Maybe the issue of substance use in the Caribbean region and in Jamaica, in particular, is one that is understated and or ignored to a greater extent. One cannot link substance use to any singular demographic or to any social stratum and this was quite apparent to me on my visit to Patricia House, a rehabilitation centre for those who struggle to gain control over drug use.
The effects of drug use, definitely has effects on brain chemistry and brain structure as well as other physiological impacts. However, probably we have paid too little attention, as student researchers, to the social impact of drug use. This is probably due to our own biased approach in favour of the disease model that we have chosen to focus more on the physiological effects. Of course, with the disease model, the genesis of drug use was precipitated by an inherited gene that pre-disposes its host to the use of drugs and subsequent addiction.
To the contrary, the facilitators at Patricia House believe that addiction is a psycho-social phenomenon; that drug use is an emotional response to social occurrences. In other words, persons’ drug use is precipitated by an experience or social event and they subsequently become addicted because of how the drug interacts with the reward pathways/limbic system; creating the urge for more and more use to acquire the initial feeling.
As I listened to the testimonies of the two gentlemen who availed themselves for questions and to tell their individual story, I could not help but notice some commonalities between their stories. The two, who were admitted to the facility to overcome their crack use, each began using milder substances. They both felt a sense of rejection while growing up and the use of drugs was simply a way of coping with the rejection that they felt (the way we treat our children today affect the adults they become). This revelation or testimony may seem, on the surface, to negate the claims of the disease model because a recessive drug gene was not acknowledged as the culprit, neither did any of them acknowledge that they cannot be healed of their addiction. However, I see a more eclectic embrace of a model at work at Patricia House.
The clients are taught to take responsibility for their drug use. Though the moral model is defined as being less sympathetic towards addicts because they view them as having defects in character, in some ways, principles of the moral model are applied at Patricia House. Their focus on individual choices is reflective of such model. The experiential model is also at work because they view the addiction as more temporary and situational than that of the disease, genetic, and neurobiological approaches. Consequently, it may be fair to infer that there is something that resembles a blended model being purported and employed in the treatment of addicts at Patricia House even though not all the models are employed.
As I sat and listened to the experiences of both men and reflected on the impact of crack on brain chemistry and on behaviour, I realized that the cravings and experiences that they described were consistent with the impact of crack on the dopamine within the synapses of the brain. The two gentlemen spoke about having increased energy; an experience of a high that could not be explained. Their high was immediate and that is possibly because crack is smoked and so transported to the brain much quicker. The high they experienced and maybe never understood the feeling is because of the dopamine which gets trapped in the synapse because the crack blocks the dopamine transporters, leaving the receptors vulnerable to over stimulation by the trapped dopamine found in the synapse. The over stimulation is what gives this euphoric feeling of “the high”. Crack concentrates on the reward pathway so there will be the desire to find another “hit” as the gentlemen described it. However, because of over stimulation of the receptors it will take more crack the second time around to create a euphoric feeling that can match the first. There is always the need to sense that first “high”.
Clearly, this is the internal physiological process that described the men’s experience. It was even more glaring as they told of the things they did to have the crack that will give them the high: sell television and other possessions, pilfer money from sales made on the job, use of entire salary. Their compulsion is indicative of the impact of the drug on the reward pathway and the amount that had to be bought was indicative of how over stimulated their receptors were, causing them to require more of the drug to experience euphoria.
However, no matter how much we explain this to an addict or how much they see the effects that drugs have on the physique, state of mind or family, the addict is the one to desire change. He or she has to employ will (a prominent feature of the moral model) or else even though they are equipped with the knowledge, they will relapse. The two men spoke of their own experiences with relapsing because their previous attempts to quit were as a result of the desires of others. Now, this is their decision. They take ownership.
In conclusion, we must understand that clients are not drug abusers; they are abused by the drug that holds them ransom. This view will help us to put everything into perspective. It is more than political correctness. If drugs do have the impact on the brain as we are taught, then addiction and over use is not necessarily a choice even if the initial use was. While one can argue that the first use is a sign of moral weakness, it may be fatuous to argue that continued use is. This outlook makes me even more sympathetic toward those who find themselves in the situation of addiction.
This reflection has impacted me affectively; making me into a more vigilant and empathetic individual toward addicts. It has also helped me to identify and acknowledge some of my own behaviours with regards to substance use and brought me closer to taking steps to arrest those issues.