When we talk about addiction to drugs we typically think of heroin. It’s a drug that’s portrayed as the demon lurking on every street corner, ready to spread its filthy tentacles around anybody foolish enough to succumb to its lure. In the eyes of the media, heroin has become the epitome of evil: corrupting anyone who goes near it.
We’re all familiar with the image of a junkie shooting up in a filthy squat before passing into a stupor, like something from a scene in Danny Boyle’s drugs movie Trainspotting. So it might surprise you to learn that heroin began life as a substance that was not only perfectly legal, but also routinely prescribed by doctors for common ailments such as coughs, colds and diarrhoea.
The word ‘Heroin’ is a brand name invented by the German pharmaceutical company Bayer for one of two legal wonder drugs that it developed at the end of the 19th century. The other drug was Aspirin, so Bayer had simultaneously created the world’s best drug and what was to become regarded as the world’s worst drug.
Initially, it was heroin that looked like being the best banker. As a painkiller it was eight times stronger than morphine, and when prescribed in moderation it seemed like the ideal pick-me-up for a range of minor ailments. In 1956, the drug was outlawed in the UK, prompting an outraged leader column in The Times newspaper entitled ‘The Case for Heroin’.
Such a headline would be unthinkable today, but The Times may have actually got it right, all those years ago, because one thing that I’m now absolutely certain of is that our modern social policy towards heroin and other Class A drugs is deeply flawed.
In 1956, there were just 317 registered addicts of ‘manufactured drugs’ in Great Britain, of whom 47 were addicted to heroin. If you go onto the National Treatment Agency/NHS websites today, you’ll see that, according to the latest figures, there are now 298,752 ‘opiate/crack users’ in the UK.8
In the 50 years since we decided to tackle drug addiction via the criminal justice system, the problem has increased in size almost 1,000 times! Clearly, something isn’t working.
The fact that heroin was once regarded as a safe drug, and it was handed out by GPs, illustrates just how polarized our attitude to drugs has become. We see everything in terms of good or bad. Legal drugs are regarded as good, and illegal drugs are regarded as bad. But if heroin was once legal – and widely prescribed – then surely we can’t have it both ways?
In my opinion, what this actually shows is that it doesn’t matter whether the substance you’re addicted to is legal or not, the consequences can be just as harmful. Indeed, the manner in which a substance is classified often appears to be purely arbitrary.
When it comes to addiction, it’s not the nature of a substance that’s wholly to blame: it’s also down to the habits of users and the reasons why they take it. The drugs themselves obviously have addictive properties, but they don’t necessarily cause addiction on an emotional level unless other factors come into play. I’m not for one minute trying to argue that heroin is a harmless substance. Far from it. I’m the first to acknowledge that it causes a great deal of suffering, and I’ve seen first-hand the misery and despair endured by heroin addicts, many of whom are doomed to die a horrific death as a result of their habit. I wouldn’t recommend its recreational use to anybody. However, what I am saying is that criminalizing it is not the answer.
I’m convinced that being addicted to legal substances, such as alcohol and nicotine, or prescription drugs, can be just as serious, and in some cases more dangerous, than heroin.
In almost every modern country booze and cigarettes kill far more people than heroin does. In many Western societies the biggest killer of all is actually obesity, due to over-consumption of sugary food. Yet we don’t even widely regard sugar as being addictive.
What matters for understanding addiction isn’t so much the legal status of a drug, it’s the effect it has upon us, and the reasons that we abuse it. Clearly, not everybody who drinks alcohol is an alcoholic, and it would be preposterous to even suggest that.
Similarly, not everybody who takes drugs on a recreational basis is an addict (although granted, the majority probably are). Some will dabble only occasionally, while others may use certain drugs on a semi-regular basis, but they’ll have no major problems quitting when the circumstances of their lifestyle require them to do so.
For example, during the Vietnam War, large numbers of American GIs regularly used heroin while they were in Southeast Asia. When they returned to the USA, the vast majority of them stopped. Only around 10 per cent – roughly the same proportion of the population that I estimate suffer from an addictive nature today – continued to take it.
So what is it that defines addictive consumption of a substance, as opposed to recreational or social use? Well, here’s one possible way of discovering a clue.
A good way to find out if you’re using a substance in an addictive manner is to ask yourself a very simple question: does it cost you more than you pay for it?
This simple acid test can be applied to everything from alcohol consumption right through to regular abuse of an illegal substance such as cocaine. For example, if you drink regularly but it doesn’t cause you any negative consequences, I’ll be the first to wish you all the best. But if the true cost of your drinking includes damage to your health, or to your relationships or to your self-esteem (or anything else), you need to evaluate what the overall cost is (as clearly, it’s a lot more than just the price of the booze).
If so, is it a price you’re willing to pay? Are the consequences of your drinking becoming increasingly negative as time goes on? You can use the same approach to assess drug use. The answers to these questions are always likely to be dictated by the reasons why you take a substance – and it’s usually one of two effects that you’re looking for.
