Does one form of sensation-seeking substitute for another?

In the last post Ruth, a mental health nurse, discussed how she had been more willing to participate in risky activities such as bungy jumping while she was working in prisons. This led to a discussion of changes in perception of identity that may be associated with drug taking by young people who are seeking to escape from emotional pain. Ruth discussed how mental health patients with a history of drug use could be helped to perceive a wider set of possibilities for their future lives.


This post explores implications of evidence that some adolescents take drugs as a form of sensation seeking. A literature review by Jonathan Roberti notes that sensation seeking individuals tend to engage in behaviours that increase the amount of stimulation they experience. Sensation seeking is more common among young males than other groups. While risk-taking is involved it is not a primary motive – high sensation seekers tend to appraise risky and stressful situations as less threatening than do low sensation seekers.

Sensation-seeking is associated with stimulating occupational choices e.g. a desire for greater novelty and flexibility in work and with choice of risky vocations such as fire fighting. It is also associated with a preference for arousing music e.g. hard rock; travel to less familiar places; participation in relatively risky sports e.g. bungy jumping, white water rafting, surfing, snow boarding, scuba diving and parachute jumping; gambling; crime; impulsive behaviour; and health risk behaviours e.g. unsafe sex, unsafe driving, binge drinking and use of illicit drugs (‘A review of behavioral and biological correlates of sensation seeking’, Journal of Research in Personality, 38, 2004).

Roberti has high hopes that adverse consequences of sensation seeking traits could be reduced by substituting sensations with low health risks for sensations with high health risks:

‘Early identification of risky behaviors, attitudes, and preferences in young adults, such as engaging in promiscuous sexual activities, reckless drinking habits, use of illicit drugs, gambling, and high-risk sports and replacing those with non-risky options is essential in reducing negative health consequences. Recommending appealing, non-risky forms of sensation seeking to individuals that once engaged in risky behaviors is one way of reducing negative health consequences. The effectiveness of using alternative arousal sources that are non-risky but are equally stimulating has yet to be determined and would be a fruitful line of research’ (p 274).

When I consider this from an economics perspective, it is not entirely clear whether, or to what extent, sensation seekers would view such activities as substitutes. It would be nice to think that an afternoon engaging in an extreme sport would satisfy a sensation seeker’s desire for thrills until the following week - and that the culture associated with all extreme sports would tend to encourage healthy living. It might be possible, however, for a sensation seeker to spend an afternoon engaging in an extreme sport, followed by an evening of illicit drug use and gambling, and then to end the day participating in a sex orgy (although I can’t verify this from personal experience). More research may be required. (Perhaps I should clarify that I am suggesting surveys of the lifestyles of people who engage in various extreme sports.)

Jonathan Roberti draws attention to research suggesting that sensation seekers prefer certain types of friends and tend to surround themselves with others who have similar sensation seeking characteristics. I expect that the behaviour of sensation seekers in this respect would be strongly influenced by their own sense of identity.

How can parents ensure that children with sensation seeking tendencies develop a sense of identity consistent with adopting healthy lifestyles? My previous consideration of this question suggests that the main environmental shaper of personality is a child’s peer group. Parents may not be able to choose their children’s friends for them, but parents do make decisions about where they live and what schools their children attend.

Postscript:
There seems to be increasing evidence linking cannabis use among young people to mental illness. Some recent research is reported here. That suggests that it is stupid for young people to use cannabis. However, that does not provide sufficient reason for cannabis use to be illegal.

How can we explain the attitudes of young drug users towards the risks involved?

This post is the sixth in a series of discussions with Ruth, a mental health nurse who has worked with drug users in prisons and hospitals. There is a brief summary of earlier post in the series, on my other blog.


Ruth began the discussion by considering whether her own history might help us understand why kids engage in risky behaviour:

When I worked in the prison system, I participated in activities such as bungy jumping and solo trekking through the Himalayas and so on. These are risky activities. They differ from drug taking because they are socially acceptable. But they are similar because they involve a risk of being injured or killed. I saw myself as capable in extreme situations. It felt good!

