The 'High' Priest

     A clergyman from Tucson, Arizona has taken an informal survey of fellow clergy and discovered that up to 80% had been 'scarred' by substance abuse within their families, this often being a factor leading to their entry into the priesthood. A study from Columbia University suggested that spirituality and religion can reduce the risk of substance abuse.
     But the conclusion of this article really addresses drug abuse among members of the congregation, not the religious leaders themselves. However, drug abuse among the clergy has not been completely ignored. A web-site about substance abuse among clergy does exist, a support-site with contact information for clergy who need help with their addiction problems.

Gregory Efimovich Rasputin

     Gregory Efimovich Rasputin, the infamous monk and advisor of the Russian Tzar and his family was said to have learned Siberian shamanic rituals from a fellow monk, Mikhail Nickolayevich Ivanov, also known as the Reverend (St.) Makariy of the Russian Orthodox Church. Makariy had cured Rasputin's sleep disorder, trained him in hypnotism and taught him the use of alcohol and 'other drugs' for 'spiritual transformation'.

     The drug used by Makariy (and Rasputin) was likely derived from the mushroom 'amanita muscaria' (fly muscaric), a species common in Siberia and much of the boreal forests of northern Europe. The fungus is known for its hallucinogenic properties due to its content of muscimol, a substance similar to psilocybin but producing more dissociative effects (see post: Drugs Used in Religion-The New World).

Mikhail Nickolayevich Ivanov

     A prescription drug called Zolpidem (Ambien in the US) has a mechanism of action similar to muscimol (potentiates a neurotransmiter called GABA), resulting in a lucid-dream like state.

     Zolpidem has been used to treat insomnia, a common sleep disorder. Muscimol, derived from the fly muscaric mushroom was likely the drug given to Rasputin by Makariy in order to 'cure' that monk's sleep difficulties.
     Hallucination, increased libido and delusion are potential side effects of this drug and, taken in unregulated form (as in the form of a mushroom extract), this may have been a contributing factor to Rasputin's notorious behaviour.

amanita muscaria

     But the most well-known 'high' priest, at least in modern times, is the Reverend Jim Jones, leader of The Peoples Temple (see post: The Reverend Jim Jones). Jonestown, the Peoples Temple hideaway in Guyana, South America is where Jones convinced over nine hundred of his followers to commit suicide by ingesting cyanide-laced fruit drink.
     Inside Jones' living space within the Guyana compound, enormous quantities of drugs (sedatives, narcotics) were found. Within his dead body, Jones was packed with the residue of barbiturates, marijuana and LSD.

Reverend Jim Jones

     *Religious personality cults: subject of research for the novel  The Tao of the Thirteenth God - Amazon Kindle.

The Addictive Personality

     Alcoholism and other damaging substance addictions are often said to be symptoms of depression and other emotional distress.

King Alcohol 1820

     The concept of the 'addictive personality' has significant scientific support and is defined as a distinct psychological trait that predisposes particular individuals to addictions. While the nature and even the existence of this trait is debatable, there is evidence that there exist factors in the brain that contribute to addiction.

     Drug exposure on a repetitive basis does indeed change brain function. Positron emission tomography (PET) images demonstrate similar brain changes in dopamine receptors resulting from addiction to different substances - cocaine, methamphetamine, alcohol, or heroin. The striatum (which contains the reward and motor circuitry in the brain) shows up as bright red and yellow in the controls (non-addicted group), indicating numerous dopamine D2 receptors. The brains of addicted individuals show a less intense signal, indicating lower levels of dopamine D2 receptors.

Dopamine Receptors - Normal and 'Addicted'

     The addictive personality: Does there really exist a set of traits which can define an individual as prone to developing an addiction? While no one has succeeded in proving the existence of a true addictive personality, many experts believe that the predisposition to addiction is a combination of biological, psychological and environmental factors.

     But are there identifiable aspects of behaviour that are common to addicts. If identified before addiction takes hold, can these traits be said to be representative of an addictive 'tendency'?

