We use drugs for two main reasons: to experience pleasure, and to relieve suffering
Drugs are the product of a complex evolutionary game. As fungi and plants evolved, some developed chemicals in their leaves or seeds that deterred the insects and other animals that fed on them, helping the plants to survive and reproduce. These chemicals mimicked the natural substances in insects’ brains which told them how to behave, confusing the insects, or overloading their nervous systems and poisoning them.
Insects and the larger animals that followed them evolved in turn, adapting to these changes and sometimes developing a liking for the plant chemicals. Many animals in the wild seek out drugs: goats eat coffee beans, and pigs and elephants gorge on the alcohol in rotting fruit. In laboratory settings, small mammals such as mice and rats have remarkably similar reactions to humans, and become addicted to the same sort of drugs as we do. Most of the drugs we use today are either made directly from plants, or are synthetic derivatives of these plant chemicals.[…]
Chemicals in the human brain
The chemicals that send messages between nerve cells (neurons) in our brains are called neurotransmitters; they respond to our environment and tell us how to behave. When we’re hungry our bodies tell us to eat, and when we’re full our bodies tell us to stop, just as when we’re safe we need to be able to relax, and when we’re in danger we need to be alert.
A neuron releases neurotransmitters into the synapse (gap) between it and a neighbouring neuron. The neurotransmitters move across the gap to the other neuron, where they activate receptors specifically designed to recognize the particular chemical, and so create feelings – for example, of hunger or fear. These neurotransmitters are then reabsorbed at reuptakesites when the signal isn’t needed anymore – for example, when a predator has gone.
To illustrate how these chemicals work, let’s meet Ben, a cleanliving man who doesn’t like to take any drugs at all – not even coffee. As he wakes up and gets out of bed, glutamate is released, kick-starting his body’s transition into being awake. He drives into work, getting stuck in traffic; it’s really important he’s on time today, and his brain is flooded with noradrenaline as he becomes angry and stressed at the thought of being late. When he gets to work, it turns out his boss is also late, so Ben isn’t in trouble after all, and a rise in serotonin levels makes him feel better. As lunchtime approaches, there’s a dip in his cholecystokinin which makes him feel hungry, so he goes to the canteen and his cholecystokinin level rises again as he eats.
After lunch Ben gives an important presentation, which his boss is really pleased with, and his being congratulated causes the release of the reward chemicals endorphins and dopamine. On the way home he has an argument on the phone with his wife, and his serotonin drops making him feel miserable, but after going for a run his endorphin levels go up and he feels a lot happier. While making dinner to apologize, he cuts his finger and endocannabinoids and endorphins help numb the pain. As night falls, adenosine builds up in the brain, glutamate levels fall, and GABA levels rise, making Ben feel tired and ready for sleep.”
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 were human”.
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 livable. 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 symptoms 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 experience. 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.
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