I had read about a third of Johann Hari’s powerful book, Chasing the Scream: The First and Last Days of the War on Drugs, in quick snatches during my weeks of travel. I’d seen his TED talk and read reviews in the press. He’s the guy who traveled the world uncovering the damage done by the War on Drugs. He’s the poster child of decriminalization – and perhaps legalization. I liked his book a lot, and I kept looking forward to spending more time with it.
Hari is a journalist by profession, and he writes in stirring detail about the victims of the draconian punishments handed down by court systems all over the world, intended to stamp out the scourge of addiction. He writes about the mayhem and murder that keep sprouting up in the footprints of drug prohibition – resulting not from drugs but from the clashes of criminal gangs. And he writes about the feelings and beliefs of those who’ve supported, enforced, and legitimized anti-drug policies for compelling personal reasons.
Now I was about to meet him: He was designated as the chair of my final talk in Australia, to be held in the magnificent Sydney Opera House. Who was this guy? What was he like?
I had a foretaste a couple of days before my talk. We were interviewed together on a popular Sydney radio station. He was rather manic, or so it seemed in the flat silence of the studio. His answers went on too long. Isn’t it my turn now? I thought, maybe success has gone to his head. We’d agreed to go out for a drink after my lecture, but maybe that wouldn’t be such fun after all.
Then I met him again onstage. He was a delight. He introduced me with real generosity and warmth. His clever, sometimes pyrotechnic wit and sparkly knowledge of the addiction field created the perfect backdrop for my talk, and we got into an easy banter in response to comments from the audience. I started to like him a lot.
We left the Opera House and found an outdoor café – one of dozens lining the harbor in a royal road of good cheer. And I noticed a couple of times without really noticing it that he had his voice recorder on the whole time and he kept asking me questions. The guy was interviewing me! I guess I was flattered – I really didn’t mind – but by the time we parted I realized I had done all the talking. I regret that now…
Before meeting Johann, I’d gotten into an email discussion with a guy name Percy Menzies, a thoughtful and passionate man who worked for a major pharmaceutical company, a division of DuPont, for many years, training doctors in the use of medications derived from opium. This company had produced a number of well-known medicines, most important among them being Naloxone and Naltrexone, opioid antagonists which suppress the effects of heroin, making it almost impossible to OD. Now he runs several clinics combining drug therapy with counseling to help addicts withdraw, stay clean, and reconnect with their community.
Well Menzies has what can only be called a simmering contempt for Hari. Like other “pro-choice” advocates, Hari reminds us that heroin-addicted American GIs mostly quit the habit once they got back from Vietnam. Just as in Rat Park, environment mattered hugely, so addiction could be seen as a response to trauma and disconnection rather than a characteristic of drugs themselves.
But Menzies makes the following counterargument:
Yes, they came home to a “park” mostly free from fatal threats and populated by loved ones. Environment mattered.
But what mattered most was supply. In their day-to-day lives, most returning soldiers were in no position to continue scoring dope, especially not at the potency they had enjoyed in Southeast Asia. The 1980s Soviet experience in Afghanistan is particularly revealing: many soldiers found themselves addicted to the region’s pure heroin. But unlike their American counterparts, demobilized Soviet troops continued using heroin back home as it was readily available. Today Russia has one of the worst heroin problems in the world.
Menzies goes on to another potent example of why access matters so much:
Hari ignores all historical evidence that identifies access and price as the two most significant factors contributing to the spread of addiction. We as a society have known this for the longest time, yet people like Hari ignore these facts.
In his intellectual arrogance, Hari fails to consider the larger consequences of drug legalization. Returning again to Afghanistan, before the early 1980s that country had virtually no heroin addicts. Local drugs of choice were hashish and smoking opium. This was because most of the opium grown in Afghanistan was smuggled into other countries for processing into heroin. But a combination of
international trafficking disruption and supplier economic savvy relocated processing to the countries where opium originates. Cheap, potent heroin was now available to Afghans for the first time ever. As a result, today Afghanistan has more than 1.5 million heroin addicts.
