Many feel repulsed by addiction. Some view it as a moral failing, while others view it as a disease. It is apparent that there is a societal prejudice against the use of drugs of addiction. This stigma serves as a preventative strategy to keep people from trying drugs, but this may not keep people off of drugs once they have already tried them. In fact, it may facilitate addiction processes, even at the biochemical level. There is an opioid neuropeptide known as dynorphin that seems to be a common biological pathway in addictions of many kinds, as well as playing a role in what is termed social defeat and stress generally. Addiction and social defeat are explored in relation to prejudice to show why the societal stigma against drug-use is not conducive to managing the kind of addiction crisis that seems to be emerging in our world today. Later, solutions involving social intervention and social-rejection-sense attenuating and anti-addiction drugs such as psychedelics are noted.
Common drugs of addiction such as cocaine, alcohol, nicotine, methamphetamine, and morphine share common biological pathways, notably the kappa opioid receptor system (Shippenberg et al 2007; Isola et al 2009; Hanson et al 1988; Nylander et al 1995), which will be made relevant to prejudice in the sections to come. The dynorphins are a group of opioid peptides that predominantly interact with this kappa opioid receptor (KOR) system (Chavkin & Koob 2016). This is in contrast to common opioids that many are familiar with, such as the endorphins, heroin, or morphine, which predominantly interact with the mu opioid receptor (MOR) system (Raehal & Bohn 2005).
The MOR system is popularly known for inducing effects such as euphoria, reinforcement of rewarding stimuli, and pain relief (Roth-Deri, Green-Sadan, & Yadid 2008). On the other hand, the KOR system is antagonist to the MOR system, producing aversion (opposite of reinforcement), dysphoria, and is thought to be involved in the negative emotional component induced by both pain and stress (Massaly et al 2019; Land et al 2008), and likely plays a role in the withdrawal syndrome of addictive drugs (Chavkin & Koob 2016). In this sense, the MOR system can be viewed as a reward centric mechanism, while the KOR system is something like a punishment mechanism in the brain. The KOR system has been argued to be involved in a whole host of mental health issues, notably anxiety, PTSD, schizophrenia, stress and depression (Crowley et al 2016; Rabellino et al 2018; Clark & Abi-Dargham 2019; Knoll & Carlezon Jr 2010). Drugs that stimulate the KOR system tend to produce dysphoria, dissociation, psychosis, hallucinations, and nightmares (White & Roth 2012; Coursey 1978).
Cocaine, methamphetamine, alcohol, nicotine, and opioids increase dynorphin activity with use (Shippenberg et al 2007; Isola et al 2009; Hanson et al 1988; Nylander et al 1995). Some researchers have suggested that dynorphin plays the role of the withdrawal effects of rewarding drugs, namely symptoms like anhedonia (Chavkin & Koob 2016), and while it isn’t mentioned in the research on addiction, other withdrawal symptoms like hallucinations, nightmares, or psychosis may also be mediated by dynorphin since the dynorphin/KOR system has been implicated in those effects in other research. One mechanism of the dynorphin increase from rewarding drugs seems to be an intersection of dopamine and glutamate mechanisms, specifically the binding of the dopamine D1 receptor and the glutamate NMDA receptor are both implicated in the observed increase of dynorphin in response to psychostimulants (Hanson et al 1995; Johnson et al 1993), and since many of these addictive drugs stimulate dopamine activity, the mechanisms of dynorphin release may be conserved. Dynorphin/KOR modulating drugs have also been researched as a treatment for addiction (Gerra, Fantoma & Zaimovic 2006).
Opioid peptides have been suggested to play a role in social reward and motivation (Loseth et al 2014; Nummenmaa et al 2018; Manninin et al 2017; Trezza et al 2011). While the MOR system seems to be involved in enhanced social motivation and social reward, the dynorphin/KOR system has been linked to something known as social defeat (Bérubé et al 2013; Donahue et al 2015). Social defeat is a research construct often used to study the behavior of animals, although it is sometimes talked about in the context of humans as well. In animals, it usually refers to the state of a victim animal when another animal shows repeated aggression. In humans it is often used to describe being chronically subordinated, like in the case of being abused or bullied. The concept of social defeat seems to be, in essence, social punishment rather than reward. The term has been used in the social defeat hypothesis of schizophrenia, where researchers noticed that populations facing prejudice had higher rates of schizophrenia (Selten et al 2013). This is important for the topic of addiction, as those with addiction are often subjected to prejudice and stigma, in essence, addicts are often socially defeated.
