This article originally appeared at https://volteface.me/drug-use-is-not-the-same-as-addiction/
Conflating drug use with addiction causes a wide variety of issues. Years of fear-mongering and moralizing regarding drug use, particularly in the US but also across the Atlantic in the UK and Europe, have given the general public a skewed view of many drugs.
Medical benefits of substances are ignored due to panics regarding the risk of addiction or the stigma of prescribing a so-called “drug of abuse”. Yet addiction is not, as some fear, the inevitable result of the consumption of certain substances. Drugs can be used responsibly by adults, whether in a medical context or recreationally. Indeed, a comprehensive evaluation of studies addiction rates in the US found that the addiction rate in the adult population to be for 5% for illicit drugs and 10% for alcohol. Substances are not ‘good’ or ‘bad’, but morally neutral tools which can be helpful or harmful depending on the precise context.
To be clear, here I’m defining ‘drug addiction’ as an ongoing pattern of drug use that interferes with one’s social life, work, and/or studies, feels out of control, and continues despite adverse consequences. Getting way too high one time or even overdosing isn’t addiction. Wanting to use drugs isn’t addiction, although cravings can be a symptom. Physical dependence isn’t addiction, yet people with addiction are sometimes physically dependent. Drug use itself isn’t addiction, even if the drug use in question is illegal or stigmatized. Addiction is a specific kind of ongoing harmful relationship with drugs. Of course, drug-related harms can occur outside of addiction as well. Also, it is worth noting that drug use is not the only activity people develop addictive relationships with – but, curiously, there aren’t any moral panics about excess work or compulsive exercise.
When it comes to illegal drugs, we must also remember that many of the harms associated with them are not in fact the inevitable side effect of the substances themselves, but closely related to their status as illicit. For example, unregulated products contain adulterants and do not come in standardized doses, increasing the risk of accidental overdose. The cost can also be prohibitive, something made worse by the fact that a criminal record can prevent one from finding stable employment. This is the logic behind prescription heroin programs, which – despite seeming counterintuitive at first glance – are an evidence-based solution for especially serious cases of opioid addiction. If you can take someone out of the desperate cycle of acquisitive crime and illicit drug purchases, they can rebuild their lives and escape harmful patterns even without quitting.
Medication for addiction is often derided by critics as “replacing one drug with another” or “not really recovery” – a perspective that only really makes sense if one views the drug use itself, rather than the harmful patterns of use, as the primary issue with addiction. This idea that one must be totally abstinent from even prescribed medication to live a productive and functional life is based less in science and more in the beliefs put forward by those in 12 step recovery programs, a support group system that is not evidence-based. Yet medications for opioid addiction such as methadone, buphrenorphine, or even the above-mentioned prescription diamorphine can allow people to regain control over their lives, whilst also decreasing the risk of death and keeping them in treatment.
Even in the case of highly taboo drugs like opioids, the drug itself is not as much of an issue as the chaotic manner in which the drug is used. If these harmful patterns can be eliminated and the person in question can regain whatever functionality they lost, we ought to be happy indeed. We shouldn’t slander these methods even if they don’t conform to the standards of traditional abstinence-only programs. Defining recovery as total abstinence from all potentially recreational substances (save for nicotine and caffeine) also ignores the fact that one can be sober and quite unhealthy, just as one can use drugs without having a problem. This is why I prefer to view recovery as a return to functionality. So long as someone is doing better and not hurting anyone else, there’s no real reason to criticize them or their medical team.
That is not to say that using opioids doesn’t come with risks. Certainly, they do, particularly when injected in unsanitary conditions or used in unknown doses. But they are also necessary medications which can be life saving in the correct context. This is true both of opioids prescribed for addiction and those given to patients for pain. If one is operating under the faulty assumption that drug use is the same as addiction, then logically all pain patients who take opioids regularly are addicted and in need of treatment. Of course, this is far from true. Often people with chronic pain cannot support themselves or their families without opioids to take their agony down to a more bearable level, allowing them to work and function. In the United States, cutting off the prescriptions of pain patients has led to not only needless suffering, but also suicides and overdose deaths. This is particularly true when prescriptions are stopped suddenly.
