This paper (2021) makes a case for broadening our conceptualization of substance use in order to develop more effective drug policy and education. It is argued that we need to move beyond our current framing of substance use as a pathological issue and that research on recreational drug use would be beneficial. Incorporating perspectives on positive drug use would enhance prevention and harm reduction strategies.
“This article advances the proposition that contemporary perspectives on psychoactive drug use are epistemologically limited and that a broadened conceptualization of substance use would aid the development of more effective drug policy and education. It contends that psychoactive substance use cannot be accounted for from an exclusively pathological frame of reference and that by neglecting positive drug instrumentalization, opportunities to advance public health, safety, and well-being are being overlooked. Using the field of positive psychology as a point of comparison, this article thus argues for greater acknowledgment of, and research on, beneficial recreational substance use. The adaptive function of psychoactive drug use and the limitations of conceptual discourse which fails to distinguish between deleterious and salubrious use are first discussed. This is followed by an overview of the cartography of psychoactive drug use and consideration of biopsychosocial parameters germane to positive drug instrumentalization. The classic psychedelics are highlighted due to their psychopharmacological properties and tendency to evoke self-transcendent states. Limitations of regulatory and educational approaches grounded exclusively in the pathological paradigm are broached, with a discussion of how incorporating perspectives on positive drug use would complement extant models of prevention and harm reduction. Areas for future research are considered.”
Authors: Kevin O. St. Arnaud
This article discusses the adaptive function of psychoactive drug use, the limitations of conceptual discourse that fails to distinguish between deleterious and salubrious use, and the importance of incorporating perspectives on positive drug use into current models of prevention and harm reduction.
Drug policy, positive psychology, psychedelics
Over the last few decades, there have been great advances in our understanding of the dangers associated with psychoactive drugs, but little recognition of the importance of positive drug utilization. This has served to propagate dubious policies of drug prohibition and impede the development of judicious drug education.
This article discusses the adaptive function of psychoactive substance use, the limitations of conceptual discourse which fails to consider it, the spectrum of drug use and biopsychosocial facets relevant to understanding use outcomes, and consideration for future research.
Positive psychology and psychoactive drug use
The field of positive psychology was developed to redress the knowledge deficit in clinical psychology, which had historically focused on maladaptation and psychopathology. Positive psychology does not seek to deny or minimize the harmful reality of psychopathology.
It is increasingly clear that a comprehensive understanding of psychoactive drug use cannot be accounted for from a solely pathological perspective. This does not discount the risks associated with drugs, but it is clear that current drug policies have not effectively addressed drug abuse and addiction.
Resistance to the positive psychology of drug use
Hart (2020) points out that although non-problematic drug use is the norm, medical, psychological, and public health research continues to emphasize the dangers of drug abuse and addiction while ignoring the potential benefits. This resistance may be due to pharmacological Calvinism.
Resistance to positive psychology of drug use involves concerns that this line of thinking fails to recognize abuse and addiction, and that it is a ‘pollyanna’ or ‘childish’ view of reality. However, positive psychology does not imply the denial or refutation of the risks and harms of drug use.
Resistance to advancing the well-being of those already faring well may be due to the contention that those suffering from drug abuse and dependence should be helped before considering methods to advance the well-being of those already faring well.
The third source of resistance to research on drug use may stem from epistemological bias in medical and social science, particularly when it comes to positive self-report testimony of drug users.
With these potential sources of resistance in mind, this outline aims to reimagine the conceptual landscape of substance use to include beneficial use.
Conceptualizing psychoactive drug use
To understand the genesis of psychoactive substance use, it is important to note that several animal species have been observed to consume psychoactive plants. This indicates that psychoactive substance use is not unique to humans.
Psychoactive plants have been used for therapeutic, social, and religious purposes by numerous cultures for hundreds of years, and may help explain the ubiquitous adoption of drug use across human cultures.
Most modern societies now prohibit the great majority of psychoactive drugs, with alcohol and tobacco being two notable exceptions. This has served to perpetuate what Taylor et al. (2016) refer to as drug apartheid.