     Addiction has been  defined as a reliance on a substance or behavior that the individual has little power to resist. Of importance as well, is the fact that addiction is a 'brain disease' and a disease which is chronic and relapsing, reflected in those visible changes which occur in the brains of addicted individuals, changes that are long-lasting, sometimes permanent.

     In describing addiction, it is important to address the types of addiction and types of substance abuse that are often accredited to the 'addictive personality'. There are two primary forms of addiction, one being substance-based, the second being behavior-based.

Nicotine Addiction

     People who are substance-dependent are characterized by a physical or a psychological dependency that negatively impacts their life. These substance-based addictions, such as alcoholism, nicotine, prescription and narcotic addictions, are more easily explained and identified neurologically. Particular drugs, such as crack and heroine cause massive surges in dopamine in the brain (see post: The Genetics ofAddiction), with different sensations ranging from invincibility and strength to euphoric and enlightened states. Use of these substances changes particular aspects of the brain, making most individuals immediately susceptible to future abuse or addiction.

     Behavior-based addictions include gambling, shopping, eating, pornography, sexual activity and even exercise (see post: Your Personal Narcotic). These addictions are not as easily explained neurologically as are the substance-abuse cases, but do appear to have a similar susceptibility characterized by the 'personality trait'.

Gambling Addiction

     There is also a third type of addiction called combined addictions, that is, addictions which include both substance, as well as behavioral aspects, most commonly the addiction to nicotine, either smoking or chewing. This particular addiction combines a physical addiction to nicotine and a mental aspect, the repeated routine of the behavior, such as a cigarette after meals.

     The spectrum of behaviors seen as addictive are described in terms of five interrelated concepts which include patterns, habits, compulsions, impulse control disorders, and physical addiction.
     An individual is considered to be at the risk of developing addictions when he/she displays signs of impulsive behavior, nonconformity combined with a weak commitment to the goals for achievement valued by the society, a sense of social alienation, and a sense of heightened stress. This individual may switch from one addiction to another or may be addicted to multiple substances or behaviours at different times.

The Running 'Addiction'

     In all types of addiction, there seems to be a relationship with gender. Studies have shown that male adolescents are more active in early drug and alcohol experimentation and that men in general are four times more likely to become dependent on alcohol, twice as likely to routinely use marijuana, and one and a half times more likely to become addicted to cigarettes.

     On the other hand, female adolescents are more likely to experience activities associated with behavioral addictions.  

     Women outnumber men in addictions to eating, bingeing and purging and tend to develop eating disorders at a greater rate.

     This gender difference in regards to addiction type and rate may have a genetic component but are certainly related, at least in part to societal values and the images presented to young men and women. For instance, advertising for alcohol consumption is primarily aimed at young males.

The 'Boys Have Been Drinking'

     The symptoms of excessive alcohol consumption and drunkenness (uncontrolled behavior, lessened inhibitions, weight gain) are less acceptable for women than men in western society. Many popular images associated with cigarettes have a markedly masculine undertone, as the main face of the tobacco industry. One of the best examples of this is the 'Marlboro Man'.

The 'Girls Have Been Drinking'

     According to the notion of the 'addictive personality', these individuals are very sensitive to stress, have trouble handling situations that they deem frustrating, even when that event is for a very short duration. The 'addictive' person often lacks self-esteem and shows impulsive behavior such as excessive caffeine consumption, Internet usage, eating of chocolates or other sugar-laden foods, television watching, or even running.

     Self-monitoring ('second guessing' oneself) and loneliness are also common characteristics found in those who suffer from addiction and certain studies have shown that those who score high on self-monitoring are more prone to developing an addiction. High self-monitors are sensitive to social situations and act how they think others expect them to act. The 'addictive' individual craves to 'fit in' and are therefore easily influenced by others. Most with low self-esteem also seek peer-approval and therefore  participate in 'cool' activities such as smoking or drinking simply as a means to 'fit in'.

     The 'addictive personality' has even, by some, been classified as a disorder, the 'Addictive Personality Disorder' (APD). Those suffering from APD find it difficult to manage their stress levels, lack of stress tolerance being  a tell-tale sign of the disorder. Stressful situations are difficult to face and avoided if possible and, when caught up in a situation that is unavoidable, the individual with APD often finds it difficult to extricate him/herself from that situation. The stress that comes with getting through short-term goals makes long-term goals difficult to achieve. These individuals will often switch to other enjoyable activities quickly and on the spur of the moment that they are deprived of enjoyment in their previous addiction or behaviour.

