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Are Psychiatric “Medications”Essentially The Same As Recreational Drugs?

by Jeffrey Rubin, PhD

Welcome to From Insults to Respect. Today we shall look at a theory that is certain to fire up some mighty strong emotions.

Most advocates within the medical profession say their prescriptions for psychiatric drugs, which they refer to as “medications,” improve the health outcomes for their patients. There are some within the profession that fervently object to this claim and provide extensive research evidence for their position, but nevertheless are clearly a minority. Meanwhile, taking legal and illegal recreational drugs are mostly viewed as distinctly different not only by medical doctors, but a majority of those in the general population.

That said, I do think it is useful for us to look at the case that although there are some differences, essentially they are the same when it comes to opportunities to 1. assess side effects/toxicity as one makes decisions to partake, and 2. what keeps users to continue consuming them.

Assessing Side-Effects and Toxicity

The Food and Drug Administration provides readily available information on the internet, regarding the side effects and toxicity of these substances. Updated research on this information is regularly appearing in the press. For example, we have recently seen stories about how even one glass of an alcoholic beverage can have negative effects on some aspects of health outcomes.

Anyone who wants to delve into a more thorough assessment of health consequences of any of the legal and illegal recreational drugs and psychiatric drugs can do a literature search. I have found Google Scholar fairly easy to use for this purpose. It provides the abstract of the research for free. There is an occasional pay wall that can be modestly costly in order to read the entire paper, but anyone who wants to make a fully informed decision on the risk of partaking can obtain the available evidence at a reasonable cost. Many of the published evidence can be misleading particularly because most studies look at just short-term results, yet many folks take these drugs for much longer. But this is true for recreational and psychiatric drugs, so assessing safety is hardly perfect regardless of what drug is being considered.

The Physical and Psychological Reasons People Continue to Consume These Legal, Illegal, and Psychiatric Drugs Are Essentially the Same.

Let’s begin this theory by using nicotine as an example and by taking a close look at an impressive study in the scientific literature (see HERE).

smoking 5Our body, upon beginning the habit of consuming nicotine, at first fires its receptors more frequently than usual upon each exposure to this drug. This leads to feeling more alert, which some of us experience as rather pleasant. But your body recognizes that if you were to keep firing those receptors at the pace that occurs when you first start smoking, certain functions in your body will end up exhausted. Thus, your body starts to reduce the number of these receptors. In the scientific literature, this process is called “down regulation” or “tolerance.”

For smokers, we see evidence of tolerance in studies that indicate fewer responses than do non-smokers to the same amount of nicotine (Perkins et al. 2001b). More specifically, we see a reduction on measures of subjective stimulation that may be viewed as pleasurable, such as arousal, vigor, and a subjective experience often referred to as “head rush” or “buzz.”

Once the down regulation process is complete, you end up with enough receptors to function fairly well as long as you continue to consume using this drug. withdrawal 2However, shortly after you pause from smoking even for a few minutes, you end up not having enough of these receptors to do what they were originally designed to do. It is this shortage of receptors that occurs when there is not enough nicotine in your system to keep your receptors firing at a rate that would typically occur if you were not regularly consuming the drug that leads to the uncomfortable, sluggish, stressful feelings that lead to a craving for the next cigarette. When you light up, you feel relief because now the reduced amount of receptors are sufficient to carry out your major life functions in a less distressed manner.

The relief that smokers feel each time they give themselves another dose of nicotine creates the powerful illusion that cigarettes help them to deal with stress. Thus, in a study published in the American Psychologist, researchers found the following:

smokingSmokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.

drug withdrwal 1Theoretically, this same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and even the drugs that psychiatrists prescribe, such as the so called antianxiety drugs (anxiolytics), antidepressants, and ADHD stimulants such as Ritalin. They all have the potential of creating for addicted people the illusion that they are functioning better than they did before they started consuming the addictive drug.

Another major part of the addiction process is that the addictive substance often is used as part of a ceremony creating a very pleasant experience. As an example of this, listen to the actor John Cusack explaining his smoking habit:

John Cusack

John Cusack

To me, cigars are a much better situation than cigarettes. Cigarettes are compulsive and cigars are kinda, languid, luminous conversation. Like you’re gonna sit for a couple of hours and talk to somebody. If you gotta smoke, I would say, at least have a long conversation with someone you like, rather than just compulsively sucking down a cigarette. That’s how I’m gonna lie to myself so I can keep smoking cigars.

Although the cigarette habit is not John’s cup of tea, many people have fond associations of sharing a cigarette with others, and drinkers have associations of some very good times hanging out with their buddies. Of course, others have very negative associations with an addictive substance.

