Drugs and Pregnancy

Women expose their unborn babies to harm by consuming drugs — any drugs — during pregnancy Many doctors now advise that expectant mothers take no drugs whatever during the first three months of pregnancy and as few as possible thereafter. Psychoactive drugs are no exception. In the 1960s thousands of badly deformed babies were born to women who took the sedative thalidomide, prescribed as a "safe" relaxant and promoter of sleep.

Recreational drugs can also be risky to the fetus, but in most cases the exact dangers are unknown. It is known that mothers who smoke cigarettes have more miscarriages and regularly give birth to babies that weigh less than normal, are more susceptible to respiratory infections, and die more frequently in infancy. Drinking alcohol during pregnancy also increases the rate of birth defects; unfortunately, no one can say what a safe intake of alcohol is for a pregnant woman.

Most of the drugs discussed in this book enter the system of the fetus and affect it in some way. For example, pregnant heroin addicts give birth to addicted babies who must be weaned off opiates in the first few days of life. Given these facts, pregnant women should make an effort to discontinue the use of all psychoactive substances until after they deliver. Even then, they should be careful if they breast-feed, because if they take drugs, their milk may contain high enough amounts to affect a baby. Smoking around an infant can also put drugs into its system, and babies are very sensitive to smoke of all sorts.

Psychiatric Problems

The most common acute psychiatric problem is panic. Typically, people will take a drug, feel it begin to work, and become convinced that they are dying or losing their minds. Panic reactions occur most frequently in people with little drug experience, especially in settings that encourage anxiety. A teen-ager who has never smoked marijuana and is pressured into trying it at a party with strangers is a good candidate for a panic reaction. People who are slipped drugs unawares, or who wind up taking much larger doses than they are used to, are also likely to panic. Panic can be very dramatic, making people agitated, helpless, incoherent, and sources of great anxiety to others. People in panic often use the anxiety they produce in others to fuel their own reactions.

Doctors have sometimes misdiagnosed panic reactions as episodes of psychosis and have prolonged them by confirming patients' fears of going crazy. People who are panicked need to be reassured and calmed down, preferably by someone with experience, such as a worker at a drug crisis center. They should not be given sedatives, tranquilizers, or other psychoactive drugs. A hospital emergency room may not be the best place to take people in panic, because it can produce more anxiety than reassurance. Most panic reactions will end quickly, provided they are recognized for what they are and not intensified by improper management.

Paranoia and "bad trips" are similar to panic reactions and are also mostly products of set and setting. They, too, will subside by themselves if left to run their course.

True psychotic reactions are occasionally triggered by drug experiences, but they are not nearly so common as panic reactions. Just as a first sexual experience, or going away from home to college, or losing a job can trigger psychosis, so can a stressful drug experience. A person who becomes mentally disturbed after taking a drug and who continues to be disturbed after the effects of the drug wear off should be seen by a professional.

Coming down from drugs ("crashing") presents special problems. People who rely on drugs to feel good may become depressed when the drugs wear off. Not only can this depression encourage frequent and abusive drug-taking, but it can also become a chronic psychological problem. Psychiatrists these days often see severely depressed patients who are heavy users of cocaine, and similar depression can occur with the regular use of any psychoactive drug. It is often a component of dependence on alcohol and downers, as well as dependence on stimulants.

Crusaders against drugs like to cite many other chronic psychological problems that are supposed to be drug-connected, but there is little evidence to support most of their claims. There does seem to be a pharmacological basis for the paranoia and hallucinations that occur in people who shoot amphetamines, and alcohol certainly can cause brain damage, producing distinctive losses of mental function. Heavy use of cocaine often causes personality changes in the direction of irritability, paranoia, and hostility. Major psychological problems may also go hand in hand with heavy consumption of other drugs, but whether they are direct effects of the drugs is seldom clear.

As an example, there has been much talk of "burn-outs" — young people who are supposed to be casualties of intense use of marijuana, psychedelics, and other illegal drugs. Certainly, there are people who wind up as aimless, confused misfits after using a lot of drugs, but what were these people like before, and what other factors played a role in the change? Many of them lived in communes, engaged in unusual sexual experimentation, or joined religious cults in addition to taking drugs. It is easy to blame the drugs, but evidence for their causative role is lacking.

