Cocaine addiction is a dreadful thing. I’ve seen it so many times: bright, once-pretty people with washed-out grey faces who can’t think about anything else. Children, partners, careers – they can all go hang so long as the restaurant has a loo where you can do a quick line between courses, or you can nip outside to suck on a crack pipe. This how frantic it can get:
If anyone has stopped to watch me go to the cash machine and withdraw stacks of bills, several times because of the $200 transaction limit, then head out to an idling van with tinted windows, and return minutes later with bulging pockets, it wouldn’t take much imagination to understand what had just transpired. As obvious and sloppy as I know the whole operation is, I know that once I get back to the room and take a big hit off one of the crystal-clear new stems, everything will be okay. That all the grim and alarming truths barking loudly around me will vanish in a blast of smoke.
That’s from Portrait of an Addict as a Young Man by Bill Clegg, whose career as a young literary agent in New York slid into grotesque chaos after he acquired a vicious crack habit. It’s one of the great car-crash memoirs. I really don’t need persuading how horrible cocaine addiction is. But I do need persuading that it’s as ‘addictive’ as we’re told it is.
I put ‘addictive’ in inverted commas because addiction is difficult to define. I don’t think addiction is a trendy word for bad behaviour, as Peter Hitchens fatuously suggested when we took part in a Spectator podcast. Although addiction isn’t a disease, whatever the 12-step lobby may tell you, it’s a pattern of self-destructive behaviour (associated with changes to brain chemistry – but then most things are) that’s becoming more of a danger as technology increases the supply of things we like too much for our own good.
I started thinking about addiction again this week when addictionblog.org published this infographic (below) about the harmful effects of cocaine and encouraged people to circulate it.
To see it full size, click here, where underneath the infographic you’ll find a long list of the ‘adverse effects of cocaine’. They include: aggressiveness, decreased libido, constriction of peripheral blood vessels, increased heart rate, chronic illness, psychotic episodes, vaginal bleeding and secretive actions. These ‘adverse effects’ are grouped into subject areas (psychology, sex and sexuality, body response, general health etc) and it looks very authoritative.
But there’s a problem with this list. If anyone takes cocaine, then their blood vessels are likely to be constricted and their heart rate will increase. However, psychotic episodes and chronic illness are associated with cocaine addicts or heavy users. As with all addictive behaviours, there’s no scientific method of determining when addiction begins, but that doesn’t mean we can’t use our common sense. Let me suggest three categories: (a) people who have the occasional line of coke at parties, (b) users of cocaine for whom it’s become a habit and (c) full-blown addicts. I’m not denying that (a) can very quickly turn into (c), but what is the risk of that happening?
Don’t expect a search engine to settle that question. When I googled ‘cocaine’, ‘addiction’ and other associated words, I was met with column after column of results provided by the recovery industry – including countless treatment centres which, I suspect, had spent a lot of money on their Google ranking. And they all basically said the same thing. Cocaine is very very very addictive because, well, just look at the desperate cravings and health problems of coke addicts (but, hey, for a few thousand dollars we can sort that out).
All these rehab clinics or 12-step groups quoted doctors and neuroscientists who explained that cocaine raises levels of dopamine, a neurotransmitter linked to pleasure. In the process it disturbs the brain’s reward circuit – the flood of dopamine is so intense that you crave more, with diminishing effects, so that no matter how many lines you snort during an evening none is as thrilling as the first one. Also, the effects diminish over the long term, so that people with cocaine habits need monstrous amounts of the stuff to get a hit. That’s why cokeheads, even rich ones, often end up losing their houses.
Fine – but this we already knew. The surge of dopamine produced by cocaine creates an extraordinary sensation, at least to begin with. The psychiatrist Norman Doidge, in his remarkable book The Brain that Changes Itself, compares it to the first flush of romance: cocaine users and lovers, he says, are both ‘filled with hopeful anticipation and are sensitive to anything that might give them pleasure – flowers and fresh air inspire them, and a slight but thoughtful gesture makes them delight in all mankind’. That’s a bit of an exaggeration, but cocaine’s popularity is no accident. It’s nicer than booze – at first. And very different.
