Tripping Ourselves Up

In my now almost fifty years of clinical practice, I have learned that we trip ourselves up much more often than we are tripped by outside forces. We often hear that the definition of insanity is doing the same thing but expecting a different result. Actually, that’s the definition of neurosis and it means that we keep repeating the same mistakes without learning from them. It is in this way that we trip ourselves up.

It seems that there are crises all around us. Healthcare, the economy, foreign relations, terrorism…to name a few. Those are real but are not directly in our collective control. I have a list of problems that are in our control and, because we don’t learn from them, they are our neurosis, our way of causing our own pain. The list is as follows: alcohol, tobacco, marijuana and gambling including lotteries.

All of these problems share a common characteristic, namely, they are taxed by governments who depend upon that revenue for operations. As we'll see, there are myriad human problems generated by using these substances or activities but collectively we accept them either out of ignorance or greed or apathy. A good example is the universal decision by states and localities to consider liquor stores as "essential businesses" during the COVID pandemic. The only reason I heard to justify this action was that some alcohol users would have to detoxify if they were denied access to alcohol and that detoxification could be a medical risk. While this situation would apply to an extremely small part of the total population of alcohol users, perhaps in the order of one in one hundred thousand (my guess), supplying drug users with addicting drugs has never really proven to be effective either in managing the use or reducing problems like overdose. If anything, providing drugs only increases supply and use of the drug. Why then did virtually everyone buy into this rationalization? Ignorance or greed (tax revenue) or apathy.

Alcohol has a very special place in the world and in our culture. It is widely used in America. About two-thirds of adults use it. The fact that about one-third do not use it is usually news to most people who do drink. You see, drinkers tend to hang out with other drinkers and if everyone around you is drinking, you'll likely assume that everyone drinks. It is a drug. It is addictive and it shares cross-tolerance with the barbiturates. Simply put, alcohol and barbiturates are interchangeable. If you use one, it is the same as using the other. If you are addicted to one, you are addicted to the other. You remember barbiturates. Overdosing on them killed Marilyn Monroe and Jim Morrison. Mixing them with alcohol is particularly deadly. Barbiturates are highly controlled prescription drugs, schedule II in fact. Must be on a written prescription, no refills, limited quantity. But wait, you say. You don't need any of that to get alcohol and they're virtually the same drug. Right you are. All you need for alcohol is money and an ID, and the ID is often optional. So what gives? The US Congress is responsible. Even though alcohol is a highly addictive drug with horrendous effects on the body and the mind, the FDA is nothing to do with it. The FDA has everything to do with barbiturates but nothing to do with alcohol. So what federal agency manages alcohol? Why, the IRS of course. Who else, for it is the tax stamps that we're interested in. Elliot Ness was a T-man. Congress established the ATF to deal with alcohol, tobacco and firearms. Nice combination, don't you think? If the FDA had responsibility for alcohol, it would have to be treated the same way barbiturates are. By the way, the other schedule II drugs are narcotics and amphetamines.

Alcohol causes cancer. Alcohol causes pancreatitis. Alcohol causes heart disease. Alcohol causes gastritis. Alcohol causes hepatitis. Alcohol causes prostatitis. Alcohol causes organic brain syndrome. And alcohol makes fertile ground for respiratory virus and infection. It is said that there would be no tuberculosis in the world were it not for alcohol. Can anyone say coronavirus? But liquor stores are essential businesses.

Alcohol also causes anxiety. Alcohol causes depression. And alcohol intoxication while driving or living causes all manner of mishap from failed marriages and jobs to death. Alcohol therefore is perhaps the number one way that we trip ourselves up.