An even better example of the false linking of a problem with a drug is the amotivational syndrome. As we have said, it makes much more sense to view heavy marijuana smoking as an expression of amotivation rather than the cause of it. Many amotivated people smoke a lot of marijuana, but so do many well-motivated people. Amotivated people would probably behave in other unproductive ways if marijuana were to disappear. The tendency to see disliked drugs as causes of disapproved behavior is understandable, but it is not valid scientifically and does not help solve the real problems associated with drugs.

Social and Behavioral Problems

Drug-taking can lead to a variety of problems with other people. Many drug users feel guilty about their habits and their guilt is often an obstacle to intimacy. Using illegal drugs automatically puts people into conflict with social authorities and with parents, teachers, and employers. One of the commonest sources of family tension today is the suspicion or discovery by parents that a child is using drugs. This issue is so emotional that most people are unable to deal with it openly. Often it creates a climate of distrust and misunderstanding that pervades every aspect of the family's life. Drug use may also isolate children from the mainstream of

I guess my drug of choice is wine. Two glasses of good wine put me in just the right state after a trying day. John drinks wine, too, but for getting high he prefers marijuana.

In the past few years, our different preferences in drugs have become a problem for us. My not liking marijuana separates me from John's closest friends and weakens our relationship. I don't think married people have to do everything together, but this is something important, and my inability to share John's highs bothers me. Also, I find I resent his smoking friends, since I'm the out sider, the "straight wife," when they are around. Yet I know that if I object, I will just drive him out of the house to get high with them elsewhere. — thirty-Hvc-ycar-oId housewife their peers, driving them into the company of other drug users and limiting their possibilities for balanced social interaction. Of course, children are not the only ones who encounter social problems as a result of drug use. Different preferences in recreational drugs are frequently a source of conflict in couples and can even result in breakups of marriages.

People who abuse drugs, whether legal or illegal, usually find themselves in social trouble on all levels. The alcoholic father who can't provide for his family and antagonizes his friends and coworkers is a classic example. The heroin addict who steals from a friend to buy his next fix is another. In fact, it is rare to find a drug abuser who does not provoke some degree of social conflict.

The drug laws in our society compound the social problems of people who choose to use illegal drugs. For one, illegal drugs are very expensive; buying them regularly can significantly drain a person's economic resources. Second, although casual users of illegal drugs generally obtain their supplies from friends, at some point the lines of supply connect to the criminal underworld. Heavy users are apt to be drawn into this sphere, especially if they begin to sell illicit substances to support their own drug habits.

The dangers of associating with professional drug dealers cannot be overstated. Many dealers handle large sums of cash, are heavily armed, and live in a paranoid world of rip-offs, busts, and informers. Those who grow or smuggle drugs on a large scale are also likely to be caught up in raids by police or Federal agents. The ugliness of drug dealing is a direct consequence of laws that criminalize the possession and sale of disapproved substances. Narcotics agents who enforce these laws sometimes behave as disreputably as the people they try to catch, violating civil liberties and recklessly employing violence to chase down "drug traffickers."

Unfortunately, major traffickers are seldom touched by the law, because they are usually rich enough, smart enough, and powerful enough to stay in business. Instead, drug-law enforcement falls disproportionately on small-scale dealers and users. In recent years, so much enforcement has been directed at these people that our court and prison systems are now overwhelmed.

Quite another sort of problem arises from associating with people who are intoxicated on drugs, whether legal or illegal. Intoxication increases the likelihood of accidents and trouble of all kinds. If you keep company and go out in public with drugged friends, you may suffer for their blunders.

Drunk drivers are as dangerous to their passengers and other people 011 the road as they are to themselves. You have a choice whether to accept rides with them, as you do with drivers who are stoned on pot, tripping on psychedelics, or under the influence of any other drugs that might compromise driving skills. It can be very difficult to refuse rides with friends because you feel they are too intoxicated, but learning to exercise that choice may save you from injury or death. In Sweden, where alcoholism is common and driving-while-intoxicated laws are strictly enforced, social custom dictates that one member of a group attending a party abstain from drinking in order to be the driver for the evening. Since our society does not have a similar custom, individuals who associate with drug users must learn to judge when they should go their separate ways. By the way, police now have an effective field test to identify drugged drivers. Called the Horizontal Gaze Nystagmus Test, it uses eye movements to detect intoxication by most psychoactive drugs.

These days, because of the widely accepted practice of urine testing, and the newer method of hair sample analysis, recreational users of illegal drugs run a greater risk of exposure than ever before. Many employers require their workers to submit to random urine testing and also screen job applicants in this way. Positive test results commonly mean loss of jobs.

