Weave a circle round him thrice,
And close your eyes with holy dread,
For he on honey-dew hath fed,
And drunk the milk of Paradise.
1. Referrals to the clinic in the last few months have suggested an uptick in heroin availability, relatively cheap and "high-quality" stuff, in this area. Hard to resist, apparently, at least when you're young, bored, and have few prospects. It brings to mind Mexican drug violence, which has been in the news more lately and which for me had come appallingly to life in Robert Bolano's fictionalized account in 2666. It makes me wonder, with any given person, what awful things happened so that this guy could get his fix?
Folks in Mexico complain that the real problem is demand north of the border--is this due to our uniquely depraved American culture, or merely disposable income enabling the potential depravity of human nature? As a moral argument this is terrible; a prostitute could similarly say, "Well, the guys want it and will pay for it, so what's a gal to do?" Worse than vice is the inciting of vice in others. Purely as a practical argument, though, it does pay to arrest the Johns too. And the flood of American guns to Mexico sounds like another good reason for gun control to me. But I'm just a Liberal with a crush on Obama.
2. What is one to make of marijuana habits? It's illegal, it's bad for the lungs, and some studies suggest long-term cognitive damage with extended and heavy use. Rarely, it makes someone psychotic. But the problem is that in some areas, such as the ones I've worked in, its occasional use is endemic, and if one focuses on that with everyone who uses it a few times per month, one would never talk about anything else. And the evidence for marijuana as a "gateway drug" or as a cause of other mental disorders is pretty flimsy.
I don't use it and as a physician I don't condone it, but psychiatry doesn't seem to be too worked up about it. My current Textbook of Psychiatry (American Psychiatric Publishing, Inc.) devotes about one and a half out of nearly 1800 pages to cannabis. My Textbook of Substance Abuse Treatment (also APPI) devotes separate chapters to alcohol, nicotine, opioids, cocaine, stimulants, sedatives, and hallucinogens, but not to cannabis. Patients are surprisingly forthcoming about their marijuana, as if they not only don't see it as a problem, but can't imagine that even a stuffy shrink would either.
3. In Psychology Today Stephen Mason, Ph. D. makes a questionable attempt to revive the generally discredited notion of the "addictive personality." But the concept has all kinds of problems, including its tendency to overdefine a person and the splitting of folks into addicts and non-addicts. If one considers behaviors like eating, sex, the Internet, and gambling, I'm not sure there is even a consensus on what qualifies as addiction, much less any coherent construct of an addictive personality.
"Addicts" comprise a surprisingly diverse group and a wide spectrum of severity. Those who really will use any psychotropic substance within reach are rare. It is far more common to see the pure alcoholic, or the opioid abuser with no taste for cocaine, or the cocaine abuser with no taste for opioids. There are, to be sure, people whose impulsivity and whose need for external rewards put them at risk for problematic behaviors--I'm thinking of a former patient who was morbidly obese (largely due to binge eating) and who also had a pathological shopping habit, but she didn't abuse substances. It is hard to see how the notion of "addictive personality" is really helpful, unless it amounts to a global admonition like "If you drink or use drugs you will go to hell." On the contrary, individualize, individualize, individualize...