The Variety of Substance Involvement

I've been surprised at the variety of patients I'm seeing. They range in age from 18 to 75. I'm seeing patients for depression, anxiety, bipolar disorder, ADHD and many other problems. But many of my patients have some problematic involvement with alcohol or other substances. Use of intoxicants is of course very common, even here in the US, where we have the highest rate of abstinence from intoxicants of any other developed country. But these intoxicants "tickle" our reinforcement and pleasure centers in the brain enough that many are drawn to them and subsequently, some become overly attached to them. Either to cope or simply for the pleasure. We experience potentially "addictive" experiences daily: donuts, candy bars, soda, ice cream, orgasm, alcohol, other drugs, etc. A long time ago, I concluded that from an evolutionary basis, we are not far from ancestors who had no self-consciousness. They may have had language and culture, but not reflective self-awareness. Reflective self-awareness is both a blessing and a curse, but once it's there, it can't be undone. So I guess it's "get over it." At any rate, the ability of some self-reflective consciousness to assert control over more basic impulses, urges and patterns is quite new and relatively undeveloped. So it's no surprise that it's partial in all of us, and that self-regulation often fails.