What if more—and more open—use leads to fewer drug problems?
We live in a strangely schizoid society. Alcohol is legal so eventually most of us drink and enjoy drinking. Yet, we are preoccupied with the dangers of alcohol—no organization has greater prestige and acceptance in America than Alcoholics Anonymous, which conveys the view that alcohol can be deadly and uncontrollable.
What message are we sending to young people? Is alcohol good or bad? Now, we have added marijuana into this confusing mix. Until recently, marijuana was illegal and we could safely declare to kids that it was unhealthy and bad.
In America, this confident assertion about substances is undergirded by science. This is the “science that shows addiction, whether it’s of [sic] drugs or alcohol, significantly changes a person’s brain. These changes result in compulsive behaviors that weaken a person’s self-control, qualifying all of it as a complex, chronic brain disease. »
Addictive brain disease theory is expressed most forcefully by the director of the National Institute on Drug Abuse, Nora Volkow. Based on it, Volkow « watches anxiously as the country embarks on what she sees as a risky social experiment in legalizing marijuana…The legalization process generates a much greater exposure of people and hence of negative consequences that will emerge.”
The results of America’s experiments in drug legalization are already starting to come in. And they disprove Dr. Volkow’s vision of drug use, propagated in America since the Harrison Act made drugs illegal in 1914. Adults flock to Colorado to buy and consume marijuana. And they seem to be doing fine. The worries people have are unsubstantiated. Traffic fatalities, in fact, are down in Colorado, as is violent crime in Denver.
In a state like California, the results may be even more interesting. In 2010 California decriminalized possession of marijuana and reduced the penalties to a small fine. This reform included use by young people. As a report from the Center on Juvenile and Criminal Justice made clear, fewer young people and adults are being arrested for drug charges. Other measures of youth health and non-criminality have also been positive: “Non-marijuana drug arrests for California youth, meanwhile, are also down 23 percent.” Drop-out rates have also dropped!
These findings have led to the greatest experiment of all in the most populous and diverse state in the nation. By passing Proposition 47 last November, Californians decriminalized possession of small amounts of cocaine, heroin, and meth.
The argument can now be made that dealing with drugs rationally—not overselling their effects or prohibiting their use, thus bringing their use into the open—is actually beneficial; even those who choose to use drugs are less likely to use them compulsively or to be overwhelmed by their use under this regimen.
Prior to 1914, prominent people, like Sigmund Freud and William Halsted (the pioneering surgeon) had their own ups and downs with cocaine and narcotics, and surely there were drug excesses. Addiction is real—even though I believe it is not a brain disease. But, for the most part, people regulated their drug use, quitting (as Freud did) or controlling their use (like Halsted) when they encountered problems.
The idea that drugs fall into a special forbidden, uncontrollable category because of their special addictive effects has been rejected by the very people who invented it. That is, the APA Board of Trustees who hold the final approval for the criteria in the newest edition of the American Psychiatric Association diagnostic manual (DSM-5), which does not describe drugs as addictive, but only in terms of the severity of substance use disorders.
Meanwhile, the DSM-5 categorizes only one thing as addictive—gambling, while holding out the possibility of the addition of video gaming, among others that are up for debate. The DSM currently rejects the idea of sex addiction.
How can we summarize this baffling state of affairs? While official, medical America—and most of the general public—thinks there is something called « addiction caused by heroin and an unspecified number of other drugs, » American psychiatry, and most Americans, believe addiction is not limited to drugs. At the same time, we are accepting the idea of letting people decide for themselves whether or not to use drugs.
Our current experience with drugs and addiction reflect on our history with alcohol. We know alcohol can be addictive and believe there is such a thing as alcoholism. We know that most people drink without becoming alcoholics, we know that—at some point, perhaps earlier than we wish—most young people will choose to drink.
Somehow, we have to knit all of these threads together into a society in which people drink and use substances sensibly, without hurting themselves and others. What will a sensible, substance-using, but not overly addicted America look like? There will be a wide variety of psychoactive substances, both pharmaceutical and non-medical, readily available to people, along with a range of compelling things in which people may immerse themselves (think virtual-reality video).
In fact, this world is already upon us, however we decide to deal with it as a society.
And only a small part of dealing with it will involve treatment, including Betty Ford-type rehabs, AA, SMART Recovery, and Moderation Management. These are the mechanisms for dealing with the people who have been overwhelmed by our addictive options.
Of course, we are scared by this need to raise children in a world where drugs and other addictive options are ubiquitous. This is our greatest challenge—one in which California and Colorado show a way forward. That way involves frank discussions of drugs and their effects, including what appeals to people about them, along with identifying what sensible use looks like.
Some people—and I’m one of them—present alcohol as a case where children may learn to use a substance sensibly. Of course, to some extent, we must look for such models outside of the United States in other Western nations—almost all of which, unlike us, allow young people to drink legally before they are 21.
We often hear that divergent styles of drinking in European nations are becoming homogenized. And this is true—up to a point. But substantial differences remain. A consortium of researchers conducted a study of alcohol consumption and problems across Europe. Called the European Comparative Alcohol Study, ECAS found an inverse relationship between alcohol-related social problems and the amount of alcohol consumed in a society.
In other words, heavier drinking countries—Southern European, followed by Central and Northern European countries in order of national consumption levels—had fewer drinking problems, Scandinavia the most. Heavier-drinking countries, remarkably, also had fewer alcohol-related deaths, which stem primarily from accidents and cirrhosis.
Ironically, perhaps, Scandinavian countries have the most stringent controls on the time and place of purchase and consumption. Indeed, alcohol in these countries is controlled by state monopolies in order to maintain such strict controls.
Like the early marijuana results, this finding seems to contradict the brain disease theory of alcoholism and addiction, which holds that the greater the consumption level, the more substance problems will occur. There is an alternative theory, however, called the social-control model. According to this model, the greater the integration of a substance into a society, the fewer problems that will occur. When drinking is done in normal contexts—rather than in anti-social outbursts—it will be guided by social custom and norms.
Thus, in Europe, insofar as alcohol goes, and in Colorado and California with marijuana, the social-control model is winning. And how do children learn these norms? This is a complex and thorny question, one fraught with misgivings and fears. But, it is one that I will return to in future pieces for The Fix.
Welcome to the 21st Century on drugs.