Friday, March 27, 2015

Why Do People Use Drugs?

by Peter R. Coleman, M.D.
I have been pondering this question for many years. On the surface, it seems kind of obvious - because you feel good when you drink alcohol or take drugs. But this is a little simplistic.

It seems to me that there are three main categories of the reasons why people use addictive drugs, including alcohol:

1.     They produce a euphoria
2.     They relieve emotional distress by changing our moods
3.     They promise some spiritual relief

The first category is the one that I have predominately focused on in the past. It is an effect that all addictive drugs have - namely releasing a surge, or an increase, in Dopamine in the brains reward pathways. Dopamine is the brain molecule that is released when we eat food or have sex. It is a very powerful driver of behavior - just look at how many overweight people there are - and how hard it is for many people to control those impulses. 

All addictive drugs release extra Dopamine and this is one of the big reasons why we like to take them - they produce a euphoria. Addictive drugs release more Dopamine and produce more of a euphoria than our brains were ever meant to get. No wonder we like taking them. No wonder prohibition did not work. Cocaine is probably the most powerful example, but all drugs do it.

The second category is also very important. Addictive drugs are called “mood altering drugs” for a reason - they alter our moods (emotions). We all have emotions and many of the emotions we have are not very pleasant -  fear, anger, sadness, loneliness, boredom. 

Our emotions are not necessarily supposed to be pleasant. They are a form of pain, and pain is meant to be painful because it helps us to stop doing something. Our emotions should be our best guides for future behavior. They tell us what to avoid so that we can make some different, and hopefully, better choices in the future. But, many times, we want to avoid these negative feelings. We don’t want to feel shy or lonely. We don’t want to feel awkward at a party, so we have a couple of drinks and before you know it we are not feeling so bad. We have enough courage to start up a conversation with a stranger. Drugs are very powerful at altering our mood. The most powerful in this category are the sedative drugs, like Valium, Xanax and alcohol.

The third category is the most interesting, and one that has become more apparent to me lately. We like taking drugs, including alcohol, because they alter our reality. Drugs plunge us into a new world, a kind of magical world where there seems to be endless possibilities. Under the influence of drugs, we can enter "Alice’s Wonderland" and talk with rabbits. Under the influence of pot, music seems better than it actually is, and jokes can seem funnier than they actually are. Under the influence of alcohol, we can believe we are actually very good looking and can dance really well. If we take pain killers, we can believe that we have superhuman energy, physical and emotional pain are lessened, and some of the rules of other mere mortals don’t really apply to us.  But, unfortunately, these perceptions under the influence of mind altering drugs are not quite real. 

At some point, all of us have to confront and ultimately accept reality. Part of this acceptance of reality process is a spiritual one. As we grow up and mature, we all have to ask ourselves some of those ultimate questions. Who am I? Why am I here? Is this all there is? How can I be happy? Drugs can seem to give us a short cut to the answers to some of these questions, but of course, they are providing a distortion of reality. It is never possible to see something clearly when you are looking through distorted glasses.

In order to have a shot at recovery, patients need to first get clean off the drugs and wait for the brain to heal and be able to function normally. But, then, we need to be thinking about the above three reasons we use drugs so that we can fill up the holes that they leave when we stop. 

After we give up drugs and alcohol, we need to find solutions and answers to replace what the drugs were doing for us. We need to find pleasure in things other than drugs. We will still get a Dopamine feeling from pleasurable activities, but we need to get that Dopamine in healthy ways - things like spending time with loved ones, hiking, hobbies, eating a good meal. We also need to get used to the amounts of Dopamine that these experiences can realistically give us - not the exaggerated amounts that drugs produced. We need to find ways of dealing with our emotions without just covering the feelings up with alcohol or drugs. 

This is where one of the biggest payoffs of recovery lies. Once we learn how to really feel and identify our emotions, we can learn how to change our behavior so that life goes more smoothly. We can avoid future problems and stop making the same mistakes over and over again. And, we need to grow spiritually. We need to learn and practice honesty, acceptance, love, and tolerance. We need to find things we are passionate about and bring meaning to our lives. 

As we explore and grow in each of these areas of our lives, we can find true happiness - not some drug induced sham of happiness.


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