Author: Marc

Hi again. Sorry I’ve been so…absent…lately, but I’ve had a number of ideas I’d like to share with you in the next few weeks. The first involves psychedelics, whose benefits have long remained mysterious. We are finally getting a glimpse of how psychedelics work to improve mental health. And it’s fascinating. So consider this a sequel to the post before last.

I hope you read Eric Nada’s guest post on the promise of psychedelic therapy for helping overcome addiction. Eric reviewed the therapeutic side of psychedelic therapy, and he stressed the importance of working with a knowledgeable and supportive therapist. He emphasized the transformative power of psychedelics, and pointed out that recovery from addiction requires transformation in how we think and feel.

Here I want to focus on how psychedelics act on the nervous system, whether they are taken in a controlled setting with a therapist or on a hilltop in the forest. How do these drugs actually work? Eric began his post remarking on how counter-intuitive it feels to recommend a drug experience for people trying to overcome addiction. But I’ve never felt quite that way. Psychedelics don’t invite us to be cheered up, entertained or numbed. As Eric also concluded, they invite us to open up and change.

When I was a young man, dropping acid and climbing trails through the Berkeley Hills, what I experienced was a massive perspective change, an opportunity to be more attuned to the beauty of the natural world and to my own consciousness. During those years I was also fighting my attraction to opiates and other potentially dangerous drugs, and it took me years to resolve those issues. But LSD and psilocybin (magic mushrooms) were different animals. These substances seemed to offer a way to outgrow the rigid perseverance of my mental habits, my stuckness, my depression and my addiction. If only I could rise to the occasion.

These days we are inundated with research showing that, indeed, psychedelics can help improve mental health. Anxiety and depression have been shown to be reduced by LSD and psilocybin, in various forms and doses, over dozens of studies.  In a study of cancer patients, a single dose of psilocybin “produced immediate, substantial, and sustained improvements in anxiety and depression and led to…improved spiritual wellbeing…” Psilocybin has also been shown to help people quit smoking, and to relieve other addictive spirals. Psychedelics prove to be as effective or more effective than conventional antidepressant drugs for relieving depression, even if taken just once or twice. And there are no side-effects, no measurable addiction potential, and very little risk of ongoing thought disturbance. See this recent review and commentary in Scientific American.

The benefits are no longer speculative. They’re real, and mainstream psychiatry is finally starting to embrace them. But what might be the cause of such improvements? Does anybody know?

Recent research suggests that “opening up” with psychedelics has a very distinct biological basis. Published last month in Neuron, this study shows something almost unbelievable to students of the brain. We’ve been convinced (brain-washed?) for at least 50 years that brain cells don’t regenerate. (By brain cells I mean the “grey matter,” composed of neurons and their thread-like extensions — dendrites and axons.) They are considered the only cell type in the body that does not reproduce, except for a structure called the hippocampus, and even that shows only limited change beyond early adulthood. The ominous conclusion is, of course, that the brain runs down. Aging seems to reveal a brain that loses its plasticity, its capacity for novelty and change, and even its basic functionality. More to the point, mental problems such as addiction and depression are really hard to fix. Both can be seen as products of neural entrenchment. Maybe you can grow new connections, probably that helps, but you’re stuck with the same complement of grey matter you had at the age of 18. How depressing!

But maybe it’s not that way at all. The Neuron article shows that a single dose of psilocybin produced a rapid and long-lasting increase in the size and density of dendritic spines (the “twigs” that grow out of dendrites) throughout the frontal cortex. The subjects of the study were mice, not humans, but that hardly matters. When it comes to the characteristics of brain cells, like cell growth and regeneration, we mammals are all in the same boat. The researchers reported that the change took place rapidly, with 24 hours, and it was still evident one month later. The extent of growth was approximately 10 percent, a huge number when applied to spontaneous brain change. And — get this — neural transmission (excitatory connection strength) increased measurably, while stress-related behaviour diminished.

