Tag Archives: Addiction

Drug Use & Drug Abuse

More specifically, it is Psychiatric drug use VS Illicit drug abuse

If I have depression, or dysthymia, or an inability to experience pleasure (anhedonia), why do I need to take psychiatric drugs? I can take cocaine, amphetamine, heroin or opium too, they make me happy and feel high too. It reminded me of the patient who took his own life by jumping off from a building. He said gathering with his bunch of friends and taking those pills are his kind of pleasurable activities (case study here), just like women go shopping or people go gym. Yea, right, how about that? Take a few “pills” and I’m better?

Antidepressants like Prozac and Lexapro (the SSRIs) do not provide pleasure, it restores the capacity for pleasure. It is neither excitatory like cocaine nor satiating like heroin. The drug taker doesn’t crave Prozac and does not feel relief when it enters the system. The desired effect, a change in responsiveness to ordinary pleasures, occur gradually and is unrelated to the daily act of consuming the drug. So unlike cocaine which produces quick, strong but short-lasting “high”, people don’t “usually” get addicted to the SSRIs.

Drug addicts use stimulant drugs hoping to cope with intolerable feelings. Without medication, they may experience little enjoyment. Prescribed medication makes drug addicts who kick the street-drug habit feel less empty and better able to enjoy ordinary pleasures. For the addict, the hope is to enhance the ability to “postpone gratification”, something antidepressants may do by increasing the ability to imagine future pleasure. If and when ordinary pleasure becomes appealing (after a drug addict is treated with psychiatric medicine and begins to experience “ordinary pleasure”), it’s hoped that self-understanding and self-control will follow (no longer rely on illicit drugs to achieve “instant pleasure”).

So can we use anti-depressants (and some other medication) to treat stimulant drug addictions? I believe with a combination of behavioural therapies, and supports from the immediate family members, anti-depressants would work. But taking only anti-depressants without strong mental and motivation to quit and sufficient social supports is definitely not enough, not in long-term for sure.

Psychiatric Drug Abuse?

But anti-depressant drugs (focusing on SSRIs here) can also be abused. There are patients whose depression were treated with the SSRIs, once successfully weaned from the tablets, want to restart it, not because they are depressed, but because life seemed brighter when they were medicated. In psychiatry it’s a bit difficult to decide where treatment ends and depression starts again.. but doesn’t this seem a bit like taking illicit drugs? Same applies to people who take excessive anxiolytics (anti-anxiety drugs / tranquilisers) to make them calm and functional, how do we define when it’s legal psychiatric drug abuse?

There are people who feel more mentally sharp and agile, talk more fluently, and more socially confident when they are on anti-depressants, they continue to take it even when they don’t show any signs of depression at all. Unlike amphetamines which also make people more alert and productive but at the same time is addictive and causing paranoia, most of these SSRIs don’t lead to any significant side effects (and (if) any discomfort tend to go away after first few days). So does this make it morally and ethically fine to take anti-depressants to increase alertness, quickness of thought, and verbal and mechanical fluency, in the absence of illness?


P.S. SSRIs stands for Selective Serotonin Reuptake Inhibitors, which are newer drugs used to treat depression, but also work for OCD and anxiety disorders. Some commonly used in Malaysia include Lexapro (Escitalopram), Prozac (Fluoxetine), Zoloft (Sertraline), Luvox (Fluvoxamine).

N.B. This post focuses more on major and minor depression, dysthymia and anhedonia.

Substance-Induced Psychosis & Addiction-Linked Divorce

When I was doing my master back in the uni, I remember one of the presentations I did was about substance induced schizophrenia. That was just about 4-5 years ago, but I can’t quite remember the details, though I’ve always remembered that one of the triggers of schizophrenia was illicit drugs, I had a diagram in my powerpoint showing how much it contributed to the population with schizophrenia and related illness.