In most cases of drug abuse, the user tends to be seeking out one or the other of two different effects: these are either ‘nurturant’ or ‘hedonistic’. With nurturant drug abuse, the user is seeking to medicate themselves in order to chill out and relax. If you have an addictive nature, this is the perfect way to forget about all that background anxiety and emotional pain that you experience due to your overactive limbic system. Alternatively, with hedonistic drug abuse, the user is seeking to get high and wants to feel great. If you have an addictive nature, hedonistic use can also be a way of overcoming emotional pain and sensitivity.
In both cases, the process may be subconscious rather than conscious. You don’t necessarily think to yourself that you can’t ‘take’ life today – you just go out and get smashed. These two different types of drug use might also be described as taking ‘uppers’ or ‘downers’. Some substances can have both effects, depending on the context in which they are taken, and the amount that’s consumed by the user.
These are the ‘downers’, like heroin and other opiates, some of which are legal – such as codeine. They have a strong propensity to create physical dependency, and in this sense they’re highly addictive. Very few heroin users begin by injecting the drug – in fact, I’ve never come across anybody who started out by using the drug intravenously.
What tends to happen is that people start off by being introduced to smoking it by a friend. Because it’s such a strong downer, it doesn’t give you a feeling of euphoria as such, just an intense sense of inner peace. Given the horrific consequences that can follow, these feelings of peace are dangerously deceptive, but nonetheless they’re very seductive. Heroin typically comes in the form of a brown powder, which is burned on foil and the fumes are inhaled to give the desired effect.
The problem with all nurturant drugs is that, sooner or later, you have to return to reality if your life is to function in any meaningful way.
That’s when the problems set in, because if you’ve been taking the drug to medicate away distress or anxiety, you can bet your life that these feelings are going to be all the more acute when the effects of the drug wear off.
Often, the feelings are much worse than they were before, which in turn triggers an urge for even more of the drug. As the addictive cycle progresses, many heroin users switch to injecting (mainlining) the drug into their veins. This is incredibly dangerous because street heroin is often cut with all sorts of horrible substances and poisons in order to make it go further.
There are also hygiene issues; there can be dire consequences if needles are not sterile. Many heroin abusers develop horrific ulcers all over their body as they search out new places to inject the drug. Eventually, their veins start to collapse and they may resort to injecting into painful places like their groin in their desperation to chase a hit.
There’s a strong risk of fatal overdose, which is often due to the rogue ingredients that the heroin is cut with. And just to complicate the picture, the user may typically take other drugs like cocaine and alcohol at the same time as they’re on heroin.
In my opinion, the explosion in heroin abuse is partly due to the fact that it has been heavily criminalized. There’s a famous scene in Trainspotting in which Ewan McGregor’s character declares: ‘We would have injected vitamin C if only they had made it illegal.’
Ironically, I think there’s a lot of truth to this. By demonizing heroin, the authorities have helped to create a whole subculture that now surrounds its supply and usage. Just as outlawing booze during Prohibition backfired in the USA in the 1920s, banning heroin has led to an explosion of organized crime. I’ve no doubt that heroin is a dangerous substance that needs controlling, but I can’t see the point of fully criminalizing its use because that approach simply isn’t working. Instead, we should concentrate on tackling the true causes of addiction – which exist within the human condition of the addicts themselves.
Unfortunately, we fail to do this in the UK, and concentrate instead on dishing out a heroin substitute called methadone to registered addicts. I cannot think of a worse approach – in my view this is simply crazy because all it’s doing is perpetuating the problem by switching one dangerous drug for another.
The reason doctors do it is because methadone is legal under prescription, whereas heroin is illegal. Methadone does not give a user the same intense nurturant effect as heroin, so their thinking is that it’s easier to wean addicts off it than heroin. But unfortunately that doesn’t happen – and methadone users continue to be trapped in the same cycle of misery.
Methadone is typically prescribed as a green liquid that addicts are asked to drink in view of a pharmacist – but many addicts manage to smuggle it away and sell it in order to buy heroin. In some respects methadone is a more dangerous drug than heroin, because it has a lower tolerance range. Users only need to overdose by a relatively small percentage in order to suffer serious medical problems, or even death.
Many heroin addicts simply use methadone as a supplement to their wider drug use – it gets them through the day while they attempt to score enough cash to buy more drugs in the evening.
In addition to heroin, other drugs that fall into the category of downers, or nurturant drugs, include prescription tranquilizers that belong to the benzodiazepine family. The chief purpose of these drugs is to tackle anxiety, but they’re highly addictive.
This is an area in which I speak from bitter experience, because for 30 years I was addicted to a benzodiazepine called Lorazepam. I went to my doctor and explained that I was having problems coping with life because I was constantly plagued by feelings of anxiety and fear. Lorazepam is a drug that takes away anxiety and leaves you feeling nothing in the world is a problem. It’s a bit like an anaesthetic for emotional pain in that respect.
My problem was that, at the time, I was also drinking vast amounts of Jack Daniels on top if it. I was hopelessly addicted, and whenever I tried to stop taking Lorazepam, the anxiety would return with a fierce vengeance.