Cannabis Use

     Insecurity with relationships, difficulty in making commitments in relationships or trusting loved ones is common. The person with APD constantly seeks approval of others, usually experiences anxiety and depression and difficulty with managing their emotions through the development of  addiction to alcohol, other types of drugs, or other pleasurable activities.

A 'Shopoholic'?

     But are these personality 'traits' truly indicative or predictive of an individual who will become an addict?

     Or are these traits seen in addicts and 'retrospectively' seen to be present during their pre-addict life?

     The 'Diagnostic and Statistical Manual of Mental Disorders' (DSM) does not note 'Addictive Personality Disorder' as a distinct entity. The DSM does, however, link addiction, at least in an indirect way, to 'Obsessive-Compulsive Disorder', where the (often harmful) use of the abused substance or activity is continued because of the compulsive aspect of the patient's personality.

     If someone does indeed have all or most of these traits but has the proper support from family and community, will that person avoid becoming an addict?

     Or is it genetics, the 'destiny within the DNA' that dictates the rules, that declares that if alcohol is not available, you will instead use heroin or become a chronic gambler, searching in any way possible for the surge of dopamine in your 'reward center' that your genetically programmed brain demands?

   
     *The addictive personality: subject of research for the novel Whip the Dogs - Amazon Kindle

The Genetics of Drug Addiction

     Drug addiction is a chronic disease associated with alterations in the brain that result in compulsive behaviour and the urge to use one or more particular drugs. Whether the drug involved is cocaine, amphetamines, narcotics (opioids), cannabis, alcohol or even nicotine, the affliction can be a chronic, relapsing disorder in which these compulsive drug-seeking and drug-taking behaviours persist despite serious negative consequences.

The Effects of Drug Abuse

     Even the tobacco smoker, well aware of the potentially deadly effects and faced with gruesome pictures of the results of smoking ignores, overlooks or 'blanks out' these warnings, overwhelmed by the need for nicotine.

     All these addictive substances induce pleasant states or relieve distress, effects that contribute to their recreational use (see post: Altered States of Consciousness). There really is a 'reward center' in the brain. It sits centrally, in the deep brain structures and is responsible for our feelings of motivation and reward. Performing healthy activities such as eating, drinking and sex, activities that aid in survival, results in stimulation of this central area of the brain. 

Dopamine Pathways and Central Reward Center of the Brain

     Bombarded by the senses of smell, touch, taste, and sight of a morsel of food, for instance, results in the release of the neurotransmitter dopamine, producing the sensation of pleasure and 'wiring' the brain to seek out this same pleasure again.    

     Dopamine has many functions in the brain including roles in motivation, regulation of body temperature, memory, voluntary movement (it is the neurotransmitter that is low in certain areas of the brain in cases of Parkinson's Disease), mood, learning, punishment and reward.

     Nature has programmed us to repeat behaviours that maximize rewards and thus, in a perverse way, it is dopamine that is critically involved in the drug addiction process.

Parkinson's Disease with Forward-Stooped Posture

     A neurotransmitter (such as dopamine, GABA, epinephrine, norepinephrine) is a chemical substance that is released from a nerve ending that then attaches itself to contact points on the next nerve cell(s). These contact points are called receptors but, to add to the confusion, there is often more than one receptor type for the various different neurotransmitters and even more than one receptor site for any one specific neurotransmitter, such as dopamine.
     The role(s) of the various dopamine receptor subtypes on brain cells has been difficult to precisely delineate.

     And then, of course there are two important questions:

1. Are the receptors for the 'reward neurotransmitter' (ie dopamine) different in the addict as compared to the non-addicted individual?

2. Is there a genetic 'predisposition' (a marker? a subtle difference in the gene(s) that codes for these receptors?) in the 'addictively-predisposed' individual?

