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Drugs and the Whole Person

Responsibilities of the Drug User

Whole Person
New Approach

This chapter outlines the basic responsibilities that accompany responsible recreational use of psychoactive drugs. Rational decisions concerning drug use can be made if these responsibilities are considered. We understand that the right to decide rests with the individual, but the individual must also understand the rights of others in considering a course of action relative to recreational drug use.

Every individual has needs, and we recognize that there are many differences among individuals. There are, however, many commonalities that make us very much alike. One of these sets of commonalities is a basic set of needs that we all have. How we accomplish or satisfy these needs varies from individual to individual -- that is one of the things that makes us different. What are these needs, and how do they relate to drugs?

Abraham Maslow (1908—1970), an American psychologist, developed what has become known as a hierarchy of human needs. This hierarchy begins at a low level with very basic human needs that all of us must satisfy in order to exist; it peaks with a need that only some of us ever accomplish. This hierarchy is generally characterized in the following five categories.

I. Physiological needs such as food, drink, and oxygen.

2. Safety needs for protection and security, including things shelter, clothing, and confidence that one’s physiological needs will continue to be met.

3. Belongingness and love needs, which require relationships with others, identification with groups, and affection.

4. Esteem needs, which include the need for self-respect, status, and prestige.

5. Self-actualization, which is the need to "be all that one can he," to be able to develop oneself to one’s full capacity.

These needs are hierarchical; that is, an individual must satisfy the needs at the lower levels before accomplishing or satisfying higher-level needs. Individual behavior is motivated by unmet needs at each level. Unfulfilled needs can lead to deficiencies in the individual and, at higher levels, result in what Maslow called metapathologies such as alienation, apathy, and cynicism.

Maslow’s hierarchy of needs is only one of several major theories that seek to explain motivation for behavior and growth of an individual. There are others, but we choose at this point to focus on the Maslow paradigm and its relationship to another theory posited by Andrew Weil in his book The Natural Mind (1972). With some liberty, we would like to summarize the development of Weil’s theory concerning why people take drugs.

The Human Need to Alter Consciousness

Imagine yourself when you were a youngster 4 to 10 years old. Every youngster is different and therefore likely to engage in a variety of activities to satisfy curiosity, to remain active, or to socialize with others. Think about some of the activities you engaged in for those purposes. Now take this one step further and try to think about some specific activities you engaged in that you think all your friends also engaged in. Now take a giant step forward and try to picture which activities you may have engaged in that perhaps every youngster who ever lived probably did also.

If you are stymied, try some examples. Have you ever spun yourself around until you became dizzy? Of course you have. Well, probably everyone else has also at one time or another. Have you ever threatened to hold your breath for a very long time? Probably! Have you ever fantasized about being somewhere else, or doing something that you will probably never do? It is very likely that you have done some fantasizing. These are all examples of activities that youngsters often engage in and very probably have been done by almost all youngsters who ever lived. Why do we do these things? What do they accomplish?

Think carefully about what these activities are. They are all means to alter consciousness. They take us out of our ‘ordinary" consciousness to what Weil terms “nonordinary" consciousness, which is presumably pleasurable. We continue to engage in these activities because we ‘‘enjoy" the results. Now imagine that this motivation or drive to experience this nonordinary consciousness was a basic need, as in Maslow’s hierarchy. It seems possible, then, that children engage in certain specific activities to satisfy one of the basic needs for growth and maturation—the need to alter consciousness or to experience nonordinary consciousness.

As we grow older, spinning around until we become dizzy is less socially acceptable and holding one’s breath for long periods of time seems to be deviant; therefore we look for more acceptable ways to satisfy the unmet need to alter consciousness. Some people succeed in experiencing nonordinary consciousness by engaging in risk-taking behavior, some of which seems socially acceptable (mountain climbing, skydiving, etc.) and others less socially acceptable (e.g. high-speed driving or playing any one of a wide variety of "chicken games"). Some people succeed by stretching their bodies to the limits of pain, endurance, or skill (such as training for and taking part in any one of many sports, some of which involve competition against others, some of which involve competition against oneself) or by studying ways to extend our senses through natural means (such as with meditation, yoga, or the martial arts). Some people succeed in altering consciousness by using drugs recreationally.