Although legal drugs may also be conceptualized in a similarly derogatory manner, they are nonetheless granted considerable latitude in retaining social acceptability. Users of unacceptable and thus illegally demarcated substances are not afforded the same luxury.
The spectrum of psychoactive drug use
Drug use can be beneficial if one is thoughtful, well-prepared, and aware of the means to minimize the risks. However, the distinction between drug use and abuse is often not extended to illicit substances, and this bias persists despite mainstream psychiatry’s stance that drug use must cause clinically significant impairment or distress.
Most illicit drug users do not harm themselves or others and do not develop a substance use disorder. In fact, most illicit drug users lead productive, healthy lives.
The Institute of Medicine (1996) recognized a range of outcomes for drug use and thus classified drug use on a spectrum from dependence to abuse to controlled use. However, the reality is that for some, drug use may be demonstrably positive.
Positive drug instrumentalization
Askew and Williams (2020) contend that a wide range of substances can be beneficially used to enhance self-insight, well-being, creativity, and spirituality. Evidence for positive drug instrumentalization has been documented for various substances.
In a meta-analysis of the literature, Peele and Brodsky (2000) found that low to moderate alcohol consumption was associated with psychological, physical, and social well-being, lower rates of stress and mental illness, enhanced social participation, and less work absence or disability.
Although limited drug instrumentalization may hold benefits, frequent and heavy use can lead to harmful patterns of abuse or addiction. This reality has contributed to the scientific community’s hesitance to acknowledge positive drug use.
Muller and Schumann (2011) contend that positive drug instrumentalization is controlled and limited, while drug addiction is uncontrolled, compulsive, and associated with frequent consumption of large doses. Addictive drug use is often an attempt to cope with psychosocial ‘dislocation’.
The line demarcating positive instrumentalization from addiction is muddied because abuse/problematic use and pleasure/beneficial use may co-exist. A better understanding of enhancement substance use is needed to maximize positive outcomes, minimize harms, and predict problematic outcomes.
Biological parameters of positive drug use
The reality is that not all drugs are comparably safe or likely to be salubrious. Individuals differ in terms of physiology and drug metabolism, and thus the effects and outcomes of a given drug can vary considerably between individuals.
Although various drugs have positive potential, this article will focus on the ‘classic’ or serotonergic psychedelics, which likely renders them amongst the most promising classes for a positive psychology of drug use.
The classic psychedelics
Krebs and Johansen (2013) found no relationship between classic psychedelic use and psychological distress or symptoms of mental illness, whereas Hendricks et al. (2015) found a significantly reduced likelihood of psychological distress, suicidal thinking, and suicide attempts amongst users.
Positive psychologists contend that promoting self-transcendent or hypo-egoic states may be a method of fostering greater mental health given their well-established associations with well-being, prosociality, and spirituality.
Many studies suggest that the positive impact of classic psychedelics may be in part due to their capacity to reliably promote these states in both experimental and recreational contexts.
The classic psychedelics are apparently able to foster self-transcendent states, which may be related to the serotonergic system. Therefore, understanding how these drugs may be used to foster these states may be important.
Psychological parameters informing positive drug use
Despite the importance of biological factors, understanding a drug’s pharmacology is insufficient to predict the outcomes of its use. Understanding one’s motivation for using a substance provides substantial insight into the potential harms or benefits of drug use.
Learned drug skills and dosing
Learning how to instrumentalize a drug as a tool involves acquiring the ability to detect subtle changes in sensation, cognition, and perception. This is important because achieving a mental state for a given context and purpose requires taking a drug in a specific dosage range.
Initially, a substantial dose is required to discern the subtle shifts in perception suited for a particular task, but once the user knows what to expect, a smaller dose is often required to evoke the desired state, thus limiting potential toxicity or side effects.
Social parameters informing positive drug use
Social contexts surrounding drug use are important for understanding positive and negative drug use. For example, legal alcohol use is accompanied by frameworks that maximize safe consumption while simultaneously limiting harmful use.
The beneficial use of illicit drugs is partly informed by the social contexts and rituals established by a given drug’s subculture. Unfortunately, most Western societies have undermined the knowledge and the contexts that provide the structure for positive drug use, and they typically discriminate against it.