My attitude toward risk-taking has changed since I stopped working in the prisons. I now experience greater fear of heights and tend to allow that fear to dictate my actions. For example, I was walking down some steps – the open variety – descending about 100 metres underground last year. I was terrified, simply of the height, as I looked down to see where to put my foot next. Vertigo had got me – and not for the first time in my life. Yet, only a few years prior, I had bungy jumped off the side of a swing bridge over a river.

The only difference I can point to is that I am now engaged in less risky activities on a daily basis. I experienced great fear on both occasions, but it seems to me that I was accustomed to taking risks back then. Now I am out of practice, so to speak.

This makes me wonder if young drug users see drug-taking as a measured risk - just as the risk of trekking solo through the Himalayas or bungy jumping or so many other things I did, mirrored the risks I took working in the prison. A lot of drug users may consider that the risks involved are not out of the ordinary, relative to the risks that are part of their daily lives. This might explain why so many argue that drug use is quite safe.

I expect that many could relate some of what Ruth has been saying to their own experience. I know that when I took on new roles at work that required me to get out of my comfort zone, this also affected other aspects of my life. If we think in terms of identity economics, a change of role may be associated with a change of perceived identity, which in turn has implications for the satisfaction we obtain from different kinds of behaviour and the choices we make.

Tammy Anderson, a sociologist, has developed a cultural-identity theory of drug abuse which suggests that drug abuse is the outcome of an identity change process. The process may involve a range of factors relating to personal circumstances, identification with sub-cultures and economic opportunity. For example, at a personal level some kids may feel out of place and different from others, or a loss of control in defining their own identity because of unrealistic parental expectations. This may lead them to identify with alternative social groups i.e. a drug sub-culture. In turn, this provides a new identity, with acceptance by a peer group and associated economic opportunities to fund drug use. (‘A cultural identity theory of drug abuse’, here)

In my view, while such a cultural-identity perspective makes sense, it would be desirable for it to be embedded into an identity economics framework in order to recognize the role of individual choice in these personal changes.

Ruth comments:

My experiences mostly centre around drug takers after their habit has become a noticeable problem. Although I know less about the introductory phase of drug taking or experimentation, I have worked with many teens (mostly girls but some boys too) who have lived through sequential painful experiences and have given up on the idea of living free of ongoing emotional pain. Young people in these situations may welcome any mind numbing activity just to escape the hurtful lives they live. This is not about immaturity or lack of worldliness or some other non-reality oriented scenario. I'm referring to situations where there are real reasons for the emotional pain they feel. Many are still too young to leave home and are therefore doomed to continue living in circumstances that are painful to them until they come of age.

The young people I've had most regular contact with have long dispensed with the idea that they can change themselves, or their life circumstances. They have usually had limited exposure to the idea that they can consciously create a life for themselves and much less exposure to ideas about how they might do such a thing. In their own eyes their identity is defined and absolutely limited to what they are now and has been determined indisputably and irrevocably by the circumstances of their birth and upbringing.

From the therapy side, I see these self-perceptions as an excuse to avoid dealing with what the individuals see as an unchangeable future. As these limiting perceptions change then they see that they have greater potential to change their lives than they realized. It would be helpful if the community as a whole could adopt a similar approach to these people.

I found that talking to these patients about travel adventures like trekking the Himalayas and Swiss Alps and so on can make a difference to their long term projections for their own lives. The potential to have that kind of adventure can be enough for them to think it is worth getting through their ordeal. They often turn off drugs as a direct result - not always, but often. What is happens is that their confidence builds in a natural way. I could point out how 'ordinary' I was, much like themselves, and how I went about achieving my goals – the usual methods of planning, practicing and reading relevant material and talking to others who had done similar things. This led the patients to see a whole new set of possibilities - which in turn opened options and gave them confidence to act differently, and with choice.

Confidence and choice are at the heart of every behavioural decision. I suspect identity building is limited by an assumption of 'who I am' in the world around me.

The discussion continues here.

Difficult questions Part V: How effective is anti-drugs advertising?

In a recent post I discussed the question of whether identity economics might help to improve understanding of teenage drug use. I have been discussing this question with Ruth, a nurse who has cared for drug users in psych wards. In this post Ruth comments on the effectiveness of anti-drugs advertising.


