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I think what drives me to drink (and I don't drink nearly as much as I used to) is dreams of a better reality, in my case of a more considerate society, contrasted with my own inabilities to take part in realizing them. Alcohol (and drugs) make it easier to think uncritically, but with potentially terrible drawbacks. I'd speculate a successful pragmatist (or someone with level aspirations) will be much less likely to abuse themselves this way.
Pretty much the same thing that drives them to write, I imagine. Pain -> Art