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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.
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Smokers 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.
Theoretically, 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
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.
“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:
Now when I get up in the morning
And I’m feeling mighty lowThere’s just one thing that will pep me upAnd I want you all to know.Well it happens every morningNo matter where I’m atI just gotta have a cup of coffee
And a cigaretteCoffee, coffee,
And a Cigarette
Is a habit
That you can’t forget…
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.
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.
Hi Jeffrey, it seems to me that you are talking about the consumption of psychoactive substances that have positive and negative effects and often profiles of dependence. Psychiatry is the medicalization of psychosocial demands. There are advantages and disadvantages to this. The drug approach in psychiatry is one of the possible approaches but it is not the only one. We find in the to psychiatric field also psychological, psychotherapeutic, biological non-drug approaches, such as physical interventions and physiotherapy, and social, dialogical, conflict resolution and human rights defense approaches, in particular disability-related aids and insurance systems. The other non-medical approaches would be the consumption of non-prescribed psychoactive substances, most often alcohol, cannabis and opioids, psychological approaches and social approaches like community support and defense of one’s human rights, which would be independent of the medical. I think that the consumption of recreational drugs is something else, it is more the exercise of one’s freedom and responsibility, and this includes risk-taking, and positive and negative experiences of life. The advantages of medical prescription would be the provision of controlled substances in quality and dosage and better information on the products. The disadvantages would be the imbalance of power and the loss of freedom and responsibility with the absence of moral judgment and the indoctrination in a real or supposed need for consumption. The imbalance of power becomes extremely harmful in the case of non-consensual prescriptions or prescriptions made to children.
Sometimes the products are the same: amphetamines for ADHD, benzodiazepines for anxiety, psylocibin for depression, MDMA to facilitate psychotherapy for PTSD.
It seems to me that the products most often self-consumed add something, like euphoria, facilities for socializing, energy, libido, concentration, composure, special experiences or hallucinations. On the other hand, it seems to me that the most commonly prescribed drugs take something away from the person: the ability to care, to be anxious, to think, to remember, to suffer, to be enthusiastic, to be spontaneous, to have experiences or hallucinations. The prescribed product is most often administered continuously, the consumed product is often intermittent.
Hi Luc,
Always a pleasure to hear from you.
Your first sentence states, “Hi Jeffrey, it seems to me that you are talking about the consumption of psychoactive substances that have positive and negative effects and often profiles of dependence.” I would change it to, “Hi Jeffrey, it seems to me that you are talking about the consumption of psychoactive substances that are PERCEIVED to have positive and negative effects and often profiles of dependence.” I’m not at all convinced that they in actuality have positive effects, but rather they create the illusion that they do by relieving the withdrawal effects of the drugs. You go on to point out that under the title of Psychiatric Services there are several other services that are provided. True. My post just focuses on the psychiatric medication approach. You go on to say, “The advantages of medical prescription would be the provision of controlled substances in quality and dosage and better information on the products.” I think that anyone interested in the relevant information regarding all of these drugs is readily available, although your point about the quality and dosage of prescribed psychiatric drugs has some validity. The rest of your comment strikes me as sound reasoning.
My Best,
Jeff
Thank you Jeffrey for your feedback,
I think that each of these psychoactive products, drugs or non-prescribed substances, can become a trap for the user and consumer, as soon as their consumption becomes an habit. I think we should keep in mind that the consumption of psychoactive substances is in reality an intoxication, and also a form of poisoning that tends to become chronic. In my view, the trap consists in developing a different personality when the substance is in the blood, that is in a state of intoxication, from the personality when sober, and not being aware of it. When I consider all the harm that can be attributed to the consumption of alcohol or cannabis, I am horrified by the number of new products that we invent and produce. I practice regression hypnosis and past life exploration experiences, and this informs me that it sometimes takes several lifetimes to completely free oneself from the tendency to self intoxicate. When I compare these notions with the active promotion of substance use by the medical world, in the name of often misleading or biased clinical trials, I denounce these prescriptions as dangerous and most often deceptive practices, with very serious and harmful potential consequences for the people themselves and for those around them, often lifelong.