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Will We Ever Learn to Think in Moderation?

The media is all black or all white about brain drugs like Oxy and Adderall.
 
 
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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/down/off 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 ‘80s and early ‘90s—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 “high octane brain fuel”). And anyone old enough to remember the ‘60s 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 “generational 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 ‘80s 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 high—often 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 ‘70s fears that heroin was the worst drug imaginable made cocaine, by comparison, seem benign to those who used it in the ‘80s. But while the coke generation tended to avoid heroin, it had also missed the nation’s ‘60s 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 ‘60s, the ‘70s heroin wave, the coke-snorting ‘80s, the Kurt Cobain junky ‘90s, the methamphetamine ‘00s.

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 ‘60s, the ‘70s heroin wave, the coke-snorting ‘80s, the Kurt Cobain junky ‘90s, with some prescription opioids on the side. By the ‘00s, 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 isn’t 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.

Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She blogs for Healthland.com, and has contributed to Time, The New York Times, Scientific American Mind, The Washington Post and many other publications. She has also published three books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). Her last column for Substance.com was about recovery high schools for teens with drug and alcohol problems.

 
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