Many addicts may become homeless after being rejected from their families and job places. Some become addicts after becoming homeless, due to the pervasive culture of addiction within the homeless community (Thompson et al 2010). On top of this, homelessness presents another layer of prejudice. Even the addicts who attempt to recover using treatments like methadone experience prejudice unfortunately (Earnshaw, Smith, & Copenhaver 2013).
By much of society, it is considered socially acceptable to be prejudiced against drug users. There are multiple problems that occur due to the social normalization of prejudice against addicts. Social reward may be granted to those who express prejudice towards the addicts. There may also be negative consequences to an individual who does not express prejudice towards the addict, which may result in social punishment for the non-prejudiced individual. These patterns are seen with other normalized prejudices in communities (Kite & Whitley 2016).
This can be likened to a game of cooties. The game of cooties is one where a member of a community is labeled as infected with a stigma, for which associating to that member will result in contagious acquisition of the stigma as well. The addict is the one with cooties in this case and is not permitted to be accepted by the community. This may take the form of shaming friends who donate money to the homeless, usually under the assumption that homeless people will simply use that money for their addiction. This kind of cooties pattern will be most apparent in the communities that feel addiction is a moral failing. Teaching that addiction is a disease with a helpless victim, may help reduce such cooties problems. This victim perspective may not necessarily help stop the addiction though. The idea that one is a helpless victim to their ‘disease’ may also permit further use without any guilt or shame of drug use.
Prejudice May Enhance Addiction
Since the dynorphin/KOR system is involved in basic stress responses, pain responses, and social defeat responses, it makes sense that prejudice will influence the dynorphin/KOR system as well. Being the target of other people’s social aggressions and prejudices is painful and stressful. The intention of the prejudiced person may be to condition or train the drug user to feel guilty or punished for their choice to consume the drug, in hopes that the person will stop using the drug. Though, in reality this may not be what occurs. Instead, the user of these drugs is often seeking to reduce their stress and pain, an effect that is often provided by the drug of choice.
What’s more, dynorphin stimulates reinstatement of drug-seeking behaviors in animal models (Nygard et al 2016), in other words, it seems to cause one to seek out the drug of choice. To further support this in humans, dynorphin/KOR blocking drugs are used for addiction (Gerra, Fantoma & Zaimovic 2006). This makes sense, as dynorphin releases during stressful situations to induce a negative emotional state, which may be relieved by the use of the drug. This suggests that punishing the addict by using stigma may drive reinstatement of drug-seeking behavior to cope, which is contradictory to the goals of the individual expressing their prejudice against the drug user. This begins to mirror ingroup and outgroup social patterns of behavior, in which both communities segregate and experience intergroup anxieties that prevents communication between each group (Kite & Whitley 2016).
Tribalism and Addiction
Those who are rejected from the ingroup of mainstream society will also be free from the cultural regulation and social norms of that society to some degree. If none of your friends or social network involves members of that society, then the pressures to conform to the rules of that society are also absent. Of course, one cannot easily escape the influence of mainstream society, though very frequently the addict finds a network of other drug users who they can bond with. In the drug-using society, the individual may be free from the impending fear of being shamed and socially punished that occurs when socializing in the mainstream society which they are rejected by. The role of prejudice here is that it drives the addict to find comfort and acceptance within their own social network comprised of fellow drug users who socially accept or even reward them.
On the other hand, those who are excluded from mainstream society for other reasons, like strange beliefs, anti-social behavior, or any number of taboo tendencies may have an increased rate of drug use. Poor social integration has been associated with behaviors that result in addiction (Heilig et al 2016). For example, those who are homosexual may face prejudice, which drives them to abandon the society that has prejudice against them and become more prone to using drugs, partly due to escaping the influence of that society that prohibits drug use. Those who are not accepted by the in-group of the mainstream cultural bubble will lack a pressure to conform to the rules of such a cultural bubble and thus be increasingly free to try drugs without as much of the stigma from mainstream society. Those who deviate from the cultures that are prejudice against drug use will be increasingly likely to try drugs due to the sudden freedom to do so without punishment or shame.
Those who are stigmatized or experience prejudice may generally tend to migrate to other communities that experience prejudice, like drug user communities. This may partially account for the higher rate of Black Americans who use substances. By feeling rejected from the White or other communities, the person may no longer feel the obligation to conform to that conservative society and may also be driven to cope with the prejudice they face. It could also be that people who face prejudice can generally resonate with each other’s social experiences, at least in some ways.
