Drug Abuse Is Not Really About Drugs, It Is About The People Who Use Drugs So Let's Look More Closely at Their Motivation

by: David Bearman, M.D.

? Introduction

Until we have policies that address motive for substance use and abuse, we will keep spinning our wheels in our efforts to make a real impact on addressing substance abuse, prevention, early intervention and treatment. If we continue our heavy reliance on a criminal justice approach, we meet Einstein's definition of insanity. He is alleged to have said “if you keep doing the same thing over and over and expect a different outcome that is insanity.” 

Reliance on the same criminal justice approach has existed at least since 1873 when the city of San Francisco outlawed smoking opium (but not liquid opium, such as that used in popular patent medicine like Lydia Pinkham Vegetable Compound for “the treatment of women's unmentionable ills”). Liquid opium accounted for 75% of imported opium used in the U.S. at that time. 

Since this first drug prohibition it's been all downhill, what with the Harrison Narcotics Tax Act (1914), the Volsted Act (1918), the Anti-Heroin Act of 1924, the Marijuana Tax Act (1937) and the Controlled Substances Act of 1970. One has to assume that these efforts were well-intentioned but there is no question that they were and remain a costly and disappointing failure. This approach has done little to address motivation and has left the landscape littered with destroyed lives and families; a disproportionate number of them being people of color.

? Motivation

Let's look at some of the motivations that drive people to use drugs:

(1) Using drugs as a time out ritual, a step back from the harsh realities of life. The number of bars and restaurants attests to the importance of that time out from the stress of reality.

(2) Substances can be a social lubricant. They may assist people in communicating with each other by breaking down our defense mechanisms. We often use these defense mechanisms to prevent revealing what is really bothering us. 

When we want to share some of our inner most thoughts or something important that's bothering us, some people have found that it may be easier with a drug/commonly alcohol. Almost all social events include tea, coffee, and/or alcohol. 

(3) Substances can be used to celebrate and/or mark a joyous event, such as a marriage, an anniversary, the birth of a child.

(4) Substances have been used since before the written word to gain spiritual insight and emotional comfort, and/or to feel at one with the universe.

(5) We have a long history of using drugs as a tool for introspection and self-reflection.

Most of us can relate to the above motives, even if they may not apply to us. While one may disagree with the choice or amount of drugs used for the above purposes, these motives may be related to occasional over use but rarely do they lead to a pattern of drug use that dominates a person's life. While one might argue that some or all of these areas can be dealt with without psychoactive substances, there can be no argument that many people find psychoactive substances helpful in having a good quality of life, just as for others these substances can have an adverse effect on their lives. We need to take a closer look at these dynamics fueling substance abuse. Here are some of the more common reasons.

Motives possibly related to abuse

So what about those whose use of mind altering drugs leads to or coincides with a deterioration of their quality of life, where drug abuse can set them on a path which leads to more destructive reliance on psychoactive drugs. 

1) The first is a genetic predisposition.

According to Dr. Marc Schukit of UC San Diego, a long time expert in studying alcohol abuse, 75% or more of alcohol abusers have a family history of alcohol abuse.

2) Dealing with difficult emotional situations particularly PTSD. 

Clearly PTSD from war, rape, natural disaster and other causes can lead to emotional damage. After a tragic accident or an intolerable traumatic event, many individuals will turn to alcohol, benzodiazepines or other drugs to numb their emotional and physical pain.

3) Wrong headed government policies such as discouraging doctors from adequately treating pain. This can cause pain sufferers to turn to street concoctions which all too often contain deadly Fentanyl. These substances may be purchased on the street to replace the more appropriate prescription opiates hdyrocodone or Oxycodone.

These government policies discouraging adequate pain treatment or a person having inadequate health coverage can lead to self-medication. Many individuals begin using drugs, especially prescription opioids, to help with pain or a chronic physical or mental illness. 

Heroin often replaces prescription opioids when they cannot find a physician who will treat individuals who are struggling with physical pain that may be the result of a chronic injury or disease such as arthritis or a traumatic accident.

4) Suffering from anxiety and stress.

Stress

It is an important cliché that stress is a product of modern times. This stress can be external and can interact with the person's underlying genetics and personal experience of PTSD and/or anxiety or genetic make-up.

PTSD

A common stressor is PTSD. No doubt the most common cause of PTSD is growing up in a dysfunctional family. While politicians and clergy give lip service to family values out of one side of their mouth, out of the other side they may enable dysfunctional family dynamics and/or create an economic environment that cannot financially sustain a family.

Economic Stress

Economic stress is a current driver of the so-called opiate epidemic. We are in a period of dramatic economic change. Jobs for unskilled or semi-skilled workers are disappearing. They may be going to China or Mexico or being replaced by automation. As we see jobs in the auto industry, fishing, lumber, coal, manufacturing and farming decrease, we are seeing the emergence and/or increase of alcohol and opiate abuse in places like Kentucky, West Virginia, Tennessee, Maine, New Hampshire, Ohio and Michigan.

? Conclusion

The most unproductive thing that we can do when addressing substance use and abuse is to focus on the drugs while ignoring the individual and their motivation for substance abuse. Until we invest not only words but action and funding into education, and parenting. Early identification of at-risk youth, intervention with an effective array of programs to help generate self-esteem, problem solving skills, and coping skills, and improving job prospects and finances for everyone, not just the upper middle class and the 1%, we will continue to have an unacceptable level of substance abuse. 

We must improve the economic environment so parents are better able to focus on the family. We must increase parenting education and parenting skills training. Until we take these steps we will have a difficult time in slowing the growth of substance abuse. This is no easy task as it means that we need a paradigm change that puts people and families above maintaining the status quo. We need to make change in our institutionalized bureaucracies that are frozen in the past and continue to fall back on approaches that have been demonstrated as failed for well over a century. We need more funding for parenting and less for prohibition.