The following is a presentation given by ReconsiDer's Capitol Region chapter president Michael Roona to the Saratoga chapter of the New York League of Women Voters. Roona talks about the difference between use and abuse, addiction, treatment, and alternatives to current policy.

I have been asked to speak for 15 to 20 minutes about the causes of drug abuse, the nature of addiction, the effectiveness of treatment and prevention programs, and alternative drug policies being implemented by democratic republics around the globe. Before I embark on these topics, however, let me express my sincere appreciation to each of you for your civic mindedness. We often forget, especially during high profile election campaigns, that the highest office in our nation is the office of citizen. The success of our great American democratic experiment is contingent upon the knowledge, intelligence, and civic mindedness of our citizens. My organization, ReconsiDer, focuses on drug policy and includes among its members people such as myself who have some professional expertise relating to drugs, but we are first and foremost a voluntary membership organization like the League of Women Voters that provides a forum in which the deliberative democratic process can unfold. We understand the political importance of voluntary associations so eloquently described 200 years ago by Alexis de Tocqueville in Democracy in America. At a time when scholars are expressing grave concern about the decline of civic participation and social capital and its potentially disastrous effects on our democratic experiment, it is important to acknowledge the contributions of voluntary associations such as the League of Women Voters which reinforce the role of citizens in a democratic republic. On behalf of ReconsiDer, I commend your efforts to collectively expand your knowledge and to facilitate public deliberation about public policies.

Let me preface my remarks about drugs and drug policies with an important semantic distinction, namely, the distinction between drug use and drug abuse. There are many possible ways to differentiate between use and abuse, but for our purposes it is less important to agree upon definitions of these terms than it is recognize that there is a fundamental conceptual difference between use and abuse which must be considered whenever one discusses causes, treatment effectiveness, or drug policies.

The causes of drug use are embedded deep in the human experience. Human beings are sensation seekers. As little kids, most of us here today at one time or another twirled around and around and then stopped suddenly to experience that woozy feeling associated with dizziness. Most of us also savored the experience of loosing our bellies after a parent driving the family car crested a hill in the road. When we got big enough, we rode carnival rides like roller coasters that combined the woozy feeling derived from twirling around with the sensation of loosing our bellies that we experienced when the car crested a hill. As we got older, we sought either similar or more varied sensations. Some of us sought our thrills by weaving in and out of moguls on a downhill ski run. Others sought our thrills by ingesting chemicals. The point is that downhill skiing and drug taking are both sensation seeking activities that carry some risk to the self and to others, but for the participant seem to be rewarding. We don’t have to like downhill skiing ourselves to appreciate that some people find it rewarding to drive on treacherous winter roads for three hours after an exhausting week at the office so they can get up first thing Saturday morning and spend the entire day in the freezing cold risking their necks sliding down a mountainside on long skinny boards. Similarly, we don’t have to like drugs ourselves to appreciate that some people find drug use rewarding, despite what they go through to use drugs and the risks they take by using drugs. Our internal reward system is partly determined by biological factors, partly determined by social forces, and partly determined by our cultural context, but it is a vital part of our humanity that has evolved over millions of years to bring us to the highest expression of consciousness on our planet.

How and why people progress from drug users to drug abusers is not clear because there are multiple mechanisms at work. Genetics play an important role in some cases. Studies involving adopted children of alcoholics have made this clear, but whether this is a genetic predisposition to substance abuse or whether substance abuse is a consequence of a more fundamental inherited problem like learning disabilities is unclear. Child neglect and abuse also play important roles, although in different ways. Child neglect tends to result in children who are not well adjusted socially. As these children mature, they tend to become either shy or aggressive and dependent upon drugs in social situations to give them the courage to come out of their shells or relaxed enough to socialize without being hostile, respectively. Victims of child abuse (especially children who were sexually molested) tend to abuse drugs alone and at an earlier age to escape from the memories of their abusive experiences. In general, however, the transition from user to abuser tends to be associated with physical or mental health problems. These health problems may have developed in childhood or they may develop during adulthood. Animal studies provide insight into how mental health problems developed during adulthood can impact substance abuse. If animals are placed in natural settings with optimal population densities and sufficient food, water, and interesting things to do, given the choice between water or milk containing a psychoactive substance and water or milk alone, they will consistently choose the liquid without the psychoactive substance. If, however, stressful stimuli are introduced (such as markedly increasing the animals population density or wildly varying their cycles of food and water availability, the animals will immediately choose the liquid with the psychoactive substance to help cope with the stress before burnout and catatonia (i.e., "learned helplessness") set in. While it is possible to become an abuser in the absence of a "co-occurring" physical or mental health problem (especially if one uses drugs prior to successfully navigating the emotionally tumultuous period of adolescence), knowledgeable adults who do not have "co-occurring disorders" are unlikely to become abusers.

