April 20, 2023 by Donald Gorassini, howinfluenceworks.com
In this blog, I begin to examine what can be learned about social influences on the brain by taking a look at psychoactive drug-taking in society. A psychoactive drug is one that changes thinking, feeling, or behaviour in some way. In this process, the brain is being changed. An examination of psychoactive drug-taking reveals the nature and strength of social influences on the practice.
There are four domains of psychoactive drug use: prescription medication, over-the-counter substances, recreational substances sold legally, and substances sold illegally. Each domain arises under specific conditions and exerts a unique form of social influence and resulting pattern of psychoactive drug-taking behaviour. In this article, I will describe, for each domain, what it is, what maintains it, and what form of psychoactive drug-taking it promotes.
This exercise addresses some interesting issues. In what ways do people influence the psychoactive drug use of other people? Who are the sources of influence? How do the sources gain the power in the first place to influence the psychoactive drug use of other people?
Domains of Psychoactive Drug-Taking
The process of social influence that leads to psychoactive drug-taking within a given domain is sketched in the diagram below. Each of the psychoactive drug-taking domains was invented to solve a real life problem. For example, the prescription drug domain solves the problem of how to help sick and injured people deal with issues such as pain. Implementing the solution always depends on the contributions of several sources. In the case of pain management, medical, commercial, scientific, and other sources would be called on. Each source will participate if its own purposes are fulfilled in the process. For example, physicians would participate because their purpose is to treat the sick and injured. The sources’ efforts blend to create a drug-taking environment. Actual drug use by relevant recipients corresponds to the type of drug use that is promoted by that environment.
Below, for each of the four psychoactive drug-taking domains in society, I describe the real life problem solved by the domain, the groups that help apply the solution, how the group contributions blend to promote a particular kind of psychoactive drug-taking, and the actual nature of the drug-taking that results. From the analysis, it is clear why the drug-taking behaviour that is characteristic of a particular domain develops as it does and why it differs across domains. I also focus on one of the most important consequences of psychoactive drug-taking, substance abuse. The four sections are ordered according to increasing probability of such abuse.
Prescribed Medications
Prescribed psychoactive drugs are given for conditions serious enough to require medical care. Pain, delirium, depression, anxiety, mania, schizophrenia, anorexia nervosa, and attention deficit hyperactivity disorder are among the more common conditions for which a doctor might prescribe such medications. Prescriptions are written within the context of the doctor-patient relationship. The domain would have been invented in a creative moment in response to an imperative, such as, “how do we help these sick and injured people deal with clinical pain?”, and developed from there.
Groups that could help with the solution would learn about the possibility. A candidate group would contribute if its purpose could be served. The prescription drug domain provided a way for the medical profession to provide patient care, a pharmaceutical company to make a profit, science to discover and apply methods for treating a condition, patients to obtain relief, families and friends of patients to help the patients obtain relief, governments to serve citizens via regulation and monitoring, and any other group that could help the system function while advancing its own agenda (insurance companies, World Health Organization, information technology professionals).
The sources in place would find a way to coordinate their respective contributions into the organized system we know today as the prescription drug domain. This has developed over many years of experience and innovation. Sources both enable and set limits on each other. For example, pharmaceutical companies get to make a profit but must yield to doctors’ prescribing decisions.
The coordinated activities of sources creates an environment that serves to promote a certain type of drug-taking behaviour. In this environment, only drugs that treat disease and injury are used, care is taken to prevent drug abuse, drug side effects are kept to the minimum possible, many profitable psychoactive drugs are used (antidepressants, analgesics), research and development is ongoing, there is a scientific literature that informs prescribing, the drugs are administered within a doctor-patient relationship, and patients’ families and friends can participate in the process.
This environment constrains drug-taking behaviour. The patient takes the drugs chosen by the doctor. The patient is expected to follow the prescription for best results. The patient is suffering from an illness and so has an incentive to follow the prescription. The prescription has a time limit. For persisting maladies, the patient will likely be required to participate in follow-up appointments and perhaps be issued new prescriptions.
