5.3 Drugs and Consciousness: Artificial Inspiration

The author of the dystopian novel Brave New World, Aldous Huxley (1932), once wrote of his experiences with the drug mescaline. The Doors of Perception described the intense experience that accompanied his departure from normal consciousness. He described “a world where everything shone with the Inner Light, and was infinite in its significance. The legs, for example, of a chair—how miraculous their tubularity, how supernatural their polished smoothness! I spent several minutes—or was it several centuries?—not merely gazing at those bamboo legs, but actually being them” (Huxley, 1954, p. 22).

Being the legs of a chair? This probably is better than being the seat of a chair, but it still sounds like an odd experience. Still, many people seek out such experiences, often through using drugs. Psychoactive drugs are chemicals that influence consciousness or behavior by altering the brain’s chemical message system. You read about several such drugs in the Neuroscience and Behavior chapter when we explored the brain’s system of neurotransmitters. And you will read about them in a different light when we turn to their role in the treatment of psychological disorders in the Treatment chapter. Whether these drugs are used for entertainment, for treatment, or for other reasons, they each exert their influence by increasing the activity of a neurotransmitter (the agonists) or decreasing its activity (the antagonists).

Some of the most common neurotransmitters are serotonin, dopamine, gammaaminobutyric acid (GABA), and acetylcholine. Drugs alter the functioning of neurotransmitters by preventing them from bonding to sites on the postsynaptic neuron, by inhibiting their reuptake to the presynaptic neuron, or by enhancing their bonding and transmission. Different drugs can intensify or dull transmission patterns, creating changes in brain electrical activities that mimic natural operations of the brain. For example, a drug such as Valium (benzodiazepine) induces sleep but prevents dreaming and so creates a state similar to slow-wave sleep, that is, what the brain naturally develops several times each night. Other drugs prompt patterns of brain activity that do not occur naturally, however, and their influence on consciousness can be dramatic. Like Huxley experiencing himself becoming the legs of a chair, people using drugs can have experiences unlike any they might find in normal waking consciousness or even in dreams. To understand these altered states, let’s explore how people use and abuse drugs, and examine the major categories of psychoactive drugs.

Drug Use and Abuse

Why do kids enjoy spinning around until they get so dizzy that they fall down? Even from a young age, there seems to be something enjoyable about altering states of consciousness.

MATTHEW NOCK

Why do children sometimes spin around until they get dizzy and fall down? There is something strangely attractive about states of consciousness that depart from the norm, and people throughout history have sought out these altered states by dancing, fasting, chanting, meditating, and ingesting a bizarre assortment of chemicals to intoxicate themselves (Tart, 1969). People pursue altered consciousness even when there are costs, from the nausea that accompanies dizziness to the life-wrecking obsession with a drug that can come with addiction. In this regard, the pursuit of altered consciousness can be a fatal attraction.

Often, drug-induced changes in consciousness begin as pleasant and spark an initial attraction. Researchers have measured the attractiveness of psychoactive drugs by seeing how hard laboratory animals will work to get them. In one study researchers allowed rats to administer cocaine to themselves intravenously by pressing a lever (Bozarth & Wise, 1985). Rats given free access to cocaine increased their use over the course of the 30-day study. They not only continued to self-administer at a high rate but also occasionally binged to the point of giving themselves convulsions. They stopped grooming themselves and eating until they lost on average almost a third of their body weight. About 90% of the rats died by the end of the study. Rats do show more attraction to sweets such as sugar or saccharine than they do to cocaine (Lenoir et al., 2007), but their interest in cocaine is deadly serious.

Rats are not tiny little humans, of course, so such research is not a firm basis for understanding human responses to cocaine. But these results do make it clear that cocaine is addictive and that the consequences of such addiction can be dire. Studies of self-administration of drugs in laboratory animals show that animals will work to obtain not only cocaine but also alcohol, amphetamines, barbiturates, caffeine, opiates (such as morphine and heroin), nicotine, phencyclidine (PCP), MDMA (Ecstasy), and THC (tetrahydrocannabinol, the active ingredient in marijuana). There are some psychoactive drugs that animals won’t work for (such as mescaline or the antipsychotic drug phenothiazine), suggesting that these drugs have less potential for causing addiction (Bozarth, 1987).

