Addiction, dependence & the ‘4th Drive’
“Addiction is not a chemical reaction. Addiction is an experience – one that grows out of an individual’s routinized, subjective response to something which has special meaning for them – something, anything that the human finds so safe and reassuring that they cannot be without it. If we want to come to terms with addiction, we have to stop blaming drugs and start looking at people, at ourselves, and at what makes us dependent. Addiction is not an abnormality in our society, it is not an aberration from the norm - it is itself the norm.” Michael Gossop, ‘Living with drugs’
The original Latin meaning of addiction was bound or surrendered to; by the time of Shakespeare it had also come to mean devoted to and by the Victorian age, it had been defined as simply meaning lacking character. The concept of physiological or metabolic addiction, as opposed to the idea of over-indulgence or moral weakness, evolved from the mid-eighteen hundreds. It remains a commonly used, albeit poorly defined term which can carry considerable stigma (indeed, addiction has been demonised in the recent past as a form of possession – albeit resulting from an evil substance rather than an evil spirit). Nonetheless, it continues to be used as a descriptive term by many people, including politicians, journalists, professional drug workers and by some drug users, most notably those involved in or influenced by the Recovery Movement (Fellowship/12 step programmes).
The 2007 RSA Commission report on illegal drugs points out that “any culture that celebrates individualism, free will and independent self-hood is liable to regard loss of control as an iniquity and a threat”, and considered within this context, dependence is not a neutral term either. It is considered to be more precise one, however, as it can be separated into its physical and psychological components. According to a 1997 government report, “Drug dependence describes a compulsion or desire to continue taking a drug in order to feel good or avoid feeling bad. When the compulsion is to avoid physical discomfort it is physical dependence; when it is to avoid anxiety or mental distress, or to promote stimulation or pleasure, it is identified as psychological dependence.” The World Health Organisation defines the dependence syndrome as:
o A subjective awareness of the compulsion to use a drug or drugs, usually during attempts to stop or moderate use
o A desire to stop in the face of continued use
o A relatively stereotyped drug habit (i.e. a narrowing in the repertoire of drug taking behaviour)
o Evidence of neuro-adaptation, tolerance and withdrawal syndromes
o Use of the drug to relieve or avoid withdrawal symptoms
o The salience of drug-seeking or using behaviour relative to most other important priorities
o A rapid re-instatement of the dependence syndrome after a period of abstinence
However, the fact that the pharmacology of a substance defines only part of its action is also explicitly acknowledged by the WHO in its recognition that “social and cultural factors influence the effects of a substance on a person and the outcome of substance use” and, similarly, it is worth noting that tolerance and withdrawal symptoms are themselves not in fact exclusively drug-related experiences, and can be an aspect involved in any experience or activity the human being identifies as pleasurable. Indeed, the paradox at the heart of the pleasure principle is that pleasure has to be respected if it is to be sustained.
Alcoholism was once seen primarily as a sin and a vice (and still can be); it is now more frequently seen as a disease. This polarisation of attitudes is extremely unhelpful – the moral viewpoint underestimates the extent to which alcohol can become a central feature of someone’s life and, because of this, it also underestimates the difficulties inherent in an individual’s attempt to stop drinking. The disease conception encourages a view of alcoholism as a specific illness over which the individual has no control, thereby ignoring the active role that he/she actually plays in determining his/her own drinking behaviour.
The 4th drive
Drug use is neither a modern phenomenon nor one limited to human beings. Many species have, somewhere in their varied diet, a substance that satisfies (what appears to be) an innate urge to get ‘high’ and there is considerable evidence that animals can display “addiction to pleasure behaviour”, i.e. Abyssinian goats and coffee beans; Yemeni goats and Khat; various animals in tropical Asia and Snakeroot; Hawk moths and the nectar of the Datura plant; Siberian reindeer and fly agaric mushrooms; cats and the perennial herb cat-nip; primates, birds, rodents and tropical fish all display similar behaviours. Experiments with rats and cocaine show the lengths the animal will go to in order to self-administer a dose of the drug, often forfeiting food in the process. However, if the animal is living in a comfortable, varied environment, with other rats as company, it will self-administer the drug at less frequent intervals while continuing to socialise, play, eat and drink.
After hunger, thirst and sex, the need to alter consciousness is, according to Siegal, “the 4th drive” of sentient life.
“The desire to experience some altered state of consciousness seems to be an intrinsic part of the human condition, and the persistence that people have shown in pursuit of this goal is as remarkable as the diversity of ways in which they have sought such altered states. This same diversity is shown in the range of different types of drug taking. Whether taken alone or in company, for relaxation or stimulation, to satisfy some personal need or to comply with social pressures, we are surrounded by drugs, some more visible than others – the cups of coffee and tea, the glasses of beer, win, vodka and whisky, the chocolate bar, the cigarettes, the snorts of cocaine, the joints, the tablets of ecstasy, the hits of heroin, and the ubiquitous tranquilizers, anti-depressants and sleeping pills. While it may be true that every drug-induced state has its counterpart in a state of mind arrived at without drugs, the use of a substance still remains one of the most immediate ways of altering psychological states; for some people, the ease and immediacy with which drugs achieve their effects proves particularly seductive.” - Dr. Michael Gossop
“If we cannot abolish a single cause of human desperation, we don’t have the right to suppress the chosen means of escape.” - Antonin Artaud
