On the Treatment of Stimulant Abuse

ON THE TREATMENT OF STIMULANT ABUSE* PIERRE F. RENAULT, M.D., and CHARLES R. SCHUSTER, Ph.D.Î As a psychiatrist and psychologist associated with a major drugabuse rehabilitation program, we are frequently asked to provide treatment, to do something about "stimulant abuse." But there is no treatment for stimulant abuse, anymore than there is really any treatment for drug abuse in general. What we are usually referring to when we speak of treating these behaviors, is our wish to stop the widespread abuse of drugs among our young people. These young people are seen as the innocent victims of their own crime, drug abuse. By their drug abuse, they have divorced themselves from the bulk of society and have put in jeopardy their economic and emotional futures, as well as their physical and mental health. This all seems very clear to us, the older, mature segment (as well as presumably the non-drug-abusing segment) of this society. But this great social problem is not amenable to any known medical or psychiatric treatment, because there is nothing which clearly differentiates drug abuse from drug taking. Drug abuse is not a definable pathological entity or disease. In fact, drug taking is simply another behavior in the vast range of behaviors which go to make up an individual's performance in our society. The determinants of drug-taking behavior are similar to the determinants of any other behavior. Thus, in order to control drug taking we would have to be able to control the contingencies that determine individual behavior in general; as yet, we do not have the power to so totally control the environment of an individual at large in our society. Thus, drug-taking behavior is like any other behavior, in that it is governed by its consequences. The only unusual quality it has is the extreme pleasure which drugs produce, especially when taken * Presented in part at the Symposium on Self Administration and Stimulant Abuse, Annual Meeting, American Psychological Association, Washington, D.C, September, 1971. t Department of Psychiatry, University of Chicago. Perspectives in Biology and Medicine · Summer 1972 | 561 intravenously. The strength and immediacy of this reinforcement makes drug taking not only able to override the threat of dire physical consequences but also likely to supercede other behaviors which depend on chains of conditioned reinforcers, chains which have become so long and complex that the final payoff is often remote. Given these powerful contingencies which support drug taking, what can lead someone to stop taking drugs? We submit that a person , once started, will only stop when the aversive contingencies far outweigh the reinforcing properties of drug taking. The degree of aversiveness needed is, of course, dependent on the individual organism , and aversiveness can only be measured by a decrease in drugtaking behavior. But many of the things which stimulant abusers have found aversive have been the very things which they joyfully embraced when they began the life of drug taking in the "subculture ."' They gradually found that poverty, the lack of economic security , the dependence on others to provide the necessities of life often became a source of disappointment. Giving up all roots in straight society and rejection in turn by that society made the drug taker helpless, unable to achieve, and gave him a sense of going nowhere. Finally, the lack of freedom caused by the compulsion to continue using drugs has led to disillusionment. Disillusionment, lack of fulfillment, and loss of personal freedom are not directly associated with stimulant drug abuse. There is an artificial quality about much of what is aversive in stimulant abuse. In fact, it is the "dropping out" that is the hardest to bear, and yet this would not occur if society did not condemn the use of certain drugs in certain ways. A basic paradox of our society is thus uncovered . We are encouraged daily to seek solutions for our problems in drugs and then condemned if we use them. The abuse of a given drug is not an isolated phenomenon. Drug taking fluctuates as a unit. As the use of all drugs increases, the use of a specific drug also increases. The more antacids and aspirins sold, the more...