People usually do not become addicted to a psychoactive drug the first time they use it. They may experiment a few times, then try again, and eventually find that their tendency to use the drug increases over time due to several factors, such as drug tolerance, physical dependence, and psychological dependence. Drug tolerance is the tendency for larger drug doses to be required over time to achieve the same effect. Physicians who prescribe morphine to control pain in their patients are faced with tolerance problems because steadily greater amounts of the drug may be needed to dampen the same pain. With increased tolerance comes the danger of drug overdose; recreational users find they need to use more and more of a drug to produce the same high. But then, if a new batch of heroin or cocaine is more concentrated than usual, the “normal” amount the user takes to achieve the same high can be fatal.

Self-administration of addictive drugs can also be prompted by withdrawal symptoms, which result when drug use is discontinued. Some withdrawal symptoms signal physical dependence, when pain, convulsions, hallucinations, or other unpleasant symptoms accompany withdrawal. People who suffer from physical dependence seek to continue drug use to avoid becoming physically ill. A common example is the “caffeine headache” some people complain of when they haven’t had their daily jolt of java. Other withdrawal symptoms result from psychological dependence, a strong desire to return to the drug even when physical withdrawal symptoms are gone. Drugs can create an emotional need over time that continues to prey on the mind, particularly in circumstances that are reminders of the drug. Some ex-smokers report longing wistfully for an after-dinner smoke, for example, even years after they’ve successfully quit the habit.

Many soldiers serving in Vietnam became addicted to heroin while there. Robins and colleagues (1980) found that after returning home to the United States, the vast majority left their drug habit behind and were no longer addicted.

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Drug addiction reveals a human frailty: our inability to look past the immediate consequences of our behavior to see and appreciate the long-term consequences. Although we would like to think that our behavior is guided by a rational analysis of future consequences, more typically occasions when we “play first, pay later” lead directly to “let’s just play a lot right now.” There is something intensely inviting about the prospect of a soon-to-be-had pleasure and something pale, hazy, and distant about the costs this act might bring at some future time. For example, given the choice of receiving $1 today or $2 a week later, most people will take the $1 today. However, if the same choice is to be made for some date a year in the future (when the immediate pleasure of today’s windfall is not so strong), people choose to wait and get the $2 (Ainslie, 2001). The immediate satisfaction associated with taking most drugs may outweigh a rational analysis of the later consequences that can result from taking those drugs, such as drug addiction.

The psychological and social problems stemming from drug addiction are major. For many people, drug addiction becomes a way of life, and for some, it is a cause of death. Like the cocaine-addicted rats in the study noted earlier (Bozarth & Wise, 1985), some people become so attached to a drug that their lives are ruled by it. However, this is not always the end of the story. This ending is most well-known because the addict becomes a recurrent, visible social problem, “publicized” through repeated crime and repeated appearances in prisons and treatment programs. But a life of addiction is not the only possible end point of drug use. Stanley Schachter (1982) suggested that the visibility of addiction is misleading and that in fact many people overcome addictions. He found that 64% of a sample of people who had a history of cigarette smoking had quit successfully, although many had to try again and again to achieve their success. Indeed, large-scale studies conducted in the 1980s, 1990s, and 2000s consistently show that approximately 75% of those with substance use disorders overcome their addiction, with the biggest drop in use occurring between ages 20–30 (Heyman, 2009). One classic study of soldiers who became addicted to heroin in Vietnam found that, years after their return, only 12% remained addicted (Robins et al., 1980). The return to the attractions and obligations of normal life, as well as the absence of the familiar places and faces associated with their old drug habit, made it possible for returning soldiers to successfully quit. Although addiction is dangerous, it is not necessarily incurable.

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It may not be accurate to view all recreational drug use under the umbrella of “addiction.” Many people at this point in the history of Western society, for example, would not call the repeated use of caffeine an addiction, and some do not label the use of alcohol, tobacco, or marijuana in this way. In other times and places, however, each of these has been considered a terrifying addiction worthy of prohibition and public censure. In the early 17th century, for example, tobacco use was punishable by death in Germany, by castration in Russia, and by decapitation in China (Corti, 1931). Not a good time to be a smoker. By contrast, cocaine, heroin, marijuana, and amphetamines have each been popular and even recommended as medicines at several points throughout history, each without any stigma of addiction attached (Inciardi, 2001).