Prescribed medications are the least likely abused. It is easy to see why this is so from the nature of influence in the prescription drug domain. Patient care is an overriding concern. Prescribing is regulated by the government and the medical profession. There is a scientific literature that provides pertinent data and theory. The drug maker imposes quality control. There is doctor training and expertise. There is patient monitoring and followup. The patient’s family and friends provide invaluable support. Things can go wrong and addiction can occur but the system is meant to minimize negative effects on the patient and provide the best therapy possible.
Over-the-Counter Medications
Commercial outlets offer over-the-counter (OTC) substances. These drugs, many with psychoactive properties, can be purchased at the local pharmacy without a prescription. The substances are meant to restore a particular state, for example, reduce pain, and in this way are similar to prescription medications. The substances are much in demand. The patient’s symptoms are not significant enough to require the attention of a doctor, but problematic enough to warrant taking the substance. OTC drugs for pain relief are a big seller. Other examples are substances that suppress hunger, improve mood, and increase energy.
The invention of an over-the-counter arrangement created opportunities for several groups to advance their agendas. Pharmaceutical companies could make massive profits. Pharmacists could provide humane products and make a living. Government regulators could fulfill an obligation to citizens to insure the drugs would be safe. Scientists could help improve the remedies and advance knowledge. Consumers could readily obtain these useful remedies and administer them to themselves and their children.
The way that the various sources work together is what we know today as the OTC domain. Substances, including psychoactive substances, are made available directly to consumers. The substances tend to have restorative applications. Selling the drugs is regulated by the government and the pharmacist profession and subject to quality control by the manufacturer. The drugs tend to be safe. Ingredients are known and amounts standardized. Selling the drugs is a highly profitable enterprise. There might be research and development for a particular drug. Guidance on how to use the drugs is readily available. There is a high demand for the drugs. The consumer decides which drugs to purchase and use. The remedies can be obtained quickly. Using the substances is widely accepted in society.
Given these influences, drug use and its consequences take a particular form. The drugs are beneficial; for example, countless numbers of people benefit from OTC pain remedies. For the most part, OTC drugs are not misused, do not result in addiction, and do not have serious side effects. This is not to say there are no problems. Some OTC substances are abused and, under certain conditions, an OTC medication can result in severe side effects. It is normally recommended that one’s doctor be apprised of the over-the-counter medications being taken.
Recreational Substances Sold Legally
I restrict this category to legal psychoactive substances. Commercial outlets sell alcoholic beverages, marijuana, tobacco, nicotine vapour, coffee, and tea. The substances are popular for their psychoactive properties, and whereas prescription and OTC drug use is designed to restore the person toward a normal state, recreational drug use is designed to enhance beyond a normal state. This can include a better than normal mood or a greater than normal mental capacity.
The invention of the recreational psychoactive drug domain provided a structure for many sources to advance their agendas in an overall effort to make the drugs available to any citizens of legal age. Companies could make lucrative profits. Governments could sell the products in order to generate revenue. Governments could contribute to citizen safety through regulation and inspection. Consumers could gain access to the substances they desired.
The blending of efforts of the various sources is what we know today as the legal recreational drug domain. The environment provides certain encouragements and restrictions on drug taking. The drugs are readily available. The drugs are primarily for recreational use. Consumption of the drugs by adults is accepted in society. Drug choice, dosage, and frequency of consumption are left to the consumer. Manufacturing is subject to quality control. The drugs must satisfy some government regulations. Ingredients are listed and their amounts standardized. The drugs can have serious health effects. Some of the drugs are addictive.
The legal recreational drug system determines the nature of drug-taking behaviour. Besides offering unlimited amounts of the drugs, the system affords complete freedom over how the drugs will be taken. Many people enjoy the psychoactive effects of the drugs that are offered. These are well known. Some people suffer negative effects, some quite severe, including addiction, fetal complications, emphysema, cancer, and problems of adjustment. A common problem with some of the recreational drugs is that their harmful effects remain undetected for some time and, when discovered, are difficult to reverse. Abuse of the drugs also creates social problems (e.g., impaired driving, family breakdown).
