Psychological Factors in Drug Use and Drug Abuse
If the induction of appetites and cravings, which has been hitherto seen as psychological dependence, is not in fact any more psychological than the physical dependence that underlies withdrawal, is there any other psychology involved? There almost certainly is (1). For example LSD, phencyclidine and many of the new designer drugs do not cause either type 1 or 2 physical dependence. Yet they are increasingly abused, despite evidence that many of these compounds may be fatal. Phencyclidine, for example, has led to a considerable number of fatalities and, despite not leading to any obvious euphoria, during the 1980s became for a period the second most common drug of abuse in the USA. Why?
Common to many of these drugs is the fact that they alter consciousness and, as a result, are interesting to take. On tis basis, one explanation that may account psychedelics, opiates or alcohol, there is a certain amount of playful activity.
This has two aspects to it. Firstly, there is the notion that people will try something new simply because it is there, just as they will climb unclimbable mountains or run across continents. In addition, allied to these things, ’simply being there’, there is the matter of our innate curiosity. Secondly, playfulness is a means to handle boredom. For want of something better to do, humans will turn to virtually anything, no matter how dangerous it may be. Even Russian roulette, as Graham Greene confessed, may be tried as a way of livening things up or structuring them. It can often seem that everything that happens is just a game to counteract boredom, from intrepid mountain climbing to scientific endeavours, the writing of books or the taking of the most recently designed drugs.
When we are bored, we do things – we shop, perhaps, and find that new clothes, books or records often seem to restore a sense of purpose to life. One of the central problems of treating alcohol and opiate dependence, aside from physical dependence of both types, is the question of what will the individual now do to structure their time. Frequently, it turns out that keeping an alcohol dependent individual away from pubs also means effectively abolishing their entire social life at a stroke. What are they to do with the yawning hole that opens up where their social life used to be?
From this perspective, the question of drug abuse becomes, to a large extent, a matter of accident that stems from the fact that at various points in life, some of the activities available to be sampled cause physical dependence and others cravings. Just as it is an accident that some of the pursuits available to be taken up, such as motorcycling, have a high fatality rate.
Just as with motorbikes, it seems that if one can get through the particularly playful-experimental stage between the ages of 15 to 25, without having been too involved in pursuits that have a high risk attached, then one is not likely accidentally to be killed or become substance dependent. It is not that playfulness diminishes after this age, so much as the burden of commitments and responsibilities restricts for most of us the opportunities to participate.
Disinhibitation
Along with the fear that drugs may cause dependence, there is a fear that they may change a basic personality by either abolishing the normal personality of an individual or by liberating demos from the unconscious. The adage in vino veritas is often taken to mean something like this.
Both alcohol and benzodiazepines are supposed to disinhibit people on occasion. What is happening? What may happen but is relatively rare is that these compounds, along with almost any other drug that gets into the brain, may cause dissociative reactions. These have been outlined in the following articles:
The usual disinhibition with alcohol is socially disinhibited behaviour, which may involve an inappropriate pinching of bottoms or a beating of wives. In such cases, it is typically argued that alcohol, although a general depressant, depresses brain inhibitory pathways first. Accordingly, with an inhibition of inhibitions, there is supposedly a brief period of disinhibition before increasing levels of alcohol blot out all behaviour in a general stupor. The supposed inhibitory tracts that are especially sensitive to the effects of alcohol, benzodiazepines or barbiturates are rarely specified. If pushed, advocates of this position tend to suggest that it is activity of the frontal lobes of the brain that is the first to be affected by alcohol; this being a brain region that has general executive or inhibitory control over all other brain regions. There is little evidence to support this scheme of things, other than the popular presumption that something like this must be the case. But must it?
There is no question that alcohol discoordinates and slurs speech. This can be demonstrated reliably in experimental situations, and can be correlated precisely with the actions of alcohol on coordination centres, such as the cerebelum. But disinhibition cannot be demonstrated reliably. Furthermore an individual behaving outrageously in a public situation, who then gets some troubling news – their house is on fire, say – is liable to ’sober’ up instantly, although they may still remain less than perfectly cordinated as they set about getting home. Equally, the disinhibition of one evening may be quite different to the disinhibition of the next, in contrast to the discoordination, which will be approximately the same.
An alternative account is that, misled by the real effects of alcohol on gait and coherence, we also put other changes in behaviours down to the drug that are actually a function of the social situation in which it is taken. In general, there is a gap between our knowledge of what drugs reliably do and our difficulties in explaining the complexities of social interactions, that can be exploited by both substance abusers and those who would put down societal ills to such abuses.
There are a number of factors that almost compel such an identification. There is firstly our tendency to seek an explanation for what is happening to us. This shows up well in placebo-controlled studies of drugs generally. It is the common experience of investigators that a not inconsiderable number of subjects have to be withdrawn from such studies because of intolerable side effects of the placebo.
A probable explanation is that of the subjects who enter a study, a number of them will get obscure aches or physical complaints of some sort, on at least one occasion. Such discomforts are borne none too happily in the normal course of events. We put up with them because it is unclear what the cause is and, accordingly, we have little option. But if they occur during a week, when we are taking some new pill, it may be very difficult to believe that the pill is not responsible.
Applied to alcohol, such arguments yield the picture that alcohol itself does not disinhibit, but is commonly consumed in situations where the usual rules of restraint are altered and that, by altering the physical state, it provides a cue that a certain state has been entered in which the subject has learnt that the usual rules of restraint are altered and that, by altering the physical state it provides a cue that a certain state has been entered in which the subject has learnt that the usual rules of accountability does not apply. Thus if, after drinking, I go home and beat my wife, I know that my friends, who know me for a basically decent sort, will not attribute what has happened to me but to the drink and the fact that I may have had a bit too much. This it should be noted is not an in vino veritas argument.
These issues also play a considerable part in the abuse of other drugs. In the case of cannabis, it is quite clear that takers have to ‘learn’ to get stoned. Initial taking of the drug produces the effects on perception that are typical of cannabis, but not stoned behaviour. It is subsequent smoking in the company of others who are stoned that brings about stoned behaviour.
When it comes to abuse of drugs, generally, analysis of urine samples indicates that addicts are often taking mixtures that commonly contain a wide variety of white powders and, perhaps, even none of the particular white powder they think they are taking. Some of these extras may be other stimulants, such as strychnine. But the behaviour they display will be behaviour appropriate to the culture surrounding the drug they think they are on. This can have unfortunate consequences when an opiate addict is being transferred to methadone, for example, as the dose he receive will be based on his stated dose of opiate intake. If he has overestimated his intake, the consequent overdose of methadone may kill him.
References
- Bakalar JB, Grinspoon L: Drug control in a free society. Cambridge: Cambridge University Press; 1989.
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