- Reuters/Dima Korotayev
To be truly addicted to a drug, the conventional wisdom goes, you have to be psychologically and physically hooked.
In other words, you have to both crave the drug in your mind and feel physically sick – for example, shaky or nauseated – when you can’t get it.
But this isn’t necessarily true, at least according to neuroscience writer Maia Szalavitz and the author of the new book, “Unbroken Brain.”
The real question, then, is this: Is someone’s drug or alcohol habit interfering with their everyday life?
Focusing on specific symptoms, in other words, is a waste of time, Szalavitz says. Plus, doing so can obscure how dangerous a drug really is, since certain drugs might produce very visible symptoms and not do as much harm, while others might result in symptoms that are almost impossible to detect even while they’re doing a lot of damage.
The case of cocaine
Take cocaine, for example. In the 1970s and ’80s, numerous scientists regarded coke as fairly harmless because people who stopped using didn’t suddenly get the shakes or start vomitting.
- Shuttershock/Daniel Loretto
In a 1982 article in Scientific American, renowned University of California at San Francisco psychiatrist Craig Van Dyke and infamous Yale psychopharmacologist Robert Byck compared the behavior of people who’d used cocaine to that of people who’d recently indulged in a delicious snack. The behavioral pattern of users, they wrote, was “comparable to that experienced by many people with peanuts or potato chips. It may interfere with other activities … but it may be a source of enjoyment as well.”
This sort of thinking had drastic consequences.
The number of people who admitted using cocaine on a routine basis jumped from 4.2 million in 1985 to 5.8 million in 1989, according to data from the Drug Enforcement Administration. During that same four-year period, cocaine-related hospital emergency room visits increased 28-fold.
But most people didn’t see this coming; they thought they could judge how harmful a drug was based on how bad its visible symptoms were.
“While withdrawal from marijuana, cocaine … and numerous other drugs does not result in the stereotypical ‘opiate-withdrawal-flu-like-syndrome,’ there is no doubt that real withdrawal from these substances exists for long term users,” writes University of California at Los Angeles psychiatrist Adi Jaffe in a blog post for Psychology Today.
Jaffe adds: “Fatigue, depression, anxiety, sleep disturbances, and trouble eating are only some of the symptoms that tend to show up.”
What’s really key to pinpointing and treating addiction then, is seeing how drug use might be affecting behavior – how it might be getting in the way of normal life.
“… if you have a behavior that is making your life miserable and which you can’t seem to stop, it doesn’t matter if you’re throwing up during withdrawal or not,” writes Jaffe. “It’s an issue and you need help.”
Depressants vs. stimulants
The other problem is that our bodies and brains react very differently to depressants (alcohol, heroin) than they do to stimulants (cocaine, meth).
- Bobby Yip/Reuters
When we regularly use a depressant like alcohol, for example, we tend to develop a physical tolerance for it, meaning that each time we drink, we need more to achieve the same warm, pleasant feelings.
Most users also experience physical withdrawal when they suddenly stop drinking: They feel nauseated, shaky, or physically ill. And some of us experience psychological withdrawal, too, meaning we crave or strongly desire to drink again.
Conversely, when we regularly use a stimulant like cocaine, very different things can happen to us physically and psychologically. First, you may develop partial tolerance or sensitization, two virtually opposite reactions to the drug. In partial tolerance, users need slightly more of the drug each time to experience the same high. In sensitization, smaller amounts of the drug actually cause more intense effects. Plus, most users tend to go through psychological – but not physical – withdrawal when they suddenly stop using, meaning they might crave or strongly desire to use the drugs again.
“Stimulant withdrawal doesn’t make you physically ill like heroin or alcohol withdrawal does; nearly all of its signs can be dismissed as ‘psychological’ rather than ‘physical’ and include things like irritability, craving, depression, and sleep disturbances,” Szalavitz writes.
Using these differences as a gauge for how dangerous a drug is doesn’t work very well, says Szalavitz. And it’s about time for a new system.