Let us summarize briefly at this point. There are many ways that human growth and development have been studied and explained. One of the most widely accepted paradigms used to explain motivation for certain behaviors and drives is that of Maslow (1976), who proposed that all individuals have sets of needs that must be met. These needs are arranged in a hierarchical structure, so that before higher-level needs can be addressed, the more basic needs must be satisfied. Before we can satisfy our needs for self-esteem, we must first make sure that our basic physiological needs for food and water, our safety needs, and our belongingness and love needs are satisfied.

Without placing it anywhere in Maslow’s hierarchy of needs, Weil (1972) proposes that an additional need not identified by Maslow may be the need to experience nonordinary reality—to alter consciousness. This need, like many other human needs, is satisfied in different ways because of individual differences among those seeking to satisfy this need. Some people satisfy this need by using drugs recreationally. Taking a drug is a relatively easy, rapid, and effective way to alter consciousness. It is therefore a widely accepted approach among many individuals. We must, however, carefully make an important point here. Drug taking is not a basic need. It is only one means by which some people satisfy what has been proposed as the basic need to alter consciousness.

Although Weil’s theory may be controversial, it does seem to explain reasonably why some people use drugs recreationally. We believe that recreation is a legitimate reason to use any of a wide variety of psychoactive drugs. Making a responsible decision to use a drug recreationally, however, is only the beginning point of our major responsibility, that is, to use the drug responsibly and in a manner warranted in the particular situation. These responsibilities will be discussed in the remainder of this chapter.

Responsible Use of Psychoactive Drugs

The focus of this chapter will be responsible use of psychoactive drugs for recreational purposes. We now redefine the term drug use as it has been used throughout the text. Drug use refers to the use of a drug for the purposes for which it was intended and with minimal hazard. Earlier we defined social-recreational use of drugs as drug use that occurs within social settings and is motivated by a desire to share pleasurable experiences among friends.

Both definitions imply that the person choosing to use psychoactive drugs in a social-recreational context has the responsibility of using the drugs with minimal hazard and of contributing to the pleasurable experience of being with friends in a social setting. These are important responsibilities that should not be overlooked. However, understanding those responsibilities and being able to live up to them requires knowledge about drugs and a commitment to their responsible use. Based on the work of the Education Commission of the States, Task Force on Responsible Decisions About Alcohol (1975b), we have adapted the following discussion of responsibilities in three areas: situational responsibilities, health responsibilities, and safety-related responsibilities.

Situational Responsibilities

There are many social-recreational situations in which psychoactive drugs are available for use and a decision must be made concerning such use. It is impossible to define the scope of possible situations in which drugs may be used recreationally but, regardless of the situation, decisions must be made about whether or not to use drugs recreationally and in what manner these drugs can be used recreationally. It is with this in mind that the following responsibilities and behaviors’’ are identified.

1. Provide a variety of alternative models of acceptable social-recreational behaviors within a group. All individuals within a group setting deserve the right to choose alternatives and still be part of the group. This might involve making available a variety of recreational activities to your peer or social group. Among these activities might be the option for recreational drug use as an acceptable group activity.

2. Respect an individual’s decision concerning drug use. Providing options means that we should also abide by an individual’s choices. Several decisions can be offered in this light: the choice to use or not to use a recreational drug, and the choice of which recreational drug to use in a particular setting. Unfortunately, we occasionally attempt to coerce group members with subtle pressures to get individuals to do something the other group members are doing. For example, we might suggest that someone have an alcoholic beverage and then not take "no" for an answer. If an individual chooses not to use a psychoactive drug in a recreational setting, that is a choice we should support. On the other hand, if an individual chooses to use a psychoactive drug recreationally and within the acceptable limits of the social group, that decision should also be supported by the abstainer, as long as he or she remains a part of the group.

3. Recognize that recreational drug use may be a social lubricant, but it should not be the only motivation or focus of the social situation. It is quite acceptable to use a socially approved recreational drug within the context of most social settings; however, when the use of the drugs themselves dictates the context of the setting, we have moved from the realm of recreational to intensified or compulsive drug use. Drug users, you will remember, focus only a small percentage of their time on actual drug use, and that drug use does not play a central role in the drug user’s life. When the user’s life or lifestyle is determined by the necessity to use a drug or not, this person is no longer a user, but has lost control of drug taking.

