Reviewing an assumption I hold: Is Recreational Drug Use Inherently Bad?

A book review in the NY Times caught my attention, When Getting High Is a Hobby, Not a Habit. It seemed especially apt since there is so much discussion now about people and their political beliefs and what it takes to change someone’s mind. I read the first two paragraphs and felt the same as the article’s author:

It doesn’t take long to get to what is perhaps the boldest and most controversial statement in Carl Hart’s new book, “Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear.” In the prologue, he writes, “I am now entering my fifth year as a regular heroin user.” In all honesty, I don’t know how to feel about this admission. It’s not easy to square all that I’ve learned about this drug with the image I also hold of Hart: a tenured professor of psychology at Columbia University, an experienced neuroscientist, a father.

Hart knows this. He knows about the discomfort his readers might feel when they encounter his full-throated endorsement of opiates for recreational use. He offers the information in a spirit of radical transparency because he believes that if “grown-ups” like him would talk freely about the role of drugs in their lives, we wouldn’t be in the mess we are in, a mess brought about by our ruinous drug policies, which have had such profound — and profoundly unequal — consequences for those who fall afoul of them.

Especially the “regular heroin user” part - I just recoiled and realized I had immediate negative judgements and then thought - I don’t actually know any regular hard drug user. I know I’ve been told that my uncle is one, but he is also a psychiatrist with mental issues so I don’t really know. The majority of my “knowledge” comes from media and probably more entertainment media than anything else. And I know there are “high functioning” users but I don’t think that is discussed as much as the people who hit rock bottom. Are there “high functioning” opoid users as the book’s author states? I do believe the entire legal view of drugs and drug use needs to be rationally reviewed. I was one who told my child “Illegal drugs are just bad - don’t even try them!” because that’s what I had been told and that’s what I believed. I didn’t even question it.

I admit, I am not even tempted to do recreational drugs, I don’t even drink a beer or a glass of wine a month and I’ve never seen the point of “changing your perception of reality” maybe if I did it, I would…but I don’t have the desire to do it. But clearly a lot of other people do get a lot out of it.

I know several regular hard drug users personally. Before COVID hit my wife and I volunteered at our county’s Juvi and got close with many of the teens there. We saw many lives damaged or ruined by Meth and Heroin. My older brother was locked up for the majority of his life due to small crimes related to a Meth addition he was never able to shake.

Like my brother I also have an addictive personality. In my teens while getting my wisdom teeth removed I received a dose of morphine. My response to the drug shocked and scared me and I have since been afraid to try hard drugs out of fear I would be instantly addicted.

However, I voted for the legalization of Marijuana in my state because nearly all the teens we knew moved on to the hard stuff through the same dealers who sold them the weed. My hope was the legalization would discourage ‘good kids’ from being introduced to hard drug dealers.

I don’t have a problem with weed or mushrooms being legalized. In my opinion they are on the same level or less damaging than alcohol. Opioids are incredibly destructive. I’m not sure I would call the users themselves ‘bad.’ But I certainly consider opioids ‘bad.’

I’ve always had an International Foundation for Internal Freedom attitude. Get high on absolutely anything you want to, for any reason you want to, but you’re legally and socially responsible for your (other) actions and inactions.

Depends on what you mean by “inherently bad”. I think most drugs are inherently unhealthy for you.

IMHO, the main issue with a lot of recreational drugs is that they are addicting and they kind of make you feel ok with not doing anything all day long. So it becomes pretty easy for drugs to occupy a significant portion of your life that you could have spent doing something more interesting and productive.

You could say the same thing about TV or video games or sex. I think the key difference is that drugs (including alcohol, caffeine, and nicotine but not including cannabis; though to different degrees of course) are CHEMICALLY addictive.

When both chemical addictiveness and health issues coincide (sparing, for example, caffeine) is where drugs can do a lot of harm.

Treating users as criminals isn’t the answer, but perhaps neither is full legalization. It’s great for this guy if he can balance heroin use with a full and productive life, but clearly this isn’t true for many (perhaps the vast majority) of other users.

What would concern me about that description is whether or not they were addicted, whether they had to keep using heroin regularly to function or increase the amount of heroin they take to get the same effects.

I have heard that it’s possible that only some people actually wind up addicted, while some don’t. That said the studies I’ve seen (with mice, mind you) suggest the line is whether or not their life is happy and fulfilled, and people who seek out drugs often are doing so because they want a little extra happiness. They thus might be more prone to becoming addicted.

I do know my mom took opiates her entire life, but for pain, and she never wound up needing more. And when they found the source of her pain, her usage dropped for quite a while, going back up only after she was hurting more for other reasons. But never higher than her original dosage.

Rats Prefer Social Interaction to Heroin or Methamphetamine

Rat Park

I agree that addiction is a good marker for assessing the harm drug use could cause - but what is the real likelihood of addiction? How common are “addictive personalities”? Could that be realistically determined? Is it more or less than legal additive items like alcohol or tobacco or gambling? Dark_Sponge’s information is typical of what is talked about - but does any one know a regular hard drug user whose life wasn’t terrible?

I guess I’m trying to compare it to alcoholics - being an alcoholic is so bad on so many levels, there isn’t really any real necessity for booze besides people liking it or the effect and tradition (at least opioids have some medical uses - I don’t think alcohol does).

I have to admit I’d want a little more control than the International Foundation for Internal Freedom - it’s seems a little reactive. I don’t want pilots or train engineers or doctors or first responders high on the job. But if it doesn’t really affect anyone but you…yeah, why should society stop you?

