Substances

How to talk about drugs and alcohol, what is addiction,  how do drugs work, why do some people get addicted and others don’t, am I an addict? 

There’s always been something really goofy about the way we were taught to think of drugs.  You know, the after-school specials, the Just-Say-No campaigns, our parents, which inevitably becomes us to our own kids.   There’s always been something missing in all the talk.  Yeah, the risks are real.  But we could see that.  And any one of us could point to some valedictorian type who got into Harvard while smoking a lot of reefer.

What’s missing is that the version culture always talks about is outside-in.  It never talks about inside-out.

Outside-in, to be clear, is when you start drinking coffee because you’re in Italy for the Summer.  It’s Italy, the coffee tastes amazing because they keep the blend less bitter.  Cappuccinos like you have never known!  8 weeks later, after the flight home, you feel like you have a cold, but it’s more of a headache.  You’re not sick, it’s the sudden absence of caffeine.  You don’t want to work for coffee, so you push through and it passes.  That was withdrawal.  That was outside-in: a psychoactive chemical from the outside went into your body, changed the neurological locks, and your body went into distress when the supply stopped.

Look, if coffee is your only vice, have at it.  I, personally, don’t want to be chained to anything, but coffee is not a big deal.  Yeah, if your adrenal glands are compromised, well, then maybe, blah, blah, blah….  Look, nobody lost their kids, their career, because of Starbucks.  But that process of the locks changing is exactly the same with Caffeine as it is with Nicotine, Heroine, Xanax, or Crystal Meth.  Something comes from the outside and changes the balance.  It’s only a question of scale.

That’s the standard way substances are talked about.  It is not incorrect, but it’s only half of it.  On its own, outside-in is inadequate, it’s incomplete.

I presume, we all agree there are people who are alcoholics, as an example.  We might disagree about who, but we’ll agree alcoholism is a thing.  And yet, we also agree that the consumption of whisky doesn’t turn every person into an alcoholic.  It follows, then, that we agree that Alcohol, as one substance among many, has different effects and impacts across different individuals.  People have differing reactions to the same substance.  Some like it, but it never becomes much of a big deal, some dislike it, some get mired in it and it becomes a problem.           

The way culture talks about drugs is as if the interaction between a substance and different individuals is always the same.  That’s what was funky about the way we were taught about drugs: as if, because that person over there is a mess because of drugs, then all people who take drugs will end up a mess.  We knew this was false when we were 15.  But the inverse also applies: just because something is fine for one person, doesn’t mean it’s going to work the same way for everyone else.

The inside-out way of looking at it is that who we are, our genetics and our experiences, determines how we experience any substance.  Think of your family tree, if you know it.  How many of the past 2 or 3 generations had drinking problems, anything that sounded like Bipolar, anything that might have been Schizophrenia, Depression, or Anxiety?  None of that necessarily determines who you are, but suggests things to watch for that may complicate the effects of substances.

The next bit is to realize that substance-use problems always make sense.  People aren’t crazy.  We use because it allows us to feel ways we don’t know how to feel otherwise, and stop feeling ways we don’t know how else to stop.  Even when using causes more problems than it solves, for a moment, it takes the problems away.  There’s always some combination of grief, loss, physical pain, existential pain, or trauma that makes the substances make sense beneath the surface facts of what’s being used.  This is our inside manifesting on the outside in the form of our compulsions towards substances: inside-out.

So, then it’s putting both sides of the coin back together:  There are substances out there that are sticky.  They can alter your neurology so that you’ll only feel better if you start taking them again or if you slog through the withdrawal.  Some only take a few days to recover from.  Most take much longer.  Watch out for things that are habit forming.  That’s outside-in.  Then, inside-out, we’ve got to take a long hard look in the mirror to figure out who we each are.  It’s not a 1 minute process because neurological growth and then decline spans a lifetime.  Do we know how to get our emotional needs met through our relationships with people, or do we get our emotional needs met through substances or processes that people are only the excuse for?