Wednesday, April 20, 2005

More about Addiction

What to do about drugs and drug addiction has been hitting the news lately, and Charlie had some commentary on a book about it as well. As I noted in Charlie's comments, on one hand, I agree that the current approach--criminalizing (some) drugs in ways that virtually guarantee that young men, mostly young minority men, will spend time in jail or prison--hasn't been working. When there's a demand, and there IS a demand, then suppliers will arise to meet that demand. Incarcerating people for using or selling (some) drugs isn't going to change that; what it does instead is create a class of people, ex-convicts, who have even less chance of doing anything else with their lives than they had when they were 10.

Most drugs are controlled in some way in addition to the market that requires payment for them--e.g., by requiring a physician's prescription, and, in the case of what are called scheduled drugs, requiring special licensing to possess or dispense. Which drugs merely require a prescription and which are more severely restricted or banned is complicated and political--can anyone truly believe that marijuana and peyote are more dangerous than cocaine? That the former two have no legitimate use, according to our drug schedules? Know what drug causes more preventable deaths than anything else? Tobacco. Perfectly legal, no need for a prescription. Alcohol causes all kinds of problems--and it's also perfectly legal. That is, rationality isn't what's necessarily behind the way we think about "good" and "bad" drugs.

If you're going for an economic argument, treatment is cheaper than punishment (which the judge may well argue). Several states have not only set up treatment programs for people who'd been arrested/were addicted, they collected a lot of data to see what happened. What they discovered is that treatment is cheaper than no treatment, even if some people relapse. That is, take two people who have similar backgrounds, history, addictions, etc., put one in treatment and not the other. The one who receives treatment--even if it's expensive treatment--will cost less, over the long run, than the one who does not receive treatment. Would-be (or actual) addicted felons turn into productive, tax-paying citizens who pay money into the public coffers.

What's missing from Charlie's (or, more likely, Judge Grey's) account, at least so far, is the notion that drug use/addiction is something other than a merely economic problem. If you look at the judge's summation of the problem, as provided by Charlie, it's as follows:
1. Increased drug production and drug sales effort
2. Increased systemic violence from criminal drug industry, Increased drug use and use-associated crime
3. Increased public alarm
4. Increased public pressure for police protection against drugs and drug violence
5. Increased appropriations [I think that's what's meant here] for criminal justice measures
6. Increased police intervention in the drug market
7. Diminished drug supplies
8. Scarcity-induced higher drug prices and inflated profit incentive
9. Increased drug production and drug sales effort (which you will note is the same as #1, and the cycle continues)
And, of course, there's quite a bit to this. Prohibition, whether of drugs or alcohol, will almost certainly cause a spiral of consequences that may well be worse than the problems directly attributable to the use, rather than to the prohibition, of the drug. If you remove that prohibition or restructure it more rationally, then you will still have the problem of the addicts, but you will not have the problems of (a) the crimes they commit in order to find money to buy their drugs or (b) the arrest, prosecution, and incarceration of the people who sell but do not use those drugs, i.e., people whose only crime is to sell drugs. They'll have to find something else to do--and it might be equally unsavory--but at least some people who would now be incarcerated would no longer be arrested.

But what problems are attributable to the drugs themselves? Alcohol, for example, appears to be beneficial in moderate quantities, and many, perhaps most, people can enjoy it without endangering themselves or others. Marijuana is probably similar in that regard, and neither of these drugs is inherently addictive. That is, many people can enjoy the drugs in moderation for decades and never become abusers or addicts in any meaningful sense of those words.

Other drugs are more difficult to enjoy in moderation over long periods of time--cocaine, many (most?) of the opiates, and, especially, meth and its siblings, for example, can be extremely addictive, and relatively quickly. Nicotine is extremely addictive--moreso than cocaine or heroin, by some accounts (though I think there are complicated reasons for that, possibly in addition to whatever inherent physical properties the drug has). That is, individuals who use these drugs, even in moderation, can become addicted to them. For example, if I have two to four drinks per week, most people would not regard that as excessive. It doesn't impair my normal activities to drink that amount, and I could continue using that amount for many years without becoming an alcoholic. If I used cocaine two to four times per week, it's reasonably likely that I'd become addicted, that my normal activities would be hijacked by my desire for the drug, and that the two to four times/week would become more frequent. Drinking does not affect my desire to drink; using cocaine or heroin or cigarettes or meth affects my desire to use those drugs. (For alcoholics, drinking does affect their desire to drink, but it's possible to drink and not become an alcoholic.) In other words, we might well want to classify drugs in terms of the likelihood that people who use them will become addicted--but that's not what the current system does. If that kind of rationality were behind the drug scheduling process, then marijuana would not be regarded as "worse" than cocaine, and nicotine would have to make an appearance on the list. The latter, at least, will not happen any time soon.

What's missing from the economic argument, then, is consideration of some of the realities of addiction. We might argue that an infinite supply of heroin or meth would eliminate the need for junkies to commit crimes to support their addictions, but, with at least some drugs, I don't believe that's true. That is, it's the effects of the drugs themselves, not just the economic constraints imposed by addiction, that are intertwined with the commission of some crimes. (Ask anyone who's ever had to deal with a violent alcoholic spouse, or consider the motivation and ability to do productive work of someone who's addicted to meth or heroin.) Thus, we might also want to classify drugs in terms of what they do to the person who uses them or to that person's behavior. PCP, for example, seems to exacerbate or otherwise contribute to violent behavior; alcohol can certainly do that; marijuana just plain doesn't. (It's kind of funny to think about a stoner getting up the energy to get violent.) That is, the drug is harmful not just to the person who uses it (with a squishy notion of "harm" here--ALL drugs have the potential to harm), but it also contributes in some way to the possibility that the person who uses the drug will harm someone else. The federal government had been (and may still be) collecting figures on the number of people who are under the influence of some drug when they are arrested. Not surprisingly, that number is pretty damned high, and it's not just because people commit crimes to get more money to buy more drugs. Some (kinds of) drug use, particularly addictive drug use, impairs judgement and is implicated in other behavioral changes.

Finally, a hidden aspect to this whole discussion is that we are ambivalent, at best, about what drugs do for us. If someone has really disordered states of perception--schizophrenics, for example, or someone who's really depressed--we want to bring them a little closer to normal, enable them to function in the world (and not commit suicide). Our current climate says that it is not just acceptable, but preferable, that a depressed person take an antidepressant every day--but that it's not acceptable, and it's even wildly illegal, to occasionally use a psychedelic. It's okay to treat high blood pressure with a pill--rather than diet, exercise, and other lifestyle changes--but it's not okay to smoke some dope, even if said dope-smoking is therapeutic, but especially if it's purely recreational. And I think it's the "recreational" part that makes the puritans among us nervous, even though we're always playing with our consciousness: little kids spin in a circle to get dizzy, and it can be entertaining to see the world from a slightly (perhaps even drastically) altered state. All in all, though, rationality appears to play no part in our discussions, even as it's supposedly rationality that we're trying to maintain.

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