4. Recognize a responsibility for the health, safety, and pleasure of both the drug user and the abstainer by avoiding severe drug—induced intoxication and by helping others do the same. Whenever psychoactive drugs are available for use, the possibility exists for overstepping one’s own limits as well as the limits of the group in that setting. In a recreational setting all members share in the responsibility for the behaviors of the group and should be supportive of each of the members. Group norms should be clearly understood, and the group should exert pressure to maintain them, including norms related to drug use and its limits. We should recognize that drug misuse and abuse is neither healthy nor safe and will not be excused or accepted among peers.

5. Have contingency plans for severe intoxication if it occurs in spite of efforts to prevent it by assuming responsibility for the health and safety of others. Once again, if we provide psychoactive drugs as an acceptable recreational alternative, we should be prepared for all possibilities, ranging from being prepared to escort a person home to being prepared to provide emergency first-aid measures and/or consult with professional medical personnel in extreme situations.

6. Be aware of the influences of set and setting on psychoactive drug experiences. This is a very involved and sometimes complicated responsibility. Remember that set refers to the total internal environment of the individual at the time a drug is ingested and that setting refers to the total external environment of the user at the time the drug is ingested. For set we are generally concerned with an individual’s state of physical and emotional health at the time the drug is used, what their previous experiences are with a particular drug, and what their expectations for that drug are. For setting we are most concerned with whether the physical environment an individual is in, and the people the individual is with at the time, are conducive to a pleasurable experience. Given this, you should make decisions regarding recreational drug use with the following thoughts in mind.

6.a) Only use recreational drugs when you want to use them. Do not be coerced into using a drug you do not want to use or when you do not want to use it.

6.b) Understand your own rationale for using any recreational drug. Make sure that your motivations and rationale are appropriate to the drug, yourself, and your situation.

6.c) Use psychoactive drugs recreationally only in the company of others. Do not take sole responsibility for your actions and do not leave drug-induced outcomes to chance. Being in the company of others is comforting, sociable, and responsible if anything should go wrong.

6.d) Provide or use recreational drugs only in environments conducive to pleasant and rewarding experiences. Hazardous or threatening environments can, of course, influence the outcomes of a drug experience and make them less pleasurable.

7. Encourage your peer group to set reasonable rules and rituals surrounding the use of recreational drugs. As discussed in Chapter 15, it is important for groups to set rules and rituals for psychoactive drug use. These rules help an individual learn when and how to use a drug and when not to use a drug and how not to use it. Rituals involve stylized interchanges between people. These rules and rituals set constraints on the drug experiences and tend to reduce the hazard potential.

Health Responsibilities

The original task force report (I 974b) that provided the impetus for this chapter indicated that responsible decisions regarding the use of psychoactive drugs required some consideration for the implications for personal health. It is with this in mind that the following responsibilities and behaviors are identified.

1. Choose to abstain from social-recreational drug use when appropriate for reasons of health and physical fitness. There are many times when it is inappropriate to use certain psychoactive drugs. Among these are times when a person’s physical health is impaired due to illness or injury or when a person is under severe stress or is emotionally distraught. There are other times when abstaining is appropriate, even though we may not be ill (e.g., during pregnancy).

2. Avoid the frequent use of recreational drugs for the purpose of coping with problems. When we begin to use drugs habitually in any specific situation or circumstance, we have moved from recreational to intensified or compulsive drug use. Once again, the user is someone who controls their use of drugs, not the person whose actions are dictated by those drugs.

3. Heed the advice of a physician either to avoid the use of a particular recreational drug or use it only as suggested. There are occasions when we are not the best judge of our own state of health. During these times, we must defer to the advice of others who may have our best interests in mind.

4. Recognize that social acceptability does not require drug use. As discussed before, each member of a social group should understand the boundaries of acceptable behavior. In reasonable situations, that might include the use of recreational drugs and the right to abstain from the use of such drugs. Drug use is not an unimportant decision and should be made because you want to—and when you want to. Do not allow yourself to be put in a situation wherein you must defer to group opinion in order to be socially accepted. Conversely, do not contribute to a situation where you do the same to others.

