01.03.2014 Indulgence and risk, or why indulgence has a preventive effect
The ability to cope with indulgence helps prevent addiction. The ability to indulge in, or enjoy, something is a precondition of a fulfilled life, and the ability to identify the point at which indulgence takes on dangerous dimensions will protect the individual and society from negative consequences. Individuals therefore need to possess the ability to cope with indulgence, and the community needs to have rules that set boundaries to individual freedom wherever it harms the community.
The word "indulgence" generally triggers positive associations in us, and everybody has their own quite personal idea of what indulgence is. There are many things to indulge in, but what they all have in common is that they stimulate the brain's limbic system – the "reward system". This releases hormones that create a sense of well-being and make us want to repeat the act that triggered this feeling.
If we try to imagine a life without such feelings, we immediately realise that they, or in other words, the ability to indulge, are indispensable for a fulfilled life. However, the limbic system developed at a time which, compared with the present day, offered little in the way of indulgence and in which scarcity predominated. Thus, there was little likelihood of negative effects from an excessive pursuit of pleasure.
Scarcity then, excess today
If early times were characterised by scarcity, our problem today is rather one of excess – not in the form of an excess of food, but of many other stimuli that promise us enjoyment but are also associated with risks. Nowadays, everything we need and much that that we do not need is available at any time, at least in the first world. So if somebody who is driven by the pursuit of a sense of well-being has to exist in a world that is not forced by scarcity to set natural boundaries, then it is not surprising that problems arise. Thanks to cognitive skills located in the cortex, an organ that is very young in terms of evolution, human beings are basically able to recognise that over-indulgence is unhealthy. Unfortunately, this insight conflicts with other patterns of behaviour that have been shaped over hundreds of thousands of years and under quite different environmental conditions.
It could be said, though in very simplified terms, that in the human brain a constant struggle rages between the limbic system, which is, in a manner of speaking, geared to pleasure, and the cortical system, which wants to set limits to this pursuit of pleasure because it has learned that excess goes hand in hand with great risks and their negative consequences.
As a brief digression into the world of Greek philosophy shows, however, it is not just since neuroscientific imaging procedures gave us a clear idea of how our brain functions that this struggle has engaged the attention of mankind.
As far back as Epicurus, we find texts showing that the pursuit of pleasure is very important for a fulfilled life but also entails great risks: "No pleasure is in itself a bad thing, but the things that produce some kinds of pleasure bring along with them unpleasantness that is much greater than the pleasure itself." Epicurus therefore always recommends calling desires into question: "What will happen to me if my desire is fulfilled and what will happen if it is not?" These two quotations from the third century BC contain everything modern prevention is about. On the one hand, there is the positive attitude of enjoying life to the full with all our senses and, on the other, the awareness that boundaries need to be set to the pursuit of pleasure on account of the associated risks.
Individual needs and the rules of the community
What is needed, then, is for society as a whole and its individual members to learn how to cope with the pleasures of this world in a way that is responsible, i.e. low-risk. In other words, they must be able to indulge without causing health, social or economic difficulties.
The problem is that this learning process inevitably confronts us with the question as to whether, and to what
extent, interventions in personal and
individual freedoms are necessary and justified.
The obvious importance we attach to this issue is demonstrated by society's very lively debate about the extent to which individuals can be allowed to indulge their personal pursuit of pleasure to the detriment of society and about when and how this pursuit can be controlled by preventive or repressive measures.
A modern approach to prevention must therefore not confine itself to warning against dangers and issuing threats of sanctions, but must seek to empower people to develop skills in dealing with the rich array of available pleasures and the risks these carry. In other words, people's ability to cope with indulgence needs to be promoted.
This calls for a thorough knowledge of the positive and negative aspects of the different things in which people can indulge. A further indispensable precondition of this ability is self-control, i.e. we have to learn not only where our boundaries lie but also how to respect them.
Self-control and structural conditions
Though self-control is important and fostering it is a key requirement of behavioural prevention, we also need to increase people's awareness that there are limits to self-control. Who among us has never experienced situations in which we simply cannot say "No". This is generally not a problem and may even be enjoyable, but it does not alter the fact that we are able to control our impulses only up to a certain point.
An awareness of the limited nature of self-control can teach us to avoid situations which we know from experience that we cannot resist. But it can also cause us to conclude that we, as individuals, are out of our depth and that in certain circumstances it might be a good thing if structural conditions were changed so that certain situations would no longer occur or would at least do so less frequently. This means that, as a society, we have to create structural conditions that help us make the healthier choice.
However, in a free society the setting of limits to personal freedom of enjoyment can never be an end in itself, but must always serve the purpose of improving the conditions that allow people to enjoy fulfilled lives. If we succeed, then we are making an important contribution to public health – because people with the ability to indulge in moderation also live healthier lives.
Markus Jann, Head, Drugs Section, email@example.com