Now what are we to make of this? I am very taken with Hari’s investigation of the War on Drugs. I’ve plunged back into his book, and I’m now savoring every chapter. I am taken with his intelligence, compassion, his courage, and his mesmerizing ability to write about suffering without muting the pain or descending into sentimentality. And his argument about the damage done by drug prohibition is indisputable.
In fact, Menzies agrees that criminalizing drug use and locking up addicts is inhumane, ineffective, and wrong-headed. He says:
If we…tackle the drug addiction [problem], we have to begin with decriminalization and start dismantling the ‘treatment industrial complex’. These entrenched silos of residential treatment programs, jails prisons, methadone clinics, buprenorphine clinics have to be inter-linked. Indeed, the present treatment sets the patient up for failure and sometimes overdose deaths.
This is someone whose views resonate with my own.
Where Menzies and Hari differ is on the issue of legalization. If we decriminalize drug use, then do we make drugs legal? That is essentially what happened in Portugal, and Hari sees that small revolution as a huge step forward. But will cocaine and heroin be sold in stores in my town? Do I want my kids to be able to meander down to the local smartshop (we have these here in the Netherlands — very progressive) and buy a gram of methamphetamine?
Let me know what you think. And I’ll think about it some more myself.
Informed by unparalleled neuroscientific insight and written with his usual flare, Marc Lewis’s The Biology of Desire effectively refutes the medical view of addiction as a brain disease. A bracing and informative corrective to the muddle that now characterizes public and professional discourse on this topic.” —Gabor Maté, M.D., author of In The Realm of Hungry Ghosts: Close Encounters With Addiction
Decriminalization has to happen if we are ever to get a handle on addiction. As long as it is underground and stigmatized the way it is, treatment options, effectiveness, and changing public opinion will be minimized. Changing it will remain the Herculean, and Sysyphean task it is now. That attitude (criminalization) keeps substance use outside the umbrella of other “addictive” behaviors people engage in, and diminishes interest and efforts to look at the prevention side and how these behaviors develop in the first place.
I have read “Chasing the Scream” and much by Gabor Mate and agree that decriminalization is the first step in the recovery of any addiction. Criminalizing a habit of any kind only adds fuel to the fire. People want to feel good and coping with life presents a lot to not feel good about, most of which is not necessary. It is the unnecessary pressures that piss people off enough to seek something that feels better. Criminalization just provides more pressures and limitations to peoples lives that piss them off even more so returning to what feels good is a natural response. If societies don’t start to clean up the psychological, environmental and social pressures that make life uncomfortable unhealthy habits will stay consistent. As it is many people have know idea how to cope with many of the unreasonable demands life throws at us. The unreasonable demands need to be reduced and our ability to cope has to increase. Each of us can take responsibility in the creation of both.
Re legalization: http://www.upworthy.com/every-war-on-drugs-myth-thoroughly-destroyed-by-a-retired-police-captain.
Here’s at least one problem with using Rat Park and the heroin-addicted returning Vietnam Nam vets as arguments against the disease model of addiction: state-dependent learning is an alternative and adequate explanation of the phenomenon. The morphine addicted rat got into Rat Park, drank the morphine solution, and where did it take him? The metal cage where he’d become addicted.
The VN vet shoots up back home and where does it take him? Not exactly reinforcing.
The problem is not the disease model, it’s the one-size-fits-all treatment model that it spawned. A dysfunctional potentially fatal autonomous kindled behavior pattern is a disease. Come on, you can’t just throw out OCD and depression as diseases too, which would be required. Just because you can say that habits are learned and part of normal brain function, and that addiction is a habit doesn’t mean it’s normal. Many diseases are the result of normal processes going haywire.
Of course, the important thing is not what we call it, but implications for better treatment of it, and I think we get better traction thinking of it as a brain disorder that needs fixing.
That hyphenated term sums up most of the arguments for me. We marvel at the wondrous complexity of the human brain and behavior, and then try to cram addiction into some convenient cubby hole. There is no one-size-fits-all. You can’t cram a size 12 foot into a size 8 shoe.