So psychedelics appear to actually grow additional grey matter! Note that this is not the same as strengthening or reinforcing synapses, something which occurs during learning but is far less extensive in terms of actual physical change and far more gradual in time. What are the implications? If psychedelics have this kind of firepower, in changing the biological substrate of cognition, then they should be able to induce rapid changes in thinking. In other words, they would be natural habit-breakers! And that’s just what it feels like — that wave of novelty, new paths opening up — to be on psychedelics, whether in a psychiatrist’s office or in the fire-lit circle of an ayahuasca ceremony.

But when it comes to addiction and other mental-health problems, that’s only half the story. As Eric emphasized in his post, the transformative potential of psychedelics has the greatest traction when it’s guided or directed by someone knowledgeable, whether therapist or shaman, and when we have a chance to process, practice, and consolidate what it is we are learning. As he says, “the healing benefits of psychedelics are not just produced by the compound itself but through the whole of the experience they inspire.”

Conclusions? I should clarify that single studies showing remarkable results need replication. That’s next. As well, I’d like to see the present findings jibe with other neurobiological models. In particular, research from a few years back showed that psychedelics increase connectivity across multiple neural regions, in contrast to the usual concentration and boundedness of activation within the default mode network, a region that mediates thoughts about the self (reminiscence, daydreaming, rumination). It would make sense: rapid change in neural maps would be impossible without some kind of “growth booster,” and the rapid, spontaneous improvements reported in the clinical literature point to rapid change.

So, if we take the present results seriously, the conclusion seems pretty straightforward: We use psychotherapy to help people think and understand themselves differently, so that they don’t just respond impulsively or compulsively (as in drug taking) to their needs and fears. It’s been known by various indigenous peoples, for thousands of years, that there are natural chemicals that shake people out of habitual patterns and promote mental change. And now we are starting to learn how this works at the cellular level. Bringing these streams of knowledge together seems an obvious and optimistic route toward improving our mental health…across the board.

 

P.S. Didn’t your mother tell you that mushrooms are good for you?

 

 

A 30% increase in overdose deaths in 2020? Sure, the year of the pandemic. Most agree that isolation has been a huge causal factor, but what does isolation mean in a world patched together by social media? Rat Park and Social Baseline Theory help us see the full picture.

Over the last few months there have been numerous reports of a sharp rise in overdose deaths in 2020. Most recently (last month) the National Center for Health Statistics reported an increase of 21,000 (almost 30%) — totaling 93,000 deaths in one year.  Virtually all experts associate this increase with the pandemic. Many reasons are aired: stretched health-care facilities, less access to naloxone, less access to doctors, housing issues, and…increased isolation.

The experts agree that isolation’s been a major concern. Yet our understanding of the nature of isolation is superficial. Since almost everyone has been on social media this year, madly zooming away the hours, what does it actually mean to be alone, physically, bodily, especially for people living alone, each in their own little box?

We know that isolation makes people more vulnerable to depression. Loneliness = depression. And depression is the gateway to more extreme drug use. But while living in states of lockdown, we’ve spent the year zooming, texting, chatting, tweeting, emailing, Whatsapping, posting to Instagram, following on Facebook… Don’t these explicitly social activities dispel isolation and defeat loneliness? It certainly helps to connect with people any way we can. But  flat screens have their limits. They don’t allow for the spontaneity and ease, the free flow of real conversation, the richness of body language, the way people position themselves, move their heads, their feet, their eyes, when they’re actually, physically together. Never mind pheromones and oxytocin — the good odours that humans exude. So…some degree of closeness must remain out of reach. Maybe a large degree.

What kind of closeness do we humans need in order to feel connected, supported, safe — and free of addiction? Two research programs 30 years apart tell the story.

