Drug Addiction is an Illness: It's Time to treat it like one

In Britain today the maximum penalty for possessing a class A drug for personal use is 7 years in prison and a fine. For an addict that is 7 years in prison because a chemical has changed brain so you need it just to feel normal. We treat addicts as criminals who, through a lack of willpower, have made a mess of themselves and become reprobates. The truth is that drug and other addictions are illnesses like any other. The majority of addicts are men easily treated as disposable so we let them rot in prisons. This needs to stop. We need to help these men to their feet.

Psychoactive drugs are strange things: they include most of the illegal recreational drugs but also plenty of legal medicines as well as caffeine, alcohol and tobacco. They contain very similar chemicals to those that naturally exist within our brains. Through this similarity they are able to hijack the processes that normally regulate our emotions and cognition meaning that these drugs change your mood and how you work though tasks and problems.  These chemicals are so similar to those we find in our brains that some have even suggested that we might have evolved to be able to use them.

Some people are able to try these drugs once or twice a never look back for others an addiction takes root. Exactly why this is we aren’t sure. We have been able to find some associations for example people who are more impulsive are more likely to become addicted. We also know for example that about 20% of people (and rats) are predisposed to getting addicted to cocaine. We also know that those who get addicted are much more likely to be male.

It hard to be certain of the details but men are about twice as likely, according to The Crime Survey of England and Wales 2014/2015, to have tried illegal drugs with about 4% of men having given them a go compared to 2% of women. The results of another survey suggests that men are more likely to see use turn into addiction with men who have tried drugs twice as likely to develop a problem with 18% of men who have tried drugs saying they had developed a problem compared to 9% of women.

We would expect then about 4 in 5 (or 80%) of addicts to illegal drugs to be male. This seems to be corroborated by NHS data. It reports that of the people it treats for addiction to drugs and alcohol 70% are men, with the number being near 75% when you exclude those only treated for alcohol addiction. These figures seem likely to underestimate the gender gap as 47% of those treated came through self-referral and as we have discussed before at Year of the Male men aren’t the best at help seeking.

For whatever reason you start taking a drug. Maybe it was for fun or because you thought it might help you with a problem or help you block out some pain. It starts off well you get a great big high; you might even feel better than you ever have before. Over time though if you keep using your body adjusts and you start to need drugs to feel normal as your body adjusts to the regular overloads of chemicals it has been getting. If you stop now it is going to hurt.

Worse when it comes to this drug your prefrontal cortex has stopped weighing in on your internal debate about what to do. Your prefrontal cortex is the part of the brain that is associated with decision making and impulse control. Now you are out of your own control when it comes to that drug. You will do things for it you wouldn’t for anything else. Drug addiction isn’t about willpower – the part of the brain that provides willpower has been circumnavigated.

The likelihood is that it will be a man who finds himself in this situation and will shortly thereafter find himself in prison. He won’t get the full support he needs and he will go in and out of prison time and time again.  Failed by a brain dependent on an external chemical and now failed by a society that seems unable to provide support.

Fortunately this doesn’t need to be. The Royal Society for Public Health thinks they see the way forward. They argue that the lead responsibility for illegal drugs should be moved to Department of Health; that illegal drugs should be decimalised for personal use (but not for supply) and that addicts should be sent to support services rather than prisons. This hasn’t come from nowhere; the RSPH looked at moves in this direction from the Netherlands, Canada, Switzerland and Portugal.

Portugal offers the strongest example. They decriminalised personal drug use in 2001 and the results have been dramatic. Cases of HIV and hepatitis among drug users have fallen. Problem drug use has decline for those 15-24 years old and overall drug use is now below the European average. To top it drug related deaths are down and direct and indirect social costs of drug use are down 18%.

Addiction is an illness like any other. It is time we stopped treating the men and women who suffer from it as disposable and instead give them the support they need to manage their condition. Doing so could save money and improve the lives of many across the nation. It seems like a no brainier.

Photo by Markus Reinhardt original found on Flickr used under creative commons licence.