The difference is that addiction isn’t a habit gone haywire. It’s not like cancer, where the cell divides uncontrollably because some defunct internal mechanism. Addiction is a habit like other habits. It just reinforces better than most other rewards, and it changes the mesolimbic pathway to “overreact” to the drug of choice, causing craving and relapse.
Johann Hari is an interesting and charismatic guy. I haven’t had the chance to meet him, but I get the feeling he’s different in person. He seems to be changing his tune a bit, because when I first heard him and saw his talks, his view of addiction was a bit simplistic. He completely disregarded the “hook” factor of drugs. His example was the vets returning from war. Most didn’t keep using. Yes, but some did. There is a percentage of folks who become addicted (10-20%), similar to the percentage of rats that preferred drugs in Rat Park and the rats that were considered drug dependent in the Deroche-Gamonet/Piazza experiment in 2004. The fact that some of the rats preferred drug in Rat Park tends to get minimized. Yes, the brain can be changed back out of the addicted state, but circumstances, cravings, withdrawal, and other drug effects can make changing behavior, and hence the brain, extremely difficult.
Interesting take on Johann Hari. I’m not surprised that his views are changing with time. He’s a conscientious guy and I’m sure he’s gotten a lot of bounce-back from his book and his interviews.
Sure drugs have a “hook” factor. This was actually emphasized by Percy Menzies, whom I refer to in my post, in his correspondence with me. And physical addiction (withdrawal symptoms) is a critical factor, as you say, Paul. Such factors are what make it so significant that a majority of rats and vets did quit. They were running against the wind!
Thanks for referring to this study, Paul. Also see their 2009 study.
Thanks, Marc! I am encouraged that you think Johann is able to change his views, since he is so prevalent today as the voice of addiction policy change. I agree with him that we should decriminalize non-violent drug offenses, because we are sending people (especially minorities and people in disadvantaged situations) into a downward spiral. This, to me, is a case of addiction looking like addiction, but is really being driven by circumstances.
I just think that maybe he should inform himself more on the science of addiction. I always hear Rat Park brought up but never Serge Ahmed or Piazza and their work.
Hopefully, your interview with him was insightful and he learned a thing or two about addiction and the brain!
Hi Paul. I don’t know what he learned from me, if anything. I wasn’t trying to teach. In fact I never really got the sense of why he was asking all these questions. He seemed interested in the politics more than the science and asked a few questions about Nora Volkow.
In any case, contrary to all our suppositions, he’s really deep down an investigative journalist who found a topic that needs investigating. Not a drug specialist. He says his next book is likely to be a biography of Noam Chomsky!
And they call me a zealot! Nick, how many times have I heard you refer to Rat Park and the returning vets phenomenon as state-dependent learning? For anyone reading this, state-dependent learning means that you tend to retain learning and repeat behaviours more in the same environment in which you learned them (or the same “state” — e.g., mood state, hunger state, etc.). Which means that switching environments or states will weaken the learning or the behavioural habit.
So Nick, here’s a though experiment: take a bunch of rats who learned their addiction in rat park (the nice environment) or a bunch of addicts who learned to be addicts in the suburbs, and transfer the rats into isolated cages and the addicts to Vietnam, and make sure they still have the choice to use or not to use. If state-dependent learning is all that’s going on, then their addictive behaviours will drop in frequency or disappear entirely.
Is that what’s likely to happen?
And no, I don’t think normal depression is a disease. Although bipolar disorder is a disorder…. And as far as OCD….no, I don’t see that as a disease either. Even though it can be really debilitating. I know lots of people with wacky personality patterns that get them in a lot of trouble…but I wouldn’t call them diseased.
Anyway, why are we talking about disease again? I’m trying to put my past behind me.
No, no, no, 1000 times no. If they learn their addiction in the pleasant environment and carry it into the unpleasant one, the addictive behavior is at least as, if not more, reinforcing.
And, jeez, if you want to put the ‘disease’ stuff behind don’t subtitle your book ‘why addiction is not a disease’.
P.S. What do you think of Peter Christ’s arguments?
Oh so now it’s about reinforcement, not state-dependent learning. Ahem, would you like to decide which mechanism you’re proposing? Cause if it’s reinforcement, then you have to admit that socialization is more reinforcing than addiction and that’s why the rats dry up!
