[acb-hsp] Thinking in Moderation

[peter altschul]

Will We Ever Learn to Think in Moderation?
  Maia Szalavitz February 17, 2013
  The media seems to have three modes of action when it comes to 
psychoactive drugs: intense promotion of advances and benefits; 
general disregard; and full-on panic about negative effects, 
including potential for misuse and addiction.  During both the 
benefits and the risks periods, many myths and misinformation are 
disseminated.  But between these bouts of euphoria and panic, 
there is little coverage at all, especially of addiction.  This 
up/downstoff pattern does a disservice not only to people 
suffering from addiction, but to those with other diseases as 
well.
  Right now, we seem to be moving from a period characterized 
mainly by disinterest into one of attention and fear.  Though 
we've never returned to the peak freak-out of the late '80's and 
early '90's-in 1989, a Gallup poll found that Americans viewed 
drugs as the number one problem threatening the nation, eclipsing 
even the economy during a recession-we have seen brief but 
blinding spotlights on Oxycontin, methamphetamine and now 
prescription drugs more generally.
  A recent front-page New York Times story on Adderall addiction 
is suggestive of the new turn.  After years of focusing on these 
drugs primarily to ask whether they enhance cognition, or allow 
people to cheat in school by faking ADHD, the article puts them 
front and center; it tells story of a college student who faked 
the disorder and the physicians who enabled him to continue 
getting the drug, despite desperate warnings from his parents 
about his addiction.  Over the course of several years, he became 
psychotic and ultimately committed suicide.
  That Adderall, an amphetamine drug, can be addictive and can 
sometimes cause mental illness and suicidality is no surprise.  
If the Times searched its own archives, it would see several 
earlier periods of promotion of speed as a cognitive enhancer and 
study aid, followed by hysteria over psychosis and addictions.  
(Indeed, way back in 1937, the paper of record called it bhigh 
octane brain fuelb.  And anyone old enough to remember the '60's 
probably recalls the admonition "Speed Kills."
  Why can't we recognize that a drug can simultaneously benefit 
some people and harm others? Why do we swing from seeing 
particular drugs as panaceas to viewing them as the devil's own 
poison?
  Part of it stems from bgenerational forgetting-"a 
well-documented condition that prevails when the addicts of one 
era have aged out or died and those who saw the damage done are 
also past their youth.  When America was still in a frenzy that 
the '80's crack epidemic would continue escalating until every 
last youth was a glassy-eyed zombie, the younger siblings of 
crack addicts were already observing the devastations of the drug 
and choosing a different, less demonized highboften marijuana, 
sometimes opioids.  Crack use fell rapidly.
  That was far from the first time that an epidemic had burned 
itself out.  Epidemics are inherently self-limiting because once 
the use of a particular drug is widespread, its dangers become 
obvious to everyone-and because when a culture becomes familiar 
with a drug, it develops ways to minimize harm.  For example, our 
long-term relationship with alcohol has produced bans on drunk 
driving; price, sales, and advertising restrictions; and advice 
on moderation, like alternating alcoholic drinks with water or 
soft drink-not to mention AA.
  Unfortunately, this can also create the impression that panic 
is productive as a way of changing behavior, when it actually 
contains the seeds of the next epidemic.  Since the new 
generation is not using the previous one's "demon drug," it 
thinks its own drug use is not going to become a problem.  
Indeed, the newly popular drug appears to be safe, beneficial, 
fun-at least, that's generally how the media tends to portray 
legal drugs when first on the market.  Of course, during the 
early stages of addiction, it does seem like everything's under 
control.
  And so, the early '70's fears that heroin was the worst drug 
imaginable made cocaine, by comparison, seem benign to those who 
used it in the '80's.  But while the coke generation tended to 
avoid heroin, it had also missed the nation's '60's bout with 
stimulants, which had informed the succeeding heroin-preferring 
group.
  Every 10 years, the nation shifts from a "stimulant" decade to 
a "depressant" one: the speed-loving '60's, the '70's heroin 
wave, the coke-snorting '80's, the Kurt Cobain junky '90's, the 
methamphetamine '00's.
  Although a crude metric, this pattern suggests that every 10 
years, the nation shifts from a stimulant-dominated decade to a 
depressant drug-of-choice one: the speed-loving '60's, the b70's 
heroin wave, the coke-snorting '80's, the Kurt Cobain junky 
'90's, with some prescription opioids on the side.  By the '00's, 
it was on to methamphetamine.
  Because our attention span seems limited to one demon drug at a 
time, we create easy rationalizations for new generations of 
addicts who are not, after all, using the evil substance 
highlighted by the media during their childhood.  We start by 
focusing on the fashionable drug's benefits-an emphasis often 
encouraged by the drug company's marketing-and then turn on it, 
seeing only the risks.  (When first marketed in 1895, heroin was 
advertised by Bayer as less addictive than morphine.) As a 
result, we are unable to break out of these cycles.
  Through all of this, we miss the realities of addiction, which 
depend less on particular drugs than on people's need for relief, 
and the particular relief available when they are young and most 
prone to start using.  Addicts do follow trends, but they also 
find the drugs that most suit them: Use of multiple substances is 
more the rule than the exception.
  In the end, we damage both the addicts, when we are promoting 
the drugs and ignoring the risks, and the people who benefit-ADHD 
patients using stimulants, say, and pain patients using 
opioids-when we focus on the harms.  We continually speak past 
each other: the people who see addiction as the worst fate while 
ignoring the suffering of those who benefit from medications vs.  
those who value the benefits dismissing the risks of addiction.
  None of this is helped, either, by the demonization of 
addiction and addicts.  Panic promotes harsh treatment of drug 
addiction; in fact, it is often sowed and spread by people with a 
political agenda that is implicitly or explicitly racist and 
involves fears of "contamination" of mainstream (read: white) 
America by minorities or "aliens" who use drugs.
  The nation's history of drug criminalization illustrates this 
point: Cocaine was made illegal due to fears related to black men 
using it; opium was banned because of its association with 
Chinese railroad workers; reefer madness was spurred by its 
connection to Mexicans and blacks.  We continue to lock up black 
and brown people for their involvement with drugs, while whites 
are more likely to get "treatment, not punishment."
  Moreover, the vast majority of scare stories also involve the 
spread of the drug into the middle class.  So, for example, in 
the Times piece we get a doctor saying, "Drug addicts don't look 
like they used to," as an explanation for why a nice white 
college kid can successfully lie about ADHD to feed his 
addiction.  Addicts are never "people who look like us."
  If we're ever to break out of these cycles and deal effectively 
with addiction as a health issue, we have to learn to live with 
complexity and contradiction.  The same drug that is a lifesaver 
for me can kill you-and addiction is a perennial problem, not 
just one that surfaces with the popularity of specific drugs.  To 
appropriately treat addiction, we need to recognize the racism 
that has marred our drug policy-and also see that while addiction 
does hit the poor the hardest, the middle class isnbt exactly 
immune.
  It may make a sexier story to pretend that a drug trend is 
unprecedented and to disregard the phases of love and hate we go 
through with psychoactive drugs.  But it does a disservice both 
to those who struggle with addiction and to those who need 
potentially addictive drugs as medical treatment when we focus 
only on risk or only on benefit and ignore the Janus-faced, 
double-edged sword of the substances we love to hate or hate to 
love.