Mental Health Matters: Recognizing drug abuse for what it really is
March 12, 2015
Some weeks ago, a Truckee resident sent me a thought-provoking email regarding the columns I've written about substance abuse.
She wrote that most of those columns were "pro-drug legalization or anti legal consequences for drug use" and that my position on drugs encouraged "youth drug use and abuse." She said that I needed to emphasize how drugs contribute to local crime, domestic violence and drugged driving.
Here, in part, is how I responded: "I certainly know that drug use can be harmful. I also know that the criminalization of drug use in America has ruined countless lives. There is widely publicized information available on the harms that drugs do. You may not be as familiar with the less publicized research on the harms done to drug users by the criminal justice system."
I went on to reiterate that I am against the teen use of drugs and, also, those who encourage the demonization of drug users.
“We now put more people in prisons and jails than any other country in the world, including China and Russia. We have 5 percent of the world’s population, and 25 percent of the world’s prisoners.”
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My new friend wrote back, "We both agree on some points," and recommended a webinar on legalization vs. decriminalization and the industrialization of a drug.
I did listen to that webinar (Google "UCSF big marijuana — lessons from big tobacco") and can recommend it to you, particularly if you're the parent of an adolescent.
Building on my new friend's suggestions, let's look at a few chilling statistics about mental illness and drugs: According to the National Institute on Drug Abuse, the lifespan of heroin abusers is drastically curtailed; in one study, heroin abusers had an 18-year decrease in life expectancy. with overdosage and chronic liver disease as major contributors to this dismaying finding.
In another study, published in the British Medical Journal in 2013, the life expectancy of those with mental illness was anywhere from 6 to 20 years less than the general population; in one group of psychiatric patients, the gap was 15 years for males and 12 years for females.
Those with alcohol and drug disorders had the lowest life expectancy of all mental disorders — more than 20 years less than the general population.
Furthermore, if we assume that treatment provides at least modest benefit, the actual difference in life expectancy between the entire population of those with mental/substance abuse disorders, including those who had no mental health treatment, and the general population is even greater.
Mental illness/substance abuse is a killer. And because substance abuse, in particular, is a well-established risk factor for cardiovascular disease and many cancers, the numbers aren't surprising, even if they are startling.
So, why do I also write about the role of the criminal justice system in mental illness/substance abuse? Because the environment has an enormous impact on these problems.
I've previously written that 200 years ago, enlightened society used to "treat" people with mental disorders and substance abuse problems by chaining them to the walls of mental asylums. As we learned more about these disorders, we also learned that this "treatment" was perceived as punitively degrading, only serving to add further damage to already stunted and damaged lives.
Following on, the "modern" era of treating the mentally ill placed emphasis on providing a hospitable, enriching and nurturing environment, allowing for physical exercise, intellectual stimulation, talk therapies and medications ( See "Alex Beam, Gracefully Insane, 2001").
That changed with the invention of the "War on Drugs" in the 1970s. Now there are many more mentally ill in lockups than in mental institutions. We now put more people in prisons and jails than any other country in the world, including China and Russia. We have 5 percent of the world's population, and 25 percent of the world's prisoners (See "The Prison and the Gallows" and "Caught," both by Professor Marie Gottschalk).
The money saved by closing mental hospitals and defunding other mental health treatment resources has long been eclipsed by the cost of an expansive prison and jail population with its attendant probationary system.
It's estimated that half or more of the incarcerated have substance abuse and/or other mental illness problems. Attempts to provide woefully underfunded "rehabilitation" in the prison environment have, in the main, been an abject failure.
Here are the results of a few other academic studies:
1. The mortality rates for released prisoners is much higher than the general population (Rosen, D., "American Journal of Public Health," 2008).
2. In the first two years of release from incarceration, the death rate is 3 and 1/2 times higher (Binswanger, I., "New England Journal of Medicine," 1/11/07).
3. The mortality rate in the first two weeks after release from incarceration is 13 times higher than the general population. The likelihood of dying of an overdose is 129 times higher than the general population in those two weeks (again, Binswanger).
4. There is a high risk of suicide shortly after prison release ("Psychological Medicine," 2010).
So, we can agree that drug abuse harms people. Whether these people should be under the supervision of the criminal justice system through incarceration, probation, parole or drug courts is a wholly different issue.
As the science of drug abuse and addiction has progressed, so too has our understanding of the appropriate treatment of these problems.
Any social and governmental policy that recognizes drug abuse for what it is — a derivative of mental health problems — and supports humane treatment interventions will be a sea change of improvement over our current dehumanizing system of criminalizing drug possession.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. His column focuses on drugs, mental health and substance abuse in an effort to raise better awareness. It appears every other week in the North Lake Tahoe Bonanza and Sierra Sun. He can be reached for comment at firstname.lastname@example.org.