I’m trying to put my past behind me since last week. Just joking actually.
P.S. Who’s Peter Christ?
Let me think about that.
Peter Christ is the retired police capt in the link I sent in the first email in this chain, talking about legalization.
Hi Nick,
I finally went to the link you sent, the interview with the retired police captain. Fabulous stuff! What a persuasive, logical and insightful position. Thanks for bringing this to our attention.
By the way, I think your reference to kindling is right on, and it obviates both the state-dependent learning and reinforcement explanations. Kindling is simply a product of repeated exposure to stimuli associated with high emotional arousal.
At least you and I agree on a few things!
Lee Robins (PI for the Vietnam study) concluded that availability was the primary explanation for the high prevalence of addiction in Vietnam, but not upon return. Those who re-addicted upon return had had drug use histories prior to their time there, but even then many did not stay addicted in the U.S. She rejected the explanation that Hari provides: that the trauma of the war led them to use. Most used early in their time there, and use did not increase with combat exposure. (For more, see the published copy of a lecture she delivered on this, in Addiction, 1993.) On a side note, while Robins is still revered, I have not once heard this study mentioned at her home institution. It is not entirely clear why, though one can speculate.
Regarding decriminalization v legalization, Mark Kleiman and colleagues wrote an excellent book on this, Drugs and Drug Policy: What Everyone Needs to Know. They are not in favor of legalization for most drugs, except marijuana, which would need to be highly regulated. Their concern, if I recall correctly, is that with legalization it will be too difficult to prevent the commercialization of drugs, especially in the US. We have to question whether we want anyone to make a profit off of people’s addiction, as has happened with tobacco and alcohol.
You’re absolutely right about the Robins-led Vietnam Vet study (I’m looking at my hard copy of the abstract of that 1993 lecture), the results of which have been misinterpreted too many times to count, including by Hari himself. I highly recommend that anyone truly interested in learning more about heroin addiction read it, which you can do here:
http://www.rkp.wustl.edu/VESlit/RobinsAddiction1993.pdf
It is a fascinating read. There are so many interesting findings in that study that seem to contradict many common beliefs about addiction, that it’s amazing there have been no serious follow up studies since. Highlights include:
1) narcotic (heroin) use and addiction were extremely common in Vietnam (though, importantly, NOT as common as use of alcohol and marijuana), availability being the main explanation, but those with a history of “deviant” behavior, including prior drug use (chiefly alcohol), before Vietnam were particularly at risk;
2) addiction was rare and brief after the soldiers’ return, even when men continued to use after returning (so abstention was not a key to recovery), despite the fact that only a tiny percentage had received any treatment upon return (so treatment did not explain the remarkable recovery rates);
3) the tiny percentage of Vietnam soldiers who DID receive treatment had as high a relapse rate as civilians (roughly two-thirds);
4) heroin was not found to be an especially dangerous drug (after taking into account pre-service histories and concurrent use of other drugs)
5) to quote Robins herself on the issue war stress/trauma: “the argument that addiction in Vietnam was a response to war stress, and therefore remitted on exit from the Vietnam war theatre, is still frequently cited as though it were self-evident, because it sounds so plausible. Yet accepting this argument is difficult in the face of the facts: heroin was so readily available in Vietnam that more than 80% were offered it, usually within a week after arrival. Those who became addicted had typically begun use early in their Vietnam tour, before they were exposed to combat. Further, the dose-response curve that is such a powerful causal argument did not apply: those who saw more active combat were not more likely to use than veterans who saw less, once one took into account their pre-service histories. While combat had little effect, deviant behavior before service was a powerful predictor . . . So was pre-service drug experience; the greater the variety of drugs used before entering service, the greater the likelihood that narcotics would be used in Vietnam . . . Finally, when we asked the men why they used heroin, they did not tell us that they were overcome by fear or stress. Rather, they said it was enjoyable and made life in service bearable.”
