Thoughts on Substance Abuse

The more I delve into substance abuse, the more my perceptions have evolved.  A few years ago, Lay’s Potato Chips threw down the gauntlet in a new advertising campaign, “Bet you can’t eat just one!”  I used to think that people happened, or were perhaps dared, to try some substance and were captured by the wonderful feelings that resulted.

Reading Diamond’s 2010 article in Psychology Today, “Avoidance, Sobriety, and Reality: The Psychology of Addiction,” provides a different picture.  Many addicts are seeking some means to avoid reality.  The antidote to addiction, Diamond claims, is “learning to tolerate reality.”  He argues that people don’t happen to encounter psychological escape; they actively seek it.

What aren’t people better at tolerating reality?  One possibility is that reality is miserable.  Poverty, hunger, violence and especially hopelessness may explain while people in such circumstances commit meager resources to alcohol and drugs.  They need and want a brief respite from the onerous tasks of getting through the next day, never mind next week.

What about people whose lives are not miserable?  The driving force may then be stress.  Pressures to succeed are rampant across all sectors of our economy – schools, colleges, sales, insurance, real estate, and Wall Street.  The pressures include needs for more of everything and bonus checks that can afford everything.

Then there is the mind numbing day-to-day activities of putting up with compliance cultures laced with administrative incompetence.  We serve numerous incompatible IT systems for budgets, payrolls, travel and, if clinicians, patient records.  We create written justifications for everything.  Most submittals are rejected.  We try again on Monday after a weekend of escape, lost in sports, alcohol or worse.

Of course, the latest trend is denial of reality rather than escape.  Houston’s fifty inches of rain from Harvey was just a random event, not to mention Irma, Jose, and Maria.  The rampant opioid abuse epidemic is just another random occurrence.  There are no causes, nothing we could try to ameliorate.  Yet, perhaps as the number of people who try to escape reality steadily increases, we will see it an indicator of our collective needs to change reality.

But, this is only half the story.  Escaping reality may motivate experimenting.  At some point, however, biology, namely, the brain takes over.  A recent piece in the National Geographic on “The Addicted Brain” makes it clear that the brain supplants the individual’s volition and demands continued exposure to the substance in question.  In other words, people are not consciously choosing to stay addicted.  Their brains are demanding it.

So the full picture is that motivations to escape reality may result in humans experimenting with substances.  Use of these substances result in changes of these humans’ brains that leads them to be unable to control the needs for further exposure to the substances.  The result is often that reality for these humans gets much worse.  Conditions spiral out of control and we hear about it from friends or read about it in the paper.

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