The first is Rat Park. Most of you are familiar with Bruce Alexander’s research in the 70s and 80s, memorialized in the addiction world as “Rat Park.” These studies showed that isolated rats (kept alone in their cages) chose to drink water laced with drugs like morphine, while those allowed to socialize, cuddle, and have sex in a park-like (for rats) environment avoided the drug solution and drank plain water instead. There are thousands of references to Rat Park online (e.g., here), and Alexander’s own site summarizes the findings and extends them with a whole philosophy on what drives addiction. One of Alexander’s reflections captures the main lesson: “Solitary confinement drives people crazy; if prisoners in solitary have the chance to take mind-numbing drugs, they do.”

But does verbal communication alleviate the damage done by solitary housing? Rats aren’t verbal. When they socialize, they cuddle, play, lick, fondle and fuck. We’re mammals too. How much does verbal communication satisfy our needs?

The second research program has come to be known as Social Baseline Theory (SBT). Starting in 2006, James Coan and colleagues studied the effects of hand-holding on the activation of brain structures responsible for coping with stress. Subjects inside a brain scanner (fMRI) held hands with either a marital partner, a friend, or a stranger positioned outside the scanner. When exposed to (mild) electrical shocks (psychologists’ favourite way to induce stress) these brain structures showed less activation (they were less “aroused”) when the subject was able to hold hands, even with a stranger. In a review of these studies, Coan had this to say:

“According to SBT, the human brain assumes proximity to social resources—resources that comprise the intrinsically social environment to which it is adapted…   At its simplest, SBT suggests that proximity to social resources decreases the cost of climbing both the literal and figurative hills we face, because the brain construes social resources as bioenergetic resources, much like oxygen or glucose.”

The SBT experiments add an critical layer to what we know of isolation and stress: human proximity is processed by the brain as a physical, visceral presence. Other people are recognized by the brain not just via images on a screen or words packed in sound waves, but through actual physical closeness, optimized by the sense of touch. Even being in the same room as others, being close by, provides a fundamental context — a baseline — for handling adversity and stress. Think of being in a movie theatre, a waiting room, or in your own den watching TV with someone else. No speech is required to feel the irrepressible sense of closeness that comes with proximity itself.

I hear my friends and family talking about “Zoom fatigue.” For a reason. Zooming is way way better than no communication at all. But it’s still a partial measure. Texting, Tweeting, Instagram, and other platforms that rely (at least partially) on written characters provide even less of the colour, or tone, or the physicality of mammalian communication. Our brains are full of semantics, words and ideas, and we love exchanging these, exploring and building on them. That’s great. But our brains are part of our bodies, so the sense of comfort and care we get from others comes from an evolutionary heritage tens of millions of years old. A heritage that’s primarily nonverbal.

Even with all the digital media at our disposal, it’s been a lonely year. And that 30% increase in overdose deaths counts as a reflection of how hard it’s been for many of us. We seem to be starting to conquer Covid-19, at least in the Western world. Let’s keep it up, and let’s spread the wealth. That includes getting vaccinated, so we can protect our families and communities while protecting ourselves. It’s gotta be a group effort, and the group includes humans everywhere. People like us, all over the world, who need to come out of hiding.

 

In response to some of your requests, this guest-post portrays the context, experience, and potential value of psychedelic therapy for those struggling with addiction (and other stuff). By someone who’s been there and can talk about it with precision and depth.

 

…By Eric Nada…

I was very nervous the first time I drank ayahuasca. I had been traditionally abstinent for 20 years. Though I suspected that I would stick with my recovery afterward, 12-step philosophy insisted that all mind-altering substances would lead me to the same desperate and re-addicted end. I had recently ended my involvement with that fellowship, trading its emphasis on disease/abstinence for a more intuitive explanation of addiction as a reaction to personal trauma. I had been working on emotional healing from this perspective for a few years and found myself drawn to the stories of others who had used psychedelic medicines for healing and exploration. Still, this path rasied long-held concerns about the pitfalls of drug use.

