Drug use has been a part of human experience for thousands of years, across every known culture.
But for many of us, it’s still surprising to learn that only a small fraction of people who use even “hard” drugs like heroin or methamphetamine—according to US government data, for example, or the United Nations—become addicted.
But the War on Drugs has caused more damage than drugs themselves ever could.
As these policies fill jails, prisons, probation rolls and morgues, the US government’s own data show that, if we take rates of substance use or overdose deaths as our measures of success, drug prohibition has long since failed.
As with alcohol prohibition in the 1920s, it’s just made things more dangerous (living in the heart of moonshine country, I’ve heard stories passed down over generations).
Clearly, people experience directly harmful effects from both illegal and legal drugs. But prohibition blurs cause and effect:
- If there are harms, where do most of them originate?
- From the drugs themselves?
- From the laws that increase the dangers around these drugs?
- Or from somewhere else?
Substance Use Can Be a Rational Choice
What if I told you that drug use can be a rational choice? It’s a notion I’d once have scoffed at, even while using heroin every day. But the work of some experts backs this idea.
The theory is that substance use, even in the face of harmful consequences, can be a rational way of coping with stressors common in a society that produces pockets of isolation, extreme poverty, and an ever widening gap between rich and poor.
Dr. David Nutt of Imperial College, London says, in response to Hart’s work, “Addiction always has a social element, and this is magnified in societies with little in the way of work or other ways to find fulfillment.”
I’m no scientist or doctor, but there’s a clear connection between human suffering and addiction.
The War on Drugs compounds those issues, with criminalization and incarceration pushing people with substance use disorders further toward the margins of society, in turn increasing their suffering and vulnerability.
Some people can use drugs long-term with few harmful consequences.
They don’t fit the popular caricatures (few of us do). For a time, I was one of these people.
I used heroin and held down a highly demanding software engineering job for close to three years.
Eventually, the costs of
- spending large sums every week on heroin,
- trying to hide my use from family and friends,
- an escalating series of legal problems (I had to steal to support my use, even though I was working),
- the near-unbreakable cycle of jail, probation and prison, and
- the lost opportunities for employment and education that followed
left my life a wreck.
Overall, my heroin use became definitely harmful and seemed inescapable.
Costs and Benefits of Drug Use
It wasn’t something I considered much at the time, but most of the harms I just listed weren’t a result of heroin itself, but of its prohibition
It’s deceptively simple, just requiring a sheet of paper, but it can help people overcome ambivalence to change, gauge where harms originate, or analyze their overall health and wellness at in any stage in the change process.
I never previously thought about the costs of stopping or benefits of continuing to use because
I was conditioned to think that abstinence was always the only choice.
It’s not—and this is significant.
At the same time, behaviors that cost millions of lives per year, like using tobacco and drinking alcohol, are considered normal—within limits.
Still, the CDC lists tobacco use as the leading preventable cause of death in the US and estimates that 88,000 Americans die from alcohol-related causes each year.
Legality or social norms are poor indicators of harmful effects from substance use.
A Health Continuum
For illegal drugs like heroin or methamphetamine, reducing use or changing routes of administration (e.g., from injecting to snorting) can carry health benefits, but just using these drugs is a felony in most states. This doesn’t mean they’re impossible to use moderately
Being caught with illegal drugs by the police just one time, however, can have serious, life-altering consequences.
In addition, many rehabs simultaneously teach that
- relapse is an expected part of recovery, but
- have zero-tolerance policies when clients end up using.
Just one slip could have you living on the street, and at a much greater risk of overdose.
Traditional recovery narratives frame abstinence as the least harmful option, but that’s not true for some people.
Many street drugs mimic the effects of pharmaceutical medications.
People without access to those medications might be better off self-medicating. That’s a decision they have to make.
Substance Use and Social Conditions
Policymakers hoping for that “drug-free America” will never find it.
If they’re sincere in their efforts to improve public health, rather than exploit drug policy as a form of social control, they should prioritize treatment over punishment and increase access to proven health strategies.
In a world with so much
- social marginalization,
- structural violence, and an
- ever-widening gap between rich and poor,
substance use and self-medication are sometimes the most effective means of coping.
A policy shift toward human rights—prioritizing humanity over ideology and assistance over punishment—would be the most effective possible harm reduction tool.