Drug use as a microdose – a new trend?
On May 14, 2018, Prof. Dr. Dr. Joachim Röschke, psychiatrist and chief physician of the Scivias St. Valentinus Hospital in Kiedrich, gave a lecture titled “Sex, Drugs and Alcohol. What Managers Should Know About Addiction.” at the invitation of Dr. Hans-Christian Riekhof, Professor of Business Administration at the PFH Private University of Göttingen.
In an interview with Prof. Dr. Hans-Christian Riekhof, psychiatrist and chief physician Prof. Dr. Dr. Joachim Röschke provides insights into drug use in management circles, explains the effects of drugs and comments on the topic of legalization and suicidal dangers.
Professor Riekhof: According to reports from the USA, the intake of very small amounts of drugs, for example LSD, is a new trend that is spreading rapidly. This is called microdosing. The recommendation is: 10 micrograms of LSD every 3 days. In the reports, one reads of increased alertness, concentration and creativity, improved mood and reduced irritability – all effects that one can only wish for. The small amount is supposed to prevent hallucinations. Is it realistic and medically comprehensible that these effects occur?
Professor Röschke: The effects of even the smallest amounts of LSD are subject to widespread intraindividual variations. Scientific, controlled studies on so-called “microdosing” do not exist, at best individual reports are known. I do not want to exclude that the desired effects occur in individual cases. However, a recommendation cannot be made! As long as the mechanisms of a manifest addiction development (these are habituation effects and consecutive dose increase despite proven negative side effects) do not occur, there are no objections in individual cases. Not everyone who occasionally drinks a “small beer” becomes an alcoholic.
Riekhof: The whole thing is classified as largely harmless in newspaper reports. Do you share this assessment? Will microdosing soon become part of the everyday life of stressed managers in Germany as well?
Röschke: We are entering the field of neuro-enhancing. The dramatic consequences of cocaine use, for example, are well known: strong psychological dependence, psychoses, hallucinations, affective instability, etc. Basically, I do not see that even the smallest doses of LSD can be consumed harmlessly. Depending on the mental condition of the consumer and also genetic disposition, psychoactive substances, especially with psychedelic properties, can induce psychotic states even in small amounts. Especially if it is taken every 3 days.
Riekhof: In Switzerland, Lidl now offers cannabis products. Is smoking grass now the alternative to after-work beer? Does this show that drugs in low concentration are becoming socially acceptable? What long-term consequences do you see for dealing with cannabis?
Röschke: For some medical indications (e.g. in pain therapy), cannabis (hashish, THC) is certainly worth considering. However, I strongly advise against legalizing THC in general! Psychotic states triggered by THC are common, as are anxiety states. In genetically predisposed – but clinically not yet noticeable – risk patients for e.g. schizophrenic disorders, THC can trigger the manifest outbreak of the disease. In addition, a THC addiction can develop and an affective disorder, a so-called amotivational syndrome can be triggered. Addiction is a disease and not a character weakness. If THC is legalized, some health insurance companies already smell the opportunity not to have to pay for the costs of addiction treatment anymore. A negative example is the ViAktiv health insurance.
Riekhof: In some industries, drug abuse is more widespread than in other industries. Do you attribute this to the special stress and pressure in these industries or companies, or do you see other causes?
Röschke: Consumption is always dependent on availability. The anticipation of an “after-work beer” or the consumption of other psychotropic substances for reward or relaxation is indeed widespread. Which substance is actually consumed in which circles depends to a large extent on regional offers and prices. In the big cities, the prices for cocaine, for example, have fallen so much (oversupply) that cheap substances (designer drugs) have clearly receded among the better earners. Stress in general opens the gateway to consumption (legal or illegal) of psychotropic substances regardless of social status.
Riekhof: Is socially inconspicuous cocaine use in social life and in the professional world possible over a longer period of time?