Money is the main reason why my friends and I deal drugs. Also, there's a lot of status in it. I mean, if you've got money and drugs you've automatically got power and prestige. People say you're crazy to take the risk, but at the same time they're envious of you, and that's the truth. — seventeen-year-old boy

Developmental Problems

The use of drugs by younger and younger children is very alarming to grownups. In the 1960s, college students were the main consumers of marijuana,- today, pot is commonplace in high schools and, in some parts of the country, even in grade schools. Significant numbers of adolescents have now tried cocaine, alcohol, tobacco, tranquilizers, solvents, psychedelics, and probably more. Drugs have become prevalent in rural as well as urban schools and seem to cut across all class and ethnic boundaries.

Parents, teachers, doctors, and lawmakers generally assume that drug use by young children is especially dangerous. They fear it will cause permanent physical and psychological damage as well as create whole generations of addicts, criminals, and zombies. It may well be that children are more susceptible to the adverse effects of psychoactive drugs, but there is little hard evidence on this point. Among Native American groups who use drugs ritually, children are often introduced to natural psychedelics at very young ages without suffering any apparent harm. However, the social context of psychedelic use among these peoples is different from anything that exists in mainstream society.

Child psychologists say that adolescence is, at best, a difficult time during which children must grapple with a host of problems and pressures, some caused by internal hormonal changes, others by the changing expectations of society as they approach maturity. One concern of psychologists is that the addition of drugs into this already turbulent process will make it significantly harder. Another concern is that some children will use drugs to avoid facing the conflicts that must be resolved if they are to develop into healthy adults. At the moment there are no studies of adults who began using marijuana and other drugs while they were children. Possibly when such studies are done, the results will allay some of the worst fears. However, until then, it is no doubt safer to assume that children are at greater risk, and that below a certain age, drug-taking may impair normal mental and emotional development. At the very least, using psychoactive drugs in childhood to avoid boredom, conflict, and other bad feelings is likely to establish unhealthy patterns of drug-taking that will persist and cause problems in later life.

Legal Problems

I have been a criminal ever since the day I smoked my first joint.

— forty-year-old man, landscape architect

To think that a man should be allowed a gun and not a drug!

— Alexander Trocchi, from his novel Cain's Book (1960)

Getting arrested for possession of drugs can be devastating. At best, it can absorb a great deal of time and money (including seizure of your house, car, and other assets); at worst, it can subject you to the horrors of prison and leave a permanent blot on your record. Current drug laws are products of society's fears and prejudices and would certainly strike an unbiased observer as irrational, if not insane. In some states, people convicted for small-scale dealing of drugs such as cocaine and LSD are treated more harshly by the law than rapists, armed robbers, and even murderers. We think that the drug laws have done much more harm than good, but the fact is they exist and are enforced. The current war on drugs has spawned tougher drug laws, with mandatory minimum sentences and "zero tolerance" even of casual users possessing small amounts of marijuana. People who share drugs with friends may be considered dealers by the law, subject to heavy penalties if convicted.

If you run afoul of the drug laws, waste no time in getting the advice and help of a lawyer who specializes in this area. If you have no idea where to turn for information and have little or no money, contact a local office of the Legal Aid Society, which is listed in the telephone directories of most cities. Legal Aid can advise you and help you find a lawyer.

Dependency and Addiction

A chief characteristic of a bad relationship with a drug is difficulty in leaving it alone. Dependence on drugs is common and provokes so much censure and fear that it makes it hard to see that dependence is a basic human problem not limited to drugs. People can become dependent on many substances and practices; sources of pleasure are obviously the most frequent: food, sex, drugs. People can also become dependent on certain experiences, such as falling in love or having sex, seeking them out compulsively to the exclusion of other activities. It is also easy for people to become dependent on other people. Such personal relationships share many features of drug dependence, including tolerance (diminished pleasure with frequent exposure) and withdrawal (difficulty separating). People become dependent on jogging, gambling, watching television, shopping, working, and talking on the telephone. These observations suggest that dependence has more to do with human beings than with drugs. When people talk about the "addictive potential" of a substance, what they are really talking about is the tendency of human beings to get addicted to it.

The terms addiction and dependence are used loosely today. Properly speaking, drug addiction is a special kind of dependence marked by physical changes: tolerance that requires increasing doses of the drug to achieve the same effect and a withdrawal syndrome if the drug is discontinued. People who become dependent on marijuana do not show tolerance and withdrawal as heroin addicts do. This fact has led many experts to talk about "psychological dependence." However, psychological dependence is a fuzzy concept. How does it differ from doing something repeatedly because you like it? Is there anything wrong with doing something you like repeatedly if it does not hurt you?

