As a sceptic of the utility of the War on Drugs, I often find myself in conversations with those who deeply believe in it. In most of those conversations I have an opportunity to ask, “Why a War on Drugs?” I get several answers.
People knowing I’m an addiction psychiatrist usually start with a statement of how illegal drugs are clearly connected with sociopathy and anti-social behavior. They draw the line between illegal and legal drugs using that method with statements such as, “You don’t see the same kinds of anti-social behavior associated with cigarette smokers as you do with heroin users.” I once heard this from a former drug czar. I sarcastically answered, “Yeah, you’re right. I’ve never heard of a smoker smoking at home even though the doctor said it wasn’t good for his kid’s asthma. And I’ve never heard of anyone flicking a lit cigarette out of a car window and starting a forest fire because he just didn’t care what anyone else paid for his smoking.” He shut up after that. The argument about sociopathy is based on the act of taking an illegal substance evidencing the sociopathy. It is a circular argument, because the sociopathy is used to justify the illegality, and the illegality is used to define the sociopathy. It is the political misuse of a psychological word for cynical purposes and can be refuted.
Most people then move to the “illegal drugs attract a criminal element” argument. There’s something to this. If you make something illegal, criminals will gravitate towards it. I remember a trailer for HBO’s show Boardwalk Empire. The gangsters are at a dinner, and it’s two hours before the implementation of prohibition. The show’s lead, Nucky Thompson, tells the assembled group that in a short while liquor will be prohibited by the act of our distinguished Congress. He raises his glass and toasts, “to those beautiful, ignorant bastards.” There is no doubt that criminals are lured by profit to those prohibited items which demand the greatest mark-up. But they aren’t lured by drugs; they are lured by the profit. Those same drugs made and distributed legally offer no green fields of profit. It is not the drugs that attract criminals, but the prohibition which attracts them.
The conversation then moves on to what they are all sure will be the thing that stops me cold. It is a sure-fire argument that no logic will assail. They wind up for the pitch and hit me with their fastest throw: “These things have to be illegal because they cause addiction. You of all people should recognize that.” They are appealing to both my logic and my pride. How could they lose? Well, it turns out drugs don’t cause addiction.
Addiction, the word, comes from the same Latin root as our word “attachment.” Specifically, it comes from a Roman legal sentence that meant attachment of one to another against the will: debt slavery. We still use the legal word “attachment” today even though we don’t impose slavery on people with it. Attachment against the will is the best definition of addiction I’ve heard, and it is the most consistent with the neurobiology of addiction. I’ve outlined that already in several places, so I’ll dispense with it here. The upshot is that addiction is a primary illness and is the cause of drug use, not the effect.
There is a large body of evidence that addiction, at its core, is a single illness regardless of the reward used. There’s no evidence that addiction involving illegal drugs is in any way biologically different from addiction involving gambling, compulsive overating, or alcohol. Yet, we cling to this final rationale for the drug war, that drugs must be illegal because they cause addiction. We confuse physical dependence with addiction, which are so different that they are moderated by two different brain structures. The final idea behind the drug war, that drugs cause most addiction, is held up only by ignorance and erroneous assumptions. Yet is so powerful that it drives a $5B addiction treatment industry, not to mention the entire Federal drug budget for the drug war, research, and prevention efforts. We waste hundreds of billions a year on this assumption. Untold lives have been ruined because of this assumption. Millions of Americans have lost their freedom and hopes for employment because of this assumption. Millions have been denied treatment for an illness because of this assumption.
The assumption that drugs cause addiction is the final line to justify the War on Drugs. It is the line we cannot cross. If we cross it, we’d have to say we were wrong since June 1971, when Nixon declared the war. But it’s even worse than that, because his policies were really just an extension of all those that came before. The American government has been operating under this same assumption and fighting drugs rather than a brain illness for over a hundred years. That’s a lot of time to be doing something that doesn’t work. It builds up a lot of shame, and that shame stops us from admitting our faults. But if we don’t admit it now, how will we do it 100 years from now burdened by even more shame?
by Howard Wetsman, MD; Addictionologist, scientist, author. Principal at Idea Breeder LLC. Solves problems with TOC. Dragonsbaneproject.org Blogs at tocdr.com
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