TREATMENT
WE NEED
TO TALK ABOUT
PLEASURE
Our refusal to acknowledge that drugs can be a happy experience
is hampering our attempts at treatment, says Nick Goldstein
We’ve all heard
enough
about
coronavirus
to last a
lifetime. But
one of the more positive aspects
of the lockdown is that it has given
us time and space to sit down and
think about the difficult issues that
we kick into the long grass. One
of the subjects I find repeatedly
cropping up is pleasure – our
perception of pleasure and our
attitude towards it.
The dictionary definition of
the noun ‘pleasure’ is a feeling
of happiness and enjoyment – a
feeling we all know. Pleasure is
usually perceived to be harmless – a
fringe benefit of existence even –
BUT if that pleasure is derived from
something society perceives as a
negative, all hell breaks loose. And
there are few things society regards
as negatively as drug use.
Consequently, drug use has
become deeply stigmatised and
the root of that is ‘intoxophobia’
and faulty misperceptions of
pleasure. Intoxophobia, the fear of
intoxication, has been around for a
long time and exists as a result of
ignorance of different, altered states
of consciousness. Any behaviour
different to our norms creates fear,
and no one likes to be scared – in
fact fear makes people angry.
The misperception of drug use as
purely pleasurable is also the result
of ignorance – an ignorance that
also ends in anger, but this anger is
caused by resentment rather than
fear. Think of it as a version of Max
Weber’s protestant work ethic – a
concept that implies that pleasure
must be worked for, striven for, and
not bought by the ten bag. So, some
poor schmuck wandering around
high as a kite doesn’t go down well
because of all those misconceptions,
misperceptions and outright
intolerance relating to pleasure.
Sadly, those misconceptions
and misperceptions surrounding
drug use and pleasure exist in the
substance misuse field too. From
key workers to consultants in every
treatment agency and treatment
provider, it’s lurking. It can be seen
in the drugs prescribed (both major
drugs prescribed in treatment,
methadone and buprenorphine, are
perceived to offer little pleasure) and
in the limited amounts prescribed,
which are subsequently sub-optimal.
Have you ever heard a prescriber
say to a struggling client, ‘Oh dear!
Your sample is positive. You’re
obviously struggling with this
dosage/prescribed drug. So let’s
increase your dose/change the drug
for something you might prefer –
something you might actually want
to take because you enjoy it.’ No, me
neither. The response is much more
likely to involve decreasing dosage
and increasing restrictions for the
client.
Rather than concentrate on
Freud’s pleasure principle, it would
be far better for us all if more
emphasis was paid to a much earlier
commentator, Epicurus. Epicurus,
who was a noted Greek philosopher,
suggested that primarily pleasure
was found in relieving pain. At least
50 per cent of substance misuse
clients experience dual diagnosis
and suffering. The very fact they
‘Pleasure is
usually perceived
to be harmless – a
fringe benefit of
existence even
– BUT if that
pleasure is derived
from something
society perceives
as a negative,
all hell breaks
loose. And there
are few things
society regards as
negatively as
drug use.’
10 • DRINK AND DRUGS NEWS • SEPTEMBER 2020
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