There are more theories about why we use drugs than there are drugs. We avoid reality, abandon morality, suppress hunger pains or other unpleasantness, or turn away from God. We sell drugs out of greed or for upward mobility. Drugs cause brain damage, cancer, personality change and constipation, incite police corruption and political upheaval. We make drugs illegal in order to protect children or to support the underworld markets. Every theory grinds the axe of its proponent.
To understand our fascination with drugs in the first place, we need to ask some basic questions, such as "Why do we like to take poison in small quantities?" The truthful answer is always some variation of "To feel better." How does this come about, and why do we have so much trouble with it?
Psychoactive drugs modulate affect by acting upon both the central nervous system and the physical processes which we ordinarily associate with emotion. When we notice the relaxation of our muscles brought about by a benzodiazepine, we think that we are calmer. Drugs also act directly upon circuits that convert implicit and largely unconscious processes into explicit, linear awareness. Examples are the filtering effects of phenothiazides or serotonergics upon hallucinations and delusional or obsessive ideation, so that the cerebral static of what psychoanalysts call "primary process" and neurobiologists call "implicit imagery" is blocked from narrative consciousness.
A young man, confined involuntarily to a state hospital and diagnosed there as manic-depressive, sought to challenge his being medicated against his will. He had been detained because of his relentless pursuit of a woman who did not reciprocate his affections, and was terrified of him. His usual career, however, was that of a soap-box orator, whose message was one of hideous neo-Nazism. In all other respects, his mental status was rational, organized, controlled and cooperative, though his handshake betrayed constant hyperhidrosis, and he seemed at times edgy and pressured. His objection to treatment with lithium? "It takes away my politics!"
Nathanson was one of the first to explore the relationship between psychoactive substances and their effects upon specific affect systems, noting that alcohol is a very efficient and rapid down-regulator for the affect of shame. My own clinical work with juvenile offenders strongly suggests that cannabis is a specific attenuator of anger, in direct contrast with "Reefer Madness" doctrine. (Whether this is a direct influence upon the noradrenergic system, or a by-product of cannabis' remarkable muscle-relaxant action, is unstudied.)
Amphetamines, on the other hand, appear to increase interest and excitement, thereby enhancing attentive focus. Psychedelics, which lower the threshold for implicit imagery, provide a distraction that enables the user to avoid unpleasant shame-affect.
According to current theory, affects evolved as biological systems that intensify response to stimulus change. Sensory neurons produce electrical and chemical signals to affect-generating mechanisms, which in turn modulate behavior. The entire event is then recorded in memory, whose emotional coloring is based upon the affects involved. Perhaps it was only a matter of time before an animal evolving a technology discovered that its sensory, affective and emotional apparati could be neatly bypassed by supplying the necessary neurochemicals from exogenous sources. What we have discovered, for better or worse, is that the same intensity of motivation for action expected to produce feelings of success in the world is instead directed toward obtaining chemicals capable of producing the affective experience.
Let's look at the opiates, as an example. Under stress or challenge, we produce a very long polypeptide molecule, which, when exposed to several enzymes, breaks down into a molecule of noradrenaline, one of insulin, and several endorphins and enkephalins. The first stimulates the sympathetic nervous system and suppresses acute pain, the second mobilizes energy from carbohydrates, the last few put on the brakes and suppress less acute pain. It is as if the entire operation were designed to activate a response to an emergency, facilitate action, then pause to recover lest the organism exhaust itself. The action of the endorphin molecule, which fits mechanically onto its neuroreceptor, like a key in a lock, is to signal that the crisis is over, the battle won, the predator defeated, the deal closed and the mate secured.
To be even more specific, opiates appear to activate the same pathways between orbitofrontal and hippocampal areas as are stimulated in earliest face-to-face encounters between infant and mother, in which smiles are exchanged and feelings of joyous attunement are constructed. In the language of Tomkins' affect theory, joy-enjoyment is triggered by a particular rate of decrease in stimulus intensity. In higher doses, the rush of euphoria is attributed to dopamine release in the mesolimbic areas, found also in the action of cocaine. I am tempted to predict that a rapid infusion of money would produce the same action, but can imagine no ethical experimental procedure to test such a hypothesis.
Now it just so happens that a certain plant wraps its seed pods in an alkaloid that contains molecules of precisely the same shape as mammalian endorphins. The outcome is that we can use poppy extract to produce the illusion of feeling successful through stimulating affective centers mediating joy-enjoyment. It therefore becomes unnecessary to exert other effort in our environment to achieve the same result. What is more, opiates are relatively clean drugs, with few untoward effects upon most individuals' bodies other than anticholinergic constipation. The sense of completeness and achievement alleviates pain and hunger. In fact, nearly all of our alarm systems are silenced. We experience no distress, and we do not respond empathically to the distress of others. (Little wonder that children of opiate-addicted parents are so often less forgiving and in less conflict over their hostility toward their parents than children of other chemophiles. Their detachment is more nearly complete.) It is as if we have had a temporary brain bypass, so that we can be exposed to life's problems and pains, even overindulge therein, and not have to endure nor act upon them.
We can hereby understand why heroin use is so popular among antisocial personalities, but rarely of interest to psychopaths, the latter's affect systems being chronically under-active to begin with. Most of the former would qualify as having borderline characterological structures and suffer from chronic dysphoria. Their drive for excitement is, in Nathanson's view, an "attack-other" script, designed to alleviate shame-based affective overload. Opiates allow not only direct relief, but also a culturally determined opportunity for the excitement of scoring. Most psychopaths, however, prefer stimulants, alcohol or occasional psychedelics.
It should be apparent that whether a drug is used or abused is entirely dependent upon context. Casanova (who was a physician) is reputed to have said, "In the hands of the wise, poison is medicine. In the hands of a fool, medicine is poison." Until late in the 19th century, doctors held morphine to be God's gift to medicine. Only as opium began to be used for political purposes (i.e., for social control), did it acquire a pejorative reputation. The first law against this family of drugs forbade the sale of opium to Chinese laborers, who were perceived by the new wave of Irish immigrants to have an unfair advantage in being able to work for less, under harsher conditions, if provided the drug (Szasz, personal communication).
From an evolutionary standpoint, Diamond posits that drug abuse may be unique to humans, and likens it to other animal behavior which courts danger, such as the "stotting" of gazelles (affecting a peculiar lurching gait, as if crippled) in the presence of predators, or the growth of extremely ponderous and awkward plumage in birds of paradise. His theory, attributed to the Israeli ethologist Amotz Zahavi, is that flaunting danger can be attractive to potential mates, as if to say "My genes are so terrific that I can get away with anything!" This suggests an entirely new theory for the psychodynamics of codependents of addicts and alcoholics.
However, the assertion that danger or risk-taking is a driving force in motivating drug use overlooks history. The idea that drugs are physically dangerous is only a very recent innovation, after perhaps thousands of years of drug use by many cultures.
1. Diamond J. The Third Chimpanzee. New York: Harper Collins; 1992.
2. Lifton R. The Nazi Doctors. New York: Basic Books; 1986.
3. Melloy JR. Violent Attachments. Northvale, N.J.: Aronson; 1992.
4. Schore A. Affect Regulation and the Origin of the Self. Hillsdale, N.J.: Erlbaum Assoc.; 1994.
5. Szasz T. Ceremonial Chemistry: The ritual persecution of drugs, addicts and pushers. New York: Doubleday; 1974.