Nora Volkow, Director of the US National Institute on Drug Abuse, shaped the debate with a simple, uncomfortable statement: Addiction is not a character flaw but a brain disease. Those striving for high performance, clarity, and longevity should pay attention here. Many myths about "smart" or "controlled" use persistently linger—and they cost energy, health, and often years of productive life. This article dispels widespread misconceptions and shows how scientifically-based prevention, social support, and accessible treatment can protect real performance resources.

Psychoactive substances alter perception, mood, and behavior. These include illegal drugs as well as misused medications and alcohol. The polydrug usesimultaneous use of multiple substances, which generates interactions that even professionals cannot always predict reliably, is often downplayed. Also underestimated: adulterationadditives or contaminants in illegal substances, which can change potency, toxicity, and risk without notice. Particularly relevant for high performers is the concept of cognitive reservemental resilience through neuronal networks, which can be undermined by repeated intoxications, sleep deprivation, and neurotoxic effects. Understanding means recognizing that not only is “whether” risky, but especially “how, with what, and under what circumstances.”

Polydrug use is not a "booster" but a risk multiplier. Reviews on MDMA interactions show that the combination with medications metabolized via CYP2D6 can favor acute and life-threatening toxicity—especially with repeated doses ^[1]. Similarly, data on synthetic cathinones indicate pharmacological and pharmacokinetic interactions with alcohol, cannabis, nicotine, and cocaine that can amplify negative effects and impair cognitive and emotional functions; case reports even show persistent psychotic symptoms after repeated use ^[2]. Adding to this is an invisible risk: Adulteration. An analysis of samples seized in San Diego identified not only fentanyl, methamphetamine, and heroin but also 52 different additives—including pharmacologically active substances like xylazine and tramadol. Such contaminations increase the likelihood of unpredictable side effects and overdoses ^[3]. For performance, this means a higher risk of arrhythmias, cognitive deficits, sleep disturbances, and long-term stress system dysregulation—all antagonists of focus, recovery, and longevity.

The treatment side offers a surprisingly positive message: Medications for Opioid Use Disorder (MOUD) significantly reduce morbidity and mortality—even in complex patient groups such as individuals with liver, kidney, or heart diseases, HIV, in the peripartum period, or with concurrent use of alcohol/benzodiazepines. Methadone shows the highest retention in treatment but requires close monitoring; buprenorphine has a favorable safety profile and fewer clinically relevant interactions; depot naltrexone is selectively suitable after established abstinence but is limited by initiation barriers. The central statement: MOUD should not be withheld due to fear of comorbidities; gaps in care—especially among youth—must be actively addressed ^[4]. On the prevention side, European and international evaluations indicate clear yet differentiated effects: Programs like Unplugged reduce cannabis use and heavy drinking in the medium term; IPSYcare strengthens school connectivity and reduces alcohol and tobacco use in the long term; Preventure is particularly effective among high-risk groups but is less generalizable ^[5]. A hybrid approach combining e-learning with face-to-face training demonstrably reduces the abuse of prescription sedatives and increases risk perception regarding non-prescribed painkillers and stimulants ^[6]. Scoping reviews emphasize that development-sensitive, context-adapted school programs are effective, but their long-term sustainability depends on the quality of implementation and local adaptation ^[7]. Finally, qualitative research in the homelessness setting shows that peer recovery support builds trust, facilitates access to the system, and has harm-reducing effects—challenges remain regarding role clarification, supervision, and funding ^[8]. Taken together, the common thread is clear: Risks increase due to polydrug use and adulteration, while precise prevention, peer support, and evidence-based treatment sustainably shift the curve upward.

- Start a school-based prevention alliance: Speak with school leadership/parent committees about evidence-based programs (e.g., Unplugged, IPSYcare) and demand context-adapted implementation and evaluation. Goal: Plan for a 12-15 month follow-up to secure effects ^{[5] [7]}.
- Utilize hybrid learning formats: Combine e-learning modules with classroom workshops on skills such as refusal, stress regulation, and decision-making. Evidence: lower sedative abuse and higher risk perception among youth ^[6].
- Expand peer support options: Establish or recommend peer groups (locally/online) with clear role descriptions, supervision, and crisis plans. Advantage: quick trust-building, navigation in the care system, and harm-reducing support—particularly effective in vulnerable groups ^[8].
- Actively close care gaps: Assess local offerings for pharmacotherapy (buprenorphine, methadone, depot naltrexone) and psychotherapeutic methods. Do not hesitate with comorbidities—MOUD improves outcomes even in complex cases; orchestrate transitions between clinics, practices, and digital offerings ^[4].
- Strengthen parents as a protective factor: Schedule weekly 15-minute check-ins with clear family rules ("no tolerance for abuse"), but dialogically. Observe early warning signs and utilize parent training to enhance communication and monitoring skills ^[9].
- Consistently minimize acute risks: Strictly avoid polydrug use, especially with MDMA, alcohol, benzodiazepines, or unknown "research chemicals." When in doubt, use testing services from reputable sources; however, keep in mind that rapid tests do not reliably exclude adulteration ^{[1] [2] [3]}.

The myth of control is deceptive: Polydrug use and adulteration render risks unpredictable, while prevention, peer support, and evidence-based treatment measurably protect life and performance. Those thinking long-term about high performance invest today in clear boundaries, early education, and easily accessible help—for better health, focus, and lifespan.