Far from triggering addictive patterns, my ayahuasca experience was profound, life-altering, and rich in insight. During that first journey, for instance, I saw very clearly how abstinence had “cleared the space” for healing the patterns underlying my addictive drives, but did not provide the healing itself. I also began to see a lifelong pattern of fear that had developed alongside burgeoning feelings of love for significant others in my life. In sharp contrast to “relapse,” it provided a homecoming to my long-standing beliefs about the potential benefits of psychedelics. I have subsequently committed myself to regular work with psychedelics, ever deepening the understanding of my addictive patterns.

Healing addiction through a mind-altering process may sound counterintuitive, since we have come to emphasize abstinence as evidence of recovery. However, psychedelics, especially when taken for therapeutic purposes, don’t seem to be habit forming. The psychedelic experience is arguably, in fact, the opposite of addiction. Substances or behaviors that are traditionally habit-forming seem to please or anesthetize the very parts of the psyche that psychedelics directly challenge. Ingesting a psychedelic remains a discipline for me rather than an indulgence. Psychedelics produce not a high but an experience—a journey through consciousness.

But how can psychedelics help  someone with an active addiction? How can these wild rides into consciousness be directed to challenge the rigid bonds that our addictions represent? There is more than one way to approach psychedelic-assisted addiction therapy, and recreational psychedelic use can also be “therapeutic.” But there is a general format that seems best suited to optimize the therapeutic experience.

The process can be discussed as falling into three stages—preparation, journey, and integration. During the preparation stage, the participant addresses their mind-set. Obviously no one knows exactly how a journey’s content will be experienced, but a participant should be familiar with the process in general, and the nature of the compound they will ingest in particular. The second important aspect of the preparation stage is to establish intention. This is where the participant might formulate specific questions about their addiction. “Why did I develop this pattern? Why am I having trouble changing it? How might I need to change to become a person who doesn’t rely on the mechanics of addiction to function?” This is also the time to highlight any significant history of abuse or trauma that may also be explored during the journey. The idea is that the participant has some understanding of what to expect and what to explore.

Next comes the journey itself. Whoever guides the psychedelic journey should be experienced. They should have extensive knowledge about the compound they administer. They should be able to vet the participant to make sure that they don’t have any psychological or medical issues likely to cause real trouble. And they should be experienced with containing the setting of the experience, able to help the participant navigate any difficult emotional or physiological states encountered along the way. The psychedelic journey, itself, produces a radical shift in consciousness. Initial distortions in the visual field soon transform into vast cognitive and emotional reorientation. These shifts drastically alter the way we process our “self”—as if the egoic layers that create the story of who we are become loosened. And as they loosen, we see through them more easily, and rigid patterns that may have escaped conscious detection can become clear. As the journey deepens, the experience often transforms into a dreamlike flow of images, emotions, and physical sensations. During this stage, as the intensity peaks, insights can seem more intuitive than explicit. Eventually the journey concludes, usually bringing the participant gently back  down to the familiar. By the journey’s end, even if parts of it were difficult, the participant is usually left feeling open, unguarded, vulnerable, sated, and shrouded in a feeling of deep resolution.

Finally, there is integration. Invariably, there will be a lot of information to unpack after the journey itself, and it is important to make sense of what has been learned. The impact of the psychedelic journey often leaves the participant with the feeling that they are irrevocably changed, that parts of them have been rearranged permanently. And while certain lessons may indeed remain intact, the conditioned layers that may have seemed so translucent during the psychedelic journey will inevitably reform over the days or weeks following. Automatic thought patterns that had been largely unconscious until they were illuminated by the psychedelic beam may regain their automaticity once more. And so it is through integration that we make sense of our experience, that we take the images, impressions, and insights and create a narrative. This narrative can be woven into a treatment plan in an effort to ensure that the process leads to lasting changes after the afterglow has faded. Through integration, epiphany is transformed into practical therapeutic direction aimed at sustained change.