Can it be that the same two mechanisms–reduced receptors and pleasant ceremony– that creates the illusion for nicotine users are similar for other drugs that are the other legal, illegal, and psychiatric drugs?
Clearly, regular users of alcohol go through a withdrawal reaction when they don’t get a drink around the time they usually imbibe. We get a delightful sense of this listening to Jimmy Buffet singing about it being five o’clock somewhere and his desire for the relief he needs by taking a swig of his favorite intoxicating drink.

How intense the need can become is powerfully brought home to us during Ray Milland’s Academy Award winning portrayal of Mr. Birnam, an alcoholic in the movie, “The Lost Weekend.”

Ray“Just give me a drink,” says Mr. Birnam with exquisite anguish.
The bartender, in a disbelieving voice: “Mr. Birnam, this is the morning!”
“That’s when you need it most, in the morning,” Mr. Birnam replies with disgust. “Haven’t you learned that yet! At night, it’s a drink, in the morning, it’s medicine!”

Like nicotine, regular consumers of alcohol get a pleasant relief from the sensation of drug withdrawal reactions, and it is often associated with particularly good times.

Often, it is a combination of these drugs that work together to create the illusion that they are a type of “medicine,” relieving stress and feeling an improved sense of being.

Consider Jerry Irby who tells us in his song, One Cup of Coffee and a Cigarette:

IrbyHotlineNow when I get up in the morning
And I’m feeling mighty low
There’s just one thing that will pep me up
And I want you all to know.
Well it happens every morning
No matter where I’m at
I just gotta have a cup of coffee
And a cigarette
Coffee, coffee,
And a Cigarette
Is a habit
That you can’t forget…
There is no doubt that each of the legal, illegal. and psychiatric drugs have powerful withdrawal actions that is relieved when one once again consumes them. The ceremony that medical doctors use to encourage their patients to use psychiatric drugs involves a highly respected professional describing a process in which people often report feeling better as a result of consuming their prescription.

With so called “antidepressants” the withdrawal reaction is referred to as “Antidepressant Discontinuation Syndrome.” It causes a variety of symptoms like nausea, insomnia, fatigue and achiness. Interestingly, prescribing doctors of these drugs, when the patient reports not being helped by the first prescribed drug, often will prescribe others, and even a cocktail of others until the patient reports improvement. During this time the patient might have improved without the drug but attribute feeling better to the drug.

Different people find some drugs pleasant when they first try them while others are not. I know someone, for example, who loves his cigarettes but doesn’t like how marijuana makes him feel. The process that doctors use when trying different prescriptions until one is found that the user happens to feel better on serves this illusion creating process perfectly.

Support for the theory I am putting forth comes from several studies.

People Who Get Over Depression Without “Antidepressants” Do Better Than Those Who Had Taken Them

A recent publication in the journal American Psychologist by Professor Steven Hollon neatly summarizes what I am referring to.

Depression is an inherently temporal phenomenon. Any given episode tends to remit spontaneously even in the absence of treatment but recurrence is common (at least among people seeking treatment). There is reason to believe that depression may be an evolved adaptation (like pain or anxiety) that increases reproductive fitness (the likelihood that one’s gene line will pass on). If so, then any treatment that facilitates the functions that depression evolved to serve is likely to be preferred to one that only anesthetizes the distress.  

After this opening statement, Prof. Hollon provides a more complete description of his theory:

Depression is an adaptation that evolved because it keeps organisms focused on (ruminating about) complex social issues until they can be resolved and that medications work not so much by addressing a nonexistent deficit in neurotransmitters in the synapse as by perturbing underlying regulatory mechanisms to the point that they reassert homeostatic control over those systems. If the latter is true then medications may work to suppress symptoms in a manner that leaves the underlying episode unaddressed and patients at elevated risk of relapse whenever they are taken away. 

So, I hope you will consider this theory of the illusion regarding how helpful these drugs are and please feel free to express your reactions in the comment section below.

My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

The Rolling Stones On Going Insane

About the Author

Jeffrey Rubin grew up in Brooklyn and received his PhD from the University of Minnesota. In his earlier life, he worked in clinical settings, schools, and a juvenile correctional facility. More recently, he authored three novels, A Hero Grows in Brooklyn, Fights in the Streets, Tears in the Sand, and Love, Sex, and Respect (information about these novels can be found at http://www.frominsultstorespect.com/novels/). Currently, he writes a blog titled “From Insults to Respect” that features suggestions for working through conflict, dealing with anger, and supporting respectful relationships.

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