Opioid Use Disorder (OUD)Safety & Risk ManagementSet & SettingSubstance Use Disorders (SUD)

Constructing drug effects: a history of set and setting

This paper traces the historical evolution of the concept of "set and setting" from the 19th-century Club des Hashischins through mid-20th-century psychotomimetic research to Timothy Leary’s formulation, showing how non‑pharmacological psychological, social and cultural factors shape drug effects. It argues for the concept’s centrality across psychopharmacology, introduces "collective set and setting" to capture broader social forces, and highlights implications for drug research and policy.

Authors

  • Ido Hartogsohn

Published

Drug Science Policy and Law
meta Study

Abstract

Set and setting is a term which refers to the psychological, social, and cultural parameters which shape the response to psychedelic drugs. The concept is considered fundamental to psychedelic research and has also been used to describe nonpharmacological factors which shape the effects of other agents such as alcohol, heroin, amphetamines, or cocaine. This paper reviews the history and evolution of the concept of set and setting from the 19th-century Parisian Club des Hashischins, through to 1950s psychotomimetic research on nondrug determinants of psychopharmacology, the use of extra-drug techniques by psychedelic therapists of the 1950s, and the invention of the concept of set and setting by Leary. Later developments and expansions on the concept of set and setting are discussed, and the term of collective set and setting is suggested as a theoretical tool to describe the social forces which shape individual set and setting situations. The concept of set and setting, it is argued, is crucial not only for psychedelic research but also for advancing drug research and developing more effective drug policy.

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Research Summary of 'Constructing drug effects: a history of set and setting'

Introduction

Hartogsohn frames the paper around a central question: to what extent are psychoactive drug effects fixed pharmacological responses versus constructions shaped by psychological, social and cultural parameters? The introduction situates this inquiry within a long-running but incompletely resolved debate about ‘‘nondrug parameters of psychopharmacology’’. It notes established phenomena—placebo effects and cross-cultural variation in drug responses—while arguing that a coherent, testable account of how extra‑pharmacological variables operate is still lacking. The author highlights the practical urgency of the issue for harm reduction and drug policy as jurisdictions move towards decriminalisation and medicalised models of use. The paper proposes the concept of set and setting as a productive framework for studying these extra‑pharmacological influences. Set is defined as the internal state of the person (personality, preparation, expectations, intention, mood) and setting as the environment (physical, social and cultural context). Hartogsohn states the aims as providing a preliminary history of the concept, tracing its evolution from 19th‑century hashish experimentation through mid‑20th‑century clinical work to contemporary debates, and suggesting analytical extensions (for example, ‘‘collective set and setting’’) and practical implications for research, therapy and policy.

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Study Details

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