Psychedelic therapy is deep and profound. It can be discussed as a mind-body technique, along with other modalities that have the capacity to bypass the more conscious layers of the mind—think EFT, EMDR, Somatic Experiencing, and therapeutic hypnosis. It dovetails easily with depth psychology and Jungian archetype work. It also aligns with parts work such as IFS and Inner Child Work. Therapists will frame integration according to their training. This is why, when doing this work to heal addictive patterns, it is important to structure the experience according to a therapeutic framework relevant to addiction. Again, the healing benefits of psychedelics are not just produced by the compound itself but through the whole of the experience they inspire.

It has often been said that a psychedelic journey is akin to ten years of therapy in a single evening. I find this to be an imperfect comparison, but I get the sentiment. It does seem to deepen and accelerate the therapeutic process. Sometimes, if I journey deeply enough, I break through the egoic layers altogether and experience the transpersonal—and it’s divine. Oneness. No separation. And while I am always relieved to be reunited with myself as the precious layers that make up “Eric” reform themselves, they seem to reform less rigidly, thus I come back less attached to them and closer to the purity that lies beneath. Of course we need some of these layers so that we can navigate the world. But if we can use the psychedelic journey to help illuminate the parts of ourselves that invoke addictive patterns, if we can listen to these parts and soothe them, then we can more easily heal. Approached from this perspective, therapeutic work using psychedelics can be very, very effective.

 

 

 

 

I have not posted anything on this blog for over three months. I sometimes feel I’ve said all I have to say about addiction, and now is one of those times. But new ideas come in clusters. It’s hard to know whether and when a new cluster is about to pop up. Maybe it’s now. Anyway, if any of you were concerned, my family and I are fine. Radio silence doesn’t mean I’ve disappeared.

For now I’ve got a couple of guest posts ready to go, and I think they’ll be of interest to you. The first is from our old friend Shaun Shelly, whose March 6th post stirred a fair amount of controversy. Here’s Part 2. Get ready for more controversy — and directions for how to clear the air.

 

…By Shaun Shelly…

Previously I argued that “drugs” are essentially a construct that defies any straightforward, objective designation or referent.  Some felt that my point was mere semantics and that the drugs I referred to were indeed harmful. To minimize confusion, let me clarify that I was pointing to drugs that are often (not always) illicit or unregulated and thought to be addictive. I quoted Derrida who said “the concept of drugs is not a scientific concept, but is rather instituted on the basis of moral or political evaluations: it carries in itself both norm and prohibition…it is a decree, a buzzword.” Here I’ll use the term drugs in italics to refer to this hard-to-define category.

So, onward: If there is no empirical definition of drugs, what are we hoping to achieve when treating “drug addiction”? In this post, I argue that a value-neutral and rational understanding of drugs would save lives and change our response to the use of drugs for the better.

The opioid crisis in the USA gives an excellent example of how the impact of a moral and disease-laden framing of opioids plays out. The combination of an economic crisis, the loss of jobs, increasing inequity, the housing crisis, the increased cost of education and little chance for resolution made people vulnerable to anything that gave them some relief from the pain of their existence, lack of hope and sense of impending failure.

Widespread emotional and physical pain combined with direct end-user advertising of opioids and increased prescribing made the rise in opioid use predictable.  Opioids filled the gap, as did Trump. Another critical contributing factor was the message that opioids are highly addictive. People believed that using an opioid would make you addicted and, once addicted, your life would spiral out of control. The narrative became a self-fulfilling prophecy. People prescribed opioids started overdosing, by exceeding the correct dose or mixing their opioids with other medications and/or alcohol.  Then heroin began to be contaminated with fentanyl. Fentanyl is many times stronger than heroin and was often undetected. People who used heroin began to die from drug poisoning due to fentanyl contamination.

The response, informed by the prohibitionist narrative, was predictable: the aim was to eradicate the drug, cure the disease, get people ‘clean’. The CDC placed restrictions on prescribing opioids. Doctors cut people off from their essential pain medications, and the DEA increased inspections of doctors prescribing opioids. Information about the addictiveness of opioids and the consequences of the disease of addiction dominated the headlines. Predictably, people began to access pharmaceutical drugs from the street. When those ran out, they did the previously unthinkable and started to use heroin. When cut off from opioids, some pain patients could not live with unbearable pain and committed suicide.

