Skill at Substance Use

We don’t ordinarily think of substance use as involving skill.  But the concept of skill at substance use is essential in treatment, harm reduction, and prevention.

The Pre- and Modern History of Substance Use

There are two large framing “events” for the idea that substance use is a fundamental part of human experience — and thus that competency in such use is an essential life skill.  The first is the ubiquity of alcohol in human societies.  According to University of Pennsylvania bio-archeologist Patrick McGovern, every early human society shows evidence of the fermentation of alcohol.  McGovern postulates that alcohol was fundamental to the development of music, art, and religion and is thus imbedded in the DNA of human civilization.  Moreover, he and other archeologists believe, the need for crops for the purpose of producing beer led to farming, towns, the wheel, accounting, etc.

Moving to the other end of the spectrum of history — the present — we are now in a period of infinite creation of synthetic psychoactive substances.  These can neither be tracked, nor regulated.  (See “EU Agency: Number of synthetic drugs keeps rising.”}  At the same time, our most successful athletes (a la Lance Armstrong) often rely on chemical aids to achieve success and acclaim.  Finally, we are moving to a time when young Americans are more likely to be prescribed psychiatric medications than not to be.

At the same time, historic drugs of abuse (e.g., opiates, cocaine) are now in the process of being replaced by synthetic narcotics and “speed” drugs (e.g., methamphetamines) whose potential power is unlimited.

The Current Level of Substance Management Skill

Because of its ubiquity, alcohol users have developed the widest panoply of skills for managing drinking, as represented by Southern European societies’ development of healthy drinking practices as a basic social model for alcohol use.

Of course, synthetic drugs do not enjoy such broad-based social support for moderate, sensible, and safe use.  Nonetheless, informal channels rapidly develop around popular new drugs, as occurred with the use of ecstacy at raves. While dire warning are regularly issued about such drug use, users themselves learn, and teach others, to hydrate, avoid exhaustion, and not to mix other drugs that might combine in dangerous ways with their primary rave recreational substance.

We may wonder how such education will occur for those who are prescribed psychiatric medications (like those used for ADHD and bi-polar disorder, antipsychotics, et al.).  Oddly enough, it seems like users of these drugs receive the least education about how to manage their usage and drug effects.+

Finally, there is a failure in the United States to contemplate assisting illicit drug users to successfully manage this use — as in the seemingly perpetual resistance to providing injecting drug users with clean works in order to avoid HIV and other infections.

Basic Substance Use Skills

1.  Moderation.  Obviously, knowing how to avoid addiction is a fundamental skill for substance users.  At one time, it was thought that alcoholics could be taught to drink socially via behavior therapy.  That idea is in disrepute.  Nonetheless, teaching social-drinking skills is a primary technique in secondary prevention (as in Alan Marlatt’s program for college students).

2.  Harm reduction.  Even drinkers or users of other substances not able to moderate are able to learn harm reduction skills, such as to avoid driving, dangerous environments, and risky behaviors while drinking or using.

3.  Not confusing identity with substance effects.  One of the trickiest elements for users of psychiatric medications — particularly the growing legion of medicated youths — is to maintain their awareness of a true self beneath, or outside, the effects of drugs.  Of course, some drug advocates (such as Peter Kramer) urge people to sacrifice their identities to their prescribed medications.

If people will use substances — and they always have and always will — they must learn and know how best to use them.

+ “Parents’ fears that labeling kids will hurt their self-esteem means that many young children don’t understand why they take pills at all, or what the drugs are supposed to accomplish.  Teens must try to figure out whether intense emotions and risk-taking behavior fall within the spectrum of normal adolescent angst, or whether they represent new symptoms or drug side effects.”  Kaitlin Bell Barnett, “Dosed: The Medication Generation Grows Up.” Boston: Beacon 2012.  Bell herself started on antidepressants as a teenager.