Why Drug Addicts Should be Treated With Warmth Rather Than Shamed

I cannot recommend Chasing the Scream by Johann Hari enough. Here is a great primer video, as well as an excellent article.

Then, there is coverage from The Atlantic about the flaws of Alcoholics Anonymous.

Conventional thinking suggests that the cause of drug addiction is chemical. This chemical addiction escalates until a person is a full-time junkie.

Of course, the basis of this thought stems from the infamous rat cage studies. While alone in a cage, with a lever that could be used for heroin, a rat gets addicted and continues pulling the lever until he overdoses.

However, there was a much less featured study that got implicitly buried. In this experiment, Professor Bruce Alexander designed a rat park, a pleasant place where rats could socialize with other rats and entertain themselves with various attractions. There was water placed in the middle, along with heroin-laced water.

What happened was surprising. Few of the rats touched the heroin laced water. Even rats from the rat cage, once introduced to the park, successfully curbed their addiction.

But perhaps rats are wired differently. What are some empirical ways actual people have been influenced?

The Vietnam War

As conditions in Vietnam got worse, a lot of US soldiers got addicted to heroin (cage). There were legitimate public worries that an entire cohort of junkies would get shipped back home.

As it turns out, only approximately 5 percent of military service members remained addicted upon their return (park). Of those 5 percent, my intuition is that many returned into unstable and traumatic lives back home.

Switzerland’s Experiment

In Switzerland, there was an experiment involving free doses of hard drugs.

Here’s what happened: any addicts desiring hard drugs could simply walk into a designated clinic and receive a clean, legal dose of said drug.

Surprisingly, addicts lived relatively normal lives: they just happened to be addicted to a hard drug.

Moreover, overdoses dropped dramatically, as did HIV infections. By extension, the overall life quality of these addicts likely went way up.

Perhaps most surprisingly, the fiscal cost was comparable to the drug war policy that preceded it.

Sadly, this experiment is no longer around, having been shut down for political reasons.

Portugal’s Full Decriminalization of Drugs

For decades leading up to 2001, Portugal followed conventional drug war policy. And the problem just kept getting worse and worse. By 1999, 1 percent of the population was addicted to heroin!

Then, in July 2001, Portugal decriminalized drug possessions for drugs such as marijuana, cocaine, and heroin. They turned drug use into a public health issue from a criminal issue.

Here were the results:

Drug-related HIV infections have plummeted by over 90% since 2001, according to the drug-policy think tank Transform.
Drug-related deaths in Portugal are the second-lowest in the European Union. Just three in a million people die of overdoses there, compared with the EU average of 17.3 per million.
The number of adults who have done drugs in the past year has decreased steadily since 2001.
Compared to rest of the EU, young people in Portugal now use the least amount of “legal high” drugs like synthetic marijuana, which are especially dangerous.
The percentage of drug-related offenders in Portuguese prisons fell from 44% in 1999 to 21% in 2012.
The number of people in drug-treatment increased 60% from 1998 to 2011 from 23,600 to 38,000.

In short, it was very successful!

The core cause of drug addiction

At its core, all addiction, including drug addiction, is an escape. It can be an escape towards loneliness and emotional, financial, or physical trauma. It can also be an escape from unhappiness towards a brief, blissful high.

Given these core causes, how we think about drug policy should change dramatically.

The Economics of the War on Drugs

The drug war is incredibly counterproductive in several ways. As police crack down on dealers, availability and supply decreases, driving prices up. Unfortunately, a higher price point simply draws in new entrants, who will fight amongst one another for dominance, leading to drug violence.

Meanwhile, all the trauma from the drug war and drug violence in drug-ridden community simply increases the pool of potential addicts, increasing demand and prices. This increases the financial ruin sustaining a drug habit has on addicts’ lives.

Moreover, since the entire business is illegal, drug dealers have every incentive to sell contaminated product in order to make more money.

In his book Applied Economics, Thomas Sowell argues that a monopoly in drug distribution actually decreased violence: whenever there are power vacuums and competition for king of the hill, that “competition” leads to drug violence. In this case, less competition is a good thing.

Here’s the thing: one of the safest and most effective monopolies can actually come from the government. Yes, you heard that right!

If that sounds too revolting, then legalization and regulation of even hard drugs will quickly decrease drug violence.

On the US Epidemic from painkilling opiates

The US has seen a rapid increase in the number of heroin users. Heroin-related deaths jumped 39 percent simply from 2012–2013; even more troubling, it doubled among 18–25 year olds and increased by 400 percent since from 2002 to 2013. Moreover, 75 percent of these users began under opiate painkillers.

Since 1999, there has been a fourfold increase in painkiller administration, even as pain ratings have not changed.

It is worth noting that most who are under painkillers are not addicted. However, economic trauma in States such as West Virginia, in tandem with our current epidemic of loneliness, has also increased the susceptibility of patients to become addicted.

Unfortunately, once the pain is cleared and/or patients are discharged from the hospital, the legal, closely monitored supply abruptly stops. With nowhere else to go, addicts inevitably must obtain street heroin, which is filled with contaminants and which leaves them vulnerable to overdose.

There certainly should be careful evaluation over whether or not to prescribe painkillers. However, even a more restricted flow does little to those who are already addicted.

Policy Reform on Fighting Addiction

There are several policies that can allow addicts to get the help they need.

The key is to stabilizing the turbulent situation of addicts.

First, addicts should be aided in anything that can combat loneliness and trauma and offer some measure of stability in life. This includes affordable housing, as well as a means of employment.

Meanwhile, their addictions should be winded down over time until eventually the addiction is stopped. Following Switzerland’s example, the government can actually be a great source for this. They would provide clean needles, monitor the situation closely, and prevent overdoses.

Whatever the case, addicts generally should not go cold turkey, which increases the severity of withdrawal symptoms. Moreover, any relapse must not come laden with guilt or shaming, for that increases the chance that addicts go back to their ways.

Should drugs be decriminalized or legalized and regulated?

Honestly, I do not have a good answer for this one.

Decriminalization allows for treatment of anyone caught, turning drug use into a public health problem. On the other hand, legalization and regulation would have an immediate effect on drug-related violence and can provide a path for the reduction of contaminants within street drugs.

Perhaps the best course of action is decriminalization for addicts and legalization and regulation for dealers.

Under neither system should the number of addicts increase. In fact, without the trauma of the endless war on drugs, drug use may actually decrease over conventional policy.

There are several factors to consider on which policy is better:

  • Effect on overdoses and HIV rates
  • Effect on overall quality of life of drug users
  • Effect on number of drug users
  • The fiscal costs of each policy
  • Effect on drug-related violence

Rethinking Drug Policy

We are currently addicted to moralizing, judging, and shaming drug users. However, that behavior actually perpetuates addiction because it compounds loneliness and trauma.

We absolutely must learn how to treat addicts with warmth, like humans. Moreover, we must reshape drug policy to make it easier to do so! Only then will addicts recover from drug abuse and go on to lead healthy, productive lives.