If the response had been value-neutral, we would have had a very different outcome. Many deaths would have been prevented. The rational response, in a world without the rhetoric of drugs would have been:

With the increase in prescribing and dependence, the CDC would:

• Not reduce the supply of regulated opioids.
• Ensure additional training of physicians.
• Ban all direct-to-consumer advertising.
• Ensure the marketing of drugs to doctors was not incentivised but based on data.
• Ensure that people dependent on opioids have an uninterrupted supply of regulated opioids so they would not have to switch to unregulated opioids.

With the increase in fentanyl-related poisonings, policy-makers would:

• Lower the threshold for agonist-prescribing services (methadone programs).
• Ensure that people dependent on heroin (diamorphine) have a regulated, unadulterated supply of diamorphine via community services or retailers.
• Make fentanyl tests widely available to all drug sellers and consumers.
• Analyse heroin samples contaminated with fentanyl and identify the source.

1. To ensure immediate broad access to naloxone.
2. To promote the passage of federal Good Samaritan laws.
3. To distribute factual information and data.
4. To access networks of people who use drugs, social media and first-responder reports to map contaminated drugs and distribute information about risk areas.
5. To divert funding used for the DEA and supply reduction to community-based services and support for all community members.
6. To decriminalise the use and possession of drugs for personal use.

Tragically, the ‘opioid crisis’ has not motivated policy-makers to take logical measures to prevent further death and suffering. By thinking that drugs like opioids are ‘bad drugs’ and must be prohibited, rational options are beyond consideration. In a rational world, we would realise that the opioid crisis, most addictions and the negative consequences of drugs are not caused by the drugs themselves. Instead, they are the symptoms of our society’s misguided beliefs and policies.

Trying to stop drug use and eradicate drugs are futile pursuits. Instead, we must modify or eliminate the policies, practices and beliefs that cause harm and suffering for certain people who use certain drugs. I long for a world where people can, most of the time, make informed decisions about the what, where, when and how of using or not using drugs, especially drugs, without the threat of arrest, pathologisation, medical maltreatment and social or economic isolation.

 

If you read my blog you know that I try to post smooth, polished pieces. I try to produce something coherent, even conclusive. This one’s different: a bunch of notes that I recently found in a forgotten file from five years ago. The notes pose questions that intrigue and trouble me as much now as they did back then. I don’t even remember writing this stuff. Probably much of it landed in previous posts and articles. But anyway, here are the questions. Still without clear answers.

I’ve annotated the text and filled in a few spots that would be completely incomprehensible otherwise. I’ve also added tips to more recent work and inserted several links. But the text I started with remains relevant, at least to me. Things don’t change very fast, and I think these are hard questions.

……………

My drug use began with psychedelics. Then came heroin. They’ve always seemed like diametrical opposites. This is where I get my intuitive feel for whether drugs are good or bad. Psychedelics open you up, heroin shuts you down. But I dropped acid roughly 300 times in my late teens and early twenties. I shot heroin about 30-40 times. Why do l assume that heroin is addictive and LSD is pure sunshine?

The one wedge nearly everyone agrees on is whether a drug is addictive or not. If only it were that simple. Is addictiveness really a feature of the drug? Or a feature of the person and the social surround (Rat Park)? When you take the addict as the unit of analysis, you place him in a cage, and then analyze his interaction with this or that drug. How stupid. How is it that scientists and doctors have become the priests of such stark distinctions?

