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 present
book 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 following pages 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 the following chapters will attempt to
show, 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 him/her to exist; and because drug
research continues to make naive 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 book 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.
What the book does not say is that drugs have no
pharmacological effect; nor does it 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.
