When Logic Meets the Cruelty of Withdrawal

If you surveyed current smokers, I’m willing to bet that many would say they wished they had never started. That they don’t want to be a smoker. A quick google search came up with several statistics and articles supporting my suspicion. In fact, smoking in and of itself is not particularly pleasurable. People don’t like being tied to it, don’t want to spend the money. But then – why smoke? Why don’t people just quit if they don’t want to smoke? Why carry on if the drug effects aren’t even that great?

While some drugs produce pleasurable effects that encourage continued use (as discussed in my last post), to assume that people use drugs to achieve positive reinforcing effects is only part of the equation. If people took drugs solely for the positive effects they produce, it’d be pretty easy to quit or at LEAST use in moderation. Plenty of people have only the occasional beer, take pain medications as prescribed, or don’t find themselves driving out of their way during their morning commute to locate a Starbucks. Additionally, if positive consequences were the main driving factor with substance abuse, it’d be much easier to combat addictions by providing access to other competing reinforcers. For example, some programs falling under the name contingency management provide users who are otherwise having a really hard time quitting with money, or access to a workplace to earn money, contingent upon confirmed drug abstinence. While this method has had a good deal of success, it unfortunately isn’t a “quick fix”. It probably would be, though, if drugs were used only for fun.

Instead, most people with a substance use disorder would stray far from calling their habit “fun”. Sure – sometimes, but with the highs now come the lows. And the lows are bad. They can be so, so bad. After a person becomes addicted to a substance, they can experience withdrawal effects. Now, instead of just smoking socially while drinking, a person might smoke on the hour – even when they’re alone. They may devote excessive time, thought, and resources to gain access to the drug. Withdrawal produces a changed motivation, one that can be described by negative reinforcement.

Negative reinforcement is when you behave in a certain way because it allows you to either escape or avoid something unpleasant. This is a huge motivator for much of our other everyday rational behavior – we stop at red lights to avoid causing an accident, we walk around puddles to avoid soaking our shoes, we scratch our arm to escape from an itch. We don’t behave in these ways because it’s particularly enjoyable or anything – we do so to get out of a bad situation (or to avoid getting into a bad situation in the first place).

And unfortunately, drug withdrawal creates a bad situation – one that can be escaped from by consuming the drug again. Withdrawal symptoms and the severity differ based on the addictive substance, but the physiological effects are very real and uncomfortable. Often the withdrawal symptoms are at odds with the drug effects (e.g., if the substance your body is used to having produces dry eyes, then withdrawal might produce runny eyes. If the drug increases your appetite, you might find it difficult to enjoy eating when going through withdrawal). Detoxing from opioids – such as heroin or Oxy variants – produces major flu-like symptoms along with restlessness and agonizing pain. Withdrawing from substances like alcohol or nicotine can produce shakes, weakness, and/or an intense desire for the drug. And unfortunately – the worst of it can sometime last for weeks on end.

Many addicts describe the withdrawal experience as something of a mind game – knowing that you shouldn’t continue the cycle by taking the substance, while also knowing that you can just give in and make everything better (even for a while). Drug withdrawal can produce cravings so intense that they’re impossible to ignore, even for brief periods while trying to go about your life. It becomes pretty easy for a person to justify to themselves that taking the drug is the best current option. The pain caused by the withdrawal can be stopped so quickly by simply giving in.

The cycle repeats. Right after you take a drug and feel the relief – maybe you decide that’s IT and this was the LAST time… but then hours later… the thought of continuing on using doesn’t seem so bad. In fact – it seems completely logical! It’s the rational decision. You’re just following your (negative) reinforcers and escaping.

Again – I want to note that rationality does not necessarily mean “good” – either for the individual or society in general. We all know that there are often negative effects of sustained substance abuse, so in that sense it isn’t good to use/abuse. But, at minimum it’s an understandable decision why a person chooses to use drugs despite not necessarily “wanting” to. They might be escaping from the suffering of withdrawal, or choosing to enjoy the positive effects of the drug, or some combination – while overlooking or devaluing potential future negative outcomes. It’s hard to say objectively what is “good” when there are so many competing variables and influences on our choice behavior. Future posts will elaborate on these topics… meanwhile, I’ll probably be hanging around a coffee shop, trying to increase my productivity with an Americano.