Editorial Comment 1/12/2021: Mobs and The Drugs Within Us

We are accustomed to referring to excitement-seeking individuals as “adrenaline junkies”. It is a pithy  characterization regardless of its accuracy, as it explains behaviors that may be innately destructive using a metaphor with which we are very familiar: compulsive and progressive use of the substance that alters a mood state, such that the individual becomes progressively reliant on it. There is a little bit of literature, although surprisingly little, relating to the role of epinephrine as a culprit among the stimulant use disorders.  Of 128 citations in the past two decades, perhaps seven are suggestive of behavioral reinforcement associated with a surge in epinephrine, and in none of them is there an effort to characterize induction of cortisol or catecholamine levels as DSM5 substance use disorders.  The intoxication here is endogenous. While there may be those who self-administer pharmaceutical epinephrine for associated euphoria, I find no evidence of that in a brief survey.

This brings me to my point, which is associated with the recent invasion and occupation of the houses of Congress by hundreds of mostly young, certainly agitated adults.  My own experience of participation in mass protests, in one case arguably a riot, is not unusual among those from my generation, spanning is it did the years of the civil rights movement, the Vietnam War, and the Nixon administration.  Certainly that to which I resonated in watching crowds barge their way through the police into an institution for which most clearly had no respect, was the fervor and the agitation and the self-righteousness of the mob.  It was all strangely familiar, and no wonder: the other setting of which this seemed reminiscent, and which serves as a mnemonic for crowd behavior, is that of large bars and dance venues in which the organizing principle is intoxication. In the latter case the intoxicant is alcohol and a miscellany of other drugs, and the behaviors reverberating through the crowd mob are all fight-or-flight. I am reminded again, as if I needed reminding, why we tell our patients to stay out of bars and to take certain precautions if attending a gathering of people who will be drinking. We know that behaviors can be infectious.  The invitation to drink that exists in such a crowd may not be overt but it is powerful.  The same sharing of behaviors that we count on as being mutually and positively reinforcing (group, milieu therapy, twelve-step programs and meetings) can without controls and covenants be completely destructive. Think Sack of Rome, pillaging of Britain, rape of Nanking, all making reference to the drunkenness of the invaders.  It is again the intoxicated mob, the prefrontal inhibitory cortices disrupted not by ethanol last week but by an endogenous catecholamine.

(Footnote:  The one American death in the last occupancy of the Capitol, by the British in 1814, was that of a grand-nephew of George Washington, John Lewis, who was believed to have been drunk when assaulting a British soldier. [Good C, Smithsonian Magazine 08 DEC 2016])

- Editor-in-Chief: Dr. William Haning, MD, DFAPA, DFASAM