Chemical Structure of Dopamine

     A great deal of research has looked at the genetics of addiction, mostly focusing on the differences in the genes that code for dopamine receptors in the brain. These studies, which examined families, identical and non-identical twin subjects and control subjects who differed in their drug use habits suggest that there is indeed a significant difference in the make-up of specific dopamine receptors, most markedly at the specific 'DRD2' gene site that codes for dopamine receptors.

Neurotransmitter at Nerve Ending (Synapse)

     Unfortunately, nothing in science is ever quite this simple and these research findings do not hold true in all studies. It seems evident that drug addiction certainly has a genetic component but environment as well as social factors also play important roles.

     One key aspect to addiction however seems to be that it is the neurotransmitter, dopamine that plays a central role in addiction, this scourge of many in today's society.

     An interesting 'mouse party' that demonstrates the brain's activity in drug use has been produced by the Department of genetics at the University of Utah. Click on the link below:

 Mouse Party-Drug Addiction

   
     *The genetics of drug addiction: subject of research for the novel Whip the Dogs - Amazon Kindle

Your Personal Narcotic

     All human beings (and probably all mammals) use 'narcotics' on a daily basis. We are not all drug abusers. We are not all drug addicts. The 'narcotics' that we use are our own, made by our bodies (endogenous) for normal daily function.

The Pituitary Gland and Hypothalamus

     These endogenous narcotics are called endorphins and are produced by the pituitary gland (at the base of the brain) and by the hypothalamus (a deep brain structure). These 'morphine-like' substances are released when we are excited, when we are in pain, when we are in love, during orgasm and even during exercise. Release of endorphins provides the body with a sense of well-being and can dull pain that could otherwise be disabling.

    Endorphins are neurotransmitters (see post: The Genetics of Drug Addiction) and the most important endorphin (or at least the one most studied) is called 'ß-endorphin'. The importance of this particular endorphin comes from the fact that it reacts mostly with specific receptors on the nerve cell (called μ1-opioid receptors). These μ1-opioid receptors are the same receptors that narcotics such as morphine react with. When ß-endorphin (or morphine) attaches to the μ1, certain neurotransmitters are blocked (GABA) and others are enhanced. The enhancement is especially pronounced with dopamine, the 'brain-reward' transmitter (see post: The Genetics of  Drug Addiction).

The Runner's 'High'

     The pleasure or 'brain reward' experienced with endorphin or morphine stimulation at these μ1 receptor sites, leads to the desire and 'need' to seek out this same stimulus - endorphin release from a 'runner's high' or (often intravenous) narcotic administration. When narcotic abuse is the case, these μ1 receptors are essentially 'high-jacked', triggering dopamine release and creating dependency.

     But why do human beings have this 'natural morphine' release? What use could it be or could it have been in the past? One theory to explain this phenomenon is based on the statistics of running speed and endurance. Animals, such as human beings, are not fast runners but do have the ability to run for long distances.

Masai Hunters

     In prehistoric times, catching a fast-moving meal may have been impossible for these relatively slow-moving humans but eventually, if chased far enough and for a long enough period of time, the meal-to-be would tire, slow down and fall into the hands of the pursuer. 

     Endorphin release in the man chasing the prey enabled the hunter to ignore the pains of twists and bumps, the aches of exhaustion and reach his goal. This may explain why some of the best long-distance runners in the world originate from regions where long distance hunts are common and have been for thousands of years.

Isolation/Flotation Tank

     Certain studies have suggested that endorphin release also occurs when floating in 'isolation/flotation tanks' as well as during acupuncture.

     The placenta secretes endorphins during pregnancy into the mother's blood stream. Why this occurs is unclear but some suggest that this ß-endorphin production creates dependency in the mother and forces her metabolism to direct nutrients to the growing fetus (the child addicts the mother!).

Acupuncture and Endorphin Release

     Post-partum depression may therefore be a type of 'narcotic withdrawal' that sometimes can be countered by the mother's own endorphin release when breast-feeding.

Placental Secretion of Endorphins

     The 'runner's high' is probably not entirely due to these morphine-like substances our bodies produce. There are many other natural chemicals that have been suggested as important in feeling the euphoria of victory or extreme exertion and in dulling the pain of a severe injury.