On a similar (if somewhat less extreme) note, in recent years the potential medical benefits of cannabis and psychedelics have become increasingly well known, yet due to stigma their medical use remains taboo and limited even where it has been made legal. This is also partly due to the manner in which drugs in general are perceived by the general public as either ‘recreational’ or ‘medical’, an overly binary perspective which ignores the fact that these categories are not mutually exclusive. Pleasure is an important part of a balanced and healthy life. A person may get high on a drug at one point in their life, then later require the same substance for medical purposes.
Of course, I would argue that there is nothing wrong with using substances for fun so long as you aren’t harming anyone. Wanting to feel good or explore different states of mind is not a moral failing, it’s human nature. The stigma associated with supposedly recreational drugs should not be used to justify restricting access to substances that could help improve someone’s health and functioning, even if they could potentially get “high” on the medication in question.
Plus medical cannabis patients generally aren’t seeking a high, but relief. Yet even if they do get high, so what? Undeniably, people can and do develop problematic relationships with cannabis. But that doesn’t mean that most people who use cannabis have a problem, that these issues are inevitable, or that we should shy away from allowing more widespread medicinal use, particularly if such a thing could help treat very real suffering. There are already many people self-medicating for pain or other issues with cannabis purchased illicitly – perhaps not a good idea, but can you really blame them? Especially if they have health issues for which cannabis is approved, yet cannot get a prescription due to stigma? Accessing cannabis from a doctor would prevent them from exposing themselves to the dangers of the illicit market. Regulated, medical-grade products are safer than those purchased illegally and do not require one to risk arrest.
Similarly, the War on Drugs – a catastrophic waste of resources which has only made using drugs more dangerous – has long been justified using the idea that people who use certain drugs (i.e., everything aside from legal drugs like nicotine, caffeine, and alcohol) are “addicts” that need to be saved from themselves via incarceration. But locking up people with addiction generally creates more difficulties for them, keeping them trapped in an endless cycle of incarceration and release while restricting their ability to rebuild their lives. In jails and prisons drugs are still available, meaning that you can’t generally use such places to force someone to quit. Recently-released people are also at a significantly higher risk of fatal overdose.
Plus, as stated above, the majority of people who use drugs aren’t addicted. Arresting them just puts them in danger and saddles them with a criminal record, which may affect thier ability to travel, work, and pursue an education. Trauma is also a risk factor for addiction, meaning that incarceration may increase a person’s chance of developing a problem in the future. And for what? Prohibition has failed across time and geography to prevent drug use.
Our failed attempts to “save” people from addiction ruin more lives than they save. This is especially absurd considering we live in a society where the use of certain drugs (including alcohol, which has been judged more harmful overall than any other common recreational drug) is practically encouraged. Of course, we do not assume that everyone who enjoys the occasional pint needs to be sent to rehab or “rescued” from their “addiction” via a prison sentence. Yet many people would argue just that for the use of other drugs, both high-risk ones like opioids or cocaine and relatively lower-risk types like cannabis or shrooms.
Carvings at Newgrange, Ireland (built in 3200 B.C.) which, according to some archaeologists, implies psilocybin use by the artists. Source: Johnbod via Wikimedia Commons
This logical inconsistency underlines just how bizarrely we perceive drugs. A substance’s legal or social status doesn’t determine its actual risks. The desire to ingest psychoactive substances is a perfectly ordinary human trait. It’s not something inherently deviant nor diseased. Whilst addiction certainly exists, so do healthy or functional patterns of use. The same substance could be used addictively by one person, ingested for fun in moderation by another, and taken as prescribed for a debilitating medical condition by yet another. We cannot assume that everyone who uses drugs suffers from addiction. Nor should we allow such faulty thinking to lead us to poor policy choices, which often cause more harm than they prevent.