The NHS estimates around 2 million Britons suffer from addiction. This is probably a gross underestimate – just take a look at nicotine. There are 6 million adults in the UK alone who say “they would find it hard to last a whole day without smoking“. Cigarettes kill more than 100,000 people annually, but addiction means two-thirds of smokers say they’re struggling to stop. Our society actively supports those trying to kick the habit, though, with things like e-cigarettes and nicotine patches, and it works. Evidence-based anti-smoking campaigns have been hugely successful, enabling almost half of all tobacco users to eventually quit.
Unfortunately, this is not the case for most addictions. Where the substance being abused is illegal, a stigma exists that has repulsed efforts to effectively combat it. The police, rather than the NHS, are in charge – and addicts are criminals to be apprehended, not patients to be treated. That hypocrisy was the subject of a discussion featuring Nora Volkow, the director of America’s National Institute on Drug Abuse and an expert on how drug addiction affects the brain, at the World Science Festival two weeks ago:
Addiction is a disease of the brain… Unfortunately – even though the science has shown it’s a disease of the brain – it has been very difficult to incorporate into the healthcare system.
And as a result of that, many cases of drug addiction are never recognised. Or prevented. Or treated.”
Addiction is a contentious issue. Entire areas of our health and drugs policies are influenced by the way we view addicts, and our criminal justice system is inextricably linked with substance dependence. It informs our attitudes on every poverty-related subject from homelessness to welfare. Most damagingly, it has led us to participate in a bitterly destructive war.
It follows that both policymakers and the public should be well-informed of the nature of addiction. Yet in a society where drug addicts are viewed as feckless criminals – lacking either the desire or the willpower to quit – there is a mounting body of evidence to suggest our perceptions are off, and as a result a growing number of nations are starting to put international pressure on changing the global war on drugs. A recent report by the United Nations’ Commission on Narcotic Drugs (CND) has adopted resolutions recognising that:
[S]ubstance use disorders can result in chronic, relapsing conditions requiring, like other health conditions, treatment based on scientific evidence, support for those affected and, where indicated, governmental and community initiatives to promote recovery and facilitate reintegration”
Essentially, addiction is a disease, which requires effective medical treatment and support from society – and historically neither of those facts have been popular with the public.
Writing in The Spectator last year, Russell Brand – a recovered heroin addict – struck upon the source of our hostility towards substance abusers:
It is difficult to feel sympathy for these people.
Can there be any other disease that renders its victims so unappealing?
Would Great Ormond Street be so attractive a cause if its beds were riddled with obnoxious little criminals who had ‘brought it on themselves’?”
The notion that addiction is a choice – and the underlying insinuation that addicts are getting their dues – is incredibly pervasive. They are, as is often the case, a plausible scapegoat for all of society’s troubles. This ‘othering’ of drug addicts is so common in government and media that the Society of Editors published ‘Dealing with the Stigma of Drugs – a Guide for Journalists’. Executive director Bob Satchwell described the negative effect using words like “junkie” can have:
The award of a deviant social status to drug users may serve to discourage use but it does little to assist those most in need of help. Studies have consistently shown that perceived devaluation and worthlessness on behalf of the user does little to spur them towards recovery.
The ‘shame’ of addiction is a reason why people with drug problems – and their families – often do not seek help.”
This deep-rooted stigma also goes some way to understanding why there is such disparity between political decisions and the scientific advice. The UK Drug Policy Commission’s 2012 report recognised the UK’s attitude towards drugs as a barrier in effective policy-making:
The UK is unusual among EU countries in that the Home Office is the lead department for drug policy; most countries situate their leadership in the Ministry of Health.
It has been suggested that the Home Office leadership encourages a view of drugs as a crime issue rather than a matter of health.”
The reasons behind this are evident. The “tough on crime” line is a tried-and-tested vote winner, appeasing our fears with strong rhetoric and firm action. Yet it flies in the face of the scientific recommendations. Criminalising drug addicts only exacerbates the problem. Dr. Volkow (also chairperson of the working group advising the CND) discussed the dangers of this attitude at a Kavli Foundation-hosted teleconference last month. The three neuroscientists spoke of unanimous agreement amongst members that “substance use disorders are a disease … and thus should be addressed within a public health framework”.
Unfortunately, the notion of the British government ignoring science in favour of politics is nothing new – particularly when it comes to drugs. Neuropsychopharmacologist David Nutt was sacked from the Advisory Council for the Misuse of Drugs after criticising the government’s failure to listen to its recommendations. In a post on his blog (aptly titled “Evidence not Exaggeration”) he explains that turning a blind-eye to scientific advice is foolhardy:
Approaches which explicitly reject an evidence-based public health approach, but instead focus on incarceration and criminalisation of addicts, continue to utterly fail, at enormous financial and human cost.”
Instead, policy-makers must be prepared to accept the findings of its advisors – even when they disagree with convention. Nutt goes on to examine Switzerland’s successful strategy – a programme of providing supposedly-untreatable heroin addicts with a clean supply of the drug, which has flourished in the face of sharp political criticism:
It has stabilised chaotic lives, allowing users to be socially reintegrated, getting homes and sometimes jobs, and as well as removing the health harms associated with polluted, inconsistent street drugs. Addicts in this treatment get fitter, they virtually never overdose, and very few die.
Unlike those in other regimes, most stay in treatment, allowing some to progress later to abstinence. “
The idea of providing free, clean drugs to addicts is steadily gaining momentum as further evidence emerges for its effectiveness. Chief Constable Mike Barnett echoed this sentiment when he declared “it is time to end the war on drugs” in an article in the Observer last year. “[Addicts] must be treated and cared for and encouraged to break the cycle of addiction. They do not need to be criminalised.”
In a blogpost after the 57th session of the CND in March, Dr. Volkow summarised what is now rapidly becoming scientific consensus:
The recommendations of our committee crystalize a paradigm shift in how the problem of substance abuse and addiction are viewed by modern societies.
Shifting the problem of drug abuse and addiction from the legal (or moral) sphere to that of science and medicine, where it properly belongs, is a crucial step toward successfully tackling the problem.”
So the call for a radical rethink of our approach to drug policy continues to grow. A large part of this is intrinsically defined by the way we view and treat those suffering from substance disorders. But it is perhaps inevitable – given the continual dehumanisation of drug addicts – that discussion about addiction would eventually lose focus on those suffering from substance dependency and switch to a more pressing issue for the government.
On the Swiss clean-heroin policy, Nutt declared:
It isn’t just the addicts who benefit; crime fell enormously once users could access heroin from the State rather than profiteering dealers. The State, and taxpayers don’t lose out in this arrangement, the expensive program more than pays for itself in healthcare and law enforcement savings.”
An appeal to the economics of patient-centred treatment might be just what’s needed to convince the Coalition to rethink their plans. Not only would a health-focussed approach save lives, it would save money as well. Surely that’s a language the Home Office can understand?