I kicked off the discussion by suggesting that one possible implication of identity economics is that anti-drugs advertising would not be likely to make much of an impression on kids unless they see the story it is telling as being relevant to people like themselves.

Ruth comments:

Anti drug advertising has failed miserably and may have been counter-productive. I say this because many teens see these ads and it simply reminds them of what they imagine their friends to be doing right now and sets up the desire to be with those friends and partaking in their shared drug taking – a mostly enjoyable activity. It's like advertising positively for things like chocolate or a holiday destination – you see it, you want it.

The words are heard as nagging noises and are ignored. The images incite memories that are attractive.

No-one sees an ugly person suffering on TV and relates the image to themselves – kids see the ugly person as a looser, not like themselves at all. This is particularly so when the ad comes on TV, interrupting unpleasant thoughts or conversations previously going on for the teen.

The Australian anti-drug advertising that Ruth is talking about can easily be found by searching on Google for ‘anti-drugs advertising Australia’. Such a search also provides references to research supporting Ruth’s view that anti-drugs advertising may have been counter-productive.

When I looked again at the advertising my first thought was that showing kids the bad things that could happen if they take drugs must have some impact. The message, ‘You don’t know what drugs will do to you’ is the kind of message I would like teenagers to think about. I must admit, however, that I would not be discouraged from drinking alcohol by the message, ‘You don’t know what alcohol will do to you’, accompanied by images of alcoholics. The message would conflict with what I perceive from my own experience to be likely to happen to me if I continue to engage in moderate drinking.

Ruth concludes:

I've never found a drug user – social user or not – who relates to the characters in those ads, nor have I found anyone who sees themselves as a potential for the advertised risk. Even if they are in it over their heads already. Those who cite the ads as incentives for getting off the drugs state things like 'I saw that happen to my friend and I want to get off for his sake' or 'I know they say that could happen to me, but it won't. I'm smarter than that'. I've always found it interesting that drug users (and dealers) use terminology about their intelligence when defending their position.

The discussion continues here.

Difficult questions Part IV: Do people suffering from DIP have identity issues?

In the preceding post I suggested that identity economics may help us to understand teenage drug use. Ruth, a nurse who has worked in psych wards has responded with some encouraging comments about the potential for identity economics to help in exploring the drug-using phenomenon.


Ruth writes:

In my experience there are different aspects involved.

Some use drugs to escape their thoughts. (I suspect this is the largest group.) Those thoughts invariably include memory (what went before) and fantasy (what may come). The nature of those thoughts are hugely varied and may or not be based on shared experiences. They are not the same as delusions. Instead they are the result of a person trying to explain where he fits in his world, within the (limited) knowledge he has accrued in his life thus far. And the results are a distorted view of what's so, of where they fit, of what they mean to others, of how the world around them works, of the possibilities still awaiting them in life. The younger kids are when they start taking drugs, the more limited this knowledge is likely to be. The thoughts these people experience are particularly painful and cannot be mitigated easily through the usual counselling techniques.

A second group identifies their personalities as predominantly risk taking and therefore actually experience the need to arouse angst in those closest to them. This provides the sense of being cared about by those people. The more they upset the people around them the more evidence they have that they are loved - which of course sets up the adrenaline response very frequently (with every associated thought). Adrenaline in itself is a highly addictive drug - one that many very healthy non drug users like me are quite unashamedly addicted to.

Another group simply start experimenting with 'soft drugs' and end up with physical addictions requiring servicing at every opportunity. These people are the easiest to help as they are generally most motivated at the emotional level.

Ruth continues:

I think it's easy to get mistaken between the view looking in and the view looking out. Those close to the problem emotionally don't see through the same lens as those with an objective (professional) filter. The greatest mistake I see day in and day out is people - sufferers, family, researchers, medics, friends, observers - categorising the problem and therefore the sufferer.

The real answer - in my experience - is to take one person at a time and simply listen to them for quite some time before even attempting to think or consider what to do to help. The person themself inevitably can reveal the true cause of the problem and only then can a useful - long term effective - solution be proposed.

Short term solutions that deal with immediate symptoms such as aggression, depression

and side effects of drugs must of course be dealt with. But it is in the listening that the true cause of the problems are found. And listening is such an underrated skill; it hardly features amongst the more 'sophisticated' skills.

