The U.S. leads the world in drug consumption. Why?
Plus: How often should you get screened for cervical cancer + The role of psychedelics in mental healthcare + What’s “mechanism of action”?
Welcome to Doing Well. Today:
A Q&A on the role drugs occupy in American life, and how they shape your own health
An event on the use of psychedelics in mental healthcare
Word of the week: “mechanism of action”
How often should you get screened for cervical cancer?
Breaking down misconceptions around ADHD and gender
We Asked: What should we know about Americans’ relationship to drugs?
The U.S. leads the world in drug consumption. Some of these drugs are illicit, and others are the kind we pick up at CVS. The American approach to drugs is also a contradictory one: If measured by how much we use drugs, we love them. If measured by how we punish illicit drug use, we hate them.
In Quick Fixes: Drugs in America from Prohibition to the 21st Century Binge, Benjamin Fong, a professor at ASU’s Barrett, the Honors College and associate director of the ASU Center for Work and Democracy, dissects Americans’ relationship with psychoactive drugs—drugs that affect mental processes. Many of these drugs, including those used to treat mental health conditions like depression, can be lifesaving. But our relationships to them, as individuals and through medical systems, are complex. I spoke to Benjamin about these complex relationships, and the multilayered factors that drive American drug use. Our conversation has been edited for length and clarity.
MAL: In your book, you call America a “uniquely drugged society.” What do you mean, and how did we get here?
BF: Americans comprise between 4% and 5% of the world's population. We consume 80% of its opioids, basically all of its hydrocodone, more than 80% of its ADHD medication. So it's pretty remarkable. And if you look at 21st century consumption trends, with the notable exception of cocaine, basically every other metric of drug consumption is through the roof and rising.
MAL: What are the factors that have led to the high rates of psychoactive drug use in the U.S.?
BF: I puzzled over that question. It is in some ways the central question of the book: Why us? I don't think there's any simple answer.
One contingent factor that I would point to is that during the Second World War, and shortly thereafter, it became very important to control the world's drug supply. So not just the drugs themselves, but also different precursor chemicals and whatnot. That was one of the things that allowed the United States to have a uniquely structured and uniquely profitable and powerful pharmaceutical industry. We're one of two countries that allows direct-to-consumer drug advertising [for prescription drugs]. Those drug ads on TV are not allowed in most countries, and as a result, Americans are uniquely subject to pharmaceutical advertising.
That's the sort of supply-side factor. I would say that the real question is about demand: Why do Americans want psychoactive drugs so much? That's a really hard one to figure out. My instinct is to point to broader structural factors about American society, and those are sort of twofold. One, we're a fabulously rich nation, and the American Dream, despite it all, is alive and well, and people want to self-optimize. In that kind of situation where you have this fantasy of what you ought to be able to be doing, drugs are very appealing, because they help us move beyond our human limitations.
I would also say that the United States, amongst other industrialized countries, is fairly unique in having no real mitigating factors for the market. If you fall to the bottom in American society, you fall all the way to the bottom. In the absence of other things that might make us feel better and ameliorate our material situations, taking drugs is very appealing.
MAL: This concept of self optimization is linked to another thing that I wanted to ask you about, which is the biological revolution in psychiatry. What is that, and how has it influenced the way we medicate mental health conditions today?
In the post-War period, most psychiatrists were more influenced by Freud and psychoanalysis, and thought about mental health conditions in terms of relating back to childhood experience.
Then, in the ‘60s, ‘70s, and really solidifying in the ‘80s, there's what's called the biological revolution in psychiatry, wherein people began thinking more in terms of brain chemistry, justifying drug prescriptions in terms of certain conditions within the brain or nervous system that were treated by certain drugs. And it was partly driven by new discoveries in neurology and neuroscience. It was partly driven by the new dominance of the randomized clinical trial. But it was mostly driven by a dream, the dream that we could very precisely map mental states onto brain states and thus fix at the chemical source the things that ail us.
