What constitutes a substance of abuse?
The recurring theme of my clinical work recently has been addictions and serious side effects to supposedly “non-addictive” substances. Folks are experimenting with substances in a wide range of forms, and believing they are safe because the substances are not illegal. Some of the people with these substance addictions are impulsive teens, but many are well-educated, gainfully employed, respectable adults. Trying to stay away from the known dangers of, say, alcoholism, people are turning to “safe” and “natural” alternatives.
Problem substances I have heard about in clinic lately include (but are not limited to):
• over the counter cold and flu products (including cough syrups)
• food products like nutmeg and morning glory
• nasal sprays
• various plant-derived substances bought online from overseas
• snorted crushed “Smarties” candies
All of the above substances are available to purchase by walking in to a local shop. I am seeing people in psychiatry clinic for the negative effects of using these supposedly safe alternatives to drugs: Using these substances has led to illness, divorce, job loss, and bizarre mental health symptoms. People get hospitalized for suspected mania and schizophrenia for symptoms induced by these non-illegal highs. They have withdrawal symptoms, sometimes dangerous ones, when they try to stop using. One patient had a visit from the DEA.
After a disconcerting conversation this weekend with an intelligent, responsible adult who had naively gotten wrapped up in such substance use, I found myself worried about how we explain the dangers of non-illegal substance use to our kids. “Don’t Do Drugs” is no longer sufficient. What are drugs, anyway? Kids know that drugs are bad. But do they know when something is a drug and when it is not?
I asked my kids in the car, “How do you know if a substance is dangerous, and if you shouldn’t use it?”
My youngest child said, “It would probably make you throw up.”
If only things were so simple. Then we wouldn’t have an epidemic of substance use to contend with at all.
My 8th grader, who has had more education and exposure to substance use said something more reassuring, “No, people take drugs to feel good. You would take it and probably feel good, not sick. That’s how drugs work.”
Legal substances, bought at smoke shops, on the Internet, or made with recipes found online are increasingly available. These substances are considered "safe" and "natural," often simply because they are not classified as narcotics by the DEA. But unclassified doesn’t mean “safe” and it’s time to change the drug education conversation.
The list of legal highs is so long I can’t possibly list them all here. And if I did list them all and you successfully warned off your kids from every one, there would be new additions to the list of legal highs to replace them.
The conversation with my own children has consistently turned to this: If you are using a substance of any kind to alter your mind, that constitutes drug use. Experimenting with an unknown substance can lead to unimagined risks. It doesn’t matter whether it’s something common, or natural, it may still be dangerous. And it may cause long-term damage. This is true for plant-derived as well as chemical substances. Some “highs” felt from plant substances are the result of poisoning, and can lead to serious damage. Instead of “Don’t Use Drugs it’s “Don’t Get High.”