Can one imagine how Yemenis would feel without having a daily khat chewing (80% of Yemenis chew khat containing the alkaloid called cathinone, an amphetamine-like stimulant)? Can one imagine how a Dutch person would feel without having her caffeine in the morning (90% of the Dutch drink coffee)? Can one imagine how a French person would feel without having a glass of wine along with his meal? I could go on with numerous examples of accepted drug-taking behaviors, most of them deeply, culturally embedded into our societies. Pondering these examples, one might easily realize the more philosophical question: Why do we take drugs? Roy Wise and other neuroscientists have formulated the drug reinforcement theory (Wise & Rompre Reference Wise and Rompre1989). This theory posits that all drugs of abuse activate the brain reinforcement system and thereby act as biological rewards. This drug-induced reinforcement process increases the rate or probability of further drug-taking behavior. The drug-reinforcement theory is extremely helpful for understanding the biological substrates of a drug-taking behavior in general (Sanchis-Segura & Spanagel Reference Sanchis-Segura and Spanagel2006), but does not explain why person A likes to drink coffee in the morning and several glasses of beer when coming home from work, whereas person B might smoke a cigarette after each meal but not consume any other drug.
Müller & Schumann (M&S) have attempted to construct a new psychological/neurobiological framework – namely, drug instrumentalization – to provide an answer for individual non-addictive psychoactive drug use. Drug instrumentalization is a learned behavior designed to change the mental state and thereby improve the current quality of life by taking a psychoactive drug. M&S define an extensive list of drug instrumentalization goals, such as improved social interaction, the feeling of well-being, and many others. The definition and validation of drug instrumentalization goals will help to understand individual drug-taking profiles, which may change over the life course of an individual. However, at least three important drug instrumentalization goals are missing in M&S's target article:
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1.
Positive taste perception: Sometimes a self-reflection is very helpful. For example, without disclosing my lifetime drug-taking profile in full detail, at present I have a big cup of tea in the morning, drink different alcoholic beverages regularly in the evenings, and smoke a cigarette from time to time. Why do I consume these three different drugs on a regular basis? The first reason that comes to my mind is that I enjoy the taste. Although there are no systematic population-based studies on whether positive taste perception can be considered as a drug instrumentalization goal, there are millions of coffee/tea shops around the world, millions of wine-tasting sessions, and cigarette advertisements have historically focused on the pleasing taste of tobacco. Positive taste perception as an instrumentalization goal may be limited to alcoholic beverages, coffee/tea, and tobacco, but these are the primary semi-luxury consumables on which money is spent. Positive taste perception may also play a role in betel nut and Khat drug chewing and to a certain extent even cannabis smoking.
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2.
Adaptation to peer pressure: Very commonly, we consume drugs as a result of peer pressure. Especially during adolescence, peer pressure is an intense motivator and might even be the most important driving force behind taking drugs at a younger age (Borsari & Carey Reference Borsari and Carey2001; Faggiano et al. Reference Faggiano, Vigna-Taglianti, Versino, Zambon, Borraccino and Lemma2008). Only by taking the drug does one adapt to this peer pressure and become rewarded as being a member of a particular group.
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3.
Cultural and religious rituals: Cultural and religious traditions can be considered drug instrumentalization goals. Many indigenous populations still consume drugs only in ritual settings; for example, Voodoo is a religion that originates in Haiti and involves a zombie creation ritual where a number of psychoactive compounds, such as tetrodotoxin, are ingested and lead to the mental and physical experience of a death-like state (Davis et al. Reference Davis1983). However, Western societies also have several cultural rituals, such as champagne drinking on New Year's Eve. The purposes of these cultural and religious rituals can be diverse, but most of them are used to intensify spiritual beliefs or group affiliations.
It will be critical for the drug instrumentalization theory to provide a full list of goals that have to be integrated into a questionnaire for future validation in different ethnicities. I am really looking forward to a well-developed and validated questionnaire that will allow M&S to rigorously test their fascinating new theory!
Despite my great enthusiasm for this well-conceived novel theory that, in fact, does provide a new framework on non-addictive psychoactive drug use, I have to note one important point of criticism. M&S mention the use of methamphetamine to enhance daily performance as a drug instrumentalization goal (Lende et al. 2007). From my perspective, this is not a true instrumentalization goal as acute methamphetamine use carries immediate drawbacks and causes harm to the individual and its environment. In this context, it is important to recall a recent case of Tik (methamphetamine) use in Cape Town, South Africa, where a mother killed her own son because she could not endure his methamphetamine-induced personality changes (Maroldt Reference Maroldt2011). By no means is there a beneficial effect of methamphetamine on overall functioning, as stated in the paper by Lende et al. (2007), to which M&S refer. Methamphetamine or crack smoking is too dangerous and too addictive, and the boundaries between a controlled drug-taking behavior and a highly compulsive one can vanish within hours.