So all of a sudden, there's this new language that's pushed around chemical imbalances. For instance, the justification is that children and adults suffering from ADHD have something unbalanced in their brain, and what the medication does is fix it. It's a really appealing explanation. If you've struggled with impulsivity your whole life, and all of a sudden someone says, “we're going to fix this thing,” and then you take the drug and you feel radically different, it feels kind of miraculous. So that was the basic revolution, out with the old psychodynamic approaches and in with more categorical mental health diagnoses associated with specific drug treatments.
MAL: I resonate with what you're saying. As someone who's been diagnosed with depression and anxiety and taken medication at different times, the explanation given to me was framed under the idea of a chemical imbalance. It’s a straightforward explanation, and it fits into, at the same time, the de-stigmatization of mental health conditions. But what does our fixation with this theory of the chemical imbalance obscure?
BF: I think it's fairly uncontroversial to say now that the dream that I just laid out—the idea of tying mental states directly to brain states through studying chemical interactions and stuff like that—has been very expensive and remarkably fruitless. We still use these justifications in pharmaceutical ad copy. They still show you two neurotransmitters with little stuff going back and forth. They say, “this is what's happening.” It's always more complicated.
Those justifications, I think they're helpful personally. They provide that explanatory relief for a lot of people. They say, “Oh, this is the thing, right? This is the thing that will either help me with this particular problem or return me to ‘normal society,’ ” whatever that means.
The appeal is clear. But I would say that the only concrete truth we know about psychoactive drug effects is that some of them make some of us feel better some of the time.
And so I think that if we could just get beyond the sort of reductive brain language, and say: Hey, we know about these drug effects. Sometimes we might want to take them. If you are struggling a particular year with focusing in class or whatnot, maybe amphetamines could be useful to you. That doesn't necessarily mean you want to be taking amphetamines every day for the rest of your life.
So I think that what the biological revolution in psychiatry obscures is a more honest conversation about why we take drugs. They help us do things. They help us feel better. But that doesn't mean that they fix parts of our brain. And I think the idea that they fix us in some way can be really dangerous. It provides that explanatory relief, but I think it occludes other things that we could do. It also occludes negative long-term effects, especially of prolonged psychoactive drug use.
Well-Informed: Related stories from the ASU Media Enterprise archives
More than half of US states have legalized cannabis for recreational or medical use. In this episode of The Ongoing Transformation from Issues in Science and Technology, Yasmin Hurd, director of the Addiction Institute at Mount Sinai, discusses the implications of cannabis legalization for public health—and the questions policymakers should be asking themselves.
Plus: Dr. Richard Laughter identifies himself as the only Diné psychiatrist on the Navajo Nation, which spans more than 27,000 square miles in Utah, Arizona, and New Mexico. In this profile published in ICT, he discusses his efforts to fill the gaps in mental healthcare access in Indigenous communities, including by launching a produce prescription program and building a sweat lodge within his hospital’s behavioral health unit.
And if you’d like to read more about the chemical imbalance theory, check out this article in State of Mind, a partnership between ASU and Slate that explored mental health.
Well-Versed: Learning resources to go deeper
What’s the science behind the use of psychedelics in mental healthcare? In this Health Talk from ASU’s College of Health Solutions, Professor Candace Lewis, an expert on mental health and epigenetics, and Professor Sarah Mennenga, an expert on neuroscience and psilocybin-assisted psychotherapy, walk through the latest research.
(P.S. Need continuing education credit? You can get it for free through ASU Health Talks.)
Well-Read: News we’ve found useful this week
“Why Women Aren't Getting Menopause Help They Need,” by Ashley May, Axios, March 8, 2025
“Can a Vaccine Cure the World’s Deadliest Cancer?”, Plain English with Derek Thompson, March 7, 2025
“Vaccines Don’t Cause Autism. So What Does?”, by Katelyn Jetelina, Andrea Tamayo, and Thomas Farley, Your Local Epidemiologist, March 20, 2025
“ADHD Videos on TikTok Are Often Misleading, New Study Finds,” by Christina Caron, The New York Times, March 19, 2025
Well-Engaged: Take a guess!
