Namah Vol 2, Issue 2, 21st February 1995 p57-61.
Hedonistic Issues in Drug Dependency
Ajai R. Singh
Shakuntala A. Singh
Hedonism is a philosophical concept that regards pleasure as the ultimate
goal of life. The seeking of pleasure and avoidance of pain is the essence of hedonism. Bentham, one of the chief advocates
of hedonism, propounded the theory of' hedonistic calculus' which points out that the more we seek pleasure, the less we get
it. We should not therefore seek pleasure but seek objects that are pleasurable to us. The authors consider that substances
(drugs) with abusive potential fulfill the criteria of such objects of pleasure. The tendency to avoid pain has resulted in
an overmedicated society. The authors opine that the social consciousness is becoming more and more hedonistic. Any rehabilitation
program for drug-dependents must offer alternative and integrative outlets while concomitantly trying to change the value
orientations of the society with the help of relevant social collaborators.
It is tempting to try and lay down a simple formula which could highlight both our capability
and its effectiveness in the drug1 rehabilitation programme. However,
as most individuals who have to tackle the experience of social deviance sooner or later find, there is no such formula that
anyone can offer in this or any other condition of this nature.
1Unless otherwise stated, the word ‘drug’
refers to that chemical agent (usually non-therapeutic, but may also be therapeutic, though not so utilized in the particular
instance where it is being ‘used’) which is ingested, in the mail, by the deviant sub-culture which can be considered
to believe in ‘psychotropic hedonism’ (Klerman, 1972), to a greater or lesser degree, without any further attempts
at sub-division within this group.
If such is the case, how can a proper perspective of the issue be seen? To even attempt
an answer, we should, in the first instance, have adequate data about those social processes that generate, perpetuate and
control the expression of socially deviant behaviour in general, of which drug dependence is but one manifestation. Then,
we shall have to consider which of these processes is of how much importance in relation to drug dependence and rehabilitation.
An understanding of these processes is germane to the issue because unless we know which social processes exist, we will not
be in a position to utilise or modify any of them to suit the rehabilitation programme that we wish to carry out.
A few important corollaries arise from this. Firstly, it would be wise to consider drug dependence as a psycho-social malady, extending the disease-label of psychiatric diagnosis
from the strict medical model to a more comprehensive psycho-social one. Secondly, the psychiatrist, in such a frame of reference,
will have to consider himself as one of the social scientists (and only one of them) who, although with the training, ability
and opportunity to observe, treat, and, possibly, rehabilitate drug dependents, has much to learn from other social scientists
working in this area. Thirdly, even while tackling the issue of rehabilitation of the individual drug dependent, one cannot
lose sight of the broader issues of social relevance which will be involved in coming to grips with the situation. Finally
- and this is the inevitable conclusion that must come out of all that has been said earlier - all processes of social change
will have to move in unison. Such a harmony can only be achieved with better interaction, more communication and an interdisciplinary
model for the understanding and constructive manipulation of social deviance in general and drug dependence in particular.
The role that one can visualise for the psychiatrist in this set up is of a cog in the giant wheel,
albeit an important one, hopefully. He is constantly exposed to interactional difficulties in his patient population
and carries out various procedures that manipulate their environment to make it less stressful. This gives him a unique insight
into those measures which would best help them to get rehabilitated. Knowing fully well the marked amount of rejection, antagonism
and distrust that this patient population of his tends to generate amongst the so-called healthy environment that surrounds
them, the psychiatrist must develop the ability to make the drug dependent understand the initial inevitability of this response,
which the patient must face - nay, expect and welcome, rather than deny or reject. At the same time, the psychiatrist should
maneuver the social network around the patient so that it is more amenable to the acceptance of a changed individual. An individual
who, although retaining some of his idiosyncrasies (and, come to think of it, who, amongst the so called normal, also doesn't?),
is still a person needing an environment healthy enough to continue to offer him opportunities to remain drug free.
In this sphere, not only will the psychiatrist have a role to play but also the legislative and
legal divisions with efficient administrative handling by the drug-control wings of the bureaucracy, the judiciary and the
police. At the same time, it will involve commitment from the social thinker, the politician, the social worker, the philanthropist,
the economist and even the lay citizen of this socialist democracy: a commitment to get involved in the massive movement
for social change that the community has to undergo in order to both rehabilitate and prevent this deviance. No piecemeal,
disjointed, solitary efforts are likely to succeed, as the law enforcing agencies have realised to their dismay. Punitive
measures, again, are poor means when not combined with a reformist approach. The model will have to be more global and integrative,
and involve a combined effort from all social welfare agencies mentioned earlier.