Can one imagine how Yemenis would feel without having a daily khat chewing (80% of Yemenis chew khat containing the alkaloid called cathinone, an amphetamine-like stimulant)? Can one imagine how a Dutch person would feel without having her caffeine in the morning (90% of the Dutch drink coffee)? Can one imagine how a French person would feel without having a glass of wine along with his meal? I could go on with numerous examples of accepted drug-taking behaviors, most of them deeply, culturally embedded into our societies. Pondering these examples, one might easily realize the more philosophical question: Why do we take drugs? Roy Wise and other neuroscientists have formulated the drug reinforcement theory (Wise & Rompre Reference Wise and Rompre1989). This theory posits that all drugs of abuse activate the brain reinforcement system and thereby act as biological rewards. This drug-induced reinforcement process increases the rate or probability of further drug-taking behavior. The drug-reinforcement theory is extremely helpful for understanding the biological substrates of a drug-taking behavior in general (Sanchis-Segura & Spanagel Reference Sanchis-Segura and Spanagel2006), but does not explain why person A likes to drink coffee in the morning and several glasses of beer when coming home from work, whereas person B might smoke a cigarette after each meal but not consume any other drug.
Müller & Schumann (M&S) have attempted to construct a new psychological/neurobiological framework – namely, drug instrumentalization – to provide an answer for individual non-addictive psychoactive drug use. Drug instrumentalization is a learned behavior designed to change the mental state and thereby improve the current quality of life by taking a psychoactive drug. M&S define an extensive list of drug instrumentalization goals, such as improved social interaction, the feeling of well-being, and many others. The definition and validation of drug instrumentalization goals will help to understand individual drug-taking profiles, which may change over the life course of an individual. However, at least three important drug instrumentalization goals are missing in M&S's target article:
1. Positive taste perception: Sometimes a self-reflection is very helpful. For example, without disclosing my lifetime drug-taking profile in full detail, at present I have a big cup of tea in the morning, drink different alcoholic beverages regularly in the evenings, and smoke a cigarette from time to time. Why do I consume these three different drugs on a regular basis? The first reason that comes to my mind is that I enjoy the taste. Although there are no systematic population-based studies on whether positive taste perception can be considered as a drug instrumentalization goal, there are millions of coffee/tea shops around the world, millions of wine-tasting sessions, and cigarette advertisements have historically focused on the pleasing taste of tobacco. Positive taste perception as an instrumentalization goal may be limited to alcoholic beverages, coffee/tea, and tobacco, but these are the primary semi-luxury consumables on which money is spent. Positive taste perception may also play a role in betel nut and Khat drug chewing and to a certain extent even cannabis smoking.
2. Adaptation to peer pressure: Very commonly, we consume drugs as a result of peer pressure. Especially during adolescence, peer pressure is an intense motivator and might even be the most important driving force behind taking drugs at a younger age (Borsari & Carey Reference Borsari and Carey2001; Faggiano et al. Reference Faggiano, Vigna-Taglianti, Versino, Zambon, Borraccino and Lemma2008). Only by taking the drug does one adapt to this peer pressure and become rewarded as being a member of a particular group.
3. Cultural and religious rituals: Cultural and religious traditions can be considered drug instrumentalization goals. Many indigenous populations still consume drugs only in ritual settings; for example, Voodoo is a religion that originates in Haiti and involves a zombie creation ritual where a number of psychoactive compounds, such as tetrodotoxin, are ingested and lead to the mental and physical experience of a death-like state (Davis et al. Reference Davis1983). However, Western societies also have several cultural rituals, such as champagne drinking on New Year's Eve. The purposes of these cultural and religious rituals can be diverse, but most of them are used to intensify spiritual beliefs or group affiliations.
It will be critical for the drug instrumentalization theory to provide a full list of goals that have to be integrated into a questionnaire for future validation in different ethnicities. I am really looking forward to a well-developed and validated questionnaire that will allow M&S to rigorously test their fascinating new theory!
Despite my great enthusiasm for this well-conceived novel theory that, in fact, does provide a new framework on non-addictive psychoactive drug use, I have to note one important point of criticism. M&S mention the use of methamphetamine to enhance daily performance as a drug instrumentalization goal (Lende et al. 2007). From my perspective, this is not a true instrumentalization goal as acute methamphetamine use carries immediate drawbacks and causes harm to the individual and its environment. In this context, it is important to recall a recent case of Tik (methamphetamine) use in Cape Town, South Africa, where a mother killed her own son because she could not endure his methamphetamine-induced personality changes (Maroldt Reference Maroldt2011). By no means is there a beneficial effect of methamphetamine on overall functioning, as stated in the paper by Lende et al. (2007), to which M&S refer. Methamphetamine or crack smoking is too dangerous and too addictive, and the boundaries between a controlled drug-taking behavior and a highly compulsive one can vanish within hours.