Tuesday, October 22, 2013

Toward a Recreational Pharmacology Industry: Understanding The "Fourth" Drive

Some wise fool said once that life is all sensation. Seeing that we are humans with the capability to consciously alter our experiences and in turn our life, it would be natural or inevitable for us to develop ways of altering, optimizing, or enhancing our sensations. Not surprisingly, much of human behavior aside from basic survival (which most people in this society don’t worry about) deals with this endeavor. Some may see it as reducing boredom or making a moment more interesting. Unfortunately, with the numerous ways of altering our sensations/perceptions, some happen to be against the law; these are the illegal drugs, for which all nations around the world (in some form) are waging a war on their own populations. These wars a fought in the vein of stopping a perceived threat to humanity as a whole: drug abuse. I’d like to show how this kind of reasoning, making drugs illegal because of the possibility of abuse, would be like making sex illegal because of the possibility of disease, or food illegal because of diabetes/obesity; it is impractical and immoral in a society based on individual civil liberties. Moreover, I’d like to show how in a drug tolerant society, a recreational pharmacological industry could be established and integrated into the economic system as a whole, ultimately benefiting society by allowing for the research of these substances for their most effective uses.  

The phenomenon of recreational drug use, more specifically defined as non-prescription psychoactive usage. 

Although both humans and animals have used mood/mind altering substances (Siegal, 2005) there are laws forbidding people to ingest certain compounds, not because of health effects (Nutt, 2012), but because of a combination of xenophobia and ignorance (Block, 2013). Even though most people have used or use drugs- whether it be through caffeine, nicotine, alcohol, prescription medications, or lifestyle supplements- most see a clear distinction between drugs and their own culturally sanctioned substances. This distinction is cultural and has no basis in chemistry or health (Nutt,2012).

Despite the war on drugs, drug use is expected to rise (Travis, 2012) 25% by 2050. Currently more people- this includes people over 50 (Levine, 2013) - in the US are partaking in illegal drug use than ever before (Mann 2011). In short, the war on drugs is failing in its aim to perturb people from using illegal substances. There seems to be no stopping the demand for illegal drugs. Criminal legislation, propaganda, and alternatives to drug use have not dampened the drive to seek and use substances. What is it that causes people to seek and use mind/mood altering substances?    

In order to better ask what the behavioral etiology of non-prescription drug use, we need to understand exactly what a psychoactive substance is and what makes it different from some other substance or phenomenon that can alter mood or consciousness. According to most dictionaries, a psychoactive drug is a substance which is taken into the body and influences metabolism through crossing the blood-brain barrier and directly altering neurotransmitters. In essence, psychoactive drugs are exogenous neurotransmitters because of their high affinity and similarity to receptors in the synapse.

Moving on, there are two major psychological theories which attempt to explain why people use and seek mood/mind altering drugs or substances; they can be broken into two basic groups: Learning theories and inadequate personality theories. The former (McAuliffe,1975; Bejerot, 1980) deals with the idea of positive and negative reinforcement. So for example, someone seeking a drug does so to either feel euphoria (positive reinforcement) or to combat withdrawal symptoms once addicted (negative reinforcement). The problem with this explanation is that it fails to account for why people who have never felt the drug's effects seek it, or why some who use fall into either habituation, occasional use, addiction, or abstinence; the theory also fails to explain the use of non-physically addictive drugs like psychedelics or cocaine. Therefore the learning theory is insufficient as an explanation for why people seek and use non-prescribed psychoactive drugs.

The latter group of theories account for non-prescription psychoactive usage with a defected, inadequate, and/or pathological personality. That is, this kind of drug use is done by someone as a defense mechanism against their own feelings of inferiority (Ausubel, 1980; Wurmser, 1980). Traits such as low self-esteem are seen as primary motivators for people ingesting psychoactive substances. Although recent research (Goode, 2002) has shown that low self-esteem is not a good indicator of drug use as people with high self-esteem use as well. Nonetheless, other inadequate personality theories postulate the trait of conventionality-unconventionality (Jessor&Jessor,1980)  as a surefire way to separate and explain the behaviors of psychoactive drug users. This idea, that conventional people do not seek or use psychoactive drugs that not prescribed to them, will be addressed in more detail later.  

Interestingly, a newer personality theory for this kind of drug use claims that people who are more prone to take risks are more apt to use. This theory is quite different from others as it puts people on a spectrum rather in discrete categories of user/non-user. Rather, the spectrum says that most people fall in between taking many risks and avoiding them altogether. Those who fall on the more extreme side of the scale are more likely to abuse drugs, those in the middle are likely to experiment and cease use eventually, and those on the mild side of the scale don't take any non-prescribed psychoactive drugs at all. The problem with this theory is that it still classifies this kind of drug use as deviant to natural behavior. Yet some researchers (Sunstein, 2003) have shown that people who take risks and who are unconventional contribute greatly to the wealth and progress of culture. Knowing this, could these kinds of drug using behaviors be a part of normal curiosity and development instead of being solely pathological?