The boiled-down argument re drugs and addiction: think about Percy Menzies [see his guest-post here] and the idea of chemical hooks (in Percy’s view, the only real cure for heroin addiction is OST, opiate substitution therapy, and he especially likes naltrexone: kill the good feeling and they’ll stop). [The idea of opiates as chemical hooks is also pitched in Dreamland, by Sam Quinones.] Then along comes Carl Hart (High Price) who says “addiction” is just a label used to badmouth drugs, and our only responsibility is to educate drug users. [In his new book, Drug Use for Grown-ups, Hart argues that all drugs, including heroin, can be taken recreationally, and  it’s repressive for governments to ban any drug for personal use by normal, sane adults.] And along comes Johann Hari (Chasing the Scream), who says that the opposite of addiction isn’t sobriety, it’s human connection. All very liberating. But what about addiction?

Addictive drugs: are they neurochemically distinct? Do addictive drugs mimic natural neuromodulation (opioids, dopamine, etc)….vs nonaddictive drugs (like LSD, psilocybin?) that effect perspective change? [But let me add this: last year I went to a neuroscience conference and learned that baby zebrafish will swim toward water laced with Vicodan, an opiate painkiller. I doubt they’d swim toward an LSD solution.] Mind-altering vs. mood-enhancing. Is that what decides? (Though SSRIs are mood-enhancing…and guess what, they’re addictive…sort of.) But behavioural addictions are just as serious, aren’t they? (Gambling addicts can destroy their lives as effectively as any crack-head) Can behaviour also be divided into mood-enhancing vs mind-altering? Probably not. Maybe there are just good and bad addictions…in life, love, and drugs. Oh, and in products. Where do we stop?

Why do we value control so much? Is control the wedge? Or is harm the crucial marker? Control vs harm and the history of antipsychotics…that increase control and kill the soul. Drugs that harm: don’t they require harm reduction? Or is it happiness, well-being, that’s key? Then why prescribe SSRIs when you could prescribe opiates for emotional pain? If you value control, then get this: drugs are a way to control our thoughts and feelings. Yet self-medication often leads to self-harm. How do we weigh the goodness of drugs when control, well-being, creativity, awareness and harm are all simultaneously changing variables?

Drugs and therapeutics…. Psilocybin vs. depression and anxiety. If that’s okay, why not prescribe opiates for those who crave them? The duplicity built into psychiatry: we want what’s best for you. Oh really?

 

Patches to move us from moralism to relativism:

Individual differences  — genetics are the simplest exemplar, but different life experiences matter hugely. Trauma leads to drug-use, not the reverse. Yet, the research shows that kids who never try drugs do worse than kids who do. How do we explain that?

Developmental differences  — the wrong drug at the wrong age might become the right drug at the right age.

Societal differences  — my undergrads at Nijmegen [a rural region of the Netherlands] still see addicts as a different species; in Amsterdam students don’t see it like that. Let’s send Mr Hazelden to an ayahuasca ceremony and see how/whether he evolves.

…………………………

A sort of summary:

Why would anyone put ayahuasca in the same category as heroin…isn’t there something intrinsically valuable about perspective change, for its own sake? And what’s the difference between methadone and SSRIs when it comes to allaying depression (yet one is for disgusting addicts and the other is for normal healthy people, like Aunt Mary). But I so disagree with Carl Hart when he says that when your teenage kid wants to try meth your only duty (and your only right) is to educate him/her about safety issues. Are the distinctions between good and bad drugs in the drugs themselves (as we often think reflexively) or in the relation between the drug and the user? We have to really get individual differences. And developmental differences. Binge drinking at 16, not so good…social drinking at age 28 can really help people connect. And what I learned from [my good friend and courageous colleague] Shaun Shelly: Isabel and I often reflect on his description of the unemployable/sidelined teens in Capetown smoking (not shooting) heroin…for social cohesion and a little pleasure. So, put it all together: look at the relationship between the person (of a certain age) and the drug, in the context of the social group and the society at large.

Coda: What makes drugs bad? Is there something simple and primitive like the idea of being too attracted?

Conclusion: I don’t know.

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A number of you posted very helpful comments about what you’d like to see in future posts. We’re working on it. Next, Eric Nada, a past contributor to the blog, will post a piece on psychedelic therapy for addiction. Given the above, I’m aware of possible ironies.