issue 224 - October 1991
COLIN DAVEY / CAMERA PRESS
I want it now
Trevor Turner hits the endorphin button to find the
addiction that lies behind the pleasure principle.
A leading footballer once described his habit of spending hours kicking a football against a lamppost as being ‘like a drug’. He could have said it was like driving too fast or eating chocolate – behaviours much more commonly addictive than the complicated business of shooting adulterated opiates into a battered vein – but that would not have served his purpose.
Perhaps we should ask a more pointed question: what deters more people from getting into drug addiction? After all, the principle is pleasure and few on this planet are beyond its appeal.
Theories as to why people take drugs usually begin with biological and pharmacological analyses. Convinced ‘mechanists’ in fact regard such theories as entirely sufficient. Forget the social and psychological wrapping, they say, let’s talk about endorphins, encephalins and the ‘hard data’. The human brain has a complex system of pleasing itself. Morphine-like substances (‘endorphins’) are released by all sorts of stimuli. Endorphins kill pain, induce euphoria and stop your gut churning.
But most people given opiates, for pain relief after surgery for example, do not become addicted. Over 80 per cent of GIs returning from Vietnam had opiates detected in their urine but most did not go on to ‘regular abuse’. In other words, it may well be that addiction to opiates is just a lack of natural endorphins – that ‘addicts’ are merely self-medicating and that this replacement therapy is no different from giving hormone or vitamin supplements to those with established deficiency diseases.
By extension this theory suggests that hobbies or habits – climbing mountains, racing cars, running marathons, balloonatics – are endorphin stimulating. And as with the tale of Shangri-La, once you have been to heaven (or ecstasy, oneness with the world, utter peace or what you will) you spend your time trying to get back there. Little kicks or big kicks, once you hit the endorphin button you repeat and repeat.
MARK EDWARDS /
This model is godless and includes the idea that religious conversion is a kind of ‘endorphin storm’ in a social context of intense stress and group fervour. It extends to psychological theory. The sheer pleasure of drug taking – and addicts are as sensitive to the quality and purity of their drugs as connoisseurs of wine or whisky – acts as a reward in itself. If there is further reinforcement in terms of social acceptance or peer encouragement, then it becomes a learned habit of personal analgesia.
Alongside are the processes of craving and decision-making. If it is more painful to face the longer-term implications of dependence, then people are bound to prefer to satisfy their craving.
Such decisions are strongly reinforced by market economics. ‘It’s a hit’, screams the advertisement for Coca-Cola. ‘I can see clearly now, the rain has gone’, goes the song for a Nescafé commercial. ‘Happiness is a small cigar’, intones the Hamlet voice-over. The craving associated with thirst and hunger pangs is considered normal, and is well understood by the fast-food industry.
Yet some people regard addiction as a form of psychiatric illness, a disease that can be cured by treatment. For example there have been numerous attempts to define some sort of ‘addictive personality disorder’. While addicts are often smarter and more neurotic than average, so are psychologists and actors and a lot of other people. Addicts are said to show more ‘hostility’ and ‘intropunitiveness’, which is to say they are more readily angry with the world and themselves. But these are hardly firm features of something psychologically distinct. After all, the most common cause of irritability in hospital patients is bladder distension, but being unable to pee is hardly a diagnosis.
Addicts rarely have defined psychiatric disorders even when drug-free. More to the point, the speciality of drug dependency is poorly regarded in professional circles. Consultant posts are hard to fill with suitable appointees – an indication perhaps of the false medicalization of the problems of addiction.
Then there are the things we can all take a view on. These are the ‘deep-money veins’ (to quote Martin Amis) that stir the blood. We can say, for example, that addicts are more often male, adolescent or in their twenties, and derive from urban minority groups. Broken families and parental alcoholism are typical. Delinquency usually precedes drug use, which points to a common behavioural style rather than the floppy belief that addicts only steal because of their condition.
The cheaper the supplies of drugs are, the more people use them. Hong Kong, where opiates are cheap and plentiful, has an addiction rate of about 10 per cent; in the UK, where they are expensive and banned, it is less than a half of one per cent. By definition there are no alcoholics in Saudi Arabia and there used to be no drug addicts in Eastern Europe.
Out of this data base two main sociological theories emerge. Durkheim’s anomie has popular appeal amongst the chattering classes, proposing that deviant behaviour is a retreat for those who have failed in society. Alongside that has come ‘deviancy amplification’, wherein society establishes an agreed nonconformist group who attract to themselves a ‘deviant cohort’. Controls lead to increased awareness, and thus recruitment of further deviants.
This reflects one of the most telling statements I have heard from an addict, describing the effects of anti-heroin advertising. He said that he knew, at once, that he just wanted to be like them, to be an addict. He liked their appearance, their pallor, their thin, pinched faces, their lifestyle and their separate identity.
It is, of course, a thrilling life. Every day demands moments of action, a challenge somehow to obtain the drugs, with risks to be taken, a gauntlet to be run. It is hard work being an addict, and legal and medical controls enhance that atmosphere.
MARK EDWARDS /
It is also a phenomenon of modern times. Many have railed against tobacco, alcohol, cocaine and opiates for hundreds of years. But you could buy opium sticks at the corner shop in Victorian England – it took the twentieth century to outlaw them.
So why do people take drugs? Or rather, why do so many dabble in instant happiness? Some blame the families. ‘Shoot the parents and move the kid 3,000 miles’, said the oldest inmate of the US’s drug penitentiary at Lexington. Others like myself regard drug-taking as a marker of social discontent. The higher the rate, the more dislocated the society. Here the ‘problem’ becomes the US inner city and, like serial killers, there is a peculiarly American style about most of the problems of drug abuse.
Create an ‘I want it now’, queue-barging society and what do you expect? If your world is unrewarding, while images all around you glow with cheerful normality, what are you supposed to think? Aspirin sales are enormous, officially for headaches. Chocolate and coffee deliver caffeine for extra alertness. Tobacco and alcohol calm and stimulate to equal degrees. Most of these can be obtained from machines or in special ever-open stores because they are needed urgently. Newspapers tell of sex addiction, one-armed bandit addiction and news addiction.
This is akin to suggesting that addiction is an essential engine of high capitalism, the dark side of a demand- and consumer-led economy. By contrast, a truly cultured world has no need of that kind of buzz. When it comes to sheer personal indulgence every addict says one thing about opium, about morphine, about heroin: ‘There is nothing better to do’.
Dr Trevor Turner is a consultant psychiatrist who lives and works in the East End of London.