But is it more addictive than alcohol? The answer is probably yes if you think addictiveness is only about brain chemistry. ‘Candy is dandy but liquor is quicker’, said Ogden Nash, but to the best of my knowledge he never shoved a rolled-up banknote up his nose. Coke gives you a seriously quick hit and a depressingly rapid comedown. So you want another line, fast. But, unlike alcohol, there isn’t much of a cumulative effect: rather the opposite. And this annoys lots of recreational coke users, who also dislike the raised heartbeat and the mild paranoia that sets in when the last precious grains of powder have been assembled into a line about as wide as a needle.
And what do many of them decide? That cocaine will no longer be one of their recreations. This is just anecdotal evidence, but the number of my friends who no longer do coke is much greater than the number that do. (In fact, I can’t think of a single friend who still takes it, which makes me feel old.) Look at the politicians who haven’t explicitly denied that they ever tried the stuff – George W Bush, Barack Obama, two very senior members of the British cabinet. If they were into it, they aren’t any more. Like millions of people.
Many ex-recreational cocaine users have given up the drug because of, not despite, the intensity of the addictive experience – the disconcerting messing up of their brains’ reward circuits. They’re being pushed away from cocaine by the very thing that, according to the online experts, makes it magically addictive. Yet their experience doesn’t crack a mention in discussions of cocaine addiction – except by a few well-known sceptics in the field of addiction studies.
One of these is Bruce Alexander, a Canadian psychologist whose famous ‘Rat Park’ study in the 1970s was the first to suggest that addiction specialists were drawing flawed conclusions from the behaviour of laboratory rats. He writes (my emphasis in bold):
The data from surveys, self-selected user studies, clinical studies, and
animal experiments, together with the limited information available on
smokable cocaine, provide no evidence that cocaine in any form has a high addictive liability or that we are experiencing an epidemic of cocaine use. The widespread belief that cocaine is extraordinarily addictive is based largely on subjective reports and anectotal evidence. Although most people who experiment with cocaine subsequently use it intermittently and moderately, if at all, some report that they ‘cannot control’ or ‘can’t handle’ cocaine, and must therefore abstain completely. Patients and hotline callers often describe cocaine as irresistibly addictive. It is unwarranted, however, to say that a drug has a high addictive liability if the great majority of people who have used it are not addicted, even if some of them find abstinence to be the best policy.
That’s from an essay written in 1990 but, having discussed the subject with Alexander when I was writing a book about addiction, I know it’s still his opinion. For a more recent sceptical take on addictiveness, here’s a Time magazine blog post by Nick Gillespie, who points out that ‘according to the latest National Survey on Drug Use and Health, 14.5 per cent of Americans ages 12 and older have tried cocaine at least once, but just 1.8 per cent report using the drug recreationally in the past year’.
Maybe I just don’t know how to use a search engine, but that impeccably sourced statistic is rarely quoted online. And no wonder. It undermines claims that cocaine is highly addictive and brings us closer to the truth: that cocaine addiction is particularly nasty, thanks in part to the way it hijacks dopamine, but that the risk of becoming a coke addict if you try the drug is not demonstrably greater than the risk of becoming an alcoholic if you try alcohol.
And yet… something in my gut tells me that it’s not a bad thing that the public is being told that cocaine is more addictive than it actually is. What follows isn’t very scientific – but, frankly, the scientific literature is all over the place because neuroscience is in its infancy. My impression is that cocaine reaches out to a certain personality type (to which I belong). If you have an ‘impulse control disorder’, a loose category of problems involving lack of self-control that has just made it into the American psychiatric handbook DSM-V, then coke is the drug for you. Meaning, very much not the drug for you.
I see addiction as driven by supply. Almost half the US soldiers serving in the later stages of the Vietnam war tried heroin or opium; about 20 per cent became addicted. Back home in America, most of those addicts kicked the habit because they couldn’t buy grade-A heroin from their housemaids, as they could as GIs. As a young man I was an alcoholic and the only way I could stop drinking was three years’ total immersion in Alcoholics Anonymous, to whom I owe a huge debt even though I don’t buy their disease model of addiction. Later I got into cocaine but didn’t become addicted to it – because the supply dried up. If it were legal I’d probably be a cokehead or dead by now.
To cut a long story short, the misrepresentation of cocaine as a very addictive drug is a lesser evil than making it freely available to the minority of people at serious risk of becoming hooked on it. So I’m quite happy if every young person follows the wise advice of my personal gay icon, Nancy Reagan: Just Say No.