This model of change will tackle both issues of primary prevention and rehabilitation. As most
of us are aware, there is conceptually not much difference in these processes. At least, there need not be. An efficient rehabilitation
programme must not only rehabilitate the individual who has become dependant
but also take cognizance of and rectify those processes in the community which generate such difficulty in the first place.
Another point worth noting cannot be missed here. It is probably an exercise in cynicism, may
be an attempt at chastisement. Whatever way it is considered, we cannot but accept that our social consciousness is becoming
more and more hedonistic. The seeking of pleasure and avoidance of pain, which has been acknowledged as motivating instinctual
behaviour in man. has also come to be accepted as the guiding factor for the community at large. The seeking of pleasure as
an important goal in life involves utilisation of all those processes at our disposal that can possibly give this pleasure.
Obviously, drugs serve this purpose for some individuals and this must be one of the reasons why it is used to such a major
degree in those who either lack other means of pleasure or do not consider them worthwhile. Further, the avoidance of pain
as another important goal naturally involves utilisation of means that will reduce distress to the minimum, whether the means
are legitimate or not. The results are, on the one hand, an over-medicated society (Klerman, 1974) and, on the other, the
rejection of 'Pharmacological Calvinism' for the more attractive 'Psychotropic
Hedonism' (Klerman, 1972). As an over-medicated society, we tend to increasingly
abuse chemical agents to cope with the growing number of human and personal problems (Klerman and Schechter, 1984). The games
that the medical professional can inadvertently (and, sometimes, not so inadvertently) play with the drug manufacturer,
the pharmacist and other sources interested in pushing such drugs to further 'medicalize life' (Illich, 1976), has come in for strong criticism (Lennard and
Epstein et al., 1970; Muller 1972; Illich 1976). But it again reflects our obsession with the avoidance of pain and seeking
of pleasure. As Carstairs (1969) says,
"Everybody nowadays expects to be happy. What is more,
if anybody does feel unhappy, he immediately thinks something must be wrong either with him or with the state of the
world, if not both".
To which one might add that he then sets about gaining this happiness (and getting rid of unhappiness)
in whatever way best suits him, which is usually either the easiest available to him or which carries the greatest appeal
for him in the circumstances, what with all the avenues for the supply of psychotropic drugs readily available for manipulation.
This is as regards chemical agents with abuse and addiction potential available in the pharmacies.
Those which are not - the so-called non-therapeutic drugs with abuse potential - are subjected to the trend of 'psychotropic
hedonism' which, in its essentials, has been propagated by a contemporary youth culture not only as a rebellion
to adult authority but also as a concept that increasingly incorporates drug-taking into its ethos and sees it as consistent
with its hedonistic view of life (Lasch, 1979). This sub-group culture stresses the need for the individual to assert the
right to do as he pleases with himself, including the right to use any drug that he pleases (Veatch, 1974). The obvious emphasis
on hedonistic pursuits as well as 'pleasing' of self that this group seeks to emphasize further fits the contention that
our social consciousness is becoming more and more hedonistic.
If such is the perspective, how should any rehabilitation
programme be formulated? Unless, first of all, it is able to offer alternative outlets for this hedonistic pursuit -
outlets in which the individual may achieve his own level of satisfaction with minimal distress to self and his environment
- the programme will not even have reached first base. Which alternative pursuits can the society offer, will have to be decided
by each social group according to its own social ethos; but, in general, the pursuits will have to be more integrative rather
than disruptive, alienative or anomic.
Restructuring the Social Edifice
A second, and more disturbing thought, must also compel our attention here. Is our
obsession with and propulsion of the society towards hedonistic ways itself generating this type of deviance as an inevitable
fall-out? One hates to sit in judgment like this and act the Prophet of Doom. One also hates to consider this a logical (and,
probably, also just?) reward for all the pleasure-seeking we are doing. This pessimism and cynicism may be considered uncalled
for in certain quarters. But, probably, it is worth pondering whether this is the price we have to pay for our misdemeanors
and our indulgences.
Not only is this thinking necessary for sounding a note of caution but also for its practical
implications in any rehabilitation programme which we may formulate. If this thought has any appeal, even in its germ,
then any such programme will not only have to be so broad-based as to involve most social welfare agencies in a combined effort
directed towards the drug dependent, but will also have to be able to affect and, hopefully, change the essential value-orientations
and beliefs of our society. This point may be stressed even to the extent of sounding moralistic, which in some quarters is
immediately considered unrealistic (as if moral cannot be realistic).