But the results of the study raise more questions than the answers it provides, most importantly (to me), did the study fail to distinguish between those dealing “merely” with physiological dependence as opposed to those struggling with a full-blown addiction? Robins herself seems to suggest as much in the 1993 paper: “to see whether that claim [addiction] really meant physiological addiction, we asked for frequency and length of use and withdrawal symptoms. Those who claimed addiction had almost all used narcotics heavily for a considerable time and suffered the classic symptoms of withdrawal for at least several days. We concluded that their claims of addiction were correct.”
Moreover, the rates of vets who continued to struggle with addiction after returning home are remarkably similar to the rates of those who develop troublesome addictions in the general population, a number that seems to have remained relatively constant over a long period of time, near as I can tell.
If the Vietnam vet study is really a study of the effects of physiological dependence, then we’re right back where we started with the puzzle of the more recalcitrant nature of addiction.
As I mentioned before I found Hari’s book compelling.
Deciding about decriminalization is easy– legalization less so . And can watch the outcomes of marijauna legalization as it unfolds – seems positive so far
Yet the harder drugs?? Very much more problematic . but there is time to move forward and hopefully do it right
What we are doing now sure isnt working and thats enough for me to strongly urge for change
Thanks to Hari for making it much clearer- at least for me
Decriminalize, legalize,squash the disease model, and get authoritarian medicine
( MD’s) out of the picture. Let the psychologists help manage those who will get into trouble which should become less problematic if we properly use the resources for prevention
I agree that decriminalization is easy, legalization….not easy at all. Conceptually or practically. But there are a lot of things that are legal that are not readily available. Like booze for minors — in theory. Like prescription drugs. If hard drugs could be treated similarly to prescription drugs…would that have a chance of working? I feel stymied by the problem at the moment.
But you are right that any kind of change has to be an improvement. And I’m partial to psychologists as well.
Susceptbility and availibilty are, at least, two components that increase risk for engaging in drug use behaviour. Perhaps one has to look at what is it that makes a person susceptible. There may be biological, psychological and/or enviromental factors at play. However, whenever a segment of society rather that be a single entity, group or organized association that focuses on money and power they a way of making available those things that can do more harm than good.
Addiction as well as other social problems are “Our” problem, holistically, we are all part of the problem as well as the resolution. No different than Nicotine and the sale of tobacco products that kill approximately 5 million people anually world wide, yet we, “the people” tolerate the contiuation of the sale of this product despite the scientific evidence that if used as directed will probably kill you and possibly others due to second and third-hand smoke.
Addiction, in my own personal opinion, is the symptom, what is the problem? For many of us, using alcohol and/or other drugs, was a form of resilience perhaps given other alternatives. Alcohol and other drugs provided, for me, release and escape from the mundane and perhaps stressful conditions. Without question, abusive use of alcohol was modelled within the context of my family and the idea of social drinking, for me, meant getting polluted and usually every time blacking out.
“The War on Drugs” even sounds ridiculous and many very good people with bad problems (addiction) were instituionalized (jails and prisons) which in my opinion is criminal itself. “We”, all of us, need to ask better questions in terms of ridding society of addiction problems. It’s not “us and “them” yet many people feel that way.
We all have difficulties, yet, many will never turn to alcohol and other drug use in order to solve or cope with problems. So! if being human means that sometimes I will struggle throughout the stages of my life wouldn’t it seem reasonable to assume that if drugs were made readily available and legal I would somehow be more susceptible?
Again, once a person benefits from use and the drug is made much more available developing an addiction is more likely.
Just a thought!~
See the Economist:
Unethical journalism—The depressing tale of Johann Hari
http://www.economist.com/blogs/bagehot/2011/09/unethical-journalism
People can change. It seems he has done his research and made damn sure to not repeat the same mistakes. I’ve learned to give people a chance, because in the addiction field, you are screwed if you automatically discount someone because of their past.
Right on.
The details may be skewed or spun; he may have taken some licence and liberties with facts in the interview; yet
Bottom line message is the War of Drugs is a disaster and
We urgently need to address the problem in new and compassionate ways
Marc, I think one of the reasons you feel stymied by this issue is because you are a psychologist and not a legal scholar. I may be wrong, but I’ve come to the conclusion that this is an issue that has at least as much to do with law as it does with the study of human behaviors including addiction. Isn’t it a question of law when as a society we restrict people’s freedoms and behaviors even if for “their own good”?