     Naturally occurring cannabinoids (endocannabinoids) such as anandamide are thought to play such a role.
     Other neurotransmitters such as epinephrine, serotonin and dopamine (that wonderful reward neurotransmitter) have also been shown to be important.

      * The genetics of drug addiction: subject of research for the novel Whip the Dogs -Amazon Kindle

Turn On, Tune In, Drop Out

     If anyone reading the title of this post recognizes the words, it is likely that you grew up in the 1960s. 'Turn on, tune in, drop out' was the counter-culture phrase of  Timothy Francis Leary (October 22, 1920 – May 31, 1996), American psychologist, writer and Harvard professor known for his advocacy of psychedelic drugs (see post: Altered States of Consciousness).

Timothy Leary

     Leary believed LSD showed therapeutic potential for use in psychiatry, a focus that was similar to the interests of Dr. Donald Ewen Cameron  of the Allan Memorial Institute of McGill University in Montreal (1957 to 1964) who carried out research for the C.I.A. into mind-controlling drugs, 'truth' drugs as well as schizophrenia (see post: The Author and the Addict).

     Leary earned his Masters Degree in psychology at  Washington State University in 1946, and his Ph.D in psychology at the University of California, Berkeley in 1950. He travelled to Mexico with where he ate psilocybin mushrooms (see post: Drugs Used in Religion-The New World) for the first time, for Leary, a life-altering experience. With the experience of psilocybin, Leary claimed that he had 'learned more about ... (his) brain and its possibilities ... (and) more about psychology in the five hours after taking these mushrooms than ... (he) had in the preceding fifteen years of studying and doing research in psychology'.

Psilocybin Mushrooms

     Following his return to the U.S., Leary and an associate started the Harvard Psilocybin Project (an endeavour which eventually lost him his position at the university) to study the effects of the drug on human subjects. Despite his discharge from Harvard faculty, a number of spin-off projects continued led by graduate students or co-workers, including: The Marsh Chapel Experiment (the Good Friday Experiment) was run by  a graduate student in theology at. The goal was to see if in religiously predisposed subjects, psilocybin would act as a reliable entheogen, a drug which would induce religious experiences (see post: Drugs Used in Religion-The Old World).

Leary withJohn and Yoko in Montreal

     Almost all of the subjects who took part in the study reported experiencing profound religious experiences, providing  support for the concept that psychedelic drugs could facilitate religious experiences; the Concord Prison Experiment which was designed to evaluate the effects of psilocybin combined with psychotherapy on rehabilitation of released prisoners. After being guided through the psychedelic experience ('trips') by Leary and his associates, 36 prisoners allegedly repented and swore to give up future criminal activity. Leary's career became fraught with legal difficulties due to drug advocacy and drug use. He was imprisoned for trying to bring cannabis into the U.S. from Mexico.

     On June 1, 1969, Leary joined John Lennon and Yoko Ono at their Montreal 'bed-in' with Lennon subsequently writing Leary a campaign song (Leary ran for governorship of California against Ronald Regan) called 'Come Together'.

A Pegasus Rocket

      In early 1995, Leary was diagnosed with inoperable prostate cancer and died the next year. Seven grams of Leary's ashes were arranged 'buried in space' aboard a rocket carrying the remains of 24 other people including Gene Rodenberry (creator of Star trek). The rocket containing Leary's remains was launched on April 21, 1997, and remained in orbit for six years until it burnt up in the atmosphere.

Terence McKenna

     Terence Kemp McKenna (November 16, 1946 – April 3, 2000) was an American philosopher, researcher, teacher, lecturer and writer on many subjects, such as human consciousness, language, psychedelic drugs, the evolution of civilizations, the origin and end of the universe, alchemy, and extraterrestrial beings. In 1963, McKenna was introduced to the literary world of psychedelics through 'The Doors of Perception' and 'Heaven and Hell' by Aldous Huxley (see post: TheAuthor and the Addict). 

