Smacked
Page 19
Those who responded to me on HN were using modafinil, Adderall, Ritalin, lots of marijuana, cocaine, and ketamine (an anesthetic drug used illegally as a hallucinogen).
An online discussion ensued about whether or not, as humans, we are evolved for what a career in technology—or for what technology in general—demands. One commenter wrote that those in tech use a variety of these drugs because human beings aren’t “built for 8+ hours a day of intense abstract reasoning, which seems to be what the modern information economy demands of those aspiring to a middle class or better existence.”
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BECAUSE THERE ARE NO comprehensive studies of how chemical substances, legal and illegal, are being used or abused by American professionals, the information we have is largely anecdotal. We do know that for the first time in nearly a decade, cocaine use in the United States is increasing. A 2017 State Department report noted “troubling early signs that cocaine use and availability is on the rise.” In just one year, from 2014 to 2015, there were 766,000 new cocaine users in the country.
We also know, from an analysis of data published in the American Journal of Public Health in 2016, that the number of adults who filled a benzodiazepine prescription—sedatives like Xanax and Klonopin—increased almost 70 percent between 1996 and 2013, to 13.5 million prescriptions. To get a broader perspective on the scope of drug use by professionals, I decided to speak with some of the counselors, therapists, and doctors that treat white-collar addiction.
One of them is Mark Stahlhuth, a psychologist who, when I met him, was clinical director of Seasons in Malibu, a residential and outpatient treatment center in Malibu, California, which looks more like a resort than a rehab, situated on a bluff overlooking Matador Beach. The facility treats about 150 clients a year and it’s not cheap—a one-month stay (typical for residential treatment) is $59,500 for a shared room and $83,000 for a single. Clients here are generally executives, celebrities, and their adult children between thirty-five and sixty-five years old. Nearly all of them also have a mental health issue like anxiety, depression, or bipolar disorder; 90 percent have had some kind of trauma in their past. The patients at Seasons are largely addicted to alcohol and prescription pills. “Although we see a little meth and cocaine too,” said Stahlhuth.
He, like many of the clinicians I spoke with, hears repeatedly from clients that they feel an urgent need to escape from their daily lives. When love is predicated on performance, Stahlhuth says, like how much you earn each year, your title in the firm, or how much business you just brought in, the pressure to perform is enormous. Added to that is the pressure that generally exists in the workplace today to innovate, to keep up with the speed of technology and keep shareholders (many of whom are no longer willing to wait for longer-term earnings) happy. “I see business owners who feel this intense need to create, create, create,” said Stahlhuth. “And then innovate, innovate, innovate.”
Quest Diagnostics, which provides a wide range of diagnostic testing for health care, does an annual survey of drug use in the American workforce, and in 2018 found drug use to be at its highest rate in more than a decade, driven largely by the surging use of cocaine and amphetamines, as well as marijuana in states where recreational use is legal.
Sam Ball, the psychologist and director of the executives and professionals program at Silver Hill Hospital, says the higher the level of achievement, the more there is to lose, so the higher the level of denial—not only on the part of the addict but also among those around them. “With Peter, some of the people he worked with may have known there was a problem and just looked the other way because they didn’t want to get into a big HR issue or liability issues. But a lot of people are just in denial. It’s part of the disease’s effect—the people closest to the person affected should be able to see what’s going on but don’t,” he said. I certainly didn’t.
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PSYCHIATRISTS AND PHYSICIANS WHO study addiction have found that somewhere between 40 to 60 percent of a person’s susceptibility is genetic. A 2012 paper published in the journal Psychiatric Clinics of North America found that “heritability estimates for addictions range between 40 percent (hallucinogens) to 70 percent (cocaine).” According to research from the National Institute on Drug Abuse (NIDA), both genetics and the environment conspire to create addiction problems, and that means there isn’t one simple reason why a person becomes an addict or an alcoholic. Some people are just at higher risk for the disease. When I take a Vicodin, I vomit; when Peter took one, he felt fantastic. Those responses are biological, they have nothing to do with moral fiber or strength of character or anything else.
Beverly Roesch, a therapist and clinical director at Cirque Lodge, a high-end treatment facility in the mountains of Sundance, Utah, says one significant environmental factor among people at the upper end of the socioeconomic spectrum is a profound lack of “intrinsic spirituality,” at least in the clients she has seen over the years. Not religion, not even belief in a god of some kind, but a longing for some bigger meaning in their lives, a feeling of being connected to something larger than what’s in front of them. “This is a deficit that all the money and all the trappings do not address,” Roesch tells me. “What they are missing is connection to others, a sense of community.”
I asked Judson Brewer, a psychiatrist who specializes in addiction and studies how mindfulness practices affect the brain, for his thoughts on the professionals he treats. When we met, Brewer was division chief of the Center for Mindfulness at the University of Massachusetts Medical School. He is now director of research and innovation at Brown University’s Mindfulness Center. Brewer’s own experience with major depression, later diagnosed as bipolar disorder, gives him some understanding of why people seek relief for their disquiet and distress through mood-altering substances.