Although “addiction” as a concept is familiar to most of us, there is no standard clinical definition of what an addiction actually is. The concept of addiction has been extended to many human pursuits, giving rise to such terms as sex addict, gambling addict, workaholic, and, of course, chocoholic. Societies react differently at different times, with some uses of drugs ignored, other uses encouraged, others simply taxed, and yet others subjected to intense prohibition (see the Real World box on p. 212). Rather than viewing all drug use as a problem, it is important to consider the costs and benefits of such use and to establish ways to help people choose behaviors that are informed by this knowledge (Parrott et al., 2005).

Types of Psychoactive Drugs

Four in five North Americans use caffeine in some form every day, but not all psychoactive drugs are this familiar. To learn how both the well-known and lesser-known drugs influence the mind, let’s consider several broad categories of drugs: depressants, stimulants, narcotics, hallucinogens, and marijuana. TABLE 5.3 summarizes what is known about the potential dangers of these different types of drugs.

Table 5.3: Dangers of Drugs

Depressants

Depressants are substances that reduce the activity of the central nervous system. The most commonly used depressant is alcohol, and others include barbiturates, benzodiazepines, and toxic inhalants (such as glue or gasoline). Depressants have a sedative or calming effect, tend to induce sleep in high doses, and can arrest breathing in extremely high doses. Depressants can produce both physical and psychological dependence.

Alcohol. Alcohol is king of the depressants, with its worldwide use beginning in prehistory, its easy availability in most cultures, and its widespread acceptance as a socially approved substance. Fifty-two percent of Americans over 12 years of age report having had a drink in the past month, and 24% have binged on alcohol (over five drinks in succession) in that time. Young adults (ages 18–25) have even higher rates, with 62% reporting a drink the previous month and 42% reporting a binge (National Center for Health Statistics, 2012).

Alcohol’s initial effects, euphoria and reduced anxiety, feel pretty positive. As it is consumed in greater quantities, drunkenness results, bringing slowed reactions, slurred speech, poor judgment, and other reductions in the effectiveness of thought and action. The exact way in which alcohol influences neural mechanisms is still not understood, but like other depressants, alcohol increases activity of the neurotransmitter GABA (De Witte, 1996). As you read in the Neuroscience and Behavior chapter, GABA normally inhibits the transmission of neural impulses, and so one effect of alcohol is as an inhibitor—a chemical that stops the firing of other neurons. But there are many contradictions. Some people using alcohol become loud and aggressive, others become emotional and weepy, others become sullen, and still others turn giddy—and the same person can experience each of these effects in different circumstances. How can one drug do this? Two theories have been offered to account for these variable effects: expectancy theory and alcohol myopia.

Expectancy theory suggests that alcohol effects can be produced by people’s expectations of how alcohol will influence them in particular situations (Marlatt & Rohsenow, 1980). So, for instance, if you’ve watched friends or family drink at weddings and notice that this often produces hilarity and gregariousness, you could well experience these effects yourself should you drink alcohol on a similarly festive occasion. Seeing people getting drunk and fighting in bars, in turn, might lead to aggression after drinking.

The expectancy theory has been tested in studies that examine the effects of actual alcohol ingestion independent of the perception of alcohol ingestion. In experiments using a balanced placebo design, behavior is observed following the presence or absence of an actual stimulus and also following the presence or absence of a placebo stimulus. In such a study, participants are given drinks containing alcohol or a substitute liquid, and some people in each group are led to believe they had alcohol and others are led to believe they did not. People told they are drinking alcohol when they are not, for instance, might get a touch of vodka on the plastic lid of a cup to give it the right odor when the drink inside is merely tonic water. These experiments often show that the belief that one has had alcohol can influence behavior as strongly as the ingestion of alcohol itself (Goldman, Brown, & Christiansen, 1987). You may have seen people at parties getting rowdy after only one beer—perhaps because they expected this effect rather than because the beer actually had this influence.

