Expert interview on drugs

Stefan Gutwinski is the senior physician at the Charité Psychiatric University Hospital in the St-Hedwig Hospital in Berlin and head of the psychotropic substances research group. The psychiatrist or psychotherapist cares for people with various addictions. In an interview with the counselling centre, he talks about the effects of drug use and clears up prejudices.

Counselling centre: Which drugs do you deal with the most?
Stefan Gutwinski: most of the people we treat here have problems with the traditional substance groups such as alcohol, cocaine, heroin, benzodiazepines and barbiturates, amphetamines and cannabis. General consensus is that the importance of these drugs in the population has remained relatively constant in recent years. The use of cannabis, on the other hand, has increased in recent years, and new psychoactive substances are constantly being added.

Why do people take drugs? Have the motives changed over time?
I would say that the motives have largely remained the same. For some people, drug use is a kind of self-therapy to deal with stressful life events. For others, it is curiosity or everyday behaviour that lead to drug use. In regards to cannabis use, the inhibition threshold of the general population is likely to be lower for many people. Considering the fact that cannabis is still a relatively young drug, a relatively large number of people use it. This may be because the risks for most people appear to be assessable and almost everyone now knows someone who uses cannabis.

Are there any entry-level drugs?
It has not been scientifically proven that cannabis is a gateway drug. People who use drugs usually start with cannabis, but not all people who use cannabis automatically use other drugs. In general, a single time of using drugs, as many people do, does not automatically mean that you become addicted. There are exceptions, as in the case of heroin, for example, because it can happen that even a single drug use may lead to addiction. With almost all other drugs, it is more likely to be a process over several weeks, months or years before addiction develops. The sporadic individual use of most substances, on the other hand, does not end in dependence for most people.

What are the long-term consequences of drug use?
When psychoactive substances are used, long-term use is a particular problem. The single use of many substances designated as drugs in a typical dosage (i.e. not too high or contaminated) probably does not cause permanent harm to otherwise healthy adults, at least for a majority of substances. Someone consuming half a gram of cannabis once is unlikely to experience life-long adverse effects. All substances are dangerous if they are used continuously or by children, adolescents or people with mental disorders. The way in which the substance is supplied is also decisive for the type of physical effects. Cannabis is usually inhaled – resulting in increased rates of lung damage, for example. Continuous consumption of alcohol damages the oesophagus, pancreas and many other organs. In the case of heroin, contamination and infectious diseases caused by injections pose a particularly high risk. Moreover, almost all substances have specific secondary consequences. There are also psychological effects. Cannabis use can increase the probability of psychosis in humans. If children or adolescents smoke cannabis regularly, it is likely to affect their health and, in the long term, their intelligence.

In your experience, what percentage of students take or have taken drugs?
Drug use among students is roughly equivalent to the average population. This means that about a quarter of all students have had contact with drugs before.

How does drug consumption differ between students and other occupational groups?
There are only small shifts in comparison to drug consumption in the average population. Heroin use, for example, is lower, but cannabis use is slightly higher than in other social groups.

What role do performance-enhancing drugs play for students and what are the different types?
We are observing a slow increase in the prescription of amphetamine derivatives such as Ritalin, which are used to treat ADHD. In the area where people take performance-enhancing substances, people also use drugs that promote concentration or sleep-inducing substances that help people fall asleep more quickly and stay fit. Whether it actually leads to an increase in performance, especially in the long term, is probably not at all the case in otherwise healthy adults.

Can these substances become addictive?
Probably for some people. There is also a debate about whether the consumption of performance-enhancing drugs decreases the threshold for other addictions. Another question that should be asked during the discussion is whether it is fair to other students to write tests under the influence of substances. It is also a cultural question whether we can only achieve maximum performance of our society under the influence of drugs. And often, this is precisely the reason for substance abuse that has to be taken into account, because it is actually a sign of a great need when someone has to take substances in order to pass tests. The direct or indirect pressure coming from home, for example, must be extremely high. This debate, however, has many other facets with philosophical and sociological aspects that would go beyond the scope of this debate.

What does successful therapy look like today?
When it comes to therapy, you must first accept that relapses are part of the therapy process, because they are a learning process. Addiction therapy in general can only be successful if we understand the individual risk of the patient and integrate the willingness and need of the patient to stop the substance abuse into the therapy. For example, when a person from a violent parental home, who grew up in a children’s home and consumed alcohol daily for understandable reasons, starts treatment, it makes sense to understand these individual aspects. At the same time it is important to convey why addiction and consumption are still not helpful in the long term.

Thank you very much for the interview!