True therapeutic listening puts the practitioner in a place of nothingness, conscious only what is occurring in the room in each moment as it transpires. As the person speaks, the truly listening 'other' feels the person's psyche and is able to communicate in such a way that the person actually experiences a healing feeling without any recommendations or solutions or questions being offered. This is the beginning point for the journey to wellbeing for everyone. It is especially important for kids using drugs.

Ruth obviously feels passionately about therapeutic listening. Her views on this seem to me to make a lot a sense (but I can’t claim any expertise in that area). I would like to round off this discussion by pointing to possible implications of Ruth’s observations for use of identity economics to understand teenage drug use. The important point is that the people who end up in hospital as a result of drug taking do seem to have some particular identity characteristics that may help to explain why they got involved with drug taking in the first place. Ruth sees people making mistakes when they look in from the outside and attempt to categorize individuals. This suggests to me that there may be a need for better research instruments that will enable researchers to get a better understanding of individual behaviour by learning how individuals categorize themselves. In other words, if we are to understand the choices that the person makes it might help to know why the person perceives himself or herself as the kind of person who would obtain satisfaction from that kind of behaviour.

To be continued.



Difficult questions Part III: Can identity economics help us to understand teenage drug use?

This post continues the discussion in some previous posts about understanding teenage drug use. In the first post Ruth, a nurse who has worked in psych wards and prisons, illustrated the nature of the problem by telling the sad story of a man who has been suffering from drug induced psychosis (DIP) over a long period following an incident just before his 18th birthday. In the second post we explored whether viewing drug taking as a rational choice helped us to understand the problem. I concluded that it tended to put the problem back into the too hard basket.

I think the best way to try to understand complex issues is to begin by asking naive questions that help to define the problem. (The down-side of this approach is that it reveals my ignorance.) What kind of problem is this? Is it primarily genetic/neurological, psychological, sociological or economic?

Some papers suggest that genetics and neurology may be important. DIP is linked to childhood experience of attention deficit/ hyperactivity disorder and a family history of psychiatric illness. Ruth’s response on the basis of her experience in psych wards is that there is no family history of mental illness for the great majority of those with DIP.

I think there are also problems with both psychological and sociological explanations of why some teenagers are take the risks associated with drug use. It is reasonably clear that psychological issues e.g. self esteem are often involved. Yet, some kids who get involved seem to popular among their peers and achieve to a high level academically or on the sporting field.

Similarly, while incidence of drug abuse is higher among some socio-economic groups, some kids don’t adopt the culture of the socio-economic groups to which they belong. In any case, it isn’t very enlightening to answer questions about why individuals behave the way by saying, ‘Well, how would you expect someone with that cultural or environmental background to behave’. If we are attempting to explain individual behaviour we need to recognize that individuals make choices.

That brings us back to economics. The field of economics that seems to me to be most relevant is identity economics, which has recently developed by George Akerlof and Rachel Kranton (who have recently written a book about it). The basic idea is that individuals gain satisfaction when their actions conform to the norms and ideals of their identity as well as from their consumption of goods and services. Identity can be considered as an objective social category (e.g. gender, race, social class, age group) but in this instance I think it makes more sense to view it as a subjective identification with a particular group (e.g. insiders or outsiders; conformists or non-conformists) or with a particular set of attitudes. (I have previously written about identity economics in different contexts, here and here.)

So, if you want to understand why people behave the way the do it may help to know how this behaviour relates to the way they think of themselves. Kids who engage in particularly risky thrill-seeking or escapist behaviour possibly obtain some satisfaction from thinking of themselves as the kinds of people who do that kind of thing.

Ruth has responded with some encouraging comments about the potential for identity economics to help in exploring the drug-using phenomenon. Her response is in the following post.

Are some questions too difficult? Part II: How can we understand teenage drug use?

This post continues my discussion with Ruth about teenage drug use. In the last post Ruth, a nurse who has worked in psych wards and prisons, illustrated the nature of the problem by telling the sad story of a man who has been suffering from drug induced psychosis (DIP) over a long period following an incident just before his 18th birthday.
Ruth continued:

It is well established that the human brain does not finish physiological development until well into the 20's, and that smoking one cone (none before and none after) alters brain wave functioning for up to 7 years. Together, these 2 facts paint a dire outlook for teens taking drugs of any sort.