In this specific case, first, I don’t know enough about the difference between decriminalization and legalization. Going beyond the semantics, I would ask if we remove criminal consequences of using and/or selling drugs, where does that leave us? What would be comparable to this situation, in which something doesn’t have criminal consequences but is illegal? Does decriminalization necessarily then imply legalization? If so, then I would think it would have to mean legalization with restrictions. But then, what restrictions? You gave the example of prescription drugs. But those are given out by doctors, which would not be appropriate with “recreational drugs,” especially as we’re doing away with the ‘disease model.’ 🙂
If drugs across the board are going to be legal, what exactly would that mean? That people could buy, sell and use out in the street? I don’t know if this is already going on, but legal scholars and psychologists need to work together to reach a mutually acceptable outcome on this issue, because as you imply, out and out legality would not help most people and would, I think, do the opposite. At the same time, the way it is now is also terribly imperfect and harmful. Obviously, it’s not a black and white issue.
Interesting debate. This is starting to get to the reality of the matter, which is that this is a POLITICAL issue. The details of the science will never be finally decided, but there seems to be a rising tide of agreement that the drug war does not have an upside.
On the issue of legalization vs decriminalization: why get hung up on one size fits all? Cannabis should be legal as it is pretty much harmless. Like most potheads I smoke quite a bit (for relief of MS symptoms and just because I like it) but when I travel and have no supply, I have no reaction beyond it would be nice to have pipeful, then I pour myself a whiskey. Surely that is not addiction.
On the other hand you could just decriminalize meth, heroin, etc. I think it’s a bad idea to sell crack in corner stores. Decriminalization would have downsides, but it would be better than jailing addicts.
There is no final answer. People will always want drugs of all kinds. Harm reduction: the best we’re ever going to get. I think it’s a trap to get hung up on policy details. End the drug war, then fine tune the policy. Accept that its messy. Like the Affordable Care Act it’s imperfect, but better than no Affordable Care Act.
One thing I see missing from the conversation, or maybe it’s just so obvious as to be negligible, is the very existence of the technological ability to produce and distribute highly purified and potent forms of “addictive” substances. (Similarly to how refined foodstuffs have been implicated in food addiction and obesity, as well as other health problems.)
Once you can make (using large-scale industrial means or low cost mass labor) and distribute (via modern global travel and shipping systems) something so psycho-pharmacologically potent, keeping it controlled is like keeping the proverbial genie in the bottle. I don’t think there’s any way to counter this factor but I think it bears keeping in mind.
That doesn’t mean we shouldn’t continue to support and de-stigmatize those who struggle against addiction. I just think that trying to address the problem from the outside, by somehow limiting availability or “immunizing” individuals against their attraction by enriching their lives, is a no-win battle.
As for legalization vs decriminalization, both are still attempts to control and limit supply and distribution. Anytime there’s an attempt to control, there is room for people to find ways to get around those controls and profit from them. I agree that putting people in jail for using or distributing small amounts is crazy. But large-scale traffickers are criminals, engaging in destructive and anti-social business practices and probably the only way to stop them from continuing is to put them behind bars. Though many apparently sometimes are still able to continue their business there. But that’s another problem.
I love how you, Marc, are able to address the social, political, theoretical, medical and legal aspects of this topic and yet not ignore or lose sight of the individual stories and struggles. Julia
I run a lot of recovery groups throughout the week, and often the discussion turns to AA or something else, and why they’re wrong, and argue about whether addiction is a disease, and blah-be-dee blah, blah blah…. Now I’m finding it to be more a distraction from recovery than anything else, and wasting precious time people could be using to work on methods to help themselves. If I’m in a detox, it doesn’t matter whether it’s a disease or not.
I have to admit that my mind is mixed about what limits, if any, we (collectively) need to enforce around drug use. Half of my original family — both parents and my youngest sibling — are dead: all due to addiction, the effects of which accumulated into fatal disease.