We sat in his bright office with windows overlooking the woods behind the center. Brewer, who treats both low- and high-income addiction patients, said Peter’s case highlights something clinicians should know but many still seem to be learning. “Being intelligent and very fluent is not a protection against addiction. In fact, in some cases it can be enabling because you feel you know better, that you’ll never become prey to this. And being well-off means you have access, essentially unlimited access, to drugs. Someone like this will start out saying, ‘This is just a pill. I’ve got it under control,’ ” said Brewer. “Until, of course, they don’t.”
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Better Living Through Chemistry
TWO GENERATIONS ARE NOW preparing for, or beginning, their own white-collar futures—Millennials and Gen Z. In 2020, this group spans from eight-year-olds (the youngest Gen Zs) to thirty-nine-year-olds (the oldest Millennials). The Pew Research Center defines these generations as having been born between 1981 and 2012, and from this group will come America’s future lawyers, legislators, doctors, business owners, CEOs, inventors, scientists, and technologists. Millennials and Gen Z comprise almost half of the U.S. population today. More than one in three—35 percent—of the workforce are Millennials, according to Pew. Right behind them are the oldest members of Gen Z, who are just beginning their careers; today they make up 5 percent of the workforce.
Gen Z (born 1997–2012) is unique in that it is the first generation to have been born into a world where the internet is a significant part of everyday life. Research led by Suniya S. Luthar, a psychology professor at Arizona State University whose work has focused on vulnerability and resilience in young people, found that many teenagers likely destined for white-collar lives already have high levels of substance abuse, anxiety, and depression. In a 2013 paper, Luthar and two colleagues wrote that “upper-middle-class youth, who are en route to the most prestigious universities and well-paying careers in America, are more likely to be more troubled than their middle-class counterparts. Youth in poverty are widely recognized as being ‘at risk,’ but in
creasingly, significant problems have been seen at the other end of the socioeconomic continuum.”
Luthar began to sense something counterintuitive happening in the mid-1990s, almost incidentally, while studying inner-city teens. A comparison group of affluent students had also been recruited for her study, but this comparison group had significantly higher rates of substance use than their lower socioeconomic counterparts, including cigarettes, alcohol, marijuana, and “hard drugs.” A decade later the findings were replicated in a study of suburban tenth graders.
In 2017, according to the University of Michigan’s annual Monitoring the Future study, marijuana use among adolescents was up for the first time in seven years. In the 2018 survey, nearly 28 percent of tenth graders and 36 percent of twelfth graders said they regularly use it. (By the time the youngest Gen Zs are in the workforce, marijuana could be legal for recreational use in a majority of states.)
Substance use and abuse increases as well-off high school graduates head to college, says Luthar. “Every single school we looked at—public, private, day schools, boarding schools, East and West Coast, South, Midwest, every single one of them—we’ve seen this pattern, high levels of substance abuse or high rates of depression and anxiety. The common denominator, without exception, was that the school was a ‘high-achieving’ school.”
Although this book is focused on drug use and abuse at the upper end of the income curve, those at the lower end have been enormously impacted by drug addiction of all kinds. Heroin addiction, for example, is more than three times as common in those who earn less than $20,000 a year compared to those earning more than $50,000 a year, according to the CDC. Heroin addicts with either no insurance or Medicaid vastly outnumber those with private health insurance, and that severely limits their access to treatment—let alone good, comprehensive treatment—for the disease. Poverty and substance use often operate hand-in-hand, and research going back to at least the early 1990s has shown that neighborhoods with poor housing conditions, higher levels of school dropouts, unemployment, and single-parent families have higher levels of drug use. There has been far less research done into drug use among adolescents from well-off families, and Luthar wanted to learn more about them.
She and her researchers followed a group of upper-middle-class students in high-achieving high schools through college until they were twenty-seven. By age twenty-six, almost 40 percent of the young men and 25 percent of the women had a diagnosis of addiction, two to three times the usual rate for people this age. “Not abuse,” Luthar emphasizes. “Addiction.” And the earlier in their lives kids start to use, the more likely they are to abuse as adults and the more difficult it will be for them to quit.
Anxiety may be one reason why they are developing drug problems. It has surpassed depression as the reason college students most often seek out counseling services. According to the 2018 annual report from the Center for Collegiate Mental Health at Penn State University and data from the National College Health Assessment, about half of college students suffer from depression. In the previous year, more than 63 percent reported feeling overwhelming anxiety; about one in twelve had made a suicide plan.
Many factors contribute to anxiety and depression, but among the most profound differences between Gen Z and any other generation in history is that Gen Z hasn’t known a world without social media. As these children get older, the pressure they feel to achieve in all aspects of their lives can be intensified by social media. Luthar is concerned about the lack of genuine connection with others many of these young people feel. “This hooking up (casual sexual encounters) and not being able to have real, interpersonal relationships because there’s no time in their jam-packed schedules,” she says. “Instead they use Instagram and Snapchat.” And those are no substitute for real intimacy—physical and emotional—with another person.