Just as an aside, much of the cannabis available on the streets these days is lined with heroine as a 'good business measure' on the dealers part. No wonder most big time suppliers don't take drugs of any sort. For them, the cost is too great as they see first hand the longer-term effects of their drugs on their clients. Maybe that is a clue for helping - that the dealers are some of the few non-health workers who see these same people year after year. Most of us loose touch with people around us after just a couple of years, which is not long enough to see the long term effects of drug taking. These 'big guys' of the drug world understand the cost of drug taking, especially the cannabis suppliers. They have said to me as their intake nurse in the prison system over and over "I'm smart miss; I sell it, I don't smoke it".

On another note, the use of cocaine in the legal and corporate worlds is astounding - a colleague of mine who works as a consultant in this industry and who has a counselling background estimates that nearly 1/3 of these professionals are taking cocaine just to get their work done in the time allocated. These people do not tend to end up in mental health wards though, but those who take a lot of cannabis do. As a result, we are dealing with the impact of cannabis much more commonly than with cocaine for example. Which leads to the next question, What affect will the lifestyle and workstyle we currently assume to be acceptable have on our society and on our youth? And are we prepared to address it?

In our initial discussion Ruth and I agreed that the problem cannot be solved by just warning young people about the consequences of drug use. Young people are warned already about the mental health risks associated with drug use. Yet a lot of them don’t heed the warnings.

Ruth’s asked: ‘What is all that about?’ I said that I thought that was the right question. We shouldn’t just jump to the conclusion that this is a law and order problem. It might be possible to reduce levels of cannabis use among young people by putting more of them in jail, but that would hardly enhance their lives.

Ruth responded:

Nice point! In fact, there are those who prefer to live in a prison than on the streets, but the real issue is getting more of those people into care when they need it and into mainstream society when they don't. And that's the real issue we face in the western world - there is simply not enough resources to address the overwhelming problem of acute mental health issues in our youth. Not enough money, not enough staff, not enough vision. Especially not enough vision. The solution has to come from the opposite side of the spectrum - enticing people to want to hold onto their reality instead of giving their reality to their dealer, or their doctor. Which is definitely not a law and order problem.

My starting point in thinking about why some young people might use cannabis despite mental health warnings was Gary Becker’s rational addiction model. We are talking about DIP, schizophrenia and depression rather than addiction, but the principles are the same. The point is that the behaviour may be consistent with maximizing the discounted value of future happiness as perceived by the individuals concerned. In observing their behaviour we might observe that their discount rates are high and their assessments of the probability of being affected by mental illness are low. Well, economists say that kind of thing. Other people would be more likely to say that they are being short-sighted and excessively optimistic in their assessments of the risks involved. Nevertheless, it is possible that those assessments are quite rational.

When I put this to Ruth she replied:

Despite addictions and hallucinations and even delusions, those with mental illness retain the ability to make rational decisions about their own welfare in light of resources available to them and their experience of reality. Young people in particular take drugs in order to escape their reality. Those without a functional psychosis - read schizophrenia and 'traditional' type mental illnesses - who experience acute addictive / psychotic phenomena induced by drug taking spend a good deal of their lives straight, going about their work, their relationships in the usual manner. These are often people who own their own business, hold well paid responsible jobs and otherwise live perfectly acceptable and rewarding lives. And yet they have a real need to escape the reality of their lives - the cost of living within normal reality seems to outweigh the risk of loosing their cognitive autonomy. And this is what concerns me most of all.

Have we not created a world our youth want to live in? Rational theory must tell us that we have to act, that the cost of not acting far outweighs the cost of thinking, of postulating, of delaying what one day must be done. If our youth want to find another reality then surely we are charged with the responsibility of providing a liveable reality for them and for us. And for their children.

My feeling is that Ruth and I are both putting the problem back into the too hard basket. Rational addiction theory tends to put the onus on young people to make good choices even though adults must share responsibility with school age children for the choices they make. Yet, if we see the problem in terms of creating a world that our youth would not want to escape from, we may put real world solutions beyond reach. Perhaps it is a normal part of human nature to seek temporary escape from the reality of our own lives, no matter how good that reality might be. There is no problem in seeking temporary escape by reading novels or going to the movies. The problem is that some people seek forms of escape that may ruin their lives or the lives of others.

