In drugs we trust

BY SCOTT ROSENBERG | A dangerous new substance is flooding into the
country from abroad. It causes potent, speedy changes in the user's
brain, and it's powerfully addictive. Users huddle in special rooms,
breathing in its intoxicating fumes. Religious authorities pontificate
against it; political leaders declare war on it. Yet people keep using
it in growing numbers.

Coffee for that is the menacing substance we are talking about
was a big "drug problem" in 17th and 18th century England, and indeed
sporadically throughout Christian Europe, where this new import from
the Muslim East was viewed with great suspicion. Gradually, Western
culture made its peace with the undeniably popular (and profitable)
stuff, classifying it as a harmless beverage, and today it's big
business the working person's daily wakeup fix and the cafe
philosopher's stimulant of choice.

It doesn't take more than a moment's contemplation of the history of
coffee or similar legal mindaltering substances like tobacco and
alcohol to realize that American society is deeply confused,
inconsistent and ambivalent about drugs. In truth, the only constant
in our relationships with drugs of every stripe is that they all carry
a strong emotional charge. Call anything chocolate, windsurfing,
online chat a "drug" and people nod their heads, understanding what
you mean: You're deeply attached to it and you can't live without it,
even though you suspect that there's something wrong with it.

Some drugs we declare illegal and wage war upon; other drugs we
embrace and build vast industries upon. Whether a drug lands in one
category or the other seems to depend on historical circumstance,
social custom, economic influence and sheer chance. Sometimes as
with Prohibition, the legal marijuana movement or the recently
proposed "tobacco settlement" there's pressure to move a popular
drug from one category to the other; but such efforts typically create
social upheaval and meet great inertial resistance. In the U.S. today,
bureaucracies like the Food and Drug Administration have jurisdiction
over the line between what's considered food and what qualifies as a
drug; but it's the popular media that alternately and selectively
romanticize some drugs and demonize others.

We live in a nation that has fought a losing "war on drugs" for
decades. But while our electionyeartimed spasms of drugwar
militancy keep our eyes fixed on the violent crimes that surround the
illegaldrug business, we are quietly but steadily becoming more and
more devoted users of a vast spectrum of legal drugs. While crack took
the headlines, Prozac, Ritalin and their many brethren began to take
over our daily lives. And they're just the start.

Even setting aside antidrug hysteria and pharmaceuticalindustry
hype, it's difficult to master the calculus of fear and desire that
seems to govern our assessment and categorization of various drugs.
One casualty of the drug wars is our very ability to draw any kind of
useful distinctions among different drugs.

The substances that captured the imagination and bloodstream of the
'60s generation from marijuana to LSD were celebrated as
dropout mechanisms, exits from middleclass conformity and doorways
to higher consciousness. Opponents, reacting out of generational fear,
medical concern or puritanical mistrust, held that the drug culture's
promises were shams or scams. The result was a stalemate that's with
us to this day; these drugs are still illegal yet still widely used
and the kind of rigorous, fair studies that might begin to lead us
toward saner judgments remain unperformed, unfundable, unthinkable.
Other illegal drugs, from cocaine to heroin, go in and out of fashion
but also remain taboo as objects of genuinely unbiased scientific
inquiry which leaves us in the strange position of knowing far less
about them than we do about tobacco, which, despite its deadly
effects, remains quite legal.

It's hard to find clear thinking about such drugs, but a strong dose
of it can be obtained from Andrew Weil's 1972 classic, "The Natural
Mind." Written long before Weil's current popularity, "The Natural
Mind" argues that the desire for "periodic episodes of altered
consciousness" is an innate drive in human beings. (The only culture
in the world that lacks a tradition of natural drug use is the Eskimo,
according to Weil.) Drugs are simply one means people adopt toward
this end; though they may not be the best or most effective one, they
are "with us to stay." We can either keep fighting them and keep
losing or learn from other cultures about effective methods of
living with them, minimizing the harm they do to people and maximizing
their potential benefits.

Weil later also cowrote the encyclopedia of mindaltering drugs,
"From Chocolate to Morphine," an equally lucid work that, among other
things, attempts to clarify the difference between drug use and abuse.
"Any drug can be used successfully, no matter how bad its reputation,
and any drug can be abused, no matter how accepted it is. There are no
good or bad drugs; there are only good and bad relationships with
drugs." These are the book's guidelines for "good relationships with
drugs": "Recognition that the substance you are using is a drug and
awareness of what it does to your body"; "experience of a useful
effect of the drug over time"; "freedom from adverse effects on health
or behavior"; and "ease of separation from use of the drug."

But sometime between the '60s, the period that shaped Weil's
perspective, and the '90s, during which he emerged as an
alternativemedicine guru, the drug landscape radically shifted. The
legal prescription drugs that make up the fastestgrowing part of the
pharmaceutical arsenal like Prozac and Ritalin are, for the most
part, tailored not to offer release from everyday consciousness but
rather to provide support for it.

A social theorist would explain the popularity of these drugs by
pointing out that they efficiently transform malcontents and misfits
into docile employees and sedate schoolkids. An economist would note
that they provide our costcutting health system with cheap
alternatives to longterm therapy. Anyone with a humanist
philosophical bent including authors like Peter Kramer ("Listening
to Prozac") and Kay Redfield Jamison ("Touched With Fire") will
wonder whether they don't provide a superficial fix for deeper
existential concerns while cutting off the roots of artistic
creativity in human discontent.

And yet a person who has been genuinely helped by such drugs say,
someone who has found real relief from the horrors of chronic clinical
depression might hear all these objections and respond, who cares?
Whatever else you can say about them, these new drugs, like the
consciousnessaltering drugs celebrated by the '60s generation, have
gained wide acceptance because they work. For some sufficiently high
percentage of the population, they do what people expect them to do.

Our problem with these drugs is that we don't seem to know when to
stop prescribing them. Prozac and similar antidepressants can plainly
help a lot of depressed people. But tens of millions of people? Are
there really that many depression sufferers or has the desire to
squeeze profits from expensive new drugs inspired a stretching of the
definition of fullblown depression to include virtually any
bummedout situation? And what about the increasing prescription of
these drugs for children?

No matter how narrowly drugs like these are targeted at specific
chemicals in the brain and no matter how few sideeffects they may
induce, they are still serious stuff. They deserve to be distributed
with the kind of attentive care doctors are supposed to provide every
time they write a prescription. But these very same doctors are under
pressure from the HMOs paying the bills; a quick drug regimen is a lot
more costeffective than the slow, uncertain progress of serious
therapy (sometimes, true, it's also simply more effective).

As the drug companies roll out wave upon wave of new pills
promoting them in TV ads worded with discreet care to stay inside the
law our societal dependence on drugs is only going to accelerate.
As it does, here's a useful exercise for us all: Take Weil's
guidelines for a "good relationship with drugs" and apply them
collectively. Are we, as a nation, honest with ourselves about our
drug use? Do we get the "useful effects" we seek, or are there
diminishing returns? Are there adverse effects on our collective
health? And can we stop any time we want to?
July 14, 1997