Another approach to the varied effects of alcohol is the theory of alcohol myopia, which proposes that alcohol hampers attention, leading people to respond in simple ways to complex situations (Steele & Josephs, 1990). This theory recognizes that life is filled with complicated pushes and pulls, and our behavior is often a balancing act. Imagine that you are really attracted to someone who is dating your friend. Do you make your feelings known or focus on your friendship? The myopia theory holds that when you drink alcohol, your fine judgment is impaired. It becomes hard to appreciate the subtlety of these different options, and the inappropriate response is to veer full tilt one way or the other. So, alcohol might lead you to make a wild pass at your friend’s date or perhaps just cry in your beer over your timidity—depending on which way you happened to tilt in your myopic state.

Which theory, expectancy theory or alcohol myopia, views a person’s response to alcohol as being (at least partially) learned, through a process similar to observational learning?

IMAGE SOURCE/GETTY IMAGES

In one study on the alcohol myopia theory, men (half of whom were drinking alcohol) watched a video showing an unfriendly woman and then were asked how acceptable it would be for a man to act sexually aggressive toward a woman (Johnson, Noel, & Sutter-Hernandez, 2000). The unfriendly woman seemed to remind them that sex was out of the question, and indeed, men who were drinking alcohol and had seen this video were no more likely to think sexual advances were acceptable than men who were sober. However, when the same question was asked of a group of men who had seen a video of a friendly woman, those who were drinking were more inclined to recommend sexual overtures than those who were not, even when these overtures might be unwanted. Apparently, alcohol makes the complicated decisions involved in relationships seem simple (“Gee, she was so friendly”)—and potentially open to serious misjudgments.

Both the expectancy and myopia theories suggest that people using alcohol will often go to extremes (Cooper, 2006). In fact, it seems that drinking is a major contributing factor to social problems that result from extreme behavior. Drinking while driving is a main cause of auto accidents. Twenty-two percent of drivers involved in fatal car crashes in 2009 had a blood alcohol level of .08% or higher (U.S. Census Bureau, 2012). A survey of undergraduate women revealed that alcohol contributes to approximately 76% of cases of incapacitated rape (rape after the victim is incapacitated by self-induced intoxication) and 72% of drug- or alcohol-facilitated rapes (in which the perpetrator deliberately intoxicates the victim prior to rape; McCauley et al., 2009).

People will often endure significant inconveniences to maintain their addictions.

JEFF GREENBERG/THE IMAGE WORKS

Barbiturates, Benzodiazepines, and Toxic Inhalants. Compared to alcohol, the other depressants are much less popular but still are widely used and abused. Barbiturates such as Seconal or Nembutal are prescribed as sleep aids and as anesthetics before surgery. Benzodiazepines such as Valium and Xanax are also called minor tranquilizers and are prescribed as antianxiety drugs. These drugs are prescribed by physicians to treat anxiety or sleep problems, but they are dangerous when used in combination with alcohol because they can cause respiratory depression. Physical dependence is possible because withdrawal from long-term use can produce severe symptoms (including convulsions), and psychological dependence is common as well. Finally, toxic inhalants are perhaps the most alarming substances in this category (Ridenour & Howard, 2012). These drugs are easily accessible even to children in the vapors of household products such as glue, hair spray, nail polish remover, or gasoline. Sniffing or “huffing” vapors from these products can promote temporary effects that resemble drunkenness, but overdoses can be lethal, and continued use holds the potential for permanent neurological damage (Howard et al., 2011).

Stimulants

Stimulants are substances that excite the central nervous system, heightening arousal and activity levels. They include caffeine, amphetamines, nicotine, cocaine, modafinil, and Ecstasy, and sometimes have a legitimate pharmaceutical purpose. Amphetamines (also called speed), for example, were originally prepared for medicinal uses and as diet drugs; however, amphetamines such as Methedrine and Dexedrine are widely abused, causing insomnia, aggression, and paranoia with long-term use. Stimulants increase the levels of dopamine and norepinephrine in the brain, thereby inducing higher levels of activity in the brain circuits that depend on these neurotransmitters. As a result, they increase alertness and energy in the user, often producing a euphoric sense of confidence and a kind of agitated motivation to get things done. Stimulants produce physical and psychological dependence, and their withdrawal symptoms involve depressive effects such as fatigue and negative emotions.

