“The ubiquity of drug use is so striking that it must represent a basic human appetite”

Andrew Weil, The Natural Mind: A New Way of Looking at Drugs and Higher Consciousness

From cough syrup to cocaine and coffee to oxycontin, drug use pervades America. Some drugs, like the caffeine in that morning cup-o-joe, are welcomed into our daily lives to the point that we stop considering them drugs. My coffee at 8 am is just part of my morning routine. A glass of wine at a nice dinner accents the food and the mood of the evening. Other substances can alter someone’s life forever, whether that saves them from cancer or causes death from an overdose.

So what drives people to take drugs, particularly those that stand to ruin our lives?

Andrew Weil suggested in his 1972 publication that drug use is symbolic of a basic human appetite, but an appetite for what? “People take drugs because they work,” he writes. Yet the questions remain: what are we trying to accomplish; is it worth the risk?

It strikes me that the common theme surrounding the choice to take drugs revolves around the desire for change. Drugs can give us a boost in energy. They can relax us. Drugs can alter the way we perceive the world, creating feelings of transcendence. They can heal illness or pain. Drugs can give life. And they can take it away.

The justification for taking a drug is a personal one. Normative decision theory in philosophy argues that we make rational choices  when we consider the value we place on possible outcomes and base our choice on the likelihood of the outcome we most desire (generally thought to be the outcome with the most benefit or least harm). It is important to recognize that these choices are influenced by the way a person rationalizes, what a person values, and the knowledge or experience they have surrounding the drug. These are certainly not the only factors that shape how or why someone justifies using a drug. At the point an individual willingly takes a drug, they have decided that the experience of taking the drug has value that outweighs the known risks of taking the drug.

In Electric Kool Aid Acid Test, Tom Wolfe told about the high value that users of LSD and similar hallucinogens placed on transcendence. As Dr. Goff presented to our class, LSD has a relatively low toxicity; the risks of death are more closely linked to making egregiously bad decisions while tripping on acid rather than poisoning the body with the drug. For those seeking an experience beyond mundane life like Ken Kesey and the Merry Pranksters, taking LSD was a low risk with high benefits. Even when factoring in risks external to the drug itself, ie: legal punitive consequences, Kesey and crew could afford to challenge the system.

Other people take drugs within a social context. For Jim Carroll, author of The Basketball Diaries, his friend’s drug use moved him to experiment first with marijuana and later heroin.

“Funny, I can remember what vows I’d made never to touch any of that shit when I was five or six. Now with all my friends doing it, all kinds of vows drop out from under me every day. That day, I went down to the cellar of Tony’s building, all sorts of characters were in this storage room “shooting gallery,” cooking up and getting off…as simple as a walk to that cellar, I lost my virgin veins.”

-Jim Carroll, The Basketball Diaries

At the end of the novel, he recounts the struggles with himself and the drug that impacted his life.  In later years wrote a song dedicated to all the people he knew who died from drug use, aptly titled, People Who Died.

“To tell the truth, my withdrawal only lasted one more day before I shot up a bag of smokin’ stuff…Now I’m back as good or as bad as ever, hustling around…I’m back to the old knife and gun holding scene too. I don’t dig that shit really but I’m so disgusted with hustling queers that it’s my only way out now.”

-Jim Carroll, The Basketball Diaries

Carroll’s description alludes to the inner turmoil caused by the allure of the drug. Addiction has a way of skewing what we value in the world. For Carroll, the fix was more valuable than the risks or negative feelings of the hustling that he did to get the fix.

Other drugs, like prescription opioids or cancer treatments save lives and are celebrated for the benefit they bring. When deciding to take prescription pills, the rationalization still involves a cost-benefit analysis, yet it seems that the average American understands far less about the possible costs of some prescriptions, particularly when death from overdose of prescription opioids surpassed those caused by illicit drugs in 2010.

For documentary filmmaker Chris Bell, the primary fault falls on “Big Pharma” companies for failing to inform, or worse intentionally mislead, both doctors and patients regarding the side effects of new prescriptions. Jeffrey Fleishman with The Los Angeles Times describes Bell’s documentary, Prescription Thugs as “…a man’s dark venture into an epidemic that highlights the nation’s low tolerance for pain, a powerful drug lobby, lax government oversight and an American culture that craves quick fixes and escapism” (LA Times). While we are used to seeing warning labels flash across the TV screen when a “revolutionary new drug” is on the scene, Bell questions how well informed doctors, and therefore patients, actually are about the risks of some prescriptions. His target is specifically opioids, told through a lens of professional wrestlers and upper middle class housewives who pop pills on a daily basis, battling addiction. In the case of Bell’s brother, his addiction led to death.  Bell’s proposal is to encourage a more informed society with less emphasis on popping pills and assuming any prescription comes without risks because it is from a medical professional. 

How did we get to a pill-centric, prescription happy culture?

David Herzberg’s Happy Pills in America traces the extreme commercialization of pharmaceutical drugs and shows how drugs like Miltown and Prozac were used as tools to achieve the ends of various groups-be it doctors, politicians, or advertisers, to name a few. For Herzberg, the mid 1900’s marked a significant shift in prescription medication culture. Companies began directly advertising drugs to consumers, selling anxiety as the problem and happy-pills as the fix. That is not to say conditions such as depression or anxiety are the product of media campaigns, but there is concern about the extent to which we ought to swallow a pill as a quick fix.

“Medical authorities and drug advertisers circulated particular stories about what [anxiety and other emotional struggles] meant, but they did not invent the real and often painful experience that prompted people to pay attention to those stories”

-David Herzberg, Happy Pills in America

The question really becomes to what extent should we prescribe pharmaceuticals.  Mental illnesses such as anxiety and depression are more than a narrative to sell more prescriptions; they are very real conditions that impact many lives. While prescriptions are not the only way to alleviate suffering from anxiety and depression, they remain a viable option for many.  Also, consider cases where it is clear that a child with extreme ADHD or a cancer patient suffering from chronic pain benefits from a prescription. As someone who has watched several family members fight cancer, I can only begin to understand the benefit that some of these prescriptions can have to dramatically improve a person’s quality of life.

Yet, the CDC is now warning that we are over-prescribing young children. College students are taking Adderall to get a leg up in the competitive world of career focused college education, or stressing about the ‘unfair advantage that students on adderall have to succeed in school. Perhaps we are chasing an unattainable perfect life. Perhaps our hedonistic and capitalist driven culture over-emphasizes the need to succeed, buy, and be happy. What if we are missing the point of struggling through tough times in life? Should we learn to toughen up and just deal with life a little more? How do we find the balance between crippling cases of depression versus a few down days?