There is a problem with the dynamics of stigma. While the stigma serves as a preventative strategy against drug use, it does not serve as a solution for concurrent drug users. The stigma drives a fear of punishment that makes one afraid to use the drug, but it does not drive an addict to leave behind their entire social network in favor of the social acceptance of their outgroup: mainstream society (or simply one’s family). The punishment from the stigma can be averted by abandoning mainstream society further, by leaving the tribe. The addict can still remain cozy with their fellow drug-users, meanwhile entering the mainstream society and developing new relationships in that society would not only mean facing the stigma and punishment, but also losing the relationships and potentially living in a period of social deprivation until new relationships form, if they even form at all. Worse, recovering addicts that are using methadone often face prejudice despite that they are trying to leave the world of addiction behind (Earnshaw, Smith, & Copenhaver 2013). The addict’s sense of uncertainty that comes along with joining mainstream society is compared against the probable security of their current social network, which provides a stable sense of comfort that the unpredictable journey into mainstream society cannot be guaranteed to provide.
Ultimately this pattern of lifestyle disagreement between the addict and mainstream society resembles the kind of pattern that hate groups and cults have. In The Psychology of Stereotypes and Prejudice, the authors explore the crucial role of socialization in the recruitment into and out of hate groups (Kite & Whitley 2016). Often times, new members enter cults and hate groups in search of new relationships. Once relationships and bonds have formed within a hate group or cult, there is a social dependency due to the innate human need for social comforts. As mentioned, social reward even seems to be an opioid-driven process, which is notable as opioid drugs often cause users to develop an extreme dependency. This dependency may apply to one’s social connections as well. Drug users may be addicted to their social network of fellow addicts.
The Anti-Social Trap
Due to the taboo nature of drug use, the user of substances is often driven to live in the shadows, concealing their use to prevent persecution. Incidentally, chronic lying and drug use are both associated with antisocial personality disorder, which is often called psychopathy or sociopathy. There are likely two sides of this problem, that someone who is antisocial will be more likely to use drugs due to chronically disregarding social rules and norms or that the drug user is forced to take on the symptoms of antisocial personality disorder to deal with real problems.
The drug user is forced to lie in order to protect themselves, which may facilitate a learning process for navigating the social space of chronic dishonesty. The drug user may become further distanced from those they lie to. The drug user may grow to resent the persecuting others who give the drug user pressure to lie. It is a truly unfair situation, one that likely further provokes stress-induced urges to consume the drug as a coping strategy.
Eventually, the individual who lives in the veil of lies may become desensitized to the negative feelings surrounding this lifestyle. Once this occurs, the individual may adapt the newfound strategy of deception to solve other problems in their life in their desensitized state, simply because the strategy is useful and the cost (the negative affect/guilt) is no longer preventing such behavioral evolutions. Once the person has accepted that they are ‘bad’ and internalized this into their identity, they may allow themselves to do other ‘bad’ things, because they are no longer feeling the reward of being a good person. They may then seek out alternative rewards through antisocial behavior once they have identified themselves as antisocial or immoral.
Another issue is that living in the shadows can lead an individual to feel frustrated and alone, which may lead them to seek out peers who they can be honest with, such as fellow drug users. The new group of peers may share this tendency to separate from previous social circles and also the feelings of resentment and rejection surrounding the experience. This may lead the group to bond by rejecting their persecutors, which may often be much of traditional society since drug use is widely stigmatized.
In essence, the connection between antisocial tendencies and drug use may stem from an evolution of an individual’s personality that emerges from their rejection from mainstream society. This experience essentially creates an ‘us-versus-them’ scenario, a ‘drug user against society’ scenario. Once the drug user has left the socially normal society, there is no longer the same obligation to follow the social norms and rules of that society. Instead, one can apply similar strategies that one has applied to their drug use, like concealing the rule-breaking behaviors.
These drug-using communities will also attract those who already break the rules as well. Even those who are not antisocial initially will be in close proximity to those who are naturally inclined toward antisocial behavior. The influence of the antisocial personalities on these communities will increase the general rate of normalized antisocial behaviors within these communities.