The real problem with dependence is that it limits personal freedom. Of course, everyone is dependent on food, water, and other people; no one can ever be completely self-sufficient. Dependencies become problems when they take up vast amounts of time, money, and energy; create guilt and anxiety; and control one's life. It is easy for people to ignore the extent to which dependencies control their lives; sometimes other people can see the problem more clearly.

Dependence on anything is not easy to break. More often than not, people simply switch dependencies, substituting one for another without achieving greater freedom. Still, it is no doubt better to be dependent on exercising, say, than on watching TV. Perhaps the tendency to become dependent is incurable, but to a certain extent people can choose what they are dependent on. Tobacco addicts who give up smoking by becoming compulsive joggers may not be any freer, but they may live longer, be healthier, and feel better about themselves.

Dependence on drugs may be better than dependence on somethings and worse than dependence on others, but such value judgments are difficult to make without reference to particular individuals and situations. Is it better to be dependent on skydiving or snorting coke? On masturbating or eating chocolate? On fighting or shooting heroin?

Good relationships with drugs do not involve dependence. Once you become dependent on a drug it may be difficult or impossible to get back into a good relationship with it. Most experts on alcoholism say that alcoholics cannot learn to be social drinkers; their only choice is between continued alcoholism and abstinence. Most people who smoke cigarettes nonaddictively never were addicted smokers,- they formed good relationships with cigarettes and maintained them. The surest way to avoid dependence on drugs is never to use them. If you do use drugs and want to avoid becoming dependent, you will have to take steps to create good relationships with them right from the start.

The treatment of drug addiction has become big business. Private treatment centers charge thousands of dollars a week to get people off cocaine, alcohol, marijuana, narcotics, and tranquilizers. Twelve-step programs modeled on Alcoholics Anonymous have proliferated in all cities, and special programs now exist to treat the relatives of dependent persons — Adult Children of Alcoholics and Codependents Anonymous, for example. Despite the boom in the treatment industry, the rate of addiction has only increased.

We think addiction is a basic human problem whose roots go very deep. Most of us have at some point been wounded, no matter what kind of family we grew up in, or what kind of society we live in. We long for a sense of completeness and wholeness, and most often search for satisfaction outside of ourselves. Ironically, whatever satisfaction we gain from drugs, food, sex, money, and other "sources" of pleasure really comes from inside of us. That is, we project our power onto external substances and activities, allowing them to make us feel better temporarily. This is a very strange sort of magic. We give away our power in exchange for a transient sense of wholeness, then suffer because the objects of our craving seem to control us. Addiction can be cured only when we consciously experience this process, reclaim our power, and recognize that our wounds must be healed from within.

Suggested Reading

The autobiographical books listed in the Suggested Reading sections of preceding chapters give firsthand descriptions of problems with various drugs.

Two books written for a high-school audience are Our Chemical Culture: Drug Use and Misuse and Drugs: A Multimedia Sourcebook for Young Adults; the latter is discussed in the Suggested Reading section for Chapter 4. For a fictional account of drug dependence among high-school students, see Go Ask Alice (New York: Avon Books, 1972), which was made into a television movie.

Consequences of Adolescent Drug Use: Impact on the Lives of Young Adults by Michael D. Newcomb and Peter M. Bcntler (Newbury Park, California: SAGE Publications, 1988) is an analysis based upon a study that followed 700 teen-agers in Los Angeles County for eight years. See also A Family Like Yours: Breaking the Patterns of Drug Abuse by James L. Sorensen and Guillermo Bernal (San Francisco: Harper & Row, 1987).

In our society, women are especially vulnerable to drug dependence. An enlightening discussion of the reasons for their vulnerability can be found in The Female Fix by Muriel Nellis (Boston: Houghton Mifflin, 1980).

Stanton Peele's The Meaning of Addiction: Compulsive Experience and Its Interpretation (Lexington, Massachusetts: Lexington Books, 1985) is one of the most insightful commentaries on addictive behavior. Sec also Chapter 7 of Andrew Weil's Natural Health, Natural Medicine: A Comprehensive Manual for Wellness and Self-Care (Boston: Houghton Mifflin, 1990).