It’s such a tangle, our innate need to alter our consciousness, to experience brain-states beyond the ordinary … and how we can blast through all natural limits that would curtail overuse. We humans aren’t the only creatures who like to play with altering our perceptions and consciousness … Think of cats and catnip, and bears (to name just one mammal) who get loaded on fermented berries and fruits! Right now, mid-September, they’re getting bombed in the boreal forests … 😉
Each of us approaches addiction from our unique framework … Mine tends to the relational and neuropsychological (especially trauma studies). When I think of my late relatives, what strikes me most is the devastating isolation and loneliness each lived with. All were shattered by relational losses … and surely there were historical / genetic / learned components as well. I myself was well on my way to alcoholism by the age of 18 … and my mother, bless her, intervened. Nowadays, the last thing I want if I’m needing escape from the human condition is a drink.
I keep thinking of a linguistic link that I learned of when I was exploring what the word “addiction” means. It’s related to “devotion” … and I thought, “Addiction is devotion, deranged.”
What do we all want and *need* most of all, beyond the biological basics of survival (air, water, food, warmth, shelter)? — Relation. Bonded, intimate, stable, loving relation. I think of Harry Harlow’s rhesus monkeys, who, through cruel experimentation, were forced into attempting to bond with wire-constructed “mothers.” The baby monkeys whose “mothers” were naked wire became utterly despondent and crazed. Those whose “mothers” were draped with a towel clung to the “mothers.”
It doesn’t take much for us to attempt a bond … with whatever or whomever is available. Beyond our innate desire to play with our consciousness through whatever feels good (as you wrote of so eloquently in your memoir, Marc), I think that the state of our relations is pivotal in addiction … especially if we are deprived of them early in life (again, you wrote so powerfully of how being shipped off to a faraway boarding school was the genesis of your own addiction, Marc).
Relations with others … relation with ourselves. Marc, in your last chapter, you wrote of a “wisp of self-love” and the moral power of saying “No.” “No” can be a YES. YES to genuine, safe, sustained bonds. YES to something that genuinely warms us, through and through … including enough befriendment of ourselves that we can reach for something other than artificial “bonds” that can bind us to death.
There’s no easy, or one, answer. I’ve not read Hari’s book … I will.
Decriminalization / legalization … It’s a crap shoot, yes? On the one hand, potent substances are legal (alcohol, nicotine, marijuana in some places; opiates and other drugs for medical use … and who knows what might come of recent studies that show how Ecstasy is moderating symptoms of PTSD) … on the other … What limits on use can be reasonably imposed, if some individuals cannot reasonably impose them? There is so much derangement and violence that arises from substance abuse … and it has broken my heart (and sometimes terrified me) many times over to witness what unregulated use (regulation either from outside a person or within) can do. To criminalize addiction: No. It only deepens the shame and pain; only incites further abuse and its horrific ripple effects. “The War on Drugs” is more another form of war that humans inflict on one another … Somehow, to stop doing battle is a first step … Every addiction ends up being a story, a history, a life deeply scarred.
No easy answers … We just keep prodding away at the questions.
Drug policy can be considered as a dichotomy of prohibition on the one hand and unfettered legalisation on the other. Whichever would be worse, it is about striking a ‘balance of regulation’, but the policy options of prohibition, decriminalisation or legalisation are too simplistic to truly find a ‘solution’.
Consider alcohol – possibly the most harmful drug but its under-regulation in the UK/US mean it is widely available at very cheap prices. This leads to fairly high levels of societal misuse and addiction, but also with many economic and social benefits at the same time. Is the balance right? Not in the UK, but we don’t want to swing it so far as to drive an underground market. Tax, minimum pricing, licensing, advertising, legal age – all policy levers that could be applied to influence the balance of regulation for any drug. Of course politics and vested interests are often the enemies of balanced policy.
So no, we don’t want any recreational drugs easily and cheaply available in the local store. But some degree of carefully regulated access is better than undergorund market forces..