Ecstasy (also known as MDMA, “X,” or “E”), an amphetamine derivative, is a stimulant but it has added effects somewhat like those of hallucinogens (we’ll talk about those shortly). Ecstasy is particularly known for making users feel empathic and close to those around them. It is used often as a party drug to enhance the group feeling at dance clubs or raves, but it has unpleasant side effects such as causing jaw clenching and interfering with the regulation of body temperature. The rave culture has popularized pacifiers and juices as remedies for these problems, but users remain highly susceptible to heatstroke and exhaustion. Although Ecstasy is not as likely as some other drugs to cause physical or psychological dependence, it nonetheless can lead to some dependence. What’s more, the impurities sometimes found in street pills are also dangerous (Parrott, 2001). Ecstasy’s potentially toxic effect on serotonin neurons in the human brain is under debate, although mounting evidence from animal and human studies suggests that sustained use is associated with damage to serotonergic neurons and potentially associated problems with mood, attention and memory, and impulse control (Kish et al., 2010; Urban et al., 2012).

Smoking tobacco can be very difficult to quit. NPR recently reported one interesting strategy being tried in Japan is filling ashtrays with soap and encouraging people to blow bubbles rather than smoke cigarettes.

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Cocaine is derived from leaves of the coca plant, which has been cultivated by indigenous peoples of the Andes for millennia and chewed as a medication. Yes, the urban legend is true: Coca-Cola contained cocaine until 1903 and still may use coca leaves (with cocaine removed) as a flavoring—although the company’s not telling (Pepsi-Cola never contained cocaine and is probably made from something brown). Sigmund Freud tried cocaine and wrote effusively about it for a while. Cocaine (usually snorted) and crack cocaine (smoked) produce exhilaration and euphoria and are seriously addictive, both for humans and the rats you read about earlier in this chapter. Withdrawal takes the form of an unpleasant crash, and dangerous side effects of cocaine use include both psychological problems such as insomnia, depression, aggression, and paranoia, as well as physical problems such as death from a heart attack or hyperthermia (Marzuk et al., 1998). Although cocaine has enjoyed popularity as a party drug, its extraordinary potential to create dependence and potentially lethal side effects should be taken very seriously.

Nicotine is something of a puzzle. This is a drug with almost nothing to recommend it to the newcomer. It usually involves inhaling smoke that doesn’t smell that great, at least at first, and there’s not much in the way of a high either—at best, some dizziness or a queasy feeling. So why do people do it? Tobacco use is motivated far more by the unpleasantness of quitting than by the pleasantness of using. The positive effects people report from smoking—relaxation and improved concentration, for example—come chiefly from relief from withdrawal symptoms (Baker, Brandon, & Chassin, 2004). The best approach to nicotine is to never get started.

Narcotics

Opium, which comes from poppy seeds, and its derivatives heroin, morphine, methadone, and codeine (as well as prescription drugs such as Demerol and Oxycontin), are known as narcotics (or opiates), highly addictive drugs derived from opium that relieve pain. Narcotics induce a feeling of well-being and relaxation that is enjoyable but can also induce stupor and lethargy. The addictive properties of narcotics are powerful, and long-term use produces both tolerance and dependence. Because these drugs are often administered with hypodermic syringes, they also introduce the danger of diseases such as HIV when users share syringes. Unfortunately, these drugs are especially alluring because they mimic the brain’s own internal relaxation and well-being system.

The brain produces endogenous opioids or endorphins, which are neurotransmitters closely related to opiates. As you learned in the Neuroscience & Behavior chapter, endorphins play a role in how the brain copes internally with pain and stress. These substances reduce the experience of pain naturally. When you exercise for a while and start to feel your muscles burning, for example, you may also find that there comes a time when the pain eases—sometimes even during exercise. Endorphins are secreted in the pituitary gland and other brain sites as a response to injury or exertion, creating a kind of natural remedy (like the so-called runner’s high) that subsequently reduces pain and increases feelings of well-being. When people use narcotics, the brain’s endorphin receptors are artificially flooded, however, reducing receptor effectiveness and possibly also depressing the production of endorphins. When external administration of narcotics stops, withdrawal symptoms are likely to occur.

