Sex, Drugs and Chocolate: The Science of Pleasure

All men, even those it is customary to call savages, have been so tormented by this craving for strong drinks, that they have always managed to obtain them, however limited the extent of their knowledge. They have turned the milk of their domestic animals sour, or extracted juice from various fruits and roots which they suspected of containing the elements of fermentation; and wherever human society has existed, we find that men were provided with strong liquors, which they used at their feasts, sacrifices, marriages, or funerals, in short on all occasions of merry-making or solemnity.

The particular connection between intoxication and public festivities to which Brillat-Savarin alludes has equally deep roots. For thousands of years, people have used alcohol and other intoxicating drugs for religious or ritualistic reasons and to help them celebrate.

The ancient relationship between ritual and drugs is exemplified by the Eleusinian Mysteries. These culturally important ceremonies were held in Greece for almost two thousand years, from around 1500 BC until AD 400. Thousands of people attended the periodic celebrations at a temple in Eleusis, west of Athens, in which the participants drank from a sacramental cup holding a drink called kykeon. Contemporary accounts make it clear that kykeon contained a hallucinogenic substance, which historians and scientists have concluded was probably ergot.

(#litres_trial_promo) Whatever the active ingredients were, the resulting intoxication was a crucial part of the ceremony. Sophocles, Aristotle, Plato and several Roman emperors were among those who took part in what Homer described as a blissful experience.

Intoxication was such a central element in life that most ancient civilisations had their own gods of intoxication. The Egyptians had Hathor the wine god, who took the form of a bull. The ancient Greeks, and later the Romans, had Dionysus the god of drunkenness and celebration. At the time of Plato and Aristotle, in the fourth century BC, the rites of Dionysus were the most widely practised of all religious ceremonies. The celebrations lasted for days and involved drinking large amounts of wine. The Romans enthusiastically embraced the cult of Dionysus, whom they also referred to as Bacchus. The rites known as Bacchanalia became so scandalous that in 186 BC the Senate banned them. They continued nonetheless. It is very hard to prevent people from seeking pleasure.

What these ceremonies and religious rituals had in common, aside from great fun, was an underlying belief that drug-induced intoxication was a mystical state which enabled humans to experience a glimpse of the divine and commune with the gods. Drunkenness and other forms of intoxication were regarded as a form of ecstasy, in which the soul became partly separated from the body. This belief in the spiritual and mystical aspects of intoxication fell away with the emergence of Christianity and Islam, which taught that intoxication was inimical to true spirituality and must therefore be shunned.

(#litres_trial_promo) Drunkenness came to be viewed not as a god-given state, but as a shameful surrender to animal instincts. We shall return in chapter 13 to the uneasy relationship between the world’s main monotheistic religions and the pursuit of pleasure.

Despite the hardening of religious disapproval, drunken rituals continued to play a significant part in communal life in many parts of the world. In medieval England, villages held festivals in which revellers were expected to drink themselves into oblivion for days at a time. Judging by any English town centre on a Friday or Saturday night, not much has changed. Alcohol-induced oblivion has clearly retained its mass appeal. For many present-day drinkers, the prime objective of a good night out is still to get completely smashed (or annihilated, arseholed, bladdered, blitzed, blootered, bombed, bowsered, canned, guttered, hammered, lashed, legless, mullahed, obliterated, paralytic, pie-eyed, pissed, plastered, rat-arsed, scuttered, shit-faced, slaughtered, sloshed, sozzled, stewed, stinking, thrashed, trolleyed or wrecked, to use just some of the synonyms). The fact that the English language has well over a hundred different words to convey the concept of ‘drunk’ says something about our deep attachment to this state.

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Not all cultures regard alcohol as primarily a tool for getting steaming drunk. In many parts of Europe the predominant drinking culture is one of extracting maximum pleasure from that warm, buzzy state that lies roughly midway between stone-cold sober and out of your skull. For instance, several million people congregate each year at the Munich Oktoberfest, the world’s most popular annual festival, where they consume many millions of litres of foaming beer and countless kilometres of sausage. Drunkenness certainly does occur, but getting drunk is not the main reason why most people go there. The aim of most Oktoberfest revellers is to achieve a state of Gemütlichkeit, for which the nearest English translation is something like ‘a state of feeling snug, cosy and pleasant’. The legendary Soho drinker Jeffrey Bernard wrote that he had never really enjoyed being drunk; it was the process of getting there that appealed to him – particularly the halfway stage, which in his case was invariably short-lived. Other languages have words to signify this pleasant intermediate state. In Danish it is hygge; in Spanish it is la chispa. But English-speakers have little in their vocabulary to cover the extensive territory between the two extremes of sober and legless.