Some insight into the dangers of drug dealing and smuggling is provided by two entertaining books of true-life adventure: Robert Sabbag's Snowblind: A Brief Career in the Cocaine Trade (New York: Bobbs-Merrill, 1976) and Jerry Kamstra's Weed (New York: Harper & Row, 1974), which concerns marijuana. The film Midnight Express presents a horrifying story of the consequences of getting busted for drug smuggling abroad.

For an analysis of how our drug laws create more problems than they solve, see The Honest Politician's Guide to Crime Control by Norval Morris and Gordon Hawkins (Chicago: University of Chicago Press, 1969). A readable history of how those laws came into being is given in The American Disease: Origins of Narcotic Control by David F. Musto (New Haven, Connecticut: Yale University Press, 1973). Drug Control in a Free Society by James B. Bakalar and Lester Grinspoon (Cambridge, England: Cambridge University Press, 1984) is a balanced analysis of the arguments for and against various types of drug control.

Alternatives to Taking Drugs

As we mentt(ined at the beginning of this book, the main reason people take psychoactive drugs is to satisfy a basic human need to vary normal experience. Even very young children seem to have this need and experiment with techniques for altering their consciousness. Why should changing consciousness be so attractive and what do drugs have to do with it?

People who learn to change their conscious experience in safe and positive ways seem to be the better for it. They are healthier physically and mentally, more creative and productive, contribute more to society, and are more fun to be around. We believe that a desire to explore the various facets of consciousness is normal and good, but we are concerned about how people do it.

Being high does not mean being drugged. Clearly, drugs can sometimes make people feel high — at their best, energized, whole, expansive, creative, and connected. But why is it that many persons achieve high states without ever taking drugs, and why do the people who take the most drugs lose the very effects they seek? The answer is that drugs do not contain highs. Highs exist within the human nervous system; all drugs do is trigger highs or provide an excuse to notice them.

That people cannot feel high whenever they want is one of the curious frustrations of the human condition. It seems necessary to work for highs, or find tools outside ourselves to evoke them. Drugs do this by making people feel temporarily different. They directly affect the nervous system and physical body in obvious ways. For example, stimulants make people feel wakeful and energized, and psychedelics alter body sensations and perceptions. Different drugs have different pharmacological effects, and so make people feel different in different ways.

No drug makes a person high automatically. One must learn to interpret the physical effects of drugs as the occasions for highs. It is expectations of individuals and society (set and setting) that encourage people to associate inner experiences with the physical feelings drugs produce. If this association fails to develop or breaks down, people can take the largest imaginable doses of drugs and not get high — just feel drugged. This is precisely the problem of those who get into bad relationships with drugs by taking them too frequently: as the novelty of the drug's effect diminishes with repetition, it no longer produces the needed signal. First experiences are so powerful because the novelty of the change is greatest.

It is very easy to confuse the signal with the desired experience, the drug with the high. Many drug users are convinced that the experiences they need and like come from outside themselves in the form of drinks, joints, pills, and powders. It is this confusion that leads people to abuse drugs,- they take more drugs more frequently in pursuit of ever-vanishing highs.

The fact that highs exist within is a cause for optimism. It means that the potential for these states is always there and many techniques must exist for eliciting them. There really are alternatives to drugs, because drug highs differ from other highs only in superficial ways. One day scientists will understand what goes on in the brain when people feel high. It may be that these states are actually mediated by the brain's own neurochemicals, which can be stimulated equally by many different influences, including one's own thoughts. Everyone has had the experience of being rocketed out of a gloomy state by a word of praise, a demonstration of affection, or the arrival of a check in the mail. That change in mood might be exactly the same on the cellular level as the rapid euphoria that follows a snort of cocaine. In fact, it might not be accurate to talk about "natural" highs, as opposed to "drug" highs, since both may depend on the body's endogenous drugs.

Is it any better to get high without drugs than with them? The main advantage of drugs compared to other techniques is that they work powerfully and immediately. Their main disadvantage is that they reinforce the notion that the stale we desire conies from something outside us. Not only can this idea lead to trouble with drugs, but it can also make people feel inadequate and incomplete. Even those in the best relationships with drugs often feel some degree of guilt about relying on them. Perhaps this

Ram Dass, formerly Richaid Alpert, who, along with Timothy Leary, experimented extensively with LSD, psilocybin, and other psychedelics in the 1960s. Although an enthusiastic promoter of psychedelics when he was on the faculty at I larvard, Ram Dass later came to feel that frequent drug experiences were an obstacle to self-realization and that yoga and meditation were more valuable techniques. (Peter Simon)

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