James, that’s a really helpful and, well, balanced, synopsis. I think you’ve captured the unresolvable tension between these two polar “solutions” and proposed a middle ground, which, though dimly lit and rife with difficulties, is the place we have to travel to in order to fix things. At least in order to use our intelligence to come as close to fixing things as we can.
James, I like that you point out that this issue really exists on a spectrum between outright prohibition and unfettered legalization. Ethan Nadelmann of the Drug Policy Alliance sees it similarly and offers one of the best analyses of this issue that I’ve ever run across and would highly recommend checking out their website and some of his interviews (available on Youtube and the DPA’s website). Here are a couple of his best. In the first, he talks about the optimal drug control policy (about 7 minutes in):
https://www.youtube.com/watch?v=LzMoSaH-h6U
http://www.ted.com/talks/ethan_nadelmann_why_we_need_to_end_the_war_on_drugs?language=en
The problem I have with stopping at decriminalization is that many of the externalized costs associated with illegal drug transactions would persist under mere decriminalization. Property crimes to get drugs, increased gang violence, unknown drug quality, misplaced police priorities, etc. Those harms fall especially hard on people who don’t use drugs and they should be a priority over reducing harm to people who chose to take drugs.
Growing up in the US, in the Los Angeles area, the street I lived on regularly experienced drive-by shootings because we had a “non-commercialized” drug dealer down the street. While the drug war is a metaphor for some, for others the bullets are real. We definitely had more crime because drug funded gangs were plentiful. I knew three teens shot, two killed, due to gang violence, which I suspect was prohibition related. Some people don’t get this experience, so the drug war isn’t as costly for them. Some get it worse. But that’s my point, the cost is often put upon those who don’t accrue the benefit. Decriminalization would continue this.
That’s not to say drug addicts or problem users can’t cause harm to others and reducing addiction isn’t a decent goal. But have we really reduced addiction, or just distorted it? In the US one of our drug use reports is the SAMHSA report (http://www.samhsa.gov/) which you are probably familiar with. If you look at the 2013 SAMHSA report (figure 7.1 if you are really looking), from the period 2002-2013, we have not substantially changed the overall number of addicts when you include alcohol addicts in the calculation. The combined number of alcohol and illicit drug addicts stayed relatively steady, between 20.6 million to 22.7 million. By the way, I am using “addict” as a substitute for the DSM IV substance dependence or abuse category used in the SAMHSA report. I realize that’s not a perfect measurement of addiction. If you look at the mix of addicts in the overall addict population, over that same time period the mix is about 68% alcohol addicts, 19% illicit drug addicts, and 12% both. It remains relatively steady at those rates.
So maybe drug prohibition is most effective at making sure potential addicts chose alcohol over other substances. Is that really wise? I wonder if that’s true in other countries.
What if we could change those percentages, and steer addicts to drugs which though harmful, are more risky to themselves. What if we could reduce the number of victims of drunk driving and gang violence, but our cost would be more opioid overdose deaths? Of course, it’s a tradeoff, and I agree it would be scary to have a smartshop your kids could wander into and buy meth. But the illegal drug dealer on my corner was pretty scary too.
You’ve raised some important points here.
And let’s not forget the problems in countries such as Honduras, which is heavily involved in the international illegal drug trade, and which currently has the highest homicide rate in the world, partly as a result of that illegal trade. Not to mention how the opium trade in Afghanistan fuels terrorist activity. I’m sure there are other examples, these are just two I thought of at the top of my head.
Also, there is the whole ‘the harder the prohibition, the harder the drug’ problem. Even with alcohol prohibition, one could see those who drank turning to hard liquor at the expense of the arguably safer wine and beer. Same with opioids really. From smoking opium or taking laudanum you get to shooting up morphine or heroin which is a lot more easily transportable.
No wonder Iranian authorities are now seriously considering re-legalizing opium.
So let me get this straight: Menzies claims that stress is exaggerated as a source of addiction, and as a counterargument offers the situation in…
1.Afghanistan, a country ravaged by war in the last decades.
2.Russia, a post-socialist country which has barely recovered from 90s century transition chaos; and which, by the way, has a much higher rate of alcoholism than the US, despite comparable supply systems.
Makes total sense.