Alchemy

     McKenna claimed that one of his early psychedelic experiences with morning glory seeds (see post: MotherNature's Psychedelic Roadside Drug Store) made him realise 'that there was something there, worth pursuing'.  Mckenna began smoking cannabis regularly during the summer following his 17th birthday and while in college, in 1967, he begun studying shamanism (see post: The Shaman) through the study of Tibetan folk religion. In 1969, McKenna traveled to Nepal where he worked as a hashish smuggler, until 'one of his Bombay-to-Aspen shipments fell into the hands of U. S. Customs'.

     McKenna switched majors to a Bachelor of Science in ecology and conservation when he returned to Berkeley and soon after graduating, McKenna and his brother, Dennis published a book inspired by their Amazon experiences, 'The Invisible Landscape: Mind, Hallucinogens and the I Ching', relating to their consumption of ayahuasca.

     After the publication of his second book, 'True Hallucinations', McKenna, like Leary became a fixture of popular counterculture. These were followed by several more books which promoted his predilection towards 'Altered States of Consciousness' (see post: Altered States of Consciousness) via the ingestion of naturally occurring psychedelic substances.

Ayahuasca.

     But perhaps, KcKenna is most famous for his 'Stoned Ape Theory of Human Evolution'. According to McKenna, it was the psychedelic mushroom which had also given humans their first truly religious experiences and it was the potency to promote of the mushroom that led to 'linguistic thinking', promoting vocalisation and speech. In 1985, McKenna co-founded Botanical Dimensions with his then-wife Kathleen, in Hawaii, where he lived for many years before he died of glioblastoma multiforme, an aggressive brain cancer.

Graham Hancock

     Graham Hancock (born 2 August 1950 in Edinburgh, Scotland) is a writer and journalist (formerly for The Economist magazine) who specialises in unconventional theories involving ancient civilizations, megaliths, ancient myths and astronomical/astrological data from the past.

     His 'stand-out' book, entitled 'Supernatural' is a fascinating adventure into the world of paleolithic cave art and mind-altering substances. In it, Hancock see the 'Machine Elves' described much like McKenna did, both men, under the influence of DMT.

     Is this evidence to support McKenna's 'Stoned Ape Theory of Human Evolution'? Is this supportive of the idea that the brain is a 'receiver', opened up by certain pharmaceuticals that allow us to perceive messages from 'alien beings'? After all, the two men, under the influence of the same/similar drugs did see virtually the same things.

Sigmund Freud

     Perhaps the most famous researcher who investigated and used pharmaceuticals was the Austrian neurologist and father of the discipline of psychoanalysis, Sigmund Freud (Sigismund Schlomo Freud 6 May 1856 – 23 September 1939). Freud was an early user and proponent of cocaine as a stimulant, anti-depressant, pain-killer and a cure for morphine addiction. Despite witnessing a friend experience 'cocaine psychosis' and subsequently revert to his addiction for morphine, Freud continued to use cocaine on a daily basis for 'depression, migraine and nasal inflammation' during the early 1890s, before giving it up in 1896.

     It has been suggested that much of Freud's early psychoanalytical theory was a by-product of his cocaine use. In September 1939, Freud, who was suffering from throat cancer and in severe pain, persuaded his doctor and friend Max Schur to help him commit suicide. On 21 and 22 September, 1939, Schur administered doses of morphine to his friend, relieving his suffering and allowing Freud to die.

   
     For an interesting audio by Terence McKenna, 'Mushrooms are an Extra-Terrestrial Phone, click on the link 'The Best Interview About Drugs' below:

      The Best Interview About Drugs

    
     Graham Hancock's most recent non-fiction book, 'Supernatural: Meetings With the Ancient Teachers of Mankind' (published in the UK in October 2005 and in the US in 2006) examines paleolithic cave art, its relation to drug use and the development of the 'fully modern human mind'.

     His first novel, 'Entangled: The Eater of Souls' makes use of Hancock's prior research interests much as he described in 'Supernatural'.

   
     A (rather long) talk by Graham Hancock concerning his novel 'Entangled' relates to many of these experiences he recounts in 'Supernatural'. Click on the link: 'Elves, Aliens, Angels and Ayahuasca' below.