It is worth noting that this pattern will not generalize to all drug-using communities. Different drugs have their own culture and subsequently their own social norms surrounding them. As an example, psychedelic culture often prizes themselves on the empathy enhancement of their drug-of-choice, while often holding prejudice against the opioid users, possibly as a scapegoat for giving drugs a bad reputation. This is often seen with dissociative drugs too, where the community is blamed for the bad effects of hallucinogens or the horror stories of people sawing their legs off or eating their children’s eyes out. The influence of natural antisocial people on these communities likely pools most among the most stigmatized groups, where an antisocial person would not fear the stigma. The other communities may have more cultural infrastructure and rules guiding what is allowed or not allowed. Though, these are all generalizations and there are very many complex subcultures within the world of drug users.
In order to help addicts escape, we may find success in providing new social relationships that allow the drug users to abandon the drug without worries of social threat, something that may drive them to maintain their drug use in order to protect themselves against such threats. This is kind of how rehabilitation centers work, although they essentially provide people relationships that have a set of problematic preconditions. For example, individuals in rehabilitation are often undergoing concurrent withdrawals from drugs and they may potentially be bonding over relapse stories, mutually shared traumas, difficulties, and essentially provide the addict with a culture that is still centered on drug use. These rehabilitation centers may serve as a chronic reminder of the person’s social identity as a drug user. For an addict to become fully healed from addiction, one may need to go through another stage of transition in which the post-addict may lose their relationships yet again or become unable to connect with the relationships that they developed in rehabilitation centers.
It isn’t clear whether there is an easy solution to this problem. There may be the possibility of re-integrating the post-addict with their prior relationships (from before addiction), although it seems highly likely that these relationships were dysfunctional enough for the addiction to have developed in the first place. Instead, a program developed to help addicts find new social networks that are based on hobbies or interests may be a candidate solution. Such a program should not necessarily be identified as an addiction-related solution, as this may only embed the idea of addiction into the communities. The idea would be for an individual to burn bridges with their past communities. After such a healthy community is formed, stigmas on drug use may be valuable in raising the costs and decreasing the benefits of drug use for post-addicts. Once they are part of the ingroup of a new healthy community, they may feel that using drugs is no longer worth it. This stigma strategy comes with its’ own complications, of course, and may not be an optimal strategy.
The best solution may be to simply focus on the development of healthier communities that are not based on bonding over shared coping strategies such as drugs. One study argues that addiction is heavily intertwined with the culture of homelessness and that to escape this problem, the use of ‘new lived plots’ and essentially the establishment of a new lifestyle and culture can help in transitioning out of this homelessness culture (Heuchemer & Josephsson 2006). Teaching perspective-taking to the public by making them aware of the processes underlying these social dynamics of addiction and prejudice may help reduce the barrier that is segregating addicts from healthier communities.
Considering the role of the biological components of stress and social interaction may be useful in devising temporary psychedelic drug-based treatments that aide in transitioning out of the unhealthy social communities and into optimal communities. For example, LSD has been found to attenuate the effects of the KOR system (Sakloth et al 2019) and has also been proposed as a rapid treatment for addiction (Fuentes et al 2019). A similar drug, psilocybin was able to induce cessation of nicotine use in addicts that persisted even to the 6 month checkup date (Garcia-Romeu, Griffiths, & Johnson 2014). Psilocybin has been observed to increase openness to experience long after it has worn off (Garcia-Romeu et al 2014), which may help one to become open to new lifestyles and change. Psilocybin and MDMA have been observed to attenuate social rejection feelings (Preller et al 2016; Preller et al 2017), which may help reduce the feelings of social defeat that drive the addict to stay within the security of their own addiction-focused community. LSD was found to facilitate social adaptation when a communities’ opinions are similar to one’s own opinions, meaning that it enhanced adapting to a communities norms and attitudes, as long as they were in agreement with the subject’s attitudes (Duerler et al 2020). This may help an addict transition into a new community as long as they are motivated to participate in that community. Through a combination of psychedelic and social interventions, the addict may be able to leave behind the culture of addiction and establish new roots in a healthier community.
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On a final note, while it isn’t touched on much here, it is important to consider that drug use may not be inherently problematic. The use of drugs is essentially neutral and whether it is good or bad use is dependent on the context. This may even be true of addiction, that it is not inherently bad. Psychological drugs can be useful tools, sometimes even when used repeatedly. Critical assessment of the scenario is important in these contexts. People are not typically good at critical assessment, both non-user and user alike. So the judgment of the drug user or non-user should not be taken as authority. Very often the majority culture takes dominance and authority in these situations but we should look at these problems through the lens of critical thinking. Perhaps when drugs are fully decriminalized and legalized we may observe the rise of new niche jobs like drug-advising coaches. Something like a psychiatrist but more broad and drug-focused. Perhaps a shaman!
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