Saturday Features

Sympathy for the user

  • Not all people who experiment with drugs go down its rabbit hole, and not all who go down fail to come out again
- Dr Sikhar B Swar

Aug 25, 2018-

Our minds are structured in such a way that forbidden things hold far greater potential for satisfaction (albeit, perhaps, only psychological), than the things we are meant, and expected, to do. This fascination and desire for what is denied persists but as we grow older, we start choosing things that make sense, things that everybody says makes sense.

Of the many ‘Do-nots’ in our society are drugs. Do not do drugs. No further questions. They are bad for you. How bad? Are they worse than the other addictive substances and tendencies that society deems worthy of being ‘legal’? These questions fall by the wayside before even registering into mass consciousness.

Drugs, by definition, are substances that alter our pattern of activity—of processing thought, stimulations, everything. Some help keep us alive (in the physical sense) whereas, some by chance, create a dangerous vortex that swallows thoughts and lives whole. Thus, we separate what society terms medicine from what it calls drugs. It is the same with addiction. If it’s severe enough to mess up your social and personal life and space, it’s an addiction.

When an adolescent brain sees a skull and crossbones sign, chances are the danger and forbiddance will have them gravitating towards it. A vicious cycle can then result in a roundabout of deviant behaviour, marginalisation by society, neglect, burden, even death.

There has, throughout millennia, persisted a view of ‘drugs’ as inherently bad. That anyone who does drugs is not for society, is morally wrong. We shall call this the moral model. Once you marginalise a person from society for being morally corrupt, you start the process of dehumanising them. The treatment of those times reflected this. Confinement, punishment and even religious indoctrination were commonplace (even the Alcoholics Anonymous with its inflated success rates collected from telephone interviews, started with a dabble into the religious and later, the spiritual.)

This view has now been confined and banished to the island where bad ideas go to complain how unfair society is. We now know that drugs use is not as simple as a good/bad dichotomy. There are numerous variables that are at play, leading to substance abuse and dependence. There are numerous variables that increase one’s chances of addictive behaviour. Not all people who experiment with drugs go down its rabbit hole, and not all who go down fail to come out again. This approach to substance abuse and addiction has led to what is now the medical model. This model believes in finding out the root causes and psychopathology behind the behaviour. These could be as wide ranging as a South American shaman drinking ayahuasca to connect to mother earth and sadhus smoking ganja for a multitude of reasons to a college kid trying ‘brown sugar’ due to some misguided idea of ‘being cool’ and a professional adding a shot of vodka in their morning coffee before driving to work because he’s a bit uptight about the day’s presentation. There will always be reasons. We as psychiatrists and addiction specialists must find those reasons. In the best cases, we help find solutions and in the worst, help them live with it.

There have been and will always be drugs. It is society that has to coexist. Whether we do this by understanding addictive human behaviour and how drugs work, or by criminalising drug-related behaviour and legally or forcefully locking up people depends on us. Unfortunately, due to factors like lack of knowledge, confusion due to conflicting messages from various sources and the patient not having a say leads to many people still strongly believing this primitive idea that bad intentions and weak morals lead to drug use.

Experimentation is how human beings learn. We do things and stick with things that work. Not all people who do any particular drug become addicted to it. In fact, only 15 percent who drink alcohol will develop abuse or addiction problems. These studies have also been replicated in mice and show huge promise for the isolation of the ‘addiction gene’. There must be individual treatment plans in place for people with uniquely different problems. Experimental use, while being discouraged and managed as it should, must never be equated with the problematic use of substances. Shaming and forcing users to quit hardly seems like a long-term solution.

Prevention, of course, is the primary goal. But, how we go about that is paramount. Removing moral labels would be a good start. Current treatment methods, if they can be called that, are appallingly primitive. They need upgrading on all fronts; psychotherapeutic, pharmacotherapeutic and even the regulation of so-called rehabs. Then, there is maintenance. Unless something positive and fulfilling takes up the space previously occupied by drugs, the person will keep on going back to what they know best. There’s even a code name for people who are admitted to rehabs repeatedly.

I’ll finish with something a patient of mine told me when asked what he had achieved from his four stints at (various) rehabs: “I made a lot of damn good contacts, doc!”

Swar is an addiction psychiatrist and can be reached at He is currently affiliated with Possible Health and Sushma Koirala Memorial Hospital.

Published: 25-08-2018 08:17

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