5. Use drugs in the manner intended so as to minimize the potential risks. We have spent a great deal of time describing how drugs have been used and in what ways they may be used. This may provide some useful guidelines for you.

6. Recognize that recreational drugs are DRUGS and understand what that means. Recreational drugs are substances that have a broad range of potential effects. The determinants of the outcome of the recreational use of drugs depend on the combined effects of set and settings, the quantity of drug taken, and the manner in which it is taken. The effects we come to expect from a recreational drug do not always happen. Perhaps more than most other situations in which drugs are taken, social-recreational settings may be the most variable; therefore our expectations are more often chance than certain.

7. Set reasonable limits on the consumption of recreational drugs that are well within your own capacity, which can vary from time to time. Here, too, the consequences of set and setting become obvious. Everyone has their own limits. We learn these from experience. But even in one individual, the limits vary from time to time. The classic example is seen with alcohol. Almost everyone has experienced a situation in which they have had a few drinks, certainly less than they have many other times, and yet were more intoxicated than at any other time. We change over time, and that affects our reaction to drugs. Certainly everyone would agree that different individuals have different limits. The key point here really has two elements. First, you know your limits better than most others; therefore you should set your limits on consumption. We are occasionally poor judges of our own limits, but it is our responsibility to become more responsible judges. Second, just as you would not want others to set your limits, do not set limits for others who are acting responsibly in their own behalf.

8. Be particularly careful of using combinations of drugs in recreational settings. A substantial portion of this book was devoted to the dangers of drug interactions. This point should be carefully heeded because we know that some interactions are potentially dangerous and because we do not know all of the potentially harmful combinations of drugs.

9. Remember that the use of some psychoactive drugs may mask some signs and/or symptoms of serious illness or injury. Avoid continued use of any psychoactive drug for long periods of time. All drugs have multiple effects. In a recreational setting we are most interested in the psychoactive effects, but many drugs kill pain, slow responses to stimuli, and affect our interpretations of stimuli. Constant use of a drug may hide pain or discomfort. We sometimes forget that pain and discomfort are important to us. Without them we often do not know about illness or injury, and perhaps the most effective way to complicate some illnesses and/or injuries is to ignore them.

Safety-Related Responsibilities

Just as decisions regarding recreational use of drugs should consider the health aspects of such decisions, so should the potential user consider the safety aspects of such decisions. The following is a list of safety-related concerns.

1. Avoid performing complex tasks while using recreational drugs, such as driving a motor vehicle or operating any large or complicated machinery. Response time, perceptions of time and space, and the normal reasoning process are all affected by psychoactive drugs. Alterations in any one of these elements may mean the difference between our ability to operate a vehicle or machine safely and our inability to do so.

2. Avoid riding with a driver who is using recreational drugs and discourage that person from operating a motor vehicle. Whct~ir’~ not you are the driver, the use of psychoactive drugs and driving do not mix. Do not allow yourself to be coerced into a motor vehicle when the driver is intoxicated. Do not encourage others to drive when they are intoxicated by accepting rides from them.

3. Recognize that one’s own drug-taking behavior and attitudes will influence others, especially children. Whatever we do in the presence of others affects them in some way. Drug taking is no exception. Therefore we should be careful about our actions—particularly with substances that have the potential for doing harm. Our own responsible use of recreational drugs will foster responsible use by others. Indiscriminate use encourages others to do the same. This is most apparent in impressionable children. We should not be cavalier around youngsters when we are exercising our rights to use drugs.

4. Use recreational drugs only in relaxed and responsible social situations. Here, again, setting is important. Even if we use a drug that we have had a great deal of experience with, altered consciousness is inappropriate in potentially dangerous or unknown settings.

5. Use recreational drugs in moderation, even though you may think your tolerance is high. As we now know, one’s tolerance for psychoactive drugs is not at a constant level. It changes with the set and setting. It is important to use whatever drugs we choose to use in moderation. To exceed our tolerance, even accidently, increases the potential for bad reactions to the drugs themselves or for being in a potentially dangerous situation from which there is no easy way out.

