Drugs and side effects

I’m writing this under the influence of half an alprazolam (generic Xanax), which I regularly take in small doses to manage anxiety (it’s hereditary); I find the side effects of SSRIs/SSNRIs unacceptable. I find myself wishing I’d opted for a quarter instead of a half, as I suspect it might have relaxed my abdominal muscles without making me feel just a little foggy.

When I was a kid, from the time I can remember until after I went to college, I took an Actifed (pseudoephedrine hydrochloride) every night for allergies, which I was born with (also hereditary). The formula for Actifed changed when the meth problem came along and they put all that stuff behind the counter; the old Actifed was a powerful sedative; I once fell asleep in our swimming pool after taking one. My high school started at 0730. It was a years-long struggle for me to get to school on time. At one point, I got an in-school suspension for tardiness; my mother and I used to fight out loud about my not being ready for car pool. I had to fight to stay awake in classes that didn’t hold a strong interest; when my parents came to school to talk to my geometry teacher about my “D” in her class, Mrs. Goodwin noted that if I could stay awake I would probably do better.

And yet, at no point did anyone question the nightly Actifed. I was taking it for my allergies.

I was always a fiercely anti-drug sort of kid. As in, recreational drugs. I’ve never done any of them. Ever. Except for one.

Like so many millions if not billions of humans throughout history, I love alcohol. (That’s hereditary too.) For twenty-something years, with a two-plus year break, drinking was the centerpiece of my evening—every evening. We’re not talking anything hard-core here; no unscrewing the cap off a fifth and throwing the cap away, none of those stories AA meetings are famous for. Just a couple of double cocktails and a big glass of wine and a Scotch after dinner. Just a whole lot of booze over a whole lot of time, and a whole lot of money (I like the good stuff.) I quit a little over two years ago, because it’s easier for me to do none than to do a little, and I was tired of the side effects of it—not hangovers, which were rare, but the damage I knew I was doing, the extra body fat, and the money. Alcohol only helps with anxiety for about half an hour or so, and then it can make it worse; and because it amplifies all of our emotions, it tends to make us irritable, even belligerent. Hence the ubiquity of the “bar fight.”

Alcohol is a perfect example of how a drug—or any other technology—can acquire social sanction denied to its alternatives—even if those alternatives are less harmful. Historians of technology are writing about that phenomenon with fossil fuels and the technologies that use them. I’m glad I’m living to witness the widespread acceptance of cannabis, something far less harmful than alcohol. It’s not lost on me that, when I was a kid, a lot of the people who were 100% for putting pot smokers and dealers in jail were pickling themselves with martinis and whiskey.

I’ve said here before that I consider the birth control pill to be the most significant technological development of the modern world. I think one can make the argument that it deserves consideration as the most important technological development in human history, as it gave human females the power to control their own reproduction, and thus remove the most fundamental burden and limitation imposed upon them by nature. To broaden that argument: I think drugs in general are some of the most important technologies we have, or have ever had. Every human culture has had them. Some are medicinal, and some are recreational or spiritual in purpose. Regardless, drugs have side effects, and in that sense, they are as instructive a technology to think about as any. Most of us had to read Brave New World in high school. Obviously, Huxley had grave reservations about the possible social and cultural side effects of easy birth control.

I’m listening to an audiobook of archaeologist Ian Hodder’s Where Are We Heading? The Evolution of Humans and Things, in which he explores our “entanglement” with things and the role of that entanglement in human evolution and the evolution of our societies. Hodder contends that every thing we invent has both intended uses and unintended consequences, and the unintended consequences are what spur us to invent new things to deal with them, driving the process onward. Our inability to predict all of those unintended consequences of our inventions is part of the radical uncertainty I brought up in the last one of these; we can only imperfectly anticipate the future, so we should take risks accordingly, and be prepared to deal with unintended—and unforeseen—consequences. The FDA in the U.S. tests drugs before allowing them to come to market. There is no telling how much suffering that has saved, though of course it is not perfect, and sometimes the side effects of approved drugs prove unacceptable.

Drugs are also an easy case study in thinking about the human “need” for technology. I put “need” in scare quotes because there is real need and perceived need, and a fuzzy overlap between them. One of my favorite things ever is Netflix’s miniseries The Queen’s Gambit, which I’ve watched three times now. If you haven’t seen it (or read the novel), it’s about a girl in an orphanage who turns out to be a chess prodigy. She also turns out to be an addict; she is emotionally traumatized, and the orphanage she’s in (this is set in the late 1950s and early 1960s) gives each child a powerful tranquilizer each day to help keep them manageable—until state law puts a stop to it. Beth, our heroine, becomes addicted to them, and they allow her to “see” a giant chessboard on the ceiling and play out game scenarios in her mind. Later, she learns to love alcohol as well. She comes to believe that she needs tranqs and booze to play at her best. Eventually, she discovers that isn’t true—or perhaps it was, but is no longer. What is the true cost-benefit relationship here? That’s one of the many interesting questions raised by the story.

As we live through a time when we are forced to make serious technological transitions to address the consequences of past technological choices, it’s helpful to think about what we really need, and how badly, and how much we’re paying to meet that need, and what alternatives for meeting that need—if indeed we decide it’s a real need, and not just an addiction—are within our grasp for a bearable cost. I shouldn’t have to write much to convince anyone who’s awake that considering the main questions and problems of the history of technology is important.  

Ian Hodder, Where Are We Heading? The Evolution of Humans and Things (Yale, 2018).