Hallucinogens

Psychedelic art and music of the 1960s were inspired by some visual and auditory effects of drugs such as LSD.

ANDREW HERYGERS CREATIVE/SUPERSTOCK

The drugs that produce the most extreme alterations of consciousness are the hallucinogens, drugs that alter sensation and perception, and often cause visual and auditory hallucinations. These include LSD (lysergic acid diethylamide, or acid), mescaline, psilocybin, PCP (phencyclidine), and ketamine (an animal anesthetic). Some of these drugs are derived from plants (mescaline from peyote cactus, psilocybin or “shrooms” from mushrooms) and have been used by people since ancient times. For example, the ingestion of peyote plays a prominent role in some Native American religious practices. The other hallucinogens are largely synthetic. LSD was first made by chemist Albert Hofman in 1938, leading to a rash of experimentation that influenced popular culture in the 1960s. Timothy Leary, at the time a lecturer in the Department of Psychology at Harvard, championed the use of LSD to “turn on, tune in, and drop out”; the Beatles sang of “Lucy in the Sky with Diamonds” (denying, of course, that this might be a reference to LSD); and the wave of interest led many people to experiment with hallucinogens.

The experiment was not a great success. These drugs produce profound changes in perception. Sensations may seem unusually intense, stationary objects may seem to move or change, patterns or colors may appear, and these perceptions may be accompanied by exaggerated emotions ranging from blissful transcendence to abject terror. These are the “I’ve-become-the-legs-of-a-chair!” drugs. But the effects of hallucinogens are dramatic and unpredictable, creating a psychological roller-coaster ride that some people find intriguing and others find deeply disturbing. Hallucinogens are the main class of drugs that animals won’t work to self-administer, so it is not surprising that in humans these drugs are unlikely to be addictive. Hallucinogens do not induce significant tolerance or dependence, and overdose deaths are rare. Although hallucinogens still enjoy a marginal popularity with people interested in experimenting with their perceptions, they have been more a cultural trend than a dangerous attraction.

Marijuana

Marijuana (or cannabis) is a plant whose leaves and buds contain a psychoactive drug called tetrahydrocannabinol (THC). When smoked or eaten, either as is or in concentrated form as hashish, this drug produces an intoxication that is mildly hallucinogenic. Users describe the experience as euphoric, with heightened senses of sight and sound and the perception of a rush of ideas. Marijuana affects judgment and short-term memory, and impairs motor skills and coordination—making driving a car or operating heavy equipment a poor choice during its use (“Dude, where’s my bulldozer?”). Researchers have found that receptors in the brain that respond to THC (Stephens, 1999) are normally activated by a neurotransmitter called anandamide that is naturally produced in the brain (Wiley, 1999). Anandamide is involved in the regulation of mood, memory, appetite, and pain perception and has been found temporarily to stimulate overeating in laboratory animals, much as marijuana does in humans (Williams & Kirkham, 1999). Some chemicals found in dark chocolate also mimic anandamide, although very weakly, perhaps accounting for the well-being some people claim they enjoy after a “dose” of chocolate.

The addiction potential of marijuana is not strong, as tolerance does not seem to develop, and physical withdrawal symptoms are minimal. Psychological dependence is possible, however, and some people do become chronic users. Marijuana use has been widespread throughout the world for recorded history, both as a medicine for pain and/or nausea and as a recreational drug, but its use remains controversial. Marijuana abuse and dependence have been linked with increased risk of depression, anxiety, and other forms of psychopathology. Many people also are concerned that marijuana (along with alcohol and tobacco) is a gateway drug, a drug whose use increases the risk of the subsequent use of more harmful drugs. The gateway theory has gained mixed support, with recent studies challenging this theory and suggesting that early-onset drug use in general, regardless of type of drug, increases the risk of later drug problems (Degenhardt et al., 2010). Because of the harm attributed to marijuana use, the U.S. government classifies marijuana as a Schedule I Controlled Substance, recognizing no medical use and maintaining that marijuana has the same high potential for abuse as other drugs like heroin. Despite the federal laws against the use of marijuana, approximately 42% of adults in the United States reported using it at some point in their lives—a rate much higher than that observed in most other countries (Degenhardt et al., 2008). Perhaps due to the perceived acceptability of marijuana among the general public, several states recently have taken steps to permit the sale of marijuana for medical purposes, decriminalize possession of marijuana (so violators pay a fine rather than going to jail), or to legalize its sale and possession outright. The debate about the legal status of marijuana will likely take years to resolve. In the meantime, depending on where you live, the greatest risk of marijuana use may be incarceration (see The Real World: Drugs and the Regulation of Consciousness).

