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October 2013 |
drinkanddrugsnews
| 21
Soapbox |
Neil McKeganey
Soapbox
DDN’s monthly column
offering a platform for
a range of diverse views.
THE
BIG
QUESTION
Is drug prohibitionhelping
or hindering recovery,
asks
NeilMcKeganey
Professor Dame Sally Davies, the chief medical
officer for England, recently joined a growing
chorus of voices in the UK calling for drugs to be
treated as a health rather than a criminal
justice issue.
Earlier this year the British Medical
Association published its
Drugs of dependence
report, which included a similar call, and in May
the Royal College of General Practitioners voted
in favour of decriminalising all illegal drugs at
its 18th national conference on managing drug
and alcohol problems, advocating that drug use
should be seen first and foremost as a health
issue. It’s a debate that has been aired recently
in
DDN
, with correspondence between Dr Chris
Ford and Anna Soubry MP, among others.
The belief underpinning these calls is that
somehow drug users’ needs, including their
recovery needs, are being impeded as a result of
the drug laws, and that only by overturning
those laws will it be possible to fully meet these
needs. What is the evidence that their recovery
is being hampered by so-called ‘prohibitionist’
drug laws? One way in which this might be
occurring is if individuals are less willing to
contact drug treatment services as a result of
tougher drug laws.
Contrary to what you might expect, some
countries with the most liberal drug policies
have the lowest proportion of drug users in
treatment. In Portugal, where drugs were
decriminalised for personal use in 2002 and
treatment has been promoted in preference to
prosecution, only 14.2 per cent of problematic
drug users are in contact with drug treatment
services. Similarly, in Italy, which has a policy of
dealing with drug possession offences with
administrative rather than criminal justice
penalties, only 14.6 per cent of problem drug
users are in contact with treatment services.
Both of these countries have a lower level of
contact with drug treatment services than either
Sweden, known for its zero tolerance drug
policies, or the UK, where heroin and cocaine
attract the highest criminal justice penalty.
On the basis of these data it would appear
that there is no simple association between
restrictive drug laws and the proportion of
problem drug users receiving drug dependency
treatment. As a result it cannot be simply
asserted that the drug laws are hindering
people’s access to treatment.
Recovery, though, is about more than the level
of contact with drug treatment services. One of
the challenges that drug users often face in their
recovery has to do with avoiding the ‘cues’ that
remind them of their former drug use. It is for this
reason that recovering addicts often try to move
to a new area as a way of reducing their exposure
to the people and the places that are most closely
associated with their past drug use.
In the case of recovering alcoholics,
reducing their exposure to alcohol is made that
much more difficult by the near ubiquity with
which the product is available within our
culture. In contrast, heroin is much less
available and the recovering addict has to work
less hard to avoid being exposed to the drug.
One of the ways in which the drug laws may
actually assist individuals in their recovery is
through reducing the visibility and accessibility
of the drugs involved.
There are other ways in which the fact that
some drugs are illegal might impact adversely
on individuals’ recovery, one of which has to do
with stigma. There is no doubt that individuals
dependent upon illegal drugs are highly
stigmatised – but so too are alcoholics. The
stigma felt by those who are drug or alcohol
dependent may have less to do with the legal
status of the drugs than the negative
judgements around the individual being seen to
be ‘out of control’ in their behaviour.
Securing employment is an important part
of the process of sustaining an individual’s
recovery and one that can be adversely affected
by negative attitudes on the part of employers.
We know that many employers are reluctant to
employ a recovering drug user and that as a
result, the individual’s recovery is made that
much harder. However, the negative
judgements of employers may have more to do
with the perception of the drug user as
unreliable or untrustworthy than the illegality
of the drugs involved.
There will be many occasions though when a
recovering drug user’s chances of securing
employment will be adversely affected as a result
of them having a criminal record. This is a
problem that can be dealt with without the need
to overturn the drug laws through, for example,
expunging drugs convictions where the individual
is seen to be demonstrating a sustained
commitment to recovery.
In the calls to treat drug use as a health
rather than a criminal justice issue there is an
assumption that the drug laws are having an
adverse impact on the delivery of health-
related support and that as a result society
should choose between viewing drug use as a
health or a criminal justice issue. The fact that
certain drugs are illegal may actually help an
individual’s recovery journey and it is certainly
not the case that countries with the most
liberal drugs laws are necessarily the best at
providing accessible drug treatment services to
dependent drug users.
Instead of viewing drug use as either a
health or a criminal justice issue there is a
strong case for retaining both elements in how
we are tackling our drug problems; ensuring
that those in recovery are assisted in every way
possible, including by reducing the availability
and accessibility of illegal drugs on the streets.
Professor Neil McKeganey is at the Centre
for Drug Misuse Research, Glasgow