Since ancient times substances have been used to affect the mood. People have been making use of alcoholic drinks and plants containing ‘hallucinogenic’ substances to make life seem more agreeable, these positive effects sufficing as motivation for their use. It is largely unclear, however, why some people choose a method which inevitably endangers their health.

It is not only ‘hallucinogenic’ substances on which people can become dependent. Nowadays people who expend a vast amount of time and energy working, are sometimes referred to as ‘workaholics’, because just as with an addiction, these people can experience withdrawal symptoms when they stop working. Although a number of stimulants are known to be harmful to the health, the compulsive use of them is by no means always seen as an addiction. Smoking, for example, is a generally accepted phenomenon, and in some circles it is regarded as childish not to drink. Yet everyone knows the dangers of both smoking and drinking.

It is therefore striking how little governments do to restrict the use of alcohol and tobacco. The economic importance of these stimulants is, of course, very great.

Habit and dependence

Man uses tools to manipulate his external environment and drugs to change his internal environment. Most drugs are used primarily for their physical ef-fects, but the mind and body are so closely connected that few drugs are entirely free of psychological effects. Antihistamines, for example, are used to control physical symptoms such as the streaming nose and eyes of hay fever, but they also make the user drowsy. Corticosteroid drugs, which mimic the action of natural steroid hormones, reduce inflammation, but they can cause euphoria and even disorders of thought and perception in people who are susceptible. Thus, many people experience mental effects from drugs even when these are not intended. The real difficulties arise when drugs are taken deliberately to influence the mind. There are large groups of drugs that are used by psychiatrists to treat mental illness and these are the ‘mindaltering’ drugs which are not subject to abuse. The major and minor tranquillisers and most of today’s antidepressants are examples. The fact that these drugs are not abused, although they effectively do the job they are prescribed for, is partly because many have a slow, cumulative effect over several weeks, and thus do not have the attraction of provoking immediate euphoria, and partly because they sedate or stimulate the brain without causing any feelings of pleasure. The drugs thath cause real problems are those which quickly produce euphoria and intoxication. Many, such as the opiates, have a medical use – or did until their potential for addiction was realized. Others, such as the hallucinogens, which include cannabis and LSD (lysergic acid diethylamide), have no ben-eficial effect currently recognized by orthodox medicine.

Many of these substances are thought of as being addictive. That is, some of the people who use them regularly will eventually experience a compulsion to carry on taking the drug. Addiction is, however, a complicated process. It requires a drug with certain effects on the brain, plus a particular kind of person who uses it, plus a special set of social circumstances to cause addiction.

The importance of this interaction was not always realized. It was thought, for example, that anyone who injected heroin more than a few times would inevitable become an addict. This conclusion was based to a large extent on the fact that heroin users who came to the attention of the authorities were, by definition, people whose drug use had led to prob-lems. There are probably many more people who have used heroin and later given it up without serious difficulty than those who have become addicted to the drug. However it is difficult to predict who these people will be. Trying heroin or any other addictive drug therefore remains very dangerous and potentially lethal. Even if the risk of addiction is not as great as was once thought, its consequences may be so destructive that it is best to run no risk at all. Heroin is an extreme example of drug use. At the other end of the spectrum, almost everyone uses some form of mild stimulant, usually the caffeine in coffee, tea and cola drinks. (Strong tea contains almost as much caffeine as coffee.) Caffeine is also found in small quantities in cocoa and chocolate. It is so common a feature of our daily life that it is hardly recog-nized in western societies as a drug. Nevertheless, anyone drinking more than five cups of coffee per day (depending on its strength) many become mildly addicted to it.

Many people drink alcohol – socially, in small quanti-ties, or in larger amounts, because it is a powerful sedative drug. Many people smoke, thus experiencing the slight sedative or stimulant effects of nicotine (the precise effect depending on the dose of the drug that is absorbed). Smoking causes the most widespread health problems of any of the selfadministered drugs, although, ironically, the damage to our bodies comes more from the cancer-producing tars in smoke, and the poisonous gases produced by burning tobacco, than from the drug, nicotine, itself. Smoking provides an interesting example of the way in which social attitudes influence the pattern of drug use among a populace. Before World War II it was unusual for women to smoke, and women who did smoke were regarded as improper. Since then, the increasing adoption by women of roles in society previously filled by men has coincided with an in-crease in the number of women who have taken up smoking, until there are now as many women smokers as men. So instead of there being a difference be-tween the sexes in terms of who smokes, there is now (according to at least one study) a difference between social classes, with the more educated and affluent professional people less likely to smoke than those on a lower social scale. •

Marcel V.L.G.E. Proust (1871-1922) observed that the strength of a human habit increases in proportion to its absurdity. Seeing the way some people smoke, overeat and drink themselves to death, you might be tempted to agree. Many kinds of behaviour seem to have no real value. They do not contribute to our nutritional needs; they do not aid reproduction of the species; and they play no identifiable part in religious or social ritual.

Explaining the prevalence of non-medical drug use is a challenge to psychology and medicine. Two powerful forces seem to be involved. The first is a search for variety, which is a very human trait. We seek variety in our mental state just as we seek it in our physical surroundings. Even if conditions are already good, we crave change. Searching for something better, we risk finding something worse. The second reason is a need to escape; sometimes from conditions which are so unpleasant that they are almost intolerable, at other times simply from the limitations of being human.

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