How often do doctors recommend cervical cancer screening?
Find the answer at the bottom of today’s newsletter. In the meantime, here’s what else you should know:
Cervical cancer is the fourth most common cancer in women globally, according to the World Health Organization. In 2022, its annual death toll sat around 350,000. Ninety-four percent of those deaths were in low- and middle-income countries, a disparity that highlights the fact that screening, prevention, and early-stage treatment of cervical cancer are quite effective—the problem lies in access to those services. In fact, in the US over the past 30 years, “the number of cases of cervical cancer and deaths has decreased by one half,” according to the American College of Obstetricians and Gynecologists (ACOG), a decline largely attributable to increases in cervical cancer screening.
According to the ACOG, cervical cancer screening involves a Pap test (or Pap smear), a human papillomavirus (HPV) test, or both. These tests involve taking cells from the cervix, and examining them for abnormalities and/or the presence of high-risk types of HPV.
HPV infection causes most cases of cervical cancer, and it has also been linked to cancer in the vulva, vagina, penis, anus, mouth, and throat. HPV spreads through sexual activity, and it’s incredibly common: According to the ACOG, “most people who are sexually active will get an HPV infection in their lifetime.” This isn’t a reason to panic: Most HPV infections won’t lead to cancer; they usually go away on their own. But it is a reason to protect yourself—and vaccinating against HPV is an effective way to do so.
Well-Defined: Word(s) of the week
The mechanism of action is the technical term to describe how a drug or substance achieves its desired effect. For example, aspirin’s mechanism of action involves inactivating an enzyme, which in turn reduces the production of compounds that contribute to pain and inflammation. Sometimes, multiple mechanisms of action work in tandem.
So, next time you see “mechanism of action,” just think: how it works.
Well-Aware: Setting the record straight on health myths
Have you ever heard that ADHD is a “boys’ disorder”? Let’s break down that myth, and explore the different ways Attention-Deficit/Hyperactivity Disorder shows up across gender and age groups.
Impulsive, unmanageable, disruptive, unable to focus—people often associate these words with ADHD. In reality, people with ADHD exhibit a wide range of behaviors, and some may not exhibit these traits at all. There are three subtypes of ADHD: hyperactive/impulsive, inattentive, and combined, which includes characteristics of the first two.
Studies show that more males than females are diagnosed with ADHD. This is partly because symptoms can appear differently for women and girls, but diagnostic criteria reflect the symptoms more common among men and boys. Women and young girls often exhibit lesser-known symptoms, such as being perfectionists, crying when experiencing deep emotions, daydreaming, being shy, and showcasing repetitive behaviors like leg bouncing and nail-biting. As a result, they are frequently undiagnosed or misdiagnosed with conditions like anxiety and depression. Although men and young boys can also present these symptoms, they are more likely to interrupt others during conversations, have angry outbursts, and exhibit hyperactive, disruptive behavior. These lists are by no means exhaustive, people can experience ADHD in a plethora of different ways.
Research shows that, on average, women and girls receive ADHD diagnosis and treatment around four years later than men and boys. Girls who did not receive a diagnosis in adolescence may receive a diagnosis later in life due to adult-onset ADHD symptoms. For example, instead of having 'too much energy,' an adult with ADHD may take unnecessary risks. Rather than struggling to pay attention in class, they might appear forgetful about appointment times and bill deadlines.
It’s crucial to understand how ADHD is experienced differently across age and gender so that everyone can access the support and care they need. No one should have to struggle to understand their mind alone.
-Kitana Ford, health communication assistant and ASU student
Question: How often do doctors recommend cervical cancer screening?
Answer: Recommendations vary depending on your health history, but generally the ACOG recommends:
Women aged 21 to 29: Pap test every three years
Women 30 to 65: Three options, including a pap test every three years, a pap test and an HPV test every five years, or an HPV test alone every five years
Find a screening program near you.
Do you have a question or topic you’d like us to tackle? Would you like to share your experience? Reach out at any time—we’d love to hear from you.