These theories being thirty or more years old have been challenged by threads of inquiry/investigation in the fields of public health policy, psychopharmacology, and neuropsychopharmacology. First and oldest is the public health policy of Harm Reduction. It represents a third approach (Marlott, 1996) to drug use and abuse- the other two beings the moral/criminal and disease models of non-prescription psychoactive use. Its basic aim is to treat this kind of drug use as any other kind of high-risk behavior (sky-diving, driving, bungee jumping, etc) and develop strategies and methods which reduce the harm associated with it. Harm reduction offers pragmatic and compassionate ways of dealing with the problems of drug abuse The major assumption of this health policy is that people will always be drawn to and use these kinds of substances, no matter what society has to say about the matter. The implication here is that drug use is a natural behavior that must not be made deviant. It aims to normalize (Crofts, 2012) what has been demonized by society and culture.

Second, the US psychiatrist and psychopharmacologist Ronald K. Siegal published the 2nd edition of his book on the culmination of his research into human and animal non-prescription psychoactive usage. The title gives a clear picture of the conclusion of his life's work: "Intoxication: The Universal Drive for Mind-Altering Substances". The main thesis of the book is that the kind of drug use discussed here represent a "fourth drive" after the drives to acquire food, shelter, and sex. In other words, over twenty years research lead him to believe that people seek these kinds of substances not because of any deficit, but because it's a part of their natural biological drive to do so. He cites examples from animal and human studies to show how this drive is at the heart of behavior, not at the periphery. Radical in its presentation, but sound in its methodology, this book gives us a clear picture as to why the so-called drug epidemic is so pervasive: It's our natural inclination to seek these substances!

Third, the psychopharmacologist Carl Hart has written a book entitled "High Price". The books serve as part auto-biography part scientific work. Using personal examples and scientific studies as foundations for his claim that the stereotype of the drug user as violent, irrational, and non-functional is fictional. He points out how most people who use non-prescribed psychoactive drugs are working competent adults who pay their taxes and besides their drug habit, obey the law. The book supports the claim that not only the search for drugs but the use of them can be integrated with ordinary society, because of the fact most drug users behave like average law abiding citizens. He also shows how the racial disparity in drug arrests and that drugs are not to blame for poverty and violence. It's pointed out how politicians use the drug issue as a cover for more legitimate issues which are left untreated. His book helps the average person shake the decades of misinformation about drug users and the effects of drugs, for a more nuanced and evidence-based view.        

Finally, comes the work of David J. Nutt, a British psychiatrist, and neuropsychopharmacologist. Ironically he worked for the UK government as a drug policy advisor before being fired for giving his advice and disagreeing with the then current UK drug policy. The main thrust of his work and his recent 2012 book: "Drugs without the hot air", is that drug harm can be on par with harm in other parts of life. One of his most famous studies (Nutt, 2010) shows a graph of how drugs like Alcohol and Tobacco are more harmful than illegal or restricted drugs like Cannabis, LSD, Ketamine, Amphetamine, and MDMA. Knowing this, it could be speculated that what brings people who are conventional to not seek drugs is not the conventionality itself, but rather an inflated/false conceptions of psychoactive substances and their apparent consequences.

Knowing that non-prescription psychoactive usage may be a consistent aspect of human behavior, what are the implications for our current illegal drug policies? Some have argued for legalization while others fear that such a move would only increase usage and the problems associated with it. The latter group believes either decriminalization or toning down of hard penalties is sufficient. What these two groups fail to consider is how research on these substances will affect the way people use and abuse them. Consider the following scenario.

In much the same way medicinal drugs are carefully researched for their effects and are replaced by newer generations of drugs with more of the target effects and fewer side effects, a recreational or responsible adult use pharmacology industry would do the same. Many of the currently illegal drugs will become more or less obsolete as alternatives with fewer side effects and more desirable effects become available. However, this kind of industry can not emerge overnight. It could only come after a ten year period of mere research and no legal availability for personal use. This time is to work out what are the effects of these substances devoid of political or social biases as to their moral value. During this time personal use will be decriminalized but still illegal. After this period, the substances will be obtainable but not regularly marketed- no ads will appear in any public places (more restricted than erotic material or cigarette advertising). People interested in such substances will, more often than not, come to it by their own volition. Information about their safety and proper usage will be freely available to anyone wishing to partake.

Any of the ill effects such as addiction or careless use can be circumvented by medical and community support programs which will treat these afflictions with compassion and pragmatism (dealing only with the most pressing issues affecting health and well-being- not use in general). This is a much better alternative to our current policy of criminalizing users. The amount of money to treat people in intervention and maintenance style programs is just a tiny fraction of the money needed to incarcerate someone for a year.  Also, addiction rates of drugs show that only a small percentage of people using drugs end up afflicted. This may be due to personality traits of the person rather than the substance itself.

It becomes clear, considering that non-prescription psychoactive use is an expected part of the human experience, that making drugs illegal because some people may abuse them is illogical. Most behaviors have a degree of risk to them- so there is no valid reason to arbitrarily pick out these kinds of substances as illegal. Cars can cause crashes, love can cause insanity (for a while), knives can cut, eating can impact health negatively, and taking psychoactive without a prescription can lead to addiction. There are many cautions, but considering how the war on drugs has affected the world for the worse, a better approach would be to accept these behaviors as a natural part of life and work accordingly to reduce the personal and social suffering of people- not with criminality and harsh legislation, but with knowledge and respect for people’s civil rights regarding their personal decision making.