From your work experience, what are some main reasons why people use drugs?

I guess I’d like to start by observing that all kinds of people use all kinds of psychoactive substances (Drugs which affect thinking, perception, or mood). For instance, many of us (including me!) use coffee to “perk up” or to feel more awake and alert, while studying for instance. Tobacco, alcohol, and cannabis are also widely used by all kinds of people and have effects on mood and alertness, as well as having a range of physical effects. There are also prescription drugs which affect mood, attention, etc. So, drug use is very widespread and most humans throughout history have used drugs of some kind. 

I think we use drugs in order to “feel better”: to function in a way that feels comfortable, to celebrate good things, and to dull the pain of bad things.

It might be useful to look at drug use along a continuum: from use that is helpful to use that is harmful, but the underlying reasons for using substances are often similar, although the effects on a person’s life and well-being can be really different. When we talk about drug use as a problem, we are often referring to drugs that are illegal, or legal drugs that are being used in ways that are considered excessive or harmful. 

I think that no matter what the drug is, or whether it is legal or illegal, the reasons that people use are the same. People take substances that make them feel better, or so that they can function in a way that works for them. For instance, opiate medications are routinely prescribed by doctors when people have surgery, to treat pain. These drugs are used because they are very effective for managing pain.

What is interesting to me is that psychological and emotional pain have very similar effects on our ability to function day-to-day – just as physical pain does. Some people use drugs, including opiates, as a way to manage and endure pain. When people experience trauma, this can lead to psychological and emotional pain – sadness, grief, anger, all kinds of feelings that are difficult or unbearable to tolerate. Some people use drugs in response to this pain. The concern with this coping mechanism is that drug use may become a problem for people.

 One set of problems is related to whether a drug is legal or illegal. Using illegal drugs can lead to involvement with the criminal justice system which is not a great outcome for anyone. Second, there may be, as we have seen over the past several years, poisoning in the drug supply, which has resulted in a horrific death toll. Third, the difficulty people may have in affording or getting access to drugs that are illegal can expose people to risky environments/people/activities. 

Another set of problems relates to the substance itself. There may be risks of dependence, where a person needs increasing amounts of the substance to get the same effect. People might start using prescribed medications and move to using unsafe street drugs if they develop dependence. Some drugs can be harmful to the body, as with tobacco and alcohol which have harmful health effects. The drug may interfere with a person’s ability to do the things that they want to do. For example, using large quantities of alcohol might interfere with being successful at work or school. 

A big problem overall is that the stigma associated with some drugs, especially illegal drugs, means that it is difficult for people to ask for or to get help when they want or need it. Stigma also means that our society is very judgmental about people who are using drugs in response to emotional pain – even though the effects of emotional pain on the brain are very similar to physical pain. Imagine that you have a painful and serious burn on your hand, and you are expected to just carry on with your everyday activities. Of course, this would be very difficult. The same is true with emotional pain, such as we see with trauma and grief. Chronic emotional pain makes it very difficult to manage our lives or to do the things we are expected to do. The tricky thing with psychoactive drugs is that they are helpful in some ways – they make people feel better – but they can cause incredible harm as well, particularly when a safe supply of drugs is not available. It is a problem that other treatments, like counselling, which is another way of managing pain, are not available or affordable for many people.  Stigma is a reason that treatments for mental health or substance related disorders are less available than treatments for physical illnesses and injuries.