Chapter 4: Why Do People Take Drugs?
Less-easily classified drugs
“Some drugs are less easy to classify. Ecstasy seems to be somewhere between a stimulant and a psychedelic, giving alertness and large amounts of energy but also producing sociability and talkativeness, because it increases serotonin by releasing it and blocking its reuptake. Mephedrone seems to work partly on serotonin as well. Figure 4.4 shows how some of the most common stimulants differ from each other in terms of the neurotransmitters they target, where the higher the peak, the bigger the action of the drug.
Ketamine is another drug that falls between the classes. It is like a depressant as it blocks glutamate, switching off the brain in a similar way that increasing GABA does (Figure 4.5), which accounts for its medicinal usefulness as an anaesthetic. However, subjectively many users liken it to a psychedelic, distorting time and space and presenting them with new perspectives; this is probably how it works when used to treat depression.
Finally, cannabis combines the feelings of relaxation typical of depressants with distortions of perception, openness, talkativeness and great pleasure from eating. It’s not surprising that cannabis has unique effects, because the drug interacts with a specific natural system in the brain, known as the endocannabinoid system. Somewhere in our evolutionary history, cannabis must have been a very important part of the ecosystems that our animal ancestors lived in, since it developed the ability to target one particular element of our brain chemistry so precisely!
We seem to have a particular liking for drugs that combine both sedation and stimulation. Alcohol and cannabis are the most obvious examples, but Figure 4.6 shows some others as well. One of the most popular drugs of the 20th century was Dexamyl (commonly known as Purple Hearts), an early antidepressant which appeared in the 1930s. Purple Hearts contained a combination of amphetamine (to raise mood) and barbiturates (to counteract the side-effects of the amphet- amine). Even more potent were the “speedballs” invented by soldiers in Vietnam, where liquid cocaine and heroin were injected in the same syringe. It was this combination that killed actor River Phoenix in 1993. More recently it’s been the powerful sedative †propofol that has killed media stars such as Michael Jackson, who was using it to overcome extreme insomnia.
Why do people take drugs?
Let’s go back to the opening question: why do people take drugs? Looking at how drugs came to exist, it would be surprising if we didn’t take them. Plants were producing chemicals especially designed to interfere with animals’ brains long before humans existed, and humans have evolved to respond to their effects just as we’ve evolved to digest certain foods. Cultures that haven’t employed the psychoactive powers of plants have been in the minority, and have used other methods to alter their states of consciousness. From this point of view, taking drugs is entirely natural; as Mike Jay puts it in his book †High Society, “we were taking drugs long before we werehuman”.
We use drugs for two main reasons: to experience pleasure, and to relieve suffering. These could crudely be referred to as “recreational” and “medicinal” drug use, but although the †international treaties of the 1960s created a strict legal division between the two, in reality the line between them is very blurred. The most obvious examples are drugs such as cannabis and LSD which were placed in the most restrictive Schedule 1 (with no recognized medicinal value), so that any use at all is seen as “recreational”, despite the fact that many people with conditions like multiple sclerosis (MS) or cluster headaches are demonstrably reducing their suffering by taking them. This situation with cannabis has now changed; it has been made a medicine in more than 20 countries (including the UK and US), though it is still illegal in most. †Psychedelics, however, despite growing evidence of clinical value are still illegal in almost every country, the only exceptions being some American countries that allow ayahuasca magic mushrooms and peyote.
Other drugs that have recognized but limited medicinal uses, such as heroin for extreme pain, may still be reducing suffering when taken outside of an obviously therapeutic context. For people who have experienced serious trauma (such as soldiers with PTSD) taking a drug like heroin might be the only thing that makes their lives liveable. Alcohol is often used to self-medicate trauma memories.
