Becoming a prescription pill smoker: Revisiting Becker

The academic literature detailing escalations in pre-existing substance use practices is primarily understood through a biomedical lens, which situates drug escalation as a result of increases in biological markers like drug tolerance and dependence. This article seeks to frame the escalation of prescription drug misuse within a paradigm that situates drug use as a dynamic and interactional learning process shaped by set and setting. The data drawn upon for this article are derived from 41 qualitative interviews of young adults (aged 18-29 years) socially active in nightlife scenes who reported engaging in smoking prescription painkillers, sedatives, or stimulants. Results highlight how theories of drug use as a deviant behavior that is socially learned can be stretched beyond explaining patterns of initiation to also address the escalation of pre-existing drug use behaviors as users' transition from one route of administration to another.