The discussion is continued here.

Are some questions just too difficult? Part I: Should I blog about DIP?

The other day I was talking to Ruth about this blog. Ruth is a nurse who has worked in psych wards and prisons. So she has an interesting range of experiences to talk about and she's interested in economics.


I mentioned that there were some issues that I steered clear of in my blog because they were just too difficult. Ruth objected strongly to this approach on the grounds that ‘someone should be writing about the difficult issues’. I’m not sure why that someone should be me, but I can see the point she was making.

The first example that Ruth gave of what she was talking about was the high incidence of mental illness among young people that has been linked to drug use. She said that this had increased to a huge extent, since the 1990's. We talked around the problem for a while and later exchanged emails about it. The story that Ruth tells below is one of the saddest stories I have ever read.

Ruth says that the most prevalent mental health diagnosis in acute mental heath facilities these days is a relatively new one - Drug Induced Psychosis (DIP). People are only admitted to acute mental health facilities if they are in danger to themselves or someone else (not simply suffering extreme effects of illness as was the case prior to the onset of the drug problem). DIP is now recognized in the DSM4 manual - the diagnosis tool used by all western mental health medics. A major difference between DIP and schizophrenia is the level of associated violence and treatability. Schizophrenia is treated reasonably well with psychotropic medications as the primary treatment regime whereas DIP is treated mostly through drying out and containment (of extreme violence) with medications used as secondary measures.

Ruth tells me that she has chosen not to study a great deal of the theory about the relationship between drug use and mental illness because she wants to stay in touch with the reality on the wards. She writes:

Can I tell a story? It's the story of a young man, well, a boy about to be a man. He was out with his friends celebrating early, his 18th birthday which was to fall during the next week. So this weekend he and his friends went partying to celebrate. During the night one of his friends slipped him a tablet - slyly into his drink. The young man woke the next day still tripping. He was happy as can be, but by the Tuesday, his parents were very worried and took him to the doctor; he was still tripping - having a laugh. He celebrated his 18th birthday in an acute mental health ward, thinking he was still tripping, but was now fed up with being unable to tie his shoe laces, unable to get the fork into his mouth and having to eat with his hands. He was now hating this experience and getting angry with himself for not 'straightening out'. He began to cry in desperation. He cried over and over again, day in day out, while the medics tried in vain to help. After a couple of weeks, his parents wanted to take him home - they wanted to get him out of hospital thinking that maybe it was the hospital causing their son's problem. They took him home and he stopped crying. He still could not tie his shoe laces, or dress himself if there were buttons to be managed. But his parents were happy he'd stopped crying. After all, this fine young man was looking down the barrel of a great career as expected dux of his school, and a fine life. They were devastated at this turn of events. After a few days they brought him back to the hospital. They had not helped him and were even more devastated than they were before. This young man spent nearly a year in hospital, unable to 'get off his trip' as he so beautifully put it.

I was one of his nurses at the time. I was 22 years old, just 4 years his senior. Eventually both he and I left that hospital. But our paths met again in another hospital, another city even, about 6 years later. He told me he had never had a job for more than a few days, he still couldn't do up his buttons - he didn't wear buttoned garments - and that he was still having his 18th birthday trip. He still wanted to study economics (ironically enough) at university. He could still quote and discuss GDP / inflation / employment figures, monetary and fiscal policies, but old figures, those he'd learned for the HSC he still wanted to sit. And yet that young man has no mental health issues in his family, had all the academic potential in the world and a caring, present family. His parents had never divorced, his siblings all got along ok, his relationship with his girlfriend was going well. And there were no identifiable early warning signs of a mental illness about to strike. This man has DIP. He has never been diagnosed with schizophrenia, or any other mental illness.

Ruth concluded:

I wish I was telling the story of just one man, but I'm not. I've seen this same story and similar others so many times. Are some questions too difficult? Yes Winton, absolutely some questions are too difficult and too costly to avoid asking AND finding answers for.

The discussion continues in the next post.