Guest Column: ‘Substance abuse’ is not a crime
July 28, 2014
Medicine makes no distinction between diseases or disorders that are "legal" and those that are "illegal." Rather, practitioners of the healing arts seek to accurately diagnose maladies and then provide the best treatments for them.
But what happens when certain diseases or disorders are deemed "illegal" by the criminal justice system? When certain behaviors viewed as symptoms of disease requiring treatment by health practitioners are instead viewed as evidence of criminality requiring punishment?
In America, this story goes back over 100 years to the country's first politically driven, misguided and medically nonsensical efforts to criminalize the use of certain drugs — opium in the 1880s, cocaine in the early 1900s, alcohol in the 1920s, and later marijuana in the 1930s.
The period between 1890 and 1920 was a low point in race relations (see "Drugs, Society, and Human Behavior" by Carl Hart and Charles Kgir). Newly arrived Chinese immigrants were building railroads, Mexicans worked the fields, blacks moved north, and immigrants arrived from Italy and Ireland. This proved too potent a brew of social change for many Americans.
So, concern about crime, drugs and deviant behavior focused on new minorities. San Francisco outlawed the opium smoking dens of the Chinese; cocaine was regulated and later outlawed based partly on a belief that it caused violence in blacks; Prohibition became the law of the land; and then marijuana was criminalized based on a belief that it made Mexicans crazy.
Each of these prohibitions, save for alcohol, were based on racial fear rather than sound science or medical knowledge.
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The "War on Alcohol," i.e. Prohibition, lasted for some 12 years from 1920 to 1932 until the country realized that prohibiting the use of a substance used by millions to produce pleasurable experiences wasn't working.
The problems caused by alcohol were real enough, but Prohibition did virtually nothing to curtail them. Moreover, the unintended side effects of this disastrous social experiment included making ordinary, otherwise law abiding citizens into criminals and created a gangster industry to satisfy the people's desire for alcohol.
Now, in 2014, the production of alcoholic beverages is a regulated multibillion-dollar legal industry providing pleasurable experience to millions absent the baleful impact of criminalization.
Alcohol abuse and dependency remain a major medical and social problem, but legalization opened the doors to medical and social research leading to treatment opportunities that could not exist if drinking was a criminal offense.
Now we possess powerful pharmaceuticals and psychological therapies to treat alcoholism in humane and caring environments, the only kind of environment that has ever been shown to effectively treat substance abuse.
Alcoholism is now seen as a medical disorder rather than a form of moral turpitude or weakness of character requiring punishment. Putting aside the psychological construct of denial so typical of the early stages of alcoholism, alcohol abusers are free to seek those therapies and treatments which best meet their individual needs.
Potent pharmaceutical treatments available legally through medical prescription may be helpful. If Alcoholics Anonymous doesn't work for you, motivational counseling and group therapies provide alternative treatment approaches.
Now what happens if the drug of choice is heroin, cocaine or methamphetamine? First, unlike alcohol, you can't purchase a regulated drug of known quality. The risks of accidental overdose or dangerous side effects rise dramatically. Second, you are now drawn into a criminal culture that will prey on you and your need for the drug.
At some point, realizing you need help, where do you turn? If you haven't been arrested and convicted of "possession" of an illegal substance, there are treatment resources, but they are frequently of poor quality (see "Inside Rehab" by Anne Fletcher) and very expensive. A month's stay at some of the upscale rehab centers can run $80,000. A single visit to a physician may cost $300 to $500.
Most drug addicts begin their addiction journey in their late tens and early 20s. If they avoid arrest, some 75 percent of them are drug free by their late 20s or early 30s. Once arrested and convicted, however, their chances of recovery drop dramatically.
Why? Because the criminal justice system is not a treatment provider. Rather, the criminal justice system is built to punish criminals.
The equation is really quite simple: Punishing people with emotional problems, and here I include virtually all substance abusers because virtually all of them use substances to medicate their emotional pain, only makes their problems worse.
Once we come to understand that "substance abuse," to include all of the arbitrarily defined illegal drugs, is not a crime but a treatable mental disorder, we will all be the better for it.
Abraham Lincoln, a lawyer and arguably our greatest president, understood the ruinous consequences of certain prohibitions when he said, "Prohibition goes beyond the bounds of reason in that it attempts to control a mans appetite by legislation and makes crimes out of things that are not crimes."
We would be well advised to follow that simple wisdom when thinking about "illegal drugs."
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.