DRUG ABUSE and the NEED for a BALANCED LIFE

It has been said that in an accurate description of a problem lies an embedded solution. This is particulrly apt when applied to understanding the nature of drug abuse and effectively treating it.

Ever since my first professional job as a psychologist in 1967 at Odyssey House, an innovative therapeutic community for the treatment of heroin addicts, I have witnessed the so called war on drugs poking along just short of floundering.

Although there have been some important medical and psychological interventions {i.e.methadone and twelve steps} generally they have not been enough to significantly stem the tide of drug abuse. Why not?

In my opinion, the failure to win the war on drug abuse has to do with focusing in the wrong direction. There is an over concern to identify the surface symptoms and too little concern for identifying the core problem underlying the symptoms of drug abuse.

We have known for a long while that drug addicts suffer from an intolerance to psychic pain depending on  their drugs to avoid directly experiencing it.

While this knowledge is accurate the problem is how to connect with the addict in such a way that he can eventually use this information to his/or her benefit.

Into this mix I have recently observed a new trend that holds out a promising approach to potentially reaching this diffcult to reach population.Utilizing this point of view  enables the helper {therapist, counselor, good parent}  to connect in a way that is reasonable, fair, and respectful of the abusers' experience, thus empathic.

I am referring to a class of drug abuser who - in addition to majoring in their field of choice in college - also majors in a non credit elective field of pharmacology. Such patients are characterized as highly intelligent, have a keen sense of cause and effect, are conflict and pain intolerant, equate freedom which they crave with license, believe that it is possible to have a pain free life, and spend much of their day mixing and matching various drugs to regulate a sense of balance.

One such patient - who although having the capacity to be an outstanding student - came into treatment nearly dying from a drug overdose combined with an absolute unwillingness to go straight. This attitude remain entrenched despite the fact that he had been the 'successful' graduate of a tough love program a few months before entering treatment with me.

He soon revealed the truth that although he hates the idea of being forced into a program or jail - if given the opportunity he would spend the rest of his life getting high. I would suggest that such cliche statements as getting high on life will be met with derision and complete rejection.

So what to do? What  is the assumed underlying core problem?

Fortunately this man has been unusually articulate in his description of what makes him tick. It has become apparent that his view of reality - of normal living - is that he has been thrust into an unwanted perpetual war in which he has adopted the self appointed role of a "warrior."

The warriors' major preoccupation is to protect himself and  in finding sources of pleasure to make being a warrior worth it. To this end he needs weapons of which drugs have been his ammunition.

Additionally as he experiences a variety of threats, he has needed to become as knowledgable as possible about the whole spectrum of drugs to adequately protect himself. Examples of  threats that call for different ammunition are: (l) a need for a specific drug to help him stay up all night to cram for an important test; (2) another drug is needed to enable him to take the test feeling alert and relatively calm; (3) after the test is over he needs another drug to bring him down so he can feel relaxed enough to want to go on a date; (4) then he needs still another drug to reduce his social anxiety  permitting him to have a successful sexual experience if only not to disappoint his date; and (5) he needs still another drug to induce sleep.

In discussing this need for balance he said that  when he asked any pot heads reason for smoking pot all day the answer has typically been :"to balance me out."

Similarly I have noted that when drug abusing patients were presented with the following list of ego states and asked to rate their experience of them I have predictably gotten back a universal response of some form of 'I hate them all.' This list includes their experience of: anxiety, depression, most importantly frustration, ambiguity, weakness, not knowing, complexity, and ambivalence. At the first hint of any of these feeling states creeping into consciousness - there is an automatic craving to pop a pill, shoot up, or smoke some substance. To experience these states is to run the risk of being be knocked off balance.Most dreaded is the feeling of being overwhelmed by feelings over which they have no control.

It is evident then, that all of this pharmacological knowledge is in the service of helping this particular patient obtain, regulate, and sustain a sense of personal psychological and physiological balance.

Having majored in philosophy I have noted that his major purpose in life - the regulation of his sense of balance - is precisely the same goal of the revered ancient speculative philosophers including Socrates, Plato, Aristotle, and Spinoza.

These philosophers spent their entire lives distilling their knowledge in an effort to formulate pathways to attaining and sustaining the "good life." Briefly, Socrates formula was to "know thyself. " Plato's formula is to "have a sound mind in a sound body." Aristotles' formula is to discover ones personal balance point {"the golden mean.}

While the drug addicts goal is the same as these speculative philosophers - attaining, regulating, and sustaining a sense of personal balance - the means of acheiving this goal are significantly different.

The drug addict attempts to regulate balance by an exclusive reliance on manipulating various chemicals. The means advocated by the philosophers (and their followers) rely on the power of reason to discover a way of organizing personal chaos by processing the raw data of experience through psychological organizing structures. {Generating a life of meaningful connections}

Translated into working with drug abusers the experiences with this drug addict strongly suggests that the point of maximum focus be the identification of a clash of normal developmental principles. These principles are (1) the pleasure principle: I want what I want when I want it and want no opposition from myslef or the outside; versus (2) the reality principle which incorporates the pleaure principle but recognizes that whether one likes it or not there are inevitable internal and external limitations that are experienced as conflict that calls for resolution.

In this view one can try to maintain the illusion of an uncomplicated conflict free existence but will be doomed to inevitable disappointment; or, one can bite the bullet of accepting complicated often painful reality  learning to be an effective problem solver.

In this view - the drug abuser is not morally wrong, or bad, or even self defeating. He is, instead, suffering from experiential tunnel vision. The drug abuser really believes that he can have a conflict free life by regulating his internal experience with an exclusive reliance on the way drugs work for him individually and collectively.

Returning to philosophy - Spinoza makes it clear that the quality of our lives is determined by the concret choices we make. And with each problem we choose an easy or a hard way. In this perspective drug taking is the easy way that inevitably results not in more freedom but in ever increasing restriction.

Spinoza states that the key to the good life is accepting the inevitable limitations as problems to be mastered: stating  "all excellent things worth attaining are as difficult as they are rare." This pathway is an acceptance that the good life is attained though a continuing struggle with struggle.

The drug addict's point of view must be respected but challenged. He will resit all attempts to take away his drugs - the only means by which he keeps balanced thereby terrorized by the fear that he will be overwhelmed with psychic and physical pain feeling totally out of control. His fears are justifiable. What he is not aware of is that if he switches his attitude of avoidance of inevitable  pain and limitations to one of acceptance and  tolerating it,  he will eventually experience the delicious experience of self mastery.

In sum it is my experience that the core problem underlying drug addiction is an incohesive self and weak ego - one that uses an exclusive reliance on drugs to maintain the normal need for a sense of personal balance. The solution is providing those just right conditions for enabling the self to grow spontaneously. This just right atmosphere accepts the drug addict where he is - inducing him to become aware of alternative pathways - helping and encouraging him to gradually tolerate increasing dosages of  negative affects which he desperately tries to avoid experiencing head on. In short the treatment provides an opportunity for the drug addict to "grow up" in an atmosphere that is fair, reasonable, respectful, empathic, and realistic.