Most social welfare agencies may tend to shy away from such an idea, perhaps considering
it outside their domain. One wonders whether they can justifiably do so. If deviant behaviour is a fall-out of our hedonistic
pursuits, the situation must demand two approaches if it is to be absorbed into the mainstream:
i) Offer such alternative hedonistic pursuits to the deviant as will fall in the group
of normal variant behaviour. This will help such a group get integrated into the social group to which it originally belonged.
This thought will be acceptable to most social scientists, although that does not mean it will find favour with them, or get
ii) Attempt to reduce the society's hedonistic pursuit and its worth as a supreme goal. It is
this that has generated deviance of some type or the other from time immemorial. Unless we agree to this as well, we will
be forced to accept that one or the other deviant behaviour will forever manifest and change established social mores.
Today, it is drug dependence and AIDS, yesterday it was something else, and tomorrow it will be some other. Are we not, as
social thinkers, bound to also consider the fact that unless we can, in some way, cast a spoke in this fast revolving wheel
of hedonistic pursuits, what right have we to avoid facing the music of deviance that must inevitably follow? Each social
welfare agency, in its own limited sphere as well as in an integrative manner with the other agencies around it, will
have to give some serious thought to this. Otherwise all our efforts will only be directed at carrying out minor repairs to
the fast crumbling mansion of our social fabric, repairs carried out after the damage is already wrought. An intelligent social
consciousness must demand much more than patchwork. It demands an ability to anticipate certain repairs before
they are forced on to us. Along
with the insight to be able to revamp and restructure our social edifice itself, if need be, a commitment to change essential
value orientations and beliefs of society can be the first important step in restructuring our social edifice, a need which
has to be earnestly experienced by all, before it is forced on us by crushing circumstances in conditions where we may not
have the means necessary to carry it out.
In such a situation two processes must go hand-in-hand. Whilst on the one hand, efforts
at rehabilitating the individual drug dependent will have to be carried out, measures by which this type of behaviour will
be prevented from manifesting must also be made. To be sure, it will not be possible for every social thinker to have both
dimensions in equal measure. Nor, perhaps, would it be necessary. But a commitment from thinkers and workers towards both
these goals is a must. Firstly, to synthesize their own thoughts and convictions, and secondly, to work in tandem with other
agencies active in this area.
It is only then that drug dependence is likely to decrease. No deviance can easily disappear, howsoever much it may be the
wish of the most well meaning and well-modulated programme of social change. But, if we give a thought to this conceptual
framework and think of means to make it operative, then, probably, not only shall we look to the rehabilitation of the drug
dependent, but, in some measure at least, we shall help rehabilitate society
itself: a society which has the notorious ability to generate and sustain this and other such maladies in the enormous proportions
that it has done in the past, is doing today, and can do in the future.
G.M. Carstairs. A Land of Lotus-eaters. American Journal of Psychiatry, 1969, 125, pp. 1576-80.
I. lIIich. Medical Nemesis: The Expropriation of Health. New York: Pantheon, 1976.
G.L. Klerman. Psychotropic Hedonism versus Pharmacological
Calvinism. Hastings Centre Report, 1972, 1-3.
G.L. Klerman. Are we an overmedicated Society? Detroit: Annual Meeting of the American Psychiatric Association, 1974.
G.L. Klerman and G. Schechter. Ethical Aspects of Drug Treatment.
In 'Psychiatric Ethics', ed. S. Block and P. Chodoff. New York: Oxford University Press,
C. Lasch. The Culture of Narcissim. New York: 1979, Norton.
M.L. Lennard, L.J. Epstein, A. Bernstein.
in prescribing psychoactive drugs. New York: Science, 1997,169: 438-41.
C. Muller. The over-medicated Society: Forces in the Market-place
for Medical care. New York: Science, 1972, 176: 488-92.
Refe 9. R.M. Veatch. Drugs and Competing Medical Ethics. Hastings Centre Report, 1974,4:
Dr, Ajai Ajai
R. Singh is a psychiatrist who was a Senior Research
Fellow in WHO
W.H.O. Collaborating Centre in Psychopharrmacology , Bombay.
Dr. ShaShakuntala A. Singh, Ph.D., is a Fellow, ICPR; Lecturer in Philosophy,
K. G. Joshi C College of Arts and N. G. Bedekar
College of Commerce, Thane.