After starting to work in the clinic in KL, I’ve encountered quite some patients who have had a history of taking ecstasy pills or other drugs and have led to psychotic episodes. For the majority of them, their family members took charge and managed to stop them from continuing taking illicit drugs (by stopping them from mixing with so-called “bad friends”, moving to different or new environment, cutting off their finances, threatening to cut off their relationship with the subject etc).

Recently I’ve had this big man, who has had a long history of taking aramine and ecstasy pills, and is seeing the psychiatrist for his anxiety (no, he didn’t show signs of psychosis). He once told me that everyone has their way to release stress, some people go exercise (like me), some go shopping, some watch movies, some do gardening, some just need a good sleep, and for him, he hangs out with his friends, singing karaoke, and… taking pills, spending their nights high. During Chinese New Year, he could be drugged for over a week continuously. Though on normal days, he works, he goes gym (hence he’s called big man, as he’s not just fit, but muscular – like a staff always says, he doesn’t look like a typical drug abuser), he looks after his wife and children. Oh yes, I didn’t mention that he has a family. The wife is lovely, supportive, and all good qualities you can expect from a traditional Chinese woman.

Each time he tries to quit the pills, he would experience a moody state which lasts for two to three weeks, with fears, insomnia. Normally the psychiatric medicine that he’s taking will bring him back to normal and functional. The last time I heard from him after Chinese New Year, he said this round he would definitely quit it, he would stop seeing those friends (I later learnt that it’s much harder because one is actually his business partner), he wouldn’t want to have relapse again and again, and he doesn’t know when those drugs are going to destroy him (his brain/mind), and his family… because the wife said if he takes it again, she’s leaving him (I still remember he said “妻离子散”, such powerful words). I believed what he said, for I know how much he loves his wife.

On last Monday I encountered a motor vehicle accident and had to take the day off. On this very day, big man’s sister called up to the clinic saying that he was really unstable, as the wife brought the kids back to her parents’ house, big man was threatening to cut his wrist (which he did later on). The family members were advised to admit him to psychiatric wards in general hospital. On Thursday when I was at work, big man came with his father (who is also our patient but is in good remission and maintaining with a minimal dosage). The wife called to tell me what had happened this week. She said big man has become really paranoid and delusional recently, always suspecting that she is unloyal to him. On the Sunday before, he went outstation with his business partner (aka one of the bad friends), and spent the night being high, and had called her on 5am, questioning her about the man she kept, threatening that he would do her harm when he came back later. On the next day, he beat her up after being really angry for “what she has done behind him”. That’s the day she had to run away from him with the children, even after he sliced his wrist twice, she didn’t go back, she knows the children’s safety is the utmost important and her husband is not her husband anymore.

What the man presents, is what we call Morbid Jealousy, or Othello Syndrome (an old case study here). He was never delusional or paranoid during the years he was seeing us. He was just having anxiety and fear over some life issues, and is a perfectionist. I believe morbid jealousy is related to paranoid schizophrenia or other psychotic illnesses, and so I can’t help thinking the links between his history of substance use, and the development of his morbid jealousy. From a lot of cases that I have observed, suffering from schizophrenia or other mental illness don’t usually make your partner leave you, quite often the partner can even tolerate morbid jealousy despite how frustrating it can cause and how destructive it is to the relationship; but being mentally ill, having addiction yet refused to go into rehabilitation, and beating wife, that’s the bottom line for any woman, I believe.

N.B. this post was written in March 2016. According to the sister, big man passed away jumping off from a building at the end of March, after calling the wife and speaking to her. 

Introducing “Speed: Facing our Addiction to Fast & Faster & Overcoming our Fear of Slowing down”

Stephanie Brown Phd

By Stephanie Brown PhD.

I picked this book from the Big Bad Wolf for RM8 (under US$2), thinking that this is really something people nowadays are going to need. The content can be slightly outdated (as compared to the rapid advancement of the technology world these days), but definitely not the messages it is trying to bring.

