Drug

There’s an interesting article on the New York Times website: Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy (March 5, 2011). The essence of the article is that psychiatrists no longer engage in talk therapy to any great extent, but instead prescribe behavior-altering drugs. What’s interesting about this is that the author, Gardiner Harris, seems almost surprised at this “discovery.” In fact, the change from talk to pills occurred decades ago – during the 70’s I would say, and was more or less complete by 1980. ...

This post was edited and updated on June 29 2014, to include additional thoughts. . . . . . . . . . . . . . . . . A Rational Policy on Drugs and Alcohol In my last post I argued against government prohibitions against drugs and alcohol. My position is that substances such as cocaine, heroin, methamphetamines, etc., should be legal in the same way that alcohol and tobacco are today. I believe, however, that the distribution and marketing of these substances should be brought under direct government control. All of the commonly abused addictive substances are dangerous, and they have taken - and continue to take - an enormous toll on society. This cost includes lives, health, lost opportunities, money and general suffering and anguish. But it’s difficult to put old heads on young shoulders, and it seems that each generation - indeed each individual - has to learn these lessons anew. I don’t believe we can ever eradicate substance abuse entirely. ...

In my previous post on this subject, I discussed addiction to alcohol and other drugs. I made the point that addiction to these substances is not an illness, but rather an extremely strong habit. Treatment Programs The notion that alcoholism is a disease gained popularity in the 50’s and 60’s. At about the same time, employers were beginning the practice of offering medical insurance to their staff, and insurance companies routinely included 30 days of treatment per year for alcoholism and/or drug addiction. At the time, there were very few treatment units for these problems, and little use was made of the drug and alcohol provisions in the insurance policies. ...

The APA’s DSM lists two broad categories of diagnoses in this area: dependence and abuse. So we have alcohol dependence and alcohol abuse; amphetamines dependence and amphetamines abuse; cocaine dependence and cocaine abuse. And so on. Dependence is defined by the presence of three or more of the following criteria: tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication or desired effect markedly diminished effect with continued use of the same amount of the substance withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the substance … the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms the substance is often taken in larger amounts or over a longer period than was intended there is a persistent desire or unsuccessful efforts to cut down or control substance use a great deal of time is spent in activities necessary to obtain the substance… use the substance … or recovery from its effects important social, occupational, or recreational activities are given up or reduced because of substance use the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance … Abuse is defined as one or more of the following: recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home … recurrent substance use in situations in which it is physically hazardous … recurrent substance-related legal problems … continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effect of the substance … Let’s consider alcohol dependence, which to all intents and purposes is what most people would refer to as alcoholism. A person who drinks, say, half a bottle of whisky every day, who never appears particularly drunk, who becomes extremely sick if he stops drinking, who has made numerous unsuccessful efforts to quit, who has incurred some liver damage, and whose social life has been severely curtailed because of drinking, would normally be called an alcoholic. Some people prefer the term addicted and would describe him as addicted to alcohol. DSM would say that he has a mental disorder called alcohol dependence. The problem with all three terminologies is that they encourage us to blur the distinction between a description and an explanation. This distinction is the central theme of this blog. ...