THE REAL WORLD: Drugs and the Regulation of Consciousness

Everyone has an opinion about drug use. Given that it’s not possible to perceive what happens in anyone else’s mind, why does it matter to us what people do to their own consciousness? Is consciousness something that governments should be able to legislate? Or should people be free to choose their own conscious states (McWilliams, 1993)? After all, how can a “free society” justify regulating what people do inside their own heads?

Individuals and governments alike answer these questions by pointing to the costs of drug addiction, both to the addict and to the society that must “carry” unproductive people, pay for their welfare, and often even take care of their children. Drug users appear to be troublemakers and criminals, the culprits behind all those drug-related shootings, knifings, and robberies you see in the news every day. Widespread anger about the drug problem surfaced in the form of the War on Drugs, a federal government program born in the Nixon years that focused on drug use as a criminal offense and attempted to stop drug use through the imprisonment of users.

There are many reasons that U.S. prisons are overcrowded—this country has the highest incarceration rate in the world. Treating drug abuse as a crime that requires imprisonment is one of the reasons.

AP PHOTO/CALIFORNIA DEPARTMENT OF CORRECTIONS

Drug use did not stop with 40 years of the War on Drugs though, and instead, prisons filled with people arrested for drug use. From 1990 to 2007, the number of drug offenders in state and federal prisons increased from 179,070 to 348,736—a jump of 94% (Bureau of Justice Statistics, 2008)—not because of a measurable increase in drug use, but because of the rapidly increasing use of imprisonment for drug offenses. Many people who were being prevented from ruining their lives with drugs were instead having their lives ruined by prison. Like the failed policy of alcohol Prohibition from 1920 to 1933 (Trebach & Zeese, 1992), the policy of the drug war seemed to be causing more harm than it was preventing.

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What can be done? The policy of the Obama administration is to wind down the war mentality and instead focus on reducing the harm that drugs cause (Fields, 2009). This harm reduction approach is a response to high-risk behaviors that focuses on reducing the harm such behaviors have on people’s lives (Marlatt & Witkiewitz, 2010). Harm reduction originated in the Netherlands and England with tactics such as eliminating criminal penalties for some drug use or providing intravenous drug users with sterile syringes to help them avoid contracting HIV and other infections from shared needles (Des Jarlais et al., 2009). Harm reduction may even involve providing drugs for addicts to reduce the risks of poisoning and overdose they face when they get impure drugs of unknown dosage from criminal suppliers. A harm reduction idea for alcoholics, in turn, is to meet people where they are (in terms of their current level of drinking), and not to condemn their drinking behavior but to allow moderate drinking while minimizing the harmful effects of heavy drinking (Marlatt & Witkiewitz, 2010). Harm reduction strategies do not always find public support because they challenge the popular idea that the solution to drug and alcohol problems must always be prohibition: stopping use entirely.

In the Netherlands, marijuana use is not prosecuted. The drug is sold in “coffee shops” to those over 18.

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There appears to be increasing support for the idea that people should be free to decide whether they want to use substances to alter their consciousness, especially when use of the substance carries a medical benefit, such as decreased nausea, decreased insomnia, and increased appetite. Since 1996, 18 states and the District of Columbia have enacted laws to legalize the use of marijuana for medical purposes. On November 6, 2012, Colorado and Washington became the first two states to legalize marijuana for purely recreational purposes. The fact that marijuana continues to be a Schedule I Controlled Substance under federal law complicates matters and it may take years before the legal issues involved are fully resolved. Indeed, upon learning of the passing of the legalization initiative, Colorado Governor John Hickenlooper warned citizens of Colorado: “Federal law still says marijuana is an illegal drug so don’t break out the Cheetos or Goldfish too quickly.”