Röschke: Yes, we experience this again and again. Only when the addiction has progressed, the thoughts are almost only occupied with obtaining the substance, the affected persons become socially so conspicuous that the addiction can no longer be overlooked. Often, the consumers have already accumulated many debts.
Riekhof: Do you see an increase in drug use in management circles, or has this always existed? Has perhaps only the type of drugs that are consumed changed?
Röschke: I think that it has always been and still is alcohol that is in the foreground here (as a legal drug). Because of the risk of being identified as an alcoholic (you can smell it), switching to illegal drugs is common. In this respect, the type of drug use has shifted, not the tendency of consumption. Since the demands in the job have increased, consumers start to drive themselves to peak performance with “uppers” (e.g. cocaine), in order to bring themselves to sleep in the evening with “downers” (e.g. alcohol, benzodiazepines, THC).
Riekhof: How quickly do dependencies arise? Are there differences in the types of drugs?
Röschke: Oh yes, but very individually different. With heroin it goes extremely fast – already after a few times of consumption. With CRACK it is also not a long way. THC takes longer. Furthermore, it does not only depend on the substances, but also on the consumption behavior itself (dose and frequency of consumption). That’s why today we prefer to talk about “hard and soft consumption” instead of “hard and soft drugs”.
Riekhof: What are everyday indications of drug use? Can superiors miss for a long time that close employees regularly take drugs with the aim of temporarily improving their performance, resilience and their basic mood and well-being?
Röschke: A typical indicator is frequent absences of employees. Accumulations of individual days off, especially on Mondays, give reason to pursue the topic. In addition, superiors notice that performance does not increase, but on the contrary decreases. A change between euphoria and melancholy is also typical. And when rumors about drug use are already circulating, then as a boss you can no longer look away.
Riekhof: What do you recommend to managers if there are manifest indications of drug use among employees?
Röschke: First, one must seek the conversation. It is important to accept drug or alcohol dependence as a biological disease and not to perceive it as a character weakness. Self-control of consumption in the case of a manifest addiction (“I have it under control, I can also drink controlled”) no longer exists. The addicts can no longer do otherwise, even if they no longer actually want this consumption. There are too many stimuli in the environment that virtually flip the biological switch in the brain and force consumption. The affected people are ashamed of this – but they are helplessly exposed to this compulsive behavior due to the strong addiction pressure (Craving). As long as the substance is somewhere nearby, the temptation is given, so that one cannot resist it.
Riekhof: In your lecture, you mentioned that suicide rates have been declining for years – even though they still amount to a multiple of the annual traffic fatalities. Do you have an explanation for why suicide rates in the developed, western world are significantly higher than in traditional societies? One would actually assume that people in the richer countries of the world are better off and can lead a “happier” or even carefree life.
Röschke: A prognostically significant factor for suicidal developments is the problem of loneliness. All lonely people basically have a high risk of suicide. If other psychiatric disorders or psychosocial complications are added, e.g. depression, alcohol dependence, anxiety disorder, loss of social structure, poverty, etc., utmost caution is required. This increasing problem of loneliness is a cardinal symptom of modern society. In multi-generational houses or other forms of social life, hopeful indications are developing to counteract these structural weaknesses.
Riekhof: What do you see as the reasons that the use of psychotropic drugs in the population has increased in recent years? Has access to psychotropic drugs become easier? Or do the burdens of the individual in our society now represent an overburden for part of the population?
Röschke: The prevalence of mental illnesses has not increased according to current studies in recent years. However, the “utilization behavior” of the care system has changed. Mental disorders have become socially acceptable. By disclosing mental disorders in high-performance athletes (e.g. professional footballers) and the reports in the press about this, the taboo and stigmatization of those affected is gradually dissolving. Therefore, more and more affected people, who often do not even understand what is happening or has happened to them, are appearing in the care system, and the numbers for psychotherapeutic and psychopharmacological interventions are increasing. This clear tendency explains the phenomenon in demand. However, we are miles away from actually getting the majority of those affected into the necessary treatment.
Riekhof: Thank you very much for the conversation!
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