We like alcohol and other recreational drugs because they make us feel nice. But we are also drawn to them because they make us feel different. The kick of intoxication is not only about feeling good: it can also be about taking a holiday from normality and temporarily seeing life from an altered perspective. As Louis Lewin put it, ‘A man must sometimes take a rest from his memory.’

Recreational drugs have long been used for stimulating creativity. The nineteenth century witnessed a vogue for experimenting with psychoactive drugs as tools for exploring the inner workings of the mind and unleashing its creative potential. Among the many intellectuals to pursue this approach was Charles Baudelaire, who was inspired by the drug-fuelled works of Samuel Taylor Coleridge and Thomas De Quincey to write Les Paradis Artificiels (Artificial Paradises). In it, Baudelaire relates how he and his friends used opium and hashish to help them break into unexplored realms of the human imagination and view the world in novel ways. Their goal was nothing less than to ‘conquer Paradise at a stroke’. Baudelaire died in 1867, ruined by his drug use and addicted to opium. The artistic tradition of using drugs to aid creativity continued in the next century. Among the best-known products are Aldous Huxley’s book The Doors of Perception and its sequel Heaven and Hell. They were woven from Huxley’s own experiences in the 1950s with mescaline, a hallucinogen derived from the peyote cactus.

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Alcohol is also capable of stimulating creativity, up to a point. The ranks of creative writers and poets have famously been stuffed with boozers too numerous to mention. However, one piece of research suggests that alcohol may in fact be more effective at enhancing the creativity of individuals who are normally uncreative. Researchers found that a moderately large dose of alcohol improved the verbal creativity of men and women who were not very creative when sober, but tended to impair the performance of those who did well when sober. One way in which alcohol clearly does assist creativity is by reducing social inhibitions and releasing the shackles of conventionality. As William James observed, ‘Sobriety diminishes, discriminates, and says no; drunkenness expands, unites and says yes. It is in fact the greatest votary of the Yes function in man.’

Humanity’s longstanding attraction to drunkenness and other altered states of consciousness has led some scientists to conclude that it is deeply ingrained in our biological makeup. Indeed, the American psycho-pharmacologist Ronald K. Siegel has argued that the desire for intoxication is one of four basic drives governing human behaviour – the others being hunger, thirst and sex.

(#litres_trial_promo) Siegel’s research on how drugs affect humans and other animals convinced him that an ‘intoxication drive’ is a primary motivational force. The function of this drive, he believes, is to help maintain mental health through self-medication. According to Siegel, intoxicating drugs are a form of medicine: when we are stressed, anxious or in pain, we seek out drugs that give us some relief; and when we are tired or depressed, we seek out stimulants to lift our mood.

Other animals do the same, if given the opportunity. Historical descriptions of opium dens refer to mice, rats and birds sniffing the intoxicating smoke and nibbling leftover scraps of opium. Louis Lewin observed that ‘cats, dogs and monkeys inhale the smoke which their master expels from his opium-pipe, and it is said that monkeys consume the opium which oozes from the bamboo pipe’. The French writer and opium addict Jean Cocteau similarly described how flies, lizards, mice, cockroaches and spiders would gather round the opium-smoker, forming a ‘circle in ecstasy’.

Properly conducted scientific experiments have confirmed that many species of mammals, fish and reptiles will learn to seek out and consume psychoactive drugs. When monkeys, apes, rats, cats or dogs are given free rein to self-administer drugs under laboratory conditions, they generally prefer the same drugs as humans, including alcohol, nicotine, opium, cannabis, cocaine, ether and nitrous oxide. Like humans, they will voluntarily dose themselves with recreational intoxicants, while showing little interest in psychiatric drugs such as antidepressants. And, just like us, they will work very hard to obtain the most pleasurable and addictive recreational drugs, especially cocaine. In laboratory experiments, some monkeys have willingly pressed a lever more than 12,000 times to obtain a single injection of cocaine.

Children also display a natural propensity to experiment with altered states of consciousness. They normally achieve this without the aid of recreational drugs, using age-old techniques such as hyperventilation or spinning around to induce dizziness. Children as young as three or four will spontaneously discover the pleasures of twirling themselves into a giddy daze or hyperventilating until they almost faint. However, children soon turn into adolescents, who tend to prefer their intoxication in a chemical form such as alcohol. More than half of all 11–15-year-olds in England have drunk alcohol and more than one in five have used it within the past week.