I don’t think recreational use is inherently bad. But like KAndre, I wouldn’t want my pilot high on coke…

Not in the concentrations you can drink, no.

As someone who worked in a clinic specializing in drug treatment, especially opiates: Yes.

I’ve known opiate addicts who were able to keep themselves presentable, hold down a job, and pay their bills. Which is not to say they didn’t have problems, sometimes severe - people didn’t come to our clinic unless they were having problems.

They basically came in two categories.

First, you had folks who had been in treatment for decades on a “maintenance dose” of methadone. They took a legally dispensed opiate every day. These folks were typically employed in a steady job and paid for their treatment out of their own pockets. I will also point out that they were a very small minority of the patients (about 15 out of 1200-1500 in any month).

Then you had the people with sufficient money to fund a habit involving illegal substances that cost them a lot of money on a weekly, if not daily, basis. Most of those folks were at our clinic because they’re oh-so-elegant lives were starting to come unglued. So while they had been high-functioning they weren’t any more.

The only way to be absolutely sure you won’t become an addict and screw up your life is to not use at all.

But I never saw a “casual” heroin/opiate user. Then again, such people wouldn’t be coming to our clinic. We treated addicts, people who had a problem out of their control.

It is certainly the truth that recreational drugs being illegal complicates things. Legalization will remove some of those problems. However, addiction is a very real thing that causes a lot of damage, and there were significantly more people at our clinic who had damaging addictions to legally dispensed opiates than people who were stable long-term on maintenance doses.

So if we legalize drugs for recreation we probably will see some folks who can use on a social level and overall use will go up. We will also see even more people with addiction problems, from crushing debt to broken families to legal issues that stem not from buying drugs (as happens now) but from causing damage and/or death when driving or operating heavy machinery while high.

The question is which course is better overall for society: prohibition or legalization. Both will have problems, some serious.

Alcohol and tobacco use/abuse can be pretty damn damaging, yet they are legal. They kill a significant number of people every year - some innocent bystanders - yet they are legal.

Tobacco is very addictive, and modern strains and delivery methods have only intensified that. Yet I’ve known tobacco user who only smoked once a week, or on special occasions. But they aren’t most users in today’s world.

From my viewpoint it’s a complicated question and the answers aren’t obvious.

I think the issue is the proportion of users who cause problems for society.

Most people who gamble don’t have a problem: they go to a casino, play low-stakes blackjack for an hour or two, go home. Or they buy a few lottery tickets when they’re picking up their groceries. It’s only a very small minority who have an addiction that compels them to blow their rent money or steal from their employer or neighbor to fund their habit. The actual act of gambling also doesn’t impair most gamblers’ ability to navigate the physical world or meet their various obligations, like taking care of their kids…

The same is not true for drugs like meth or heroin. I don’t doubt there are some casual users who are able to sustain their use without fucking up the world around them, but the proportion of problem users - people who commit crimes to maintain their access to the drug, or engage in behavior that causes hardship for others (like neglecting their kids) - is going to be much higher than for things like gambling or alcohol. That being the case, it seems prudent to just outlaw the drug itself.

I use cannabis every day. I’ve known a few people who played around with heroin on the weekends, but more typically the weekend gradually morphs to include Friday, then Monday. From that point it becomes silly to not use the other three days.

I knew a guy years ago who loved heroin but would never commit a crime for it. He would stay clean, working a job, but then he’d receive $$ through good fortune. Once the money was in his account he’d quit his job and just use all day.

When the money ran out he’d stop cold turkey, find a job, and stay clean until the next inheritance or whatever windfall occurred, when he’d start all over.

It’s used to outcompete methanol, as alcohol dehydrogenase metabolizes both.

Well, if you consider 10% a drinkable concentration…

More seriously - true, I was thinking of antiseptic uses. Antagonistic poison treatment certainly qualifies as a legit medical use.

But he can quit whenever he wants to, right?

What prevents heroin and other hard-core opiate addiction from being manageable long-term is the inevitably increasing tolerance to the stuff, requiring escalation of dosages to the point that deleterious effects start to become overwhelming, the money to buy it runs out and one gets closer and closer to the fine line between getting high and getting dead.

There’s nothing “recreational” about that.

Fomepizole is preferred by FAR for treatment of methanol or other types of alcohol poisoning. Ethanol is only used in emergent situations where fomepizole is unavailable.

Nor is ethanol used to try to arrest premature labor anymore.

As to the topic of the OP, some drugs are just too addictive/deleterious to health to be successfully used recreationally by the vast majority of those who attempt to do so. Most recreational opioid users I’ve encountered (including myself) never managed to just use the stuff socially.

During prohibition, doctors could prescribe medicinal alcohol for their patients. I have a couple of these (used) prescriptions framed in my home.

Here are some more examples.

I remember seeing examples of such scripts in my History of Medicine course back in med school.

The good things such prescriptions did was prevent chronic alcoholics from going into Delerium Tremens and possibly dying due to prohibition cutting them off from their ethanol, and steering them away from methyl/isopropyl alcohol. And the lead-tainted home distillates available.

This is my reaction too. In general, i favor decriminalization. But I’m not sure i favor outright legalization of any additional highly addictive substances.

I was going to mention that. :grin: Years ago, my mother was in a maternity ward with a lot of women on IV ethanol due to premature labor.

And when my first labor started, in the evening, and i told my doctor that i hoped i could avoid going to the hospital until the morning, she recommended a warm bath and a glass of two of wine.

But I ended up going to the hospital at 2am and delivering around 5am, so it didn’t really do the trick.