Are some questions too difficult? Part II: How can we understand teenage drug use?

This post continues my discussion with Ruth about teenage drug use. In the last post Ruth, a nurse who has worked in psych wards and prisons, illustrated the nature of the problem by telling the sad story of a man who has been suffering from drug induced psychosis (DIP) over a long period following an incident just before his 18th birthday.
Ruth continued:

It is well established that the human brain does not finish physiological development until well into the 20's, and that smoking one cone (none before and none after) alters brain wave functioning for up to 7 years. Together, these 2 facts paint a dire outlook for teens taking drugs of any sort.

Just as an aside, much of the cannabis available on the streets these days is lined with heroine as a 'good business measure' on the dealers part. No wonder most big time suppliers don't take drugs of any sort. For them, the cost is too great as they see first hand the longer-term effects of their drugs on their clients. Maybe that is a clue for helping - that the dealers are some of the few non-health workers who see these same people year after year. Most of us loose touch with people around us after just a couple of years, which is not long enough to see the long term effects of drug taking. These 'big guys' of the drug world understand the cost of drug taking, especially the cannabis suppliers. They have said to me as their intake nurse in the prison system over and over "I'm smart miss; I sell it, I don't smoke it".

On another note, the use of cocaine in the legal and corporate worlds is astounding - a colleague of mine who works as a consultant in this industry and who has a counselling background estimates that nearly 1/3 of these professionals are taking cocaine just to get their work done in the time allocated. These people do not tend to end up in mental health wards though, but those who take a lot of cannabis do. As a result, we are dealing with the impact of cannabis much more commonly than with cocaine for example. Which leads to the next question, What affect will the lifestyle and workstyle we currently assume to be acceptable have on our society and on our youth? And are we prepared to address it?

In our initial discussion Ruth and I agreed that the problem cannot be solved by just warning young people about the consequences of drug use. Young people are warned already about the mental health risks associated with drug use. Yet a lot of them don’t heed the warnings.

Ruth’s asked: ‘What is all that about?’ I said that I thought that was the right question. We shouldn’t just jump to the conclusion that this is a law and order problem. It might be possible to reduce levels of cannabis use among young people by putting more of them in jail, but that would hardly enhance their lives.

Ruth responded:

Nice point! In fact, there are those who prefer to live in a prison than on the streets, but the real issue is getting more of those people into care when they need it and into mainstream society when they don't. And that's the real issue we face in the western world - there is simply not enough resources to address the overwhelming problem of acute mental health issues in our youth. Not enough money, not enough staff, not enough vision. Especially not enough vision. The solution has to come from the opposite side of the spectrum - enticing people to want to hold onto their reality instead of giving their reality to their dealer, or their doctor. Which is definitely not a law and order problem.

My starting point in thinking about why some young people might use cannabis despite mental health warnings was Gary Becker’s rational addiction model. We are talking about DIP, schizophrenia and depression rather than addiction, but the principles are the same. The point is that the behaviour may be consistent with maximizing the discounted value of future happiness as perceived by the individuals concerned. In observing their behaviour we might observe that their discount rates are high and their assessments of the probability of being affected by mental illness are low. Well, economists say that kind of thing. Other people would be more likely to say that they are being short-sighted and excessively optimistic in their assessments of the risks involved. Nevertheless, it is possible that those assessments are quite rational.

When I put this to Ruth she replied:

Despite addictions and hallucinations and even delusions, those with mental illness retain the ability to make rational decisions about their own welfare in light of resources available to them and their experience of reality. Young people in particular take drugs in order to escape their reality. Those without a functional psychosis - read schizophrenia and 'traditional' type mental illnesses - who experience acute addictive / psychotic phenomena induced by drug taking spend a good deal of their lives straight, going about their work, their relationships in the usual manner. These are often people who own their own business, hold well paid responsible jobs and otherwise live perfectly acceptable and rewarding lives. And yet they have a real need to escape the reality of their lives - the cost of living within normal reality seems to outweigh the risk of loosing their cognitive autonomy. And this is what concerns me most of all.

Have we not created a world our youth want to live in? Rational theory must tell us that we have to act, that the cost of not acting far outweighs the cost of thinking, of postulating, of delaying what one day must be done. If our youth want to find another reality then surely we are charged with the responsibility of providing a liveable reality for them and for us. And for their children.

My feeling is that Ruth and I are both putting the problem back into the too hard basket. Rational addiction theory tends to put the onus on young people to make good choices even though adults must share responsibility with school age children for the choices they make. Yet, if we see the problem in terms of creating a world that our youth would not want to escape from, we may put real world solutions beyond reach. Perhaps it is a normal part of human nature to seek temporary escape from the reality of our own lives, no matter how good that reality might be. There is no problem in seeking temporary escape by reading novels or going to the movies. The problem is that some people seek forms of escape that may ruin their lives or the lives of others.

The discussion is continued here.