For the past few decades, we’ve all been told to be efficient, to keep moving, to make full use of all our time, to be in control, to have more and more, to keep in touch every waking hours, not to stop, not to slow down, not to be left behind…

We keep adding activities into our schedules, and never take any out, thinking that as long as somehow adjusting them around, we will manage it all… We have the constant need to do something, to check the phone, to go on Facebook, to work harder, to get more, constant feeling of “never enough”. We think we are communicating better with the technology advancement, but we are no longer looking at each other and talking to each other when we dine together…

… …

The style of writing can be a bit boring to me, but repetition is needed to help people to face their fear of slowing down and to learn to live a more mindful and meaningful life.

So, whether or not you think you are so addicted to speed (or gadgets or something similar or related), take a look!

How to Unhook from Speed?

The Twenty Guidelines for Slowing Down

Your Behaviour

  1. You ask for help; you seek a mentor who believes in slowing down for guidance and support.
  2. You develop a recovery action plan.
  3. You begin to make small steps toward change.
  4. You learn to pause, to reflect on your behaviour, feelings and thinking.
  5. You ask yourself, “What am I doing?”

Your Feelings

  1. You feel the reality of limits and face the feeling of failure.
  2. You become aware of feelings, and learn to listen to them,
  3. You trust that the high of impulsive action is not the feeling you seek.
  4. You develop a wider range of new feelings.
  5. You come to trust that deep, intimate human “connection” exists in a slowed down, quiet state.

Your Thinking

  1. You behave in the reality of limits.
  2. You learn to recognize and challenge your belief in entitlement.
  3. You challenge your belief in willpower.
  4. You believe in the value of small steps and a slower sense of time.
  5. You believe in a new definition of success: your best effort within a structure of limits.
  6. You believe in the value of delay, endurance and the concept of “enough”.
  7. You believe that growth and the change are not instant; that “quick fixes” reinforce the thinking of fast and impulsive action.
  8. You believe in the value and necessity of reflection as a part of health and success.
  9. You challenge your all-or-none thinking.
  10. You give new meaning to “service”.


Adapted from Speed: Facing Our Addiction to Fast and Faster – And Overcoming Our Fear of Slowing Down, by Stephanie Brown Phd.

Addiction to Speed (Fast! Faster!)

Are you hooked on fast?

Your Behaviour

  1. Do you want to slow down, but you cannot? Have you lost control?
  2. Do you keep adding activities without taking any away?
  3. Do you work longer and longer hours, but don’t ever finish?
  4. Do you treat other problems: sleep, anxiety, depression?
  5. Do you act first and think later?
  6. Do you check your email and reach for your phone first thing and last?

Your Feelings

  1. Do you feel internal pressure to live fast and act fast, which becomes a craving to “connect” more rapidly?
  2. Do you feel empty if you are not in constant action?
  3. Do you feel nervous without your tech gear in hand or pocket?
  4. Do you feel the beep of your phone as a comfort that gives you a shot of adrenaline?
  5. Do you feel you belong when you are rushing, stressed, and in action?

Your Beliefs

  1. Do you believe you have no limits and you are entitled to live without limits?
  2. Do you believe you should think, feel, react, and behave instantly?
  3. Do you believe you will fall behind if you slow down?
  4. Do you believe success equals fast and faster, and slowing down is failing?
  5. Do you believe you should only feel good, only feel high; other feelings are a sign of failure?
  6. Do you believe stress is the price of success and chaos is normal?
  7. Do you believe that the “new intimacy” is through technology; less time for off-line relationships is the price of success?
  8. Do you believe instant action is a virtue and you can overcome anything with enough willpower?
  9. Do you believe all change must be big to count?


Adapted from Speed: Facing Our Addiction to Fast and Faster – And Overcoming Our Fear of Slowing Down, by Stephanie Brown Phd.

So, How to Unhook from Speed?