Jean M. Twenge, a professor of psychology at San Diego State University who studies and writes about generational differences, started seeing a pattern of rising mental health issues for adolescents beginning in 2012, especially anxiety, depression, and loneliness. At first, she thought these might be statistical blips of some sort, but they persisted in other national surveys too.
Eventually she determined what was significant about the year 2012. It was the moment in history when the proportion of Americans who owned a smartphone exceeded 50 percent. By 2015, according to Twenge, 92 percent of teens and young adults owned one. “Thus,” wrote Twenge and her co-authors in a research paper, “smartphones were used by the majority of teens the year that depressive symptoms began to increase and by nearly all teens when depressive symptoms peaked. Another study found major depressive episodes among teens ages 12 to 17 increased beginning in 2011.”
Millennials grew up as the web grew up, but it wasn’t in their lives around the clock; when Gen Z came into the world the web had already transformed it. Smartphones existed, albeit mostly in the form of the BlackBerry, until 2007, when Apple unveiled its first iPhone. That year the oldest Gen Zs were eleven. “The arrival of the smartphone has radically changed every aspect of teenagers’ lives, from the nature of their social interactions to their mental health,” Twenge has written. “These changes have affected young people in every corner of the nation and in every type of household. The trends appear among teens poor and rich; of every ethnic background; in cities, suburbs, and small towns. Where there are cell towers, there are teens living their lives on their smartphone.” Today, the average age at which a child gets their first phone is 10.3, and nearly 40 percent of children have access to the web via their phones.
It’s not just the phone, of course, but the world to which it grants access. Social media is now a part of children’s lives long before most of them hit puberty. Nearly 40 percent establish their first social media account—be it Facebook, Instagram, Twitter, or Snapchat—before they are twelve.
This has fundamentally changed the way people interact with one another. A 2018 research report found that 65 percent of people under 35 in the United States communicate more digitally than they do in person; in the United Kingdom, it’s 74 percent. Yet words alone account for only a fraction of our understanding of what someone is trying to tell us; there is so much more that goes into communicating with another person. Albert Mehrabian, a professor emeritus of psychology at UCLA well known for his research into verbal and nonverbal communication, found that a person’s tone of voice alone accounts for about 40 percent of communication; body language accounts for 55 percent. In order to meaningfully convey to someone else how we are feeling or what we are thinking, these three components—words, tone of voice, and body language—need to be working together. That doesn’t happen in a text message.
In a Pew Research Center survey, teenagers said they are trying to cut back on phone and social media use. It won’t be easy. Phones were designed to be addictive. They operate on a principle known as variable interval reinforcement, developed by the behavioral psychologist B. F. Skinner. Here’s how it works: A behavior—pulling a lever on a slot machine, scratching numbers off a lottery ticket, or checking your phone—is reinforced intermittently and randomly by a reward. With your phone, the reward is a new text or a notification from an app (like Tinder, for example, or a “like” on your last Instagram post). Your brain is seeking the reward but doesn’t know when it will happen, which makes you that much more determined to keep at it. “Part of what makes slot machines so alluring is the promise of maybe at some point hitting the jackpot. And we end up spending huge amounts of time seeking out that kind of reward,” says Adam Alter, an associate professor of marketing at New York University’s Stern School of Business and the author of Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked. “If you buy lottery tickets or scratch cards it’s nice to win, but it’s really that feeling when you’re about to start playing, that buzz you get from wondering whether this is the time you’re going to win. That is r
eally addictive to people.”
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GEN Z AND MILLENNIALS are unique in another way too. Many have grown up using medication to help them manage mental health problems such as depression, anxiety, and ADHD. In her book, Dosed: The Medication Generation Grows Up, Kaitlin Bell Barnett examined the psychological impact of having grown up on psychoactive medications like the antidepressant Prozac, which she began taking at seventeen. Barnett, who is an older Millennial—she was just shy of twenty-nine when her book was published in 2012—wrote, “For the first time in history, millions of young Americans have grown up taking psychotropic medications that have shaped their experiences and relationships, their emotions and personalities, and perhaps most fundamentally, their very sense of themselves.”
Long-term use of antidepressants is increasing in the United States. A 2018 analysis of federal data by The New York Times found that about 15.5 million Americans have been taking antidepressants for at least five years; that rate has doubled since 2010, and more than tripled since 2000. And a study published in December 2017 in the journal Psychiatric Services found that the use of antidepressants for children and adolescents has come back to the level it was before 2004, when prescribing for youth declined because of an FDA warning about heightened suicide risk.
Many of the psychiatrists I spoke to for this book are concerned that parents often want medications to help their children with problems that aren’t really disorders, like boredom, daydreaming, or misbehaving in school. Journalist Katherine Sharpe wrote about the potential emotional and psychological costs of long-term use of antidepressants and other medications in her book, Coming of Age on Zoloft. Sharpe, who started taking the antidepressant Zoloft when she was eighteen, wrote in an essay in The Wall Street Journal that drugs “undoubtedly help many young people who are genuinely struggling. But the expanding use of psychiatric medication in youth over the last twenty years has meant that the drugs are now prescribed in less and less severe cases.”