One of the
difficulties with putting across messages about drug use is that the problem
is more complicated than many of us would like to believe. The drug issue
usually attracts our attention through media presentations which seek to
reduce the issue to a single, instantly comprehensible message but in the
process an inaccurate and largely false impression is created. Even amongst
many drug workers and researchers, there is an avoidance of anything that
smacks of theory, and a preference for action, even if that action is based
on nothing more than personal prejudice and guesswork.
Furthermore, stereotyped and inaccurate views of
addiction are not uncommon even within the ranks of those who work
intimately with drug problems, where there is all too frequently a lack of
coherence in terms of the work carried out, and an unwillingness to consider
alternative interpretations. Perhaps most of all, there is the belief that
the ‘truth’ about the nature and causes of addiction can be revealed by
methods which rely principally on asking people to answer questions or
express opinions about their own or other people’s drug use.
However, answering questions and stating opinions are
behaviours in their own right, which have dynamics all of their own. For
these reasons, it is important to consider existing knowledge on the way
people answer questions and explain their actions, since understanding these
processes may yield fresh perspectives on the issue under investigation. The
Myth of Addiction attempts to provide such an alternative perspective in
the area of drug use and misuse. Whilst the ideas contained are not new,
they represent a species of argument which is neglected, primarily because
it is slightly more complicated than the more popular theories of drug use.
The argument presented in The Myth of Addiction is
basically that people take drugs because they want to, and because it makes
sense for them to do so given the choices available, rather than because
they are compelled to by the pharmacology of the drugs they take.
Nonetheless, we generally prefer to conceptualise our drug abusers in terms
which imply that their behaviour is not their own to control. This picture
arises because it is the picture we want to have, and the view is supported
by a body of data consisting largely of people’s self reports, opinions
and statements of belief. This body of data, whilst potentially of great
value in certain respects, is frequently put to uses for which it is ill
suited; it does not always mean what we think it means. When asked questions
by members of the research establishment, it is functional for drug users to
report that they are addicted, forced into theft, harassed by stressful life
events, and driven into drug use by forces beyond their capacity to control.
The central argument of this book is that such self reports have their own
internal functional logic which is independent of reality, and that other
research methods and forms of analysis would consequently produce a
different picture. Furthermore, the fact that the explanations people
provide for their behaviour make some reference to their own motives and
intentions is hardly new; it is a central feature of social interaction, and
not specific to drug users.
At the present moment, the standard line taken by a
majority of people in the media, in treatment agencies, in government and
elsewhere, hinges around notions of the helpless addict who has no power
over his/her behaviour; and the evil pusher lurking on street corners,
trying to ensnare the nation’s youth. They are joined together in a deadly
game by a variety of pharmacologically active substances whose addictive
powers are so great that to try them is to become addicted almost at once.
Thereafter, life becomes a nightmare of withdrawal symptoms, involuntary
theft, and a compulsive need for drugs which cannot be controlled. In fact,
not one of these things is, or rather needs to be, true. Whilst availability
is probably a major determinant of the extent of drug use, the precise form
taken by drug problems within any given society is determined in large part
by that society’s response to the problem.
Consequently, if we were to observe that within some
fairly limited time span a particular drug had become a matter of
life-and-death on the streets, this would probably indicate that the
policies we were currently implementing were extremely dangerous; more
dangerous in fact than the drugs we were attempting to stamp out.
Unfortunately, our own legislators look for advice with frightening
regularity to nations where the attempt to control drug use has had the most
grotesque and spectacular consequences, in the mistaken assumption that they
have thereby demonstrated some sort of competence in this field.
If we continue to base our policies on stereotypes and
inaccurate perceptions of the helpless junkie, the evil pusher, and the
substance with the capacity to enslave, we are already half-way to
justifying the most extreme measures in order to eliminate drug use from our
midst. If we persist in this lethal spiral, we can bring death and street
warfare into our midst, in a manner that will mirror similar developments
elsewhere.
In fact, as our beliefs about drugs and drug users are
largely inaccurate. We choose to believe in helpless junkies and evil
pushers primarily because we want to believe in them, and because such
beliefs serve functions for us. The helpless junkie only exists because we
all want h/er to exist, and because drug research continues to make naïve
use of what people say about their addictions. It is now imperative that we
start to view research based on what drug-users say about themselves in its
true light, and in consequence, to expect something more dynamic and
positive from those of us who encounter drug problems. The interrelationship
of IV drug use with HIV/AIDS makes such a new dynamic and purposive
perspective essential.
What the The Myth of Addiction says, basically, is
that most people who use drugs do so for their own reasons, on purpose,
because they like it, and because they find no adequate reason for not doing
so; rather than because they fall prey to some addictive illness which
removes their capacity for voluntary behaviour. The book then points out the
reasons why the second type of explanation is nonetheless more popular and
is generally preferred; and why scientists and practitioners frequently seek
out evidence relevant to that view rather than to any other and subsequently
impose it on their clientele for reasons that have nothing to do with
scientific knowledge. It is then argued that a different context or ‘system’
is required within which an alternative view of drug use can thrive; a view
which stresses volition and control deriving from the ability to make and
implement personal decisions.
I do not claim that drugs have no pharmacological effect,
nor do I deny that some individuals become terribly enmeshed in a cycle of
substance use and misuse, sometimes with tragic consequences. The reader
should note, however, that deaths due to illicit drug use per annum are
generally in the order of 300-400. For comparison, smoking accounts for some
100,000 deaths; and whilst figures for alcohol-related deaths are more
problematic, there are 17,500 admissions to psychiatric hospitals due to
alcohol, and the direct effects of alcohol are implicated in three out of
four of all deaths due to liver disease (The Royal College of Psychiatrists
1986; 1987). The drugs we regard as socially acceptable and that many of us
use in a more-or-less habitual fashion can hardly be regarded as ‘safe’.
The final message is that dealing with drug problems
rationally depends on giving back to people the sense of personal power and
volition which they require if they are to control their drug use for
themselves, a power which existing concepts of ‘addiction’ frequently
seek to limit or deny at the outset as a precondition to further treatment.
To take this apparently simple step, however, involves a major rethinking of
contemporary moral attitudes to drugs and addiction, since these shape the
nature of the help that we are prepared to offer. In the meantime, the
existing system does not work. There is little indication that anything on
offer at the moment does better than spontaneous recovery (that is, giving
up all by yourself); and some evidence that punitive legislative
interventions make things worse by institutionalising the type of harmful
drug use that we most wish to avoid.