuses on socio-economic inequalities and disadvantage. ‘Culture’ is usually seen as part of this picture of difference—associated with minority status, ethnicity or race; but we also need to address the role of dominant or mainstream cultures in health and well-being. Cultures provide the underlying assumptions of an entire way of life, allowing us to make sense of the world and our lives. This paper argues that aspects of modern western culture are a potent and under-estimated social factor behind drug use and abuse. It draws on a wide range of evidence from different disciplines to suggest that Western culture’s emphasis on the material and the individual, in particular, amounts to ‘cultural fraud’: the promotion of images and ideals of life that do not meet human needs or reflect social realities. This failure is conducive to diminished well-being, including addiction to drug use or other behaviours. [Eckersley RM. ‘Cultural fraud’: the role of culture in drug abuse. Drug Alcohol Rev 2005;24:157 – 163] Key words: culture, drugs, health, individualism, materialism, psychosocial, social determinants. Introduction Cultures bring order and meaning to our lives. Of all species, we alone require cultures to give us reasons to live, to make life worth living. This paper develops the author’s earlier work to set out the case for paying more attention to culture, specifically modern western culture, in seeking to understand better the broad social determinants of drug use and abuse. In doing this, it acknowledges the lack of research in this area; the subtlety and complexity of the interplay between social factors and individual behaviours; and the difficulties of measuring cultural influences, with their intangible, subjective, even ‘invisible’, qualities. Given these limitations, the evidence is often indirect, and the arguments are to some extent theoretical and spec- ulative, intended to stimulate greater research interest in the topic. The paper locates considerations of culture within the broader context of research into the social determinants of health; discusses the research on the impacts of materialism and individualism on health and well-being, including through their effects on psycho- logical needs such as social support and personal control; and, finally, considers the prospects of a transition to a healthier culture. In essence, it argues that modern western culture is ‘fraudulent’ in its promotion of cultural images and ideals that are at odds with human needs and social realities. The paper is, then, concerned less with the need for specific policy or programme interventions to reduce harmful drug use than it is with the case for a deep cultural change to promote better population health and well-being, including less drug abuse. Scientific and political interest in the effects of the social environment on health has surged in the past two decades. Recent reports [1 – 3], and other papers in this issue, discuss the social, or structural, determinants of health with regard to drug use, establishing the links between drug abuse and other psychosocial problems, and showing that these problems share common social determinants. The focus of attention in this ‘social determinants’ literature has been on socio-economic disadvantage and inequality, especially income inequality. However, recent research challenges this narrow focus [4 – 7]. Instead, the research shows that population health is Richard Eckersley, BSc(Hon), MSCSoc, Fellow, National Centre for Epidemiology and Population Health, The Australian National University, ACT 0200, Australia. E-mail: Richard.Eckersley@anu.edu.au Received 30 November 2004; accepted for publication 20 January 2005. Drug and Alcohol Review, (March 2005), 24, 157 – 163 ISSN 0959-5236 print/ISSN 1465-3362 online/05/020157–07 # Australian Professional Society on Alcohol and Other Drugs DOI: 10.1080/09595230500102590