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Children’s experimentation with making themselves feel different, whether by hyperventilating or spinning around, may be a reflection of their deeper propensity to play. We are all born with an instinct to play, so that we can learn about the world around us and how to deal with it. Play behaviour is a fundamental characteristic of young humans and young animals of other species. Play is a form of safe simulation, in which the young individual can explore the world and develop their physical and mental capabilities, whilst remaining insulated from the risks that would arise from ‘serious’ versions of the same behaviour. For example, young animals play at fighting each other, or catching prey, during a stage in their development when real fighting or real hunting would be dangerous. By playing in this way, they acquire crucial physical and social skills they will need in later life. We humans play mentally as well as physically. Our attraction to temporarily altered states of consciousness might in part be a consequence of our playfulness.

Harm (#ulink_569529e6-70ef-5f07-a99a-84ad8e4ea160)

Recreational drugs provide pleasure and relief from displeasure. They also cause vast amounts of harm and suffering to individual users and society as a whole. In the UK alone, the estimated economic costs of recreational drug use are as much as £16 billion a year in terms of health care, social costs and crime.

Addictive drugs such as heroin, nicotine and alcohol debilitate and kill people in large numbers, whether from chronic illness, overdoses or accidents. In the year 2005, for example, there were just over 1,000 deaths in England and Wales involving heroin, morphine or cocaine. Alcohol and tobacco kill far more. In the UK, where the alcohol-related death rate has more than doubled since the early 1990s, well over 8,000 deaths a year are directly related to alcohol consumption.

(#litres_trial_promo) This figure does not include the many deaths caused by alcohol-fuelled accidents, violence or vehicle crashes, neither does it include deaths from the numerous diseases for which alcohol is known to heighten the risk, such as many forms of cancer. According to some estimates, the total number of deaths to which alcohol contributes in some way may be as high as 40,000 a year in England and Wales alone. The corresponding figure for tobacco is almost three times higher, at around 114,000 deaths a year.

Legal recreational drugs – specifically, tobacco and alcohol – cause immense damage to national health, far outstripping the effects of their less widely-used illegal counterparts. An estimated 1.5 million people in the UK are addicted to alcohol. According to government estimates, up to 17 million working days are lost each year in the UK as a result of alcohol, and its misuse costs the economy around £6.4 billion a year in lost productivity. The picture is not dissimilar in the USA, where approximately a fifth of adults abuse alcohol at some point in their life. Worldwide, alcohol is estimated to be responsible for about 4 per cent of the global disease burden.

Most victims of alcohol abuse die from liver disease, heart disease, accidents or acute alcohol poisoning. Most of those with alcohol-induced liver disease are social drinkers, not alcoholics. They may not even think of themselves as having a drink problem. In England, the number of cases of alcohol-related cirrhosis of the liver almost tripled over the period between 1996–7 and 2005–6. Doctors are now encountering patients in their twenties with end-stage cirrhosis of the liver, a condition that usually develops only after years of hard drinking. Alcohol heightens the risk of many forms of cancer, including cancers of the mouth, liver and oesophagus. It may also increase the risk of breast cancer in women with a family history of the disease. Research has found that the sisters and daughters of women with breast cancer are themselves at greater risk of developing breast cancer if they drink alcohol daily.

In the UK, as elsewhere, thousands of people die every year in road traffic accidents where alcohol has been a contributory or causal factor. Thousands more die or are seriously injured in alcohol-fuelled violence and domestic accidents. Alcohol is involved in more than half of all visits to hospital accident and emergency departments and orthopaedic admissions, and is a factor in about a third of all arrests made in urban police stations. In larger doses, it is capable of killing directly. On average, one person dies each day in England from acute alcohol poisoning. The typical victim is a young person who has been celebrating with friends. Alcohol kills by suppressing the brain circuits that control breathing and the cough reflex; the victims of alcohol poisoning often die from lack of oxygen or because they inhale vomit into their lungs, causing respiratory failure.

Sexual crime is another, often underestimated, risk from alcohol. Every year, women and men are raped while incapacitated by alcohol. They often believe their drink must have been spiked with a date-rape drug such as Rohypnol, although the evidence suggests that this may be less common than often assumed. A 2006 study by the UK Association of Chief Police Officers found that only one in ten cases of alleged sexual assault was suspected of being drug-assisted. None of these cases involved Rohypnol and only a few involved another date-rape drug (GHB), whereas almost all of the date-rape victims said they had been drinking, some of them heavily. The most common method of spiking drinks is with more alcohol. It is likely that some of the rape victims who thought they had been drugged had in fact been very drunk.

As to tobacco – well, I won’t bore you by rehearsing all the baleful statistics about the toll of death and disease for which it is responsible, though I will mention an authoritative analysis which calculated that a regular smoker will reduce their life expectancy by an average of ten years. This startling statistic reinforces the point that smoking is the most dangerous thing that most people will ever do in their lives. It remains the biggest single cause of preventable death on the planet. Between them, alcohol and tobacco – those legal recreational drugs we can buy in the high street – account for approximately 90 per cent of all drug-related deaths in the UK. They are also among the leading contributors to disease and premature death worldwide.