This brings us to the topic of addiction. Addiction is a special form of abuse that for most potentially addicting activities effects between 10 and 20 percent of all people. Somewhere between 10 and 20 percent of all people who gamble become addicted to gambling, somewhere between 10 and 20 percent of all people who drink alcohol become alcoholics, and somewhere between 10 and 20 percent of all people who smoke crack become crack heads. People can become addicted to any activity that offers them powerful rewards. The business executive can become addicted to work because in a free market economy he is rewarded for his Type A personality, even though his workaholic tendencies are likely to lead to premature death due to hypertension related ailments like strokes or heart attacks.

When our concern for hypertension related ailments becomes severe enough that we create programs to address it, we do not focus our intervention on the job as a way of organizing labor and blame the capitalist system, we simply try to change the work habits of middle aged business executives. Similarly, when we counsel young women in co-dependent romantic relationships, we do not attack the institution of marriage, we simply try to change the nature of her relationship. The basic message we give to both the workaholic business man and the young woman addicted to love is that they need balance in their lives. We don’t try to transform the workaholic into a couch potato, we stress moderation and balance as keys to a better life. Yet for some reason when it comes to drugs, we act as if we can alleviate the adverse effects associated with compulsive drug use by attacking drugs and encouraging abstinence. If we walked into the office of a stressed out business executive and told him that the capitalist system was killing him and he should quit his job, he would throw us out of his office. Hence, we would never imagine that attacking the capitalist system would be a good way to address his hypertension. Yet we do something just that stupid when we tell the drug addict that drugs are killing him and he should quit. We must avoid the tendency to blame drugs and focus on the life out of balance that is responsible for the compulsive behavior. We should begin to reach out to the drug addict in the same way we reach out to the business executive, namely, by encouraging moderation. We should encourage the drug addict and the business executive to consider the impact their compulsions have on their friends and families and on the quality of their lives.

I draw the analogy between the workaholic and the drug addict for a number of reasons. First, most drug addicts are gainfully employed. They are not homeless social misfits as myth would have it. The workaholic and the drug addict are both at risk for health related problems and both exact a heavy toll on their friends and families. Second, as the Physician Leadership for National Drug Policy has found, the heritability (or estimate of the genetic contribution) of both addiction and hypertension are comparable. Furthermore, compliance with intervention protocols for treatments targeting drug addiction is comparable to compliance with intervention protocols for treatments targeting hypertension, diabetes, and asthma. This point warrants elaboration.

When we set up a strict dietary regime for a diabetic and she "relapses" by eating some ice cream on a hot summer day, we don’t say that our treatment failed and accuse the diabetic of being too weak to resist the temptation. We don’t say "you’re doomed now" and walk away, leaving the diabetic with no insulin because they violated their diet. We would never dream of conditioning future medical treatment on strict compliance with the diet. Yet this is what we routinely do with drug addicts. If they relapse, in many cases they are thrown out of treatment programs. And if the treatment programs are court mandated, we throw the addicts in jail. We must realize that relapse is a fundamental part of all medical treatments and incorporate reflection on the relapse into the treatment modality to achieve the long term objectives. Treatment that is approached in this way is highly effective and is far more cost effective than incarceration.

This approach to the drug problem is gaining acceptance around the world. In July, the Portugal Parliament joined Spain and Italy in decriminalizing the use of all drugs, including heroin. In Germany and Switzerland, addicts are provided the drugs they seek at cost in medically supervised injection rooms where they receive counseling and assistance to re-enter the job market if they are unemployed and housing if they are homeless. Even Sweden, which has long been one of the European Union’s most vocal advocates of prohibitionist drug policies emphasizing criminal justice approaches, is changing its stance. Just last week Sweden announced, to the chagrin of drug warriors within the country, that it would not be pursuing its prohibitionist crusade when it takes over European Union Chairmanship next year.

And it is not just liberal social workers advocating for these programs. On April 4, the Police Foundation of the United Kingdom release a report calling for an end to incarceration of drug users except in a few extenuating circumstances. Three days later the International Association of Chiefs of Police issued a statement calling for a National Commission on Criminal Justice to create a measured response to crime that would roll back many of the idiotic criminal justice policies we’ve adopted in the name of the war on drugs. Most recently, the Interparliamentary Forum of the Americas, created by the Organization of American States to meet the need for hemispheric information sharing among legislators in the 34 countries of North and South America, included on the agenda for its inaugural meeting in Ottawa next March a debate about the merits of legalizing the drug trade.

This item was added to the meeting agenda by Colombian congressman Julio Angel Restrepo. Restrepo told the steering committee developing the meeting agenda that stopping the drug trade in his and other Latin American countries was "virtually impossible" and that the vast profits at stake from the black market trade had kept his country in a state of guerrilla war for the past two decades. Restrepo also cited the laws of supply and demand in arguing that prohibition is doomed to failure. "The prohibitionist laws in the United States in the 1920s are a clear example that violating the law of the market is equivalent to kicking the goat" he said.

Restrepo went on to say that "Demythicization of this topic could be a great asset in the search for unconventional solutions to the problem of the international trade in drugs" and that "Legalization means depriving drug traffickers of the powerful economic ingredient that makes this illicit activity so lucrative". In closing, let me also add that it would make the world a safer and healthier place to be.

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