Tobacco is the "T" in ATF. Its active ingredient, nicotein, is said to be addictive, even though properly speaking it is not. Using tobacco, and especially smoking it, creates dependence that is perhaps the most difficult to break, certainly tougher than alcohol--witness the smoke filled AA meeting. Smoking causes heart disease, stroke, COPD and lung cancer. It is said that every year in the US there are 450,000 tobacco-related deaths. Wait a minute, didn't we just pass 600,000 COVID-related deaths over two years? And we shut down the country, causing all manner of stresses: emotional, physical, economic, etc. What are we doing about the 450,000 annual deaths from tobacco? We're urging young people not to start and accepting billions of dollars from the tobacco companies to look the other way. The infamous Tobacco Settlement of 1998 forged an agreement between 46 states and the tobacco companies which had the tobacco companies accepting responsibility for hooking smokers and causing the states to have to pay medical expenses for Medicaid smokers who developed tobacco-related illnesses. In addition, the tobacco companies agreed to pay the states hush money in perpetuity, meaning forever. In return, the states would not hold the tobacco companies responsible for future medical expenses. Sort of like paying the police not to investigate a crime-ridden business. Could call it a bribe; could call it extortion. Either way, it stinks. As in the case of alcohol, the FDA has nothing to do with tobacco and the only way you can get into trouble is if you try selling it without paying taxes.

Tobacco is probably the number two way that we trip ourselves up.

Marijuana is a developing problem. It started out as a bad drug along with heroin, cocaine and other street drugs. Gradually, it gained respectability and was lauded for its medicinal benefits. It was never an actual prescription drug, because the FDA would then have to get involved. Instead, many states permitted its use under the heading, medical marijuana. Colorado and other states since decided to drop the pretense of medical benefit and legalized its use as recreational. I say pretense because the active ingredient in marijuana is THC, an hallucinogenic, and the mechanism for medical benefit from hallucinogenics is at best controversial. Those of us in the substance abuse treatment field see much more trouble associated with pot than we do benefit by a very wide margin. It is not the substance abuse providers who championed legalization. OK, so what does pot actually do? Its most sought after and desired effect is a drug-induced stupor, sometimes referred to as being high or mellow. At its best, a state of serenity. At its worst, paranoia. Grass is not a social drug. It centers the user's attention on him- or her-self and heightens the internal experience of perceptions and sensation. If a group of people are smoking pot, you don't have a group, you have a group of individuals smoking pot. Alcohol for all its failing promotes interaction, sometimes badly, but interaction nevertheless. Witness the cocktail party or happy hour. Such social gatherings are not the hallmark of pot use. The pot users attention is directed inward so they are less likely to notice what is going on around them, whether on the highway, the workplace or a relationship. We speak of amotivational syndrome with pot because there is no better drug known to man to reduce or destroy initiative and motivation than marijuana. We are about to legalize it federally which will allow its sale to go through our banking system. It will also allow the federal government to tax it, just as the states have been doing.

Marijuana makes the list of ways in which we trip ourselves up and its just beginning. Wait until the tobacco companies start growing, producing and marketing pot.

The final entry on the list is gambling. Like the other three, gambling is habit-forming. And like the other three, governments depend upon the revenue for operations. We speak of gambling problems as addictions because the behavior of gamblers in pursuing their habit is virtually identical to substance abusers pursuing their drug habit. In promoting gambling behavior, including scratch tickets and lotteries, local and state governments are producing problem gamblers. And like the tobacco companies, running ads cautioning people not to use the mortgage money at the craps table does little to solve the problem. Lotteries and scratch tickets prey on the poor in far greater measure than the more well off. I believe in California that it was determined that a significant amount of food stamps were redeemed at casinos.

Like the addicts who depend upon their drugs, governments depend upon the revenue from alcohol, tobacco, marijuana and gambling. It is true blood money because it is linked with literally hundreds of thousands of deaths, perhaps millions, each year in the United States. Those governments, federal, state and local, are supposed to exist to protect the welfare of the citizens. Out of ignorance, greed or apathy, they do not. We will exhaust the resources of a town's fire department to rescue a kitten but we willingly accept pandemic-sized deaths for money. As I said at the outset, we trip ourselves up much more than the world ever does. If the FDA had the responsibility it should have to regulate the use of alcohol, tobacco and marijuana, how many lives and jobs and relationships would be saved.