Stigmatization and positive psychoactive drug use
Although drugs have objectively different properties, the understanding of a drug is nonetheless influenced by various sociocultural forces. Therefore, arguing for the positive potential of some drugs risks implicitly arguing against, and thus perpetuating, the stigmatization of, other drugs.
Drug users are often portrayed as weak, immoral, and a danger to society in both medico-legal research and popular media. This stigmatization contributes to self-stigmatization and feelings of shame, which are associated with reduced access to health and harm reduction services.
Ross et al. (2020) suggest that researchers should self-disclose their drug use to promote de-stigmatization and change drug policy by demonstrating that drug users can, indeed, be successful.
Reconsidering drug regulatory and educational policy
A difficult yet central question remains: how do we fit this broadened view of substance use into current models of drug regulation and education? The dominant drug discourse is grounded in the pathological paradigm.
Nutt et al. (2007) proposed that it is arbitrary to declare a drug legal or illegal based on toxicity, tendency to induce dependence and effects on social functioning. However, it is less harmful to the individual and society to regulate, rather than prohibit, tobacco and alcohol.
If society is to foster public health and safety, then evidence-based approaches to regulate psychoactive substances should be viewed as a critical undertaking. However, legalization represents the explicit societal acknowledgment of a given drug’s potential for non-problematic use.
Public health is central to shifting drug regulatory policy to reflect the admission of non-problematic and beneficial drug use. Studies have shown that adolescent cannabis use declines after legalizing use for adults, likely because it is more difficult to obtain cannabis when illicit markets are replaced by licensed vendors with minimum age laws.
The United Nations characterizes drug use as a ‘youth phenomenon,’ and research suggests that drug abuse during adolescence is particularly deleterious given that the abuse of various substances may impair neuropsychological development at this age. However, the nature of what to include in drug education is highly problematic.
Historically, many models of drug education have espoused strict abstinence. However, abstinence-oriented programs have been routinely critiqued for being unrealistic, and leave drug naive youth on their own to cope with mistaken overdoses and other dangers.
Youth easily detect biased portrayals and hyperbolic claims, and they often report a lack of trust in formal sources of drug information. Harm reduction education strives to provide youth with the skills needed to identify and mitigate the risks and dangers of drug use.
The refusal to acknowledge that youth view drug use as a pleasurable and meaningful activity is a substantial barrier to preventing adolescent drug use. Harm reduction strategies would benefit from expanded discussions around how the harms and risks of drug use intertwine with safety, pleasure, and benefit.
Muller and Schumann (€ 2011) propose a framework for comprehensive drug education that would impart judicious attitudes and veridical knowledge about drugs to youth, while also contending with the fact that many youths are motivated to use drugs for various personal and social benefits.
Considerations for future research
This article has highlighted various pharmacological, contextual, regulatory, and educational factors relevant to promoting beneficial drug use outcomes. Further study is required to elucidate the role of drug use purposes, learned drug use skill and dose, and social context.
To understand how and when drug use ‘goes right,’ we must consider when drug use is likely to ‘go wrong.’ By exploring a drug’s impact on neuropsychological processes, we can establish which substances are most likely to be mis-instrumentalized.
Future studies should examine genetic, psychological, life-span developmental, and socio-cultural factors that may contribute to beneficial drug instrumentalization, and the social and environmental contexts that promote beneficial use or may prevent the transition to abuse or addiction.
Ross et al. (2020) suggest that disclosing personal drug use may enhance the quality of research by highlighting biases, promoting transparency, and demonstrating the reality of positive drug use. However, the distinct threats of stigma and sanction are very difficult to surmount.
Alexander (2010) argues that drugs are one powerful technology among many that modern society must learn to use and regulate wisely. A comprehensive framework for understanding positive drug use is needed to establish best practices, educate users, and enhance public health and safety.
Moore (2008) argues that making pleasurable and beneficial drug use more visible might be a first step towards creating new discourses about drugs that do not recreate the same deleterious consequences as the pathological paradigm. However, this may unintentionally foment further stigmatization against those suffering from problematic forms of drug use.
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