Reality is socially constructed. What we consider to be a drug depends entirely on the context. In Germany, a drug is a substance with addictive and malignant properties; in English, a drug may very well be a remedy for a condition. Next to differences across languages, the social setting determines the meaning. Discuss possible treatments for androgenic ailments with your physician and the word “drug” means one thing, talk about an extreme night out with a bunch of hippies and the signifier signifies something else, by a mile. As a fan of constructivism, I offer some interesting facts – modus operandi: smug.

More than smug actually, since I will demonstrate to you how our understanding of drugs is completely irrational. Completely. The simple question, what is a drug and what is not, is not that simple. To begin the discussion, a professional distinction is made between pharmaceutical and recreational drugs. The lines are however consistently blurred. Medicinal marihuana and novocaine are examples of drugs that are perceived to function in one domain, but are regularly used in the other. There is considerable merit in the distinction, nonetheless it is flawed and unsatisfactory. From a theoretical perspective it may be summed up as the difference between substances that alleviate a problematic condition and substances that are used to alter a given state for fun/addiction, not out of necessity.

In real life this distinction does not hold. The above-mentioned examples are obvious ones. It becomes more problematic, and nasty, when you examine pharmaceuticals that have addictive properties and/or significantly alter brain chemistry. Sedatives come to mind, use of prescription sleeping pills by far exceeds the scope of professional supervision. The addictive potential of benzodiazepine is a call for serious concern the second it does not target a problem, but becomes part of a problematic pattern. This process is just one that blurs the distinction between pharmaceutical and recreational. Perhaps even more alarming is the trial and error approach of psychiatry in general, or even more so the aggregate power of the pharmaceuticals industry, representative of capitalism and not Hippocrates’ oath. What we sell as medicine and what we designate as substance abuse hardly offers clarity.

Another approach may be judging the severity of a given effect. When effect is the measure, our perception is largely based on societal norms. These are informed by governmental policy. Drug classification has strong roots in the 60ies. The rules that were established then influence the way we perceive drugs to a great extent. In pharmaceutical and in recreational drug use there are substances that should obviously be subject to more control than others. Then, the question should arise how to measure effect. In an independent study, aired on the BBC, several British scientists developed a method to evaluate the effects of drugs. They defined three criteria. The first is the actual effect on your system, the second is addictive property, and the third criterion is societal cost. This system generated provocative results, to put it mildly. Alcohol and tobacco scored higher in their ranking than six traditional hard drugs.

Reality is socially constructed. We are socialized into viewing your daily cup of coffee as the norm, binge drinking as a side effect of youth, and smoking is now counter culture. The reality is bleak. Coffee is the drug of choice for swaths of men and women desperate to boost their productivity. It is a highly addictive nerve toxin that actually triggers drowsiness when the required dosage is not administered. Next to that, there is a range of other negative, as well as positive, effects. Moving on to alcohol, drinking is a hugely underestimated cause for concern. Binge drinking causes serious (long-term) brain damage. The obtainability of ethanol-induced highs is a matter of economics. Alcohol is a drug, and the readiness with which we consume it is a direct reflection of the efforts alcohol selling companies make to market their poison. I do drink, however the fact that alcohol would be rated as a hard drug if invented today has woken me up. Finally, there is tobacco. Smoking is responsible for 400,000 deaths annually in the US (more than all deaths combined from hard drug abuse) and roughly 50% of hospitalizations in the UK. The societal cost of smoking is, and remains, detrimental.

The way we see drugs does not reflect the reality of the drugs, far from it. Looking into the subject, it is shocking to see that scientists rate common drugs as nicotine and ethanol as more harmful than several hard drugs. Whether pharmaceutical or recreational, the test for how to rate a drug should be in terms of their effect. Do this objectively, and the socially constructed status quo of what is okay and what is not will be shaken to its core.