The use of drugs for pleasure has a number of elements beyond their mechanical effects on our brains. Indeed, we have to be expecting to experience pleasure: most of us would find taking a drug by accident deeply unpleasant, and would think that we had been poisoned or were having a psychotic episode. Actively choosing to take a drug is an essential part of the effect it has, and even animals experience different effects depending on whether or not they’ve chosen to consume it. †Rats that are passively given cocaine injections will become physically dependent on the drug (experiencing withdrawal symp- toms if they stop), but they become much more addicted – in terms of actively seeking out the drug – when they have to push a lever themselves to self-administer it.
Drugs are social, and are usually consumed in groups, where the feelings of disinhibition and talkativeness that many drugs generate help promote social bonding. Using a particular substance, or using it in a particular way, can become a strong marker of identity, and can herald important social changes. †Coca chewing has become more popular in Bolivia since the election of an indigenous president, for example, and †greater gender equality has often been accompanied by increased rates of smoking among women. Refusing to participate in drug-taking can feel very uncomfortable, as teenagers know when they struggle with peer pressure, and as many adults experience if they refuse the offer of an alcoholic drink in the pub.
The use of some drugs, especially psychedelics, can be heavily imbued with meaning. Taking psychoactive substances in religious settings and rituals is called entheogenic drug use, and blurs the line between what is recreational and medicinal. Sometimes these occasions are explicitly for healing purposes, although it may be the shaman who takes the drug rather than the patient (which was how tobacco was used in some traditional Native American ceremonies). In other cases, the drug is used to access secret knowledge or divine experi- ence. It may be only the shaman who consumes the drug, or it may be the entire congregation, as with †the Native American Church’s use of peyote. While entheogenic drug use may have pleasurable moments of euphoria and ecstasy, these experiences are often described as painfully intense, an ordeal to be struggled through rather than an escapist “trip”. This makes them very different from, for example, the use of LSD in a dance club setting, as was recognized in 1996 when the Native American Church was granted special dispensation to use peyote in their services.
Sometimes people get pleasure from taking drugs precisely because it is risky. This is particularly noticeable when prescribed medicines get diverted: †American schoolchildren who take Ritalin illicitly have quite different reactions to those who take it as directed by their doctor. Even though it’s the same formulation of the same drug, taking it at a party with friends with the deliberate intention of having a good time and getting “high” means they do get “high” (even if it’s not all due to the drug!). But taking Ritalin at school in order to be able to work and concentrate, where they don’t want to get “high”, means that they don’t get “high”.
An illicit activity that is illegal in one context might be legal under other circumstances – for example, if your grandmother has a prescription for Valium she can take it legally, but if you take her Valium, then that’s illegal/illicit drug use. In recent years, a new trend has emerged among young people in the UK and elsewhere in Europe of deliberately trying to get so intoxicated (usually on alcohol) that they have no memory of getting “wasted” or “ended”. It can be hard to understand why this would be pleasurable, but it probably relates to the social kudos of the things people feel permitted to do while extremely disinhibited.
The use of alcohol in western society today illustrates how difficult it can be to separate the use of drugs to relieve suffering from their use for pleasure. At the most extreme end, people with low levels of GABA receptors who live in a chronic state of anxiety may feel “normal” only when they drink. While it’s certainly not the ideal medication, their drinking isn’t primarily motivated by pleasure. At the less severe end of the scale, there are millions of people in the world who find it very difficult to wind down after work without alcohol – a sort of mild self-medication against the stress of their working lives. Of course, this often takes place in the pub or bar, and chatting to friends and relaxing is pleasurable as well as medicinal. The drug, combined with the sociable context of the bar, makes people feel both “better” and “good”, and if this is where most of their social life takes place, not going to the bar in order to cut down on their alcohol intake will make them feel miserable and isolated.
Finally, a minority of users take drugs because they are addicted, which we’ll explore in greater detail in chapter 9. Addiction blurs the line between pain and pleasure. It is quite common for someone to start taking a drug for the enjoyable effects, but once they’re addicted it becomes the only thing that can relieve the intense cravings and unpleasant physical symptoms of withdrawal.”