Drugs can fuck with your brain. That's why people use them. They take you down, they push you up and they send you sideways. Whether it's a relaxing spliff after work, a Friday night piss-up, a pill to enhance a club night or a line that will transport you into an alien space world, psychoactive substances offer earth's citizens temporary escape from their everyday lives.
Millions do it. But for those who aren't feeling great about themselves, the lure of that narcotic escape can be stronger. Unfortunately, this chemically enabled sanctuary itself can worsen people's mental health.
The evidence for the two-way connection between drugs and mental illness is there in the science journals. It's also right in front of our faces. Many of us have friends who have been mentally damaged by legal and illegal drugs. Nevertheless, if you want the truth about the relationship between drugs and mental health, you have to steer a careful course between all the bullshit.
The granddaddy of the drugs-drive-you-mad hyperbole is Harry J Anslinger, America's Commissioner of Narcotics in the 1930s, a ferocious anti-cannabis campaigner. He warned people: "Smoke marijuana cigarettes for a month and what was once your brain will be nothing but a storehouse of horrid spectres." It may seem like a joke, but this kind of claptrap has formed the template for much of what Britain's most read newspapers have come out with on the topic over the last decade. Mind you, some of the zealots who have tacked themselves onto the pro-cannabis lobby, who claim all weed is completely harmless, are equally as estranged from the real world.
But the correlation is there. Government figures show that around a third of people diagnosed with mental illnesses have used drugs in the last year – three times the national average. Three quarters of those attending drug treatment services have had a psychiatric disorder in the last year.
Drugs and mental illness are entwined in a complex dance that scientists are only recently beginning to decipher. The stigma that has surrounded both issues for so long has meant that research into how they interact, and how one may lead to the other, is in its infancy.
Rachel remembers being unhappy since her family broke up when she was three. She wrote this in her diary after her first experiences with ketamine aged 14. "I had unleashed a whole new intelligence within me, from being a frustrated lonely school child, to a fairytale princess." Now 30, she says although taking drugs has eased her depression, they have fundamentally altered her life. "My head wasn't silent enough by itself and taking drugs calmed me down. I was less sad and angry. I was going out, working, playing, living and I was happy. But my brain was still developing. For me, the world outside drugs is very dull and boring – nothing matches the pinnacles of taking drugs when I was turning from a child into an adult."
Government figures show that round a third of people diagnosed with mental illnesses have used drugs in the last year – three times the national average
Much of the research on drugs as a cause or accelerator of mental illness has been focused on cannabis, because it is the most widely used illegal drug. While millions of users of the drug will be unaffected, the research has found there are some groups who are more likely to develop mental health problems than others.
Some are hobbled before they have their first toke. Cannabis users who have depression or schizophrenia in the family are at a higher risk of the drug sparking these illnesses than those who do not. Scientists believe there is a gene, AKT1, which makes people far more susceptible to developing psychosis if they use cannabis than someone without AKT1.
Studies have shown that young people who start smoking cannabis before the age of 15 are four times more likely than non-users to develop a psychotic illness. This is because the brain is still developing in the teenage years. As the Royal College of Psychiatrists puts it: "A massive process of neural pruning is going on, like streamlining a tangled jumble of circuits so they can work more effectively. Any experience, or substance, that affects this process has the potential to produce long-term psychological effects."
Depression is one possible upshot. A study of 1,600 Australian children aged 14 to 15 over seven years found that those who used cannabis every day were five times more likely to become depressed and anxious by the end of the study. Though there is insufficient evidence to show teenagers diagnosed with depression are more likely to use cannabis, there is a large body of evidence to show that teenagers facing high levels of stress are more likely to engage in problematic cannabis use.
There is a lot of media exaggeration about the strength and dangers of the high strength, skunk-style weed that now dominates the UK market (one newspaper claimed "just one puff can cause schizophrenia"). But the drug is creating problems. A study by Kings College London on 780 people at the Maudsley Hospital in south London found that, compared with those who had never tried cannabis, daily users of skunk-style cannabis had a five-fold increase in risk of psychosis.
Insight, a support service for 11 to 24-year-olds with drug problems, is a few miles down the road from the Maudsley. Project worker Anthony Stewart is seeing a rising number of teenagers, mainly young offenders, seeking help with symptoms such as paranoia and anxiety because of a "fixation with super-strong strains of cannabis".
Studies have shown that young people who start smoking cannabis before the age of 15 are four times more likely than non-users to develop a psychotic illness
"They are using brands like Amnesia, LSD and Sour Diesel, smoking all day. Even the music they listen to talks about getting stoned on skunk. One boy thinks he's getting subliminal messages via the adverts on his TV. We are going to see a big rise in mental illness in young people because of skunk."
The short-term psychological effects of drugs can be powerful and cumulative. A heavy bout of drinking alcohol will depress the nervous system, leaving people feeling depressed. The more you drink, the more depressed you get. For weekend users of stimulants such as ecstasy and cocaine, there is the midweek crash, a slump in mood caused by over stimulating or "frying" receptors in the brain. The more you use, the more over-stimulated the brain becomes and the more brittle your mental state is going to be. This leads to people overthinking things, putting meaning into things that don't exist and needless suspicion. To deal with this people take more drugs, and the knot of entanglement tightens.
It is no surprise that the organisers of Glastonbury Festival have had psychiatric nurses in attendance for three decades. Each year, there are festival goers who become mentally unwell and have to spend two or three days recovering in a psychiatric unit. Occasionally people who go to Glastonbury have to be sectioned.
