Kegan, K. & H. Moss (2008) Chasing the high  New York: Oxford Press

This a series book by the Annenberg Public Policy Center and Oxford Press. A number of interesting and readable books have been produced of first person patients and professionals in this collection.  

This is on substance abuse. It appears that there is a growing consensus that it is a disease of the brain and nervous system. Thus, it is best treated with the medical model, but the patient needs to hit bottom to want to improve.

Although substance abuse is a disease as is most addictions there are intervening variables that can not be over looked. They include as noted earlier one’s biology, and then come genetics. Most addicts have relatives that may be very indirect, but contribute to the abuse. Others social variables such as group pressure, depression and related mental issues, as well as general personal experience and environment are discussed.

Addiction at any early age compounds problems, because the brain is not prepared for such an onslaught.  Mental issues can include as noted before depression, anxiety issues, eating disorders and conduct disorders.

Substance addiction generally has a path of first an immediate and often pleasant “ high.” For the addict it is better than any elation one has felt before. Further, one knows how the high happened and that it can be repeated. The repetition is thought to be repeatable. Over time, the high is lessened without more of the substance. Repetition also increases, but is thought to be controllable. Finally, the high is replaced with a feeling that the high is harder and harder to maintain. The user realizes that control is now out of reach and they get high to not feel severe withdrawal, depression, and suicidal thoughts. Behavior changes towards survival and illegal acts are quickly entertained to keep from withdrawing. The drug then withers the person’s immune and other metabolic system to the point of death.

Recovery involves therapy at both the group and individual level. Changing the environment and ones peers is also necessary. Life is then followed with constant monitoring of one’s actions and behavior. Also, life is divided into past and present behavior. Self esteem is restored and group support should be ongoing.

When one has been clean, it is not unusual that the patient begins to take other drugs that help with depression, but do not cause euphoria. 

The book ends with “Frequently Asked Questions” and a glossary. The book is highly recommended.

Prof. Joel C. Snell

Kirkwood College