Some nurturant drugs, like codeine for example, are available over the counter without a prescription. There are numerous cases I’ve come across of people being addicted to Nurofen Plus (which contains codeine) because it gives them a feeling of tranquillity. Codeine is a powerful drug in its own right – and many heroin users will seek it out to take the edge off their distress if they cannot get hold of heroin itself. Unfortunately, in high doses, Nurofen Plus also causes extreme medical complications, not least because it also contains Ibuprofen, which can cause stomach problems when taken in excess.
Cannabis is also a nurturant drug that many people smoke for its relaxing properties. It can cause numerous health problems, including severe paranoia. It also acts as a stepping stone to harder drugs (which I’ll talk about later).
Finally, as I said earlier, some substances cross the divide and can act both as uppers and downers. This is true of alcohol and nicotine, both of which can act either as a stimulant or a relaxant, depending on the amount consumed and the mood of the user.
The typical drug of choice for hedonistic users is cocaine, which is also highly addictive. It’s a stimulant that makes the user feel invincible, boosting their confidence and making them feel as if there’s not a challenge in the world they cannot meet. Users experience a huge rush of euphoria when they take it for the first time, but they’re unlikely to ever achieve quite the same buzz again, at least not without continually increasing the dosage that they take.
Heavy use can lead to heart problems and severe paranoia and psychosis. People who use cocaine can very often still function and hold down good jobs (which they need in order to be able to afford their habit). But as they use more and more cocaine their ability to function gets less and less.
They’ll normally also be heavy drinkers, and can act out their addiction through sexual behaviour, for example by sleeping with prostitutes. If somebody has been using cocaine for a long time it can give them heart palpitations, which make them feel awful. If their drinking is also out of control, they’ll often end up in a treatment centre. Cocaine and alcohol, when combined, create a third substance in the liver called cocaethylene, which can cause heart attacks.
The effect that addicts are looking for, regardless of whether they take nurturant or hedonistic substances, is to change the way that they feel. That’s why it doesn’t really matter what the legal status of the substance is.
One substance on the hedonistic side that many people consider to be the worst in its effects is a derivative of cocaine called crack cocaine. This consists of powdered cocaine that has been washed of its impurities by chemicals in order to turn it into little rocks, which are then smoked. It gives a very, very intense high, which is then followed by a very, very intense low. Typically, crack cocaine addicts can use for days on end, until they run out of money or they’re exhausted.
In my opinion, the most dangerous of the hedonistic drugs is crystal meth – which gives users a huge high that lasts for a long time. The come down is so bad that people literally can’t stand it. They can’t cope with the physical and psychological withdrawal, so there have been instances of addicts going out and committing murder to get money to pay for their next high. In the UK, it’s linked to use within the gay community, because it lowers sexual inhibitions. My advice to anyone is to avoid crystal meth at all costs.
Ecstasy is another hedonistic drug, although very different to crystal meth in its effects. It creates feelings of intense euphoria and happiness, but like all addictive substances, there’s a price to pay later on if you become hooked on it. Some people may also derive a nurturant effect from ecstasy, so, like booze and cigarettes, it has a foot in both camps as an upper and a downer.
Clearly, abuse of illegal drugs involves some form of interaction with the criminal underworld, which brings its own risks and complications. However, what worries me far more than this is the fact that the medical profession is one of the biggest pushers of all. By dishing out tranquilizers, anti-depressants and substitute drugs like methadone, the UK’s National Health Service is institutionally biased towards tackling the symptoms of addiction, rather than the psychological and emotional factors that cause the condition. Meanwhile by criminalizing, rather than controlling, certain substances, we’re throwing petrol onto the flames.
If you calculate the entire number of deaths caused annually in the UK by illegal drugs it comes to just a few thousand. In 2008, the United Nations Office on Drugs and Crime (UNODC) estimated the figure to be 2,278.9 But if you were to combine the true death toll caused by booze, smoking and obesity, in my opinion it would be likely to run to many hundreds of thousands.
Unfortunately, there are no reliable figures, as many obesity or alcohol-related deaths are the underlying causes of other illnesses (and are therefore reported as something else). The UK’s National Office for Statistics estimates that in 2011 there were 8,748 deaths directly connected to alcohol,10 but the true figure will be many times higher.
What we do know for sure is that lung cancer – caused in the main by nicotine addiction – is a major cause of death in adult males. According to the campaign group ASH, smoking kills around 100,000 people in the UK every year.11 That’s almost 300 people a day! Imagine the outcry if there was a similar death toll on the roads, or in the aviation industry. If a plane crashed near Heathrow every day, killing hundreds of people, we would do something about it very quickly.
Banning drugs and criminalizing their usage isn’t the answer – what we need to do is start by acknowledging that addiction is a psychological and emotional problem, rather than a physical dependency issue.
I’ve one final thought, with which I’ll close this chapter: if the figures for nicotine deaths are shocking, I’m afraid they’re nothing compared to the growing death toll from obesity. Food addiction is something that takes society’s problems to a whole new level. There’s a lack of detailed data for the combined death toll from illnesses caused by obesity in the UK, which is part of the problem. However, studies in the USA suggest that it could account for 18 per cent in that country – that’s nearly one in five deaths.