Dr Niall Campbell, a consultant psychiatrist at the Priory Hospital in Roehampton, southwest London, has seen a long line of people mentally scarred by drug use. Sometimes the effects can be temporary, but no less scary. One teenager that Dr Campbell saw had become so freaked out by a recurring image of Edvard Munch's The Scream (after nibbling on magic mushroom root) that every time he closed his eyes he suffered post traumatic stress disorder. The boy nearly had to defer his university degree as a result, but the visions eventually stopped. Hauntingly for others, these effects can be, as Dr Campbell says, "switched on" for good.
"I've been treating a guy for 12 years. He went to the same school as my son and he was a heavy smoker from a young age. He was sent to me after he got chucked out of school because his grades went bad due to smoking," he says. "The problem was that in his mind, everybody in the world, whether it was a Ukrainian tractor driver or a Kalahari bushman, knew what was going on in his head." The patient stopped smoking 12 years ago, took medication to dampen it down, went to university and now works in his father's business. "All the guys in the factory in China where he goes on business know what he is thinking. He can't have a relationship with a woman because she knows what he's thinking. He's stuck in a paranoid state and he will be forever and that spooks him out."
The vast majority of drug users, even if they might have a bad trip or suffer from short-term psychiatric effects, do not suffer chronic mental illness from taking drugs. However, addiction – a diagnosed form of mental illness – can often be the precursor to further psychiatric problems.
I asked Liz Hughes, a mental health nurse who writes for the blog Mental Elf and is also a Professor of Mental Health at the University of Huddersfield, what factors can tip people over the edge from regular drug use into the kind of drug use that can lead to mental illness. "If you imagine what I call a 'stress bucket'," she says, "if it's already nearly full, perhaps with a genetic vulnerability to drugs and being bullied at school, and you pour in drugs, it will overflow. But some people will start with an empty bucket and can take a lot of drugs before they become ill."
She says that if drug use is affecting your day-to-day functioning, like being unable to work, eat, sleep or socialise properly, then this could be the sign it is developing into mental illness. "Mental illness can be difficult to manage when it appears," says Hughes. "It's better to prevent it."
Psychedelics such as LSD, mescaline and psilocybin (the active ingredient in magic mushrooms) have been linked with mental meltdowns since the 60s. Yet a study published in the scientific journal Nature in March found that people who used these drugs were not at increased risk of developing mental health problems such as schizophrenia, psychosis, depression, anxiety disorders and suicide attempts.
Stimulant drugs such as cocaine and mephedrone are associated with having fun and getting high, but they are increasingly being used in the same way that heroin and crack were more commonly used in previous generations, as tools of negative escapism, to take away feelings people don't want to have.
Dr Owen Bowden-Jones runs the CNWL Club Drug Clinic, a service for people using club drugs and new psychoactive substances (NPS). He sees people with high levels of depression, anxiety, post-traumatic stress and psychosis due to their drug taking. The biggest rising problem at the clinic is with mephedrone.
"With mephedrone I am seeing people with temporary psychosis – paranoia, feelings of being persecuted and auditory hallucinations. Mephedrone psychosis is more common now than crack psychosis in our clinic. If you are repeatedly revving up your reward system in the brain with a stimulant drug like mephedrone, all the feel-good transmitters like dopamine get depleted, so you end up with a low, flat, chronic experience of life. One way to change this is to take more mephedrone and that risks a vicious cycle developing."
If drug use is effecting your day-to-day functioning, like being unable to work, eat, sleep or socialise properly, then this could be the sign it is developing into mental illness
In November the head of Camden's mental health trust said new psychoactive substances had resulted in so many psychiatric unit beds being taken up that some patients had to be sent to Somerset for treatment. Meanwhile, synthetic cannabinoid brands such as Spice and Black Mamba are creating havoc for drug services and in British jails. Inmates have started importing the cannabis substitutes, which are more potent than normal cannabis, behind bars because drugs tests do not detect them. But many have ended up needing psychiatric help because of the drugs.
" Spiceophrenia", a study into synthetic cannabinoids published in Human Psychopharmacology in 2012, concluded: "Synthetic cannabinoids can trigger the onset of acute psychosis in vulnerable individuals and the exacerbation of psychotic episodes in those with a previous psychiatric history."
Despite the danger, drugs do possess the potential to improve cognitive functioning. They can aid memory and concentration, and be used to treat mental illnesses such as depression, PTSD and anxiety in cancer patients. Before MDMA was used as a recreational drug, it was used in the 1970s by hundreds of US psychologists alongside psychotherapy and talk therapy. Medical studies on the positive effects of MDMA show the drug has the potential to be used as treatment for anxiety and PTSD.
How people are affected mentally by their drug use is in the end a highly individual matter. As Dr Bowden-Jones says, "People take drugs either to give them feelings they can't normally get in life or to take away feelings they don't want." Some people will self-medicate but it's a difficult game to play: the antidote could itself be the poison.
To an extent the kickback is about someone's innate capacity for taking a particular substance. Different drugs will affect different people in different ways. But more importantly, it's bound up with the reason they are getting high in the first place. "I would ask people what they are hoping to get from taking drugs," says Liz Hughes. "If they are trying to escape from something or to mask negative feelings, that's already a red flag. Because rather than being a temporary relief, drug use can compound an underlying problem."
If you are concerned about the mental health of you or someone you know, talk to Mind on 0300 123 3393 or at their website, here.
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