     Elves, Aliens, Angels and Ayahuasca

     * The history of narcotics use: subject of research for the novel Whip the Dogs - Amazon Kindle

The 'High' Doctor

     Various studies have examined the subject of drug abuse among physicians and have shown that, in general, the rate of illicit drug use is less among doctors than the general public.  The rate of abuse of prescription drugs however is considerably greater for physicians, up to five times higher than in the general population. Up to 15 percent of all health care professionals will battle substance abuse at some point in their careers. Is this due to stress? Overwork? Easy access to addictive substances?

Cocaine

     Historically, physicians have experienced a high rate of drug abuse and drug addiction. With the increased use of medical cocaine in the late 1800s, physicians were thought to constitute 30 percent of all cocaine users. The problem of abuse among physicians was well recognized. 'A man who is his own lawyer, has a fool for a client'. This same line of thought was most pertinent to the medical field where cocaine used by physicians was usually self-prescribed.
     In the nineteenth century, there was no formal process by which new drugs were investigated and doctors often simply experimented on themselves. The renowned and well-respected physician William Halsted, along with several of his colleagues, became cocaine abusers while assessing this new drug, cocaine.

William Stewart Halsted

     Halsted was able to recognize his addiction and 'cured' himself of the cocaine habit by shifting to the use of morphine instead. He continued on, able to handle his morphine addiction more easily than the cocaine addiction, achieving a notable career in American surgery.

     But in the field of medicine, there is one speciality that is especially prone to substance abuse and it is abuse of the most powerful, dangerous and addictive substances known.  

Drug Addiction

     The speciality field is anesthesia (the specialists who put you to sleep for surgery) and the substances most commonly abused are narcotics (morphine and its derivatives). Needless to say, anesthesia can be a very stressful job. Knowing what type of medication is needed, how much is needed and during what point in the surgery it should be administered are all important factors that can determine life, significant brain injury or even death. No patient is the same. There are no 'recipes' for drugs except according to weight, age, cardiac condition, kidney condition, drugs the patient already is taking...The list goes on and on.

     Anesthesia is similar to piloting a large aircraft (but without any auto-pilot or computer to back you up): a period of boredom (hopefully) while the patient is safely anesthetized (the aircraft is in flight) with a period of 'terror' at the beginning (take-off), as the patient is put to sleep and another period of 'terror' at the end (landing), as the patient is brought out of anesthesia.

Prescription Drug Abuse

     But with all these powerful drugs at hand (barbiturates are also commonly abused by anesthetists) and all the stress of the job, it is perhaps surprising that more of these specialists don't become addicts. Although anesthetists make up only 3 percent of all specialists, this group accounts for 20 to 30 percent of drug-addicted doctors.

     Several organisations recognize the problem of addiction among physicians and realize that certain groups, such as anesthetists, are more susceptible to this problem. Despite campaigns as well as teaching of the risks of addiction early in medical training, the difficulty with substance abuse among doctors remains a problem.

Anesthetists at the Head of the Operating Table

     In the operating room, anesthetists usually wear short sleeves. The needle tracks of injection sites would be difficult to hide but these specialists are not just experts at putting a patient to sleep. They are also  experts at finding and accessing veins for drug administration - between the toes, on the leg or the inside of the thigh. Drug addiction is an 'occupational hazard' among this group of physicians but a hazard that can have catastrophic effects for the patient under care.

Demerol (pethidine) - An Intravenous Narcotic

     Is an anesthetist on drugs (The 'High' Doctor) still capable of performing his/her work? That depends on whether the addict has become tolerant to his 'drug of choice', when he took it, the type and sub class of drug used...This list goes on and on, too. But the short answer is 'No'. No physician, dependent on drugs is safe to 'pilot the airplane'. His response time and ability to make a decision may be unreliable. His judgement may be impaired.

     And even when giving a drug to himself, does the doctor, at that point, really know what drug he has just taken? Drugs in the operating room are administered by vein, many do not contain preservatives, the vast majority have no color. In the bottle and in the syringe (except for the labelling, if it is done correctly), they all look the same. They all look like water.