Despite these dangers, the drugs are legal because they have many effects people like and their harmful effects are known and can be avoided. The consumer is given the freedom to choose whether and how to use the substances. The reality is that a great deal of enjoyment and a lot of abuse and ill-effects occur.
Substances Sold Illegally
Drug sellers, acting illegally, provide drugs of many kinds. These drugs are almost exclusively psychoactive in nature. Among the drugs commonly sold are opiates, amphetamines, and hallucinogens.
The invention of the illegal drug strategy offered a structure for several sources to fulfill their goals. Criminal organizations have access to products that are easily made in bulk at low cost and they have expertise in all phases of the enterprise, including manufacturing and distributing the products. Selling the drugs is highly profitable. Most of the drugs (heroine, ecstasy, cocaine, methamphetamine) are not distributed in the other domains. Significant numbers of people will buy and use the drugs. Individuals, often fellow drug takers, and groups that support an illegal drug-taking subculture exert supportive influence in this realm. Government agencies attempt to enforce laws meant to disrupt the illegal drug business.
The blending of these sources creates the system we know of today as the illegal substance domain. The environment promotes a certain type of drug-taking behaviour. Criminal organizations supply drugs, many of which have enhancing psychoactive effects of an extreme sort. Most of the drugs cannot be purchased in the other domains. Many of the drugs sold are highly addictive. Many of the drugs have harmful side effects. Some of the drugs produce overdose. The ingredients and their amounts are usually unstandardized and assumed on faith by the user. Users could be robbed when trying to make a buy. Law enforcement organizations interfere with the illegal drug enterprise. Making, distributing, and using the substances brings the risk of legal prosecution.
Drug taking behaviour and its results have a distinct pattern in the illegal drug domain. Depending on type, the substances can produce euphoria, confidence, a lifting of apprehension, deep relaxation, extreme energy, feelings of love for humanity, clear thinking, and insensitivity to pain. The substances can also avert the agony of withdrawal in users who have become physically addicted. Illegal substances also have very serious consequences, which depending on the substance and how it is taken can include volatility, paranoia, delusions, hallucinations, delirium, and insomnia. Of all the domains, the illegal substance domain has the highest rates of addiction, the highest rates of illness, the highest rates of overdose and death, the most frequent, severe, and varied side effects, and the most problematic results for society (e.g., health costs, crime, family break-up, destruction of neighbourhoods).
When Things Go Awry
The drug-taking domains differ widely with respect to the drug-use that occurs within them. The above examination provides several clues regarding why some of the domains but not others produce significant amounts of drug abuse. Here is what seems to be going on:
A supply niche for a particular type of psychoactive drug emerges to meet a demand. All of the domains are identical in this respect. Where they differ, and each one is unique, is in the nature of the supply niche that is created, medical, OTC, legal recreational, and illegal. Problems occur when a demand is met with supplies of potentially dangerous substances. This is the case with legal recreational drugs and especially the case with illegal substances. It is not the case with OTC drugs and is especially not the case with prescription medications. A domain would not exist if either its supply dried up or there was no longer a demand for its substances.
Creation of a supply niche is very much a human project. It relies on the creativity, commitment, and altruism or wickedness, as the case may be, of the individuals who create the entity. If the lesson of the drug domains is any indication: if there is sufficient demand for a type of psychoactive drug, a supply niche will materialize to serve it.
Summary
This blog has focused on the social influences that underlie psychoactive drug-taking behaviour. In response to imperatives, a domain of psychoactive drug taking is invented and develops. The domain serves the interests of several groups, which blend to create an environment in which a type of psychoactive drug use is promoted. Targeted consumers of the drugs use the substances according to the requirements of that environment. The four domains of psychoactive drug use discussed in this blog were invented in response to different imperatives, attracted different sets of sources, promoted different types of psychoactive drug taking, and accordingly resulted in the types of drug-taking promoted.
In a future blog I will conduct a similar analysis of surgical and noninvasive brain changing procedures as I have done here with respect to drugs. The goals will be to account for the current state of application of the techniques and to predict future uses and possible abuses.
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