6. Take the smallest dose of a recreational drug that will produce the desired effects. The concepts of one’s own limit, or one’s tolerance, are again important here. In addition, we are adding a new element—effective dose. It is not important to use a psychoactive drug to our limits every time we use it. We are better off in the long run if we minimize the dose we take, If we take just enough to cause the desired effects, the potential side effects are minimized, as is the potential for dangerously compromising situations. We should try to remember at least four crucial questions when we are using drugs recreationally.

6.a) What is the effective dose of the drug we are taking? In other words what is the smallest amount I can take and still get the effects for which I am looking?

6.b) What is the lethal dose of the drug? Theoretically, every drug has some legal dose level. That dose level is known for many drugs, but not for all psychoactive drugs that may be used recreationally. Regardless of what we think our own tolerance may be, we do not want to chance taking a dose level approaching lethal limits.

6.c) What is the margin of safety for the drug of choice? The greater the difference between the effective and the lethal dose levels, the less likely we are to have toxic or fatal reactions to a drug when we use one. This is the concept of therapeutic index, which was discussed in Chapter 3.

6.d) At the effective dose level, what effects other than those that we seek will also occur? We have said many times that all drugs have many effects, some of which we are aware of, and some of which we are not. Sometimes the effects that occur are inconsequential. At other times, they are potentially very important. You must be aware that multiple effects is a given in any drug experience. You must also be aware that even at low dose levels, some effects that may be potentially dangerous can occur along with the desired effects.

7. Learn the usual side effects that can occur with the recreational drugs of your choice and be alert to any expected or unexpected side effects that pose a potential threat to yourself or to other users. Be aware of situations that require assistance from trained medical personnel.

8. Know basic first-aid techniques and take responsibility for applying them appropriately in cases of drug emergencies. Although these techniques are beyond the scope of this book, be aware that there are times when unconsciousness can occur when using drugs. These are times when we must be particularly alert to the needs of the unconscious person. This may mean anything from providing a safe place to "sleep it off" to performing mouth-to-mouth resuscitation for an unconscious person who is not breathing spontaneously. Be alert and take responsibility for preventing such occurrences; if they are needed, take responsibility for first aid in drug emergencies.

9. Know your source. There are many stories about the black market for recreational drugs. Be aware that among the greatest ‘horror stories’ are those related to the content of the drugs sold on the black market. Many of these stories are untrue or exaggerated, but there are also many cases of potentially dangerous black market deceptions. Often the drugs sold are not what they are purported to be. Occasionally, they are not only not what we thought, but they also contain very dangerous chemical mixtures. Your ‘source" is the person who will be providingy ou with chemicals that you are going to put into your own body. Do not assume that the quality of those drugs is high, and do not take your own safety for granted.

10. Avoid unfamiliar drugs. Do not trust someone else with the responsibility for your health and safety. All of the factors that we have outlined thus far imply that safe and responsible drug use requires respect for drugs and knowledge about them and about yourself. Do not compromise these requirements by using substances with which you are unfamiliar and for which you have no respected role models or guides.

11. Avoid mixing drugs, particularly unknown drugs. More dangerous than trusting your safety to unknown drugs is trusting your safety and well-being to mixtures of drugs, particularly if some of the drugs in the mixture are unfamiliar. Predictable drug outcomes are the result of responsible use of those drugs. Using unknowns minimizes the predictability of outcomes and therefore increases the potential for hazard associated with such use.

12. Avoid injecting drugs.

Your Right to Choose

The choice of whether or nor to use a recreational drug is yours alone. However, when considering your options, understand your responsibilities as well as the other elements in your decision process. We have outlined many such responsibilities in this chapter. We have focused on three main dimensions: situational responsibilities, health-related responsibilities, and safety-related responsibilities. There is some crossover but, where there has been duplication, it is by design. Remember, it is the whole person – you -- who makes the decisions and takes the responsibility to make them rational. You cannot make these decisions in a vacuum. They affect you and also others. You have the right and the responsibility to decide, if you choose to use drugs recreationally, to use those drugs with minimal hazard to yourself and those around you.

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