Cannabis, the most popular of the illegal recreational drugs, used to enjoy a reputation for being relatively safe. But that reputation has been eroded in recent years, as a growing body of evidence has linked it with a range of medical risks. The most serious concerns have arisen from research indicating that cannabis can increase the severity of existing psychotic disorders and induce psychotic symptoms or even full-blown psychosis.

(#litres_trial_promo) Some individuals appear to be much more vulnerable to these effects than others. Scientists remain uncertain as to why some people are particularly susceptible in this way, although the explanation is likely to involve some form of interaction between genetic and environmental factors.

Overall, the emerging evidence suggests that cannabis may be a contributory factor in about 10 per cent of psychosis cases. One analysis published in 2007 concluded that frequent use could double the risk of developing schizophrenia and other psychotic illnesses. That said, psychotic illnesses remain relatively uncommon, in comparison with many other diseases, and most people who use cannabis do not develop them. Cannabis may also heighten the risk of depression and anxiety disorders in vulnerable individuals. One study found that non-depressed people who used cannabis were four times more likely than non-users to become depressed in later years. The use of cannabis preceded the onset of depression, implying that the correlation was not simply the result of already-depressed people turning to cannabis for relief. Even allowing for this and other evidence, there is little doubt that cannabis is still substantially less harmful than, say, cocaine or alcohol. Nonetheless, it is harmful, and probably more so than many of its users once believed.

All recreational drugs are harmful and some are clearly much more harmful than others. So how should we go about judging the many different drugs in terms of the harm they cause? It all depends, of course, on how you define harm. Should harm be assessed only according to what the drug does to the individual who uses it, or should we also take account of its wider effects on the user’s family, community and society at large? What about drug-related crime, which has as much to do with legislation and social policy as it does with the pharmacological effects of drugs? Collecting high-quality data is another problem. Folklore, prejudice and untested assumptions are readily available when it comes to debating drugs, whereas verifiable scientific evidence is often in short supply. To make matters worse, scientific and medical journals have a slight bias towards publishing studies that find positive evidence of harm rather than those that have drawn a blank. The shortage of solid evidence means that much of the expensive effort to combat drug misuse, whether through law enforcement, treatment or education, may not always be targeted optimally at the drugs that cause the most harm.

Fortunately, progress is being made on this front and we do now have ways of making more rational judgements about the relative harmfulness of drugs. A significant advance came in 2006, when the UK Parliament’s House of Commons Select Committee on Science and Technology published an authoritative analysis of how different recreational drugs compare in terms of the harm they cause. The report presented a systematic, evidence-based assessment of twenty commonly used drugs, comparing the physical and social harm they cause and their potential to cause addiction. The work was led by Professor David Nutt of Bristol University and Professor Colin Blakemore of the UK Medical Research Council and its findings were published in 2007 in the leading medical journal The Lancet.

The assessments were made by two panels of independent experts from a range of disciplines, including psychiatrists, chemists, pharmacologists, lawyers and police officers. They drew on the best available scientific and medical evidence. Their analysis took account of three main dimensions, or aspects, of harm: namely, the physical harm caused to the individual user; the broader harm caused to society, including the user’s family and community; and the tendency of the drug to create dependence. Each of these three main dimensions was in turn broken down into a number of sub-dimensions. For example, physical harm was assessed in terms of the drug’s acute effects, its chronic effects and its scope for intravenous use. Some drugs cause mainly acute harm: for instance, cocaine can cause heart attacks and heroin can suppress breathing. Other drugs, notably nicotine, cause most of their harm chronically, through long-term use. Drugs that are taken intravenously tend to be more harmful for several reasons: they produce a bigger ‘rush’, making them more addictive; the user is more likely to overdose; and shared needles spread life-threatening disease such as hepatitis and HIV.

Each of the twenty drugs was assessed on these various dimensions by the experts, who then debated and revised their judgements according to what is known as an expert delphic procedure. The two groups independently arrived at similar scores, adding to confidence about their validity.

(#litres_trial_promo) The average of all the scores was then used as an overall index of harm for each drug. The resulting rank ordering, in descending order of overall harmfulness, was as follows:

1 Heroin

2 Cocaine

3 Barbiturates

4 Street methadone

5 Alcohol

6 Ketamine

7 Benzodiazepines

8 Amphetamine

9 Tobacco

10 Buprenorphine

11 Cannabis

12 Solvents