I want to start with two revelations that will certainly drive more than a few readers away:
- I am not against the use of recreational drugs for any moral reason. In fact, in a completely rational manner, I defend the gradual legalization (and regulation) of production, industrialization and commercialization of drugs as the only possible means of confronting the huge power of the drug cartels. The “war on drugs” has failed catastrophically, as hard data shows it. Therefore, I don’t support and I don’t believe in the “war on drugs”.
- I am a junkie. There is no such thing as an ex-junkie: you may spend years without touching any mind-altering drug, but once you have been and addict, you are an addict for life. Many people who have some neurological or phychiatric condition are also vulnerable to drug addiction. In many cases, understanding what came first – drug addiction or the mental disorder – is the proverbial egg and chicken dilemma.
That said, I believe we all must face the fact that addiction to recreational drugs is by and large one of the highest components of non-transmissible disease morbidity and mortality, together with inactivity and bad nutritional habits. Mortality itself is counted as 12,4% of total world deaths. Morbidity is measured through different indicators, the most important ones being years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs).
Illicit recreational mind-altering drugs (also generally known as narcotics, in spite of the fact that they are not generally numbing or inhibitory of the central nervous system) are toxic substances. They produce addiction though neurological mechanisms that have been extensively studied. Addiction to drugs is a physiological phenomenon. That does not mean it doesn’t have important emotional (psychological) and social aspects.
And one of the reasons why most “war on drugs” efforts fail is that they ignore a basic assumption: people use drugs to feel better. Drugs (at least in the beginning of systematic use) numb pain, distract you from problems, quench anxiety and produce a general state of well being. Who doesn’t want that? Of course, on the long run they produce precisely the opposite, but it is very hard to believe this when the warm flow of happiness and peaceful alertness of an opiate spreads through your bloodstream.
I have used about everything I could put my hands on as a young woman. Honestly, it’s impossible to get hooked on acid or psilocybin, as well as other hallucinogens. They may produce an interesting altered state (or a horrible bad trip), but they don’t numb pain. Cocaine has, for some reason, never produced any effect on me. Maybe I lack the proper beta-adrenergic receptors – there are too many. Amphetamines just produced too much anxiety and more suffering. In my case, no euphoria driven happiness. Alcohol is always a danger, but I am probably genetically lucky here, too.
The real dangers are the drugs that help those who are in physical or mental suffering. It is not a surprise that a large percentage of opiate addicts have become so after a period of treatment for some pain generating condition. After the condition is relatively controlled, addiction has already taken place. At first, the patient is unaware that what he is suffering is drug withdrawal symptoms and he truly believes the pain is still there. The patient feels abandoned as he believes it is his original condition that is causing the pain and for some reason he is being denied treatment. He doesn’t understand that this pain is different: it is already withdrawal. He feels nobody believes him: he is sick, in pain and he needs treatment.
He is right: he needs treatment, but not for the original cause of pain. He needs treatment for the addiction drug withdrawal induced pain.
Dealing with this risk is one of the main concerns in pain management for severe conditions. New drugs offer alternatives and less addiction risk. But most of all, patient education is critical to the development of addiction or not. Patient education goes far beyond the simple explanation about the risks. It has to deal with the fact that everybody, at some level, is vulnerable because everyone needs some level of mental suffering to be controlled. It is very hard to convey how powerful a pain killer can be at this level.
Many are aware of that and choose to use mind altering drugs – whether they are inhibitory or stimulants. Both provide a quick relieve of what was originally the mental suffering. Later, it is the relief for the withdrawal symptoms.
Why do they do that? The first answer is obvious and has already been given: at first, it produces an incredible state of well being. Later, it relieves the pains of withdrawal. But there is another dimension there: life is better with the drug.
We tend to look away from an important social fact: the majority of people manage some level of mental suffering. If not a clearly diagnosed psychiatric condition, measurable by public health statistics because they end up in the health service system, a dark, undiagnosed one. When this mental suffering is socially translated into an absence of meaning, then we have a serious problem. Meaning doesn’t sprout from the ground like beans: it has to be constructed. In traditional societies they were socially constructed as part of homogeneous collective rites and procedures. Unfortunately, conditions in most modern, complex societies are not conducive to the construction and re-construction of meaning. Most people undergo stages and changes where they have to literally reinvent themselves. It is then that some simply loose hold of whatever meaning they had: it slips through the cracks of a world too big and too chaotic to be made sense of. These are the people most vulnerable to drug abuse.
The last drug I have used was prescribed to me during a spine infection – infectious spondylodiscitis -, one of the most painful pathological conditions. It was oxicodone. Oxicodone, unlike other opiates, never made me sleepy. It made me calm and peacefully alert. I could write for hours and, unlike marijuana and other “down” drugs, it made my mind faster. There was no denial: it made me a better writer.
My mind was clear and all the problems could be figured out. Alone. Totally alone. With oxicodone, I didn’t need anyone.
I was aware of the risks: whatever neurological and/or psychiatric condition I have is serious enough to have caused me to survive a suicide attempt by accident. My life history doesn’t help at all. I know I am permanently seeking to numb my inner pain.
There are two things, however that oxicodone quenches besides pain: strength and libido. It keeps me away from LOVE. Oxicodone takes away from me my means for transcendence and connection to the “all”. My cement to the fragmented parts of myself: my strength under the loaded bar. I become a contented broken person, a numb pile of fragments generating ideas from chaos. Finally, it takes away my connection to my beloved. I am aware of his existence, yet he exists in a different dimension. I reach out and cannot touch him.
The “inner war on drugs” can only be fought if there are enough sources of meaning that conflict with drug use. My case illustrates the fact that any drug will impair my ability to be a good powerlifter and to make love. Other people may have other sources of meaning and happiness, and drug addiction will destroy all of them because it takes their place, at a neurological level. After it takes their place, it leaves a hollow space that cannot be filled without great struggle. A struggle for which very often the person has no strength to face.
There lies the danger: anyone without good sources of meaning and happiness may very well choose to die as an addict. And maybe this is what they do.
Were it not for powerlifting, would I be an “active junkie”? I bet I would. Almost certainly. Without powerlifting I wouldn’t be alive, period: the reasons go beyond the drug issue. But powerlifting is so important that I refrain from the almost irresistible temptation of oxicodone because it quenches my strength, my magical powers of integration. It kills love.
It is not a hard choice. It is actually very easy. If a hardcore junkie, like me, could make it, so can anybody else.
Powerlifting is that powerful: it drives away destructive addiction and it opens the door to love.
References:
The global burden – World Health Organization
Count the costs: 50 years of war on drugs
Pain Management & Opioid Abuse
Alternative World Drug Report: Counting the Costs of the War on Drugs
America’s Addiction to Opioids: Heroin and Prescription Drug Abuse
Injury Prevention & Control: Prescription Drug Overdose