Despite what the anti-drug propaganda films from yesteryear would have you believe, most people do not go from abstinence to addiction overnight. The images of usually white teenagers being coerced into smoking a joint only to be shown being injected with heroin the very next day created a false impression of the initiation into substance use. Bottom line, it doesn’t happen that way. Instead, I am suggesting a conscious path that, for most people, does not end in addiction, but rather integration. So, what does this path look like and how can we use it to create balanced and healthy relationships with psychoactive substances?
The first stop is exploration. Nobody starts using a psychoactive substance as an expert. When you had your first sip of alcohol, you didn’t know that your preferred drink was bourbon on the rocks with a lemon wedge. You tried things, some of them good, some of them bad. The purpose of this phase is to discover: 1) if the feeling you get from this substance is something you enjoy and 2) how does the environment add to/detract from the experience? The phase is marked by irregular use, often with others who are also using, and can continue for some time. I consider myself to still be in the exploration phase of psychedelics, even though I used them for the first time almost 20 years ago. Some people stay in this phase forever. Irregular cannabis consumers for example, who never purchase or obtain cannabis for themselves, but might enjoy a joint or an edible at a social gathering if offered. The exploration phase is important because it is where we learn about safe use, and decide whether this is a substance that we want in our lives. If the answer to this is “yes”, then we move on to the adoption phase.
The adoption phase occurs after we decide that we enjoy this substance enough to seek it out and use it on our own. A person who tried cannabis for the first time at a party and enjoys it, may decide to visit a dispensary and pick up some products for themselves. Adoption does not speak to use patterns as much as it does the decision that this substance is providing a benefit, and that the individual desires to use it again, in a more regular way. Adoption of psychedelics can be the decision to use LSD every year on your birthday, or to schedule a few trips to the park and bring some mushrooms. Basically, you are saying, I had a good experience with this. If, during the exploration phase you decide that you do not like the way a substance makes you feel, your journey will likely stop there, at least for the time being. However, if you adopt a substance into your life, the next phase is where you decide what role it will play.
Once you have explored the use of a substance and decided that you like it, the next phase (and the trickiest) is integration. How will you integrate the use of this substance into your life that maintains the benefits it gives you without bringing on personal or social harms? And while yes, your own behavior and decision making are a part of the integration process, there are external factors that will affect it as well. First, stigma. Some substance use is more accepted than others. Think about showing up for work on Monday announcing that you got really drunk over the weekend. Your coworkers would likely laugh and regale you with their own tales of alcohol induced inebriation. Now, imagine coming into work and announcing that you got pretty messed up on heroin over the weekend. I doubt the response would be the same. The differential attitudes assigned to substances (regardless of their potential for harm) means that integration can be tricky depending on your substance of choice. The second factor is legal status. In the above example, admitting over use of alcohol would not have the same employment consequences as admitting over use of heroin. Not because alcohol is so much safer (it’s not), but because one substance is legal, and the other is not. Stigma and legal status can influence integration. But those factors aside, integration is about settling into a pattern of use that maximizes benefits and minimizes harms. This includes consideration over your relationships, your budget, your safety, and being mindful of your consumption so that integration does not move into the final phase, one that is not assured and only impacts about 20% of substance consumers: compulsion.
While very few reach this stage, in this context, compulsion is using a substance in a way that leaves the user vulnerable to harm. It can mean using in an unsafe situation like while driving a car; using to the point of dependence where stopping or reducing use becomes more difficult; or using in amounts that can lead to overdose. Contrary to the belief that, at this stage, people are defenseless against the substance and give up all autonomy, research by Dr. Carl Hart and others suggest that even compulsive users are able to make rational decisions about their health and safety, and the safety of those around them. Compulsive use is often an indicator of a lack of balance in the relationship with the substance. It is also often a sign that the use is self medication for an underlying issue that needs attention. Unfortunately, in our country’s addiction industry, the focus is often firmly on getting the user to maintain abstinence, sometimes without any effort to address other mental, physical and social pains. Harm reduction believes that it is possible to move people out of compulsive use and back into integration by addressing these underlying issues while not demanding abstinence.
Human beings have had relationships with psychoactive substances for 200 million years. I grew up in a time where politicians and others called for a “Drug Free America”, and I was always dubious of that possibility. Of course, what they really meant was an America where no one uses illegal drugs, but one where alcohol, tobacco, caffeine and pharmaceuticals were given a pass. The truth is, psychoactive substances are part of our human experience. Understanding how we explore, adopt and integrate these substances into our lives requires conversations about balance, mindfulness, destigmatization and safety; not shame, punishment and propaganda.