     What follows is a true story: He was a young man (J.R. - not his real identity), a specialist in anesthesia, out of training no more than 5 years. The patients who met him, loved him and had great confidence in his skills. The surgeons and nurses knew him well (or so they believed). J.R.' s behaviour seemed normal. At times, however, he would be very talkative, at other times, there was only silence behind the curtain of sterile sheets that separated the surgery from the head of the table where the patient lay.

     At the end of one very long week, J.R. 'disappeared' before his patient was transferred to the recovery room (an unusual event in the practice of anesthesia) and no body knew where he was. Just by chance, one of the nursing staff, searching for a mop in a closet, found J.R, still breathing, slumped in a corner, a needle in his arm.

     J.R., medical expert, knowledgeable of all the risks and possible complications inherent in anesthetic drugs, had mistaken his substance of choice (fentanyl, a narcotic - see post: A Basketful of Narcotics) with a paralysing agent (pancuronium). Immediately upon injecting the wrong agent, J.R. realised that he had made a mistake but it was too late. The paralysis seized his body and he stopped breathing.

     J.R. was one of the lucky ones. Nursing staff and fellow anesthetists came quickly to the scene and he was resuscitated.

     Both medications in this particular circumstance are the color of water. Both are given intravenously. Each one can be easily confused with any number of anesthetic agents. And each one alone can be deadly.

     But how can a physician in this position of authority and responsibility, in the presence of and watched by fellow staff members, obtain the drugs (narcotics, in the case of J.R.) without his co-workers knowing? Is there not a system, an accounting of drugs used? Is there not a way of measuring how much narcotic was used for the patient, when it was given and how much of the open ampoule that the drug was packaged in was left over?

     The answer is 'Yes'. But, as with most systems, there are always ways to 'outsmart' it.

 
      *The drug-addicted physician: subject of research for the novel Whip the Dogs - Amazon Kindle

Devils and Demons

     Throughout religion, good and evil are 'at war'. 'Fallen angel', Satan, demon - these terms all stand in as the metaphor for the worst characteristics that each one of us, as human beings, possesses. The devil and demons (evil) are the enemy of God (good) and humankind.

St. Anthony Plagued by Demons

     The presentation of the 'devil' can take different forms. In Zoroastrianism,  Angra Mainyu is the destructive, evil counterforce of  the force of 'good', Ahura Mazda. 'Mara', the devil-personification in Buddhism, tempts Gautama Buddha with beautiful women. In Hinduism,there are the 'asuras' that cause evil to occur. 

     Christianity's devil is a single entity, a 'fallen angel', named Satan, Lucifer, Beelzebub (the name of a Philistine god) along with a troupe of other fallen, the 'demons'.
     In Islam, the devil is called 'Iblis', created by God out of smokeless fire along with his lessers, the 'jinn'. Surprisingly different from the other Abrahamic religions, Judaism does not have a specific 'devil' character such as Satan or Iblis, just as there is no 'hell' in Judaism but rather a place of (temporary) purgatory (Gehenna).

Lucifer Expelled from Heaven

     In ancient Egypt, Set(h) was the evil 'stand-in' for the devil (see blog: A Story of Brothers).
     Demons were recognized in Mesopotamia, called 'shedu' (storm demons); in pre-Islamic Arabia 'jinn' (adopted by Islam).
     In ancient Israel there were 2 types of demon, the 'se irim' and the 'shedi' (which could cause 'demonic possession').
     In popular Islamic culture, "Shaytan" is often translated as "the Devil," but the term can refer to any of the jinn who disobeyed God and followed Iblīs. Shaytan and his minions are "whisperers," who whisper into the chests of men and women, urging them to commit sin.

Shaytan

     Some Christian theology claims that demons are the evil spirit product of sexual relations between fallen angels and human women. 

     But not all devils are bad. For the Yazidi of Northern Iraq,  'Malek Taus' is Satan, known as the 'peacock angel' the fallen angel who is worshipped and will, one day, be redeemed.
     All these are surely metaphorical stories that play well with many people but mean to say that 'good' and 'evil' reside in each one of us.

Malek Taus
The Peacock Angel

 

     *Religious belief: subject of research for the novel  The Tao of the Thirteenth God - Amazon Kindle.