Addressing Addiction When Drug Use Is Part of Life

Alternative approaches to thinking about and treating substance abuse—such as anti-stigma campaigns, treatment instead of punishment, harm reduction programs, and legalization or decriminalization of drugs—may help people feel comfortable about seeking help, address some of the problems with current drug policy, and reduce the negative effects of drug abuse.

Combating the Stigma of Addiction

Addiction is frequently seen as a moral failing and a choice, which creates stigma that ultimately causes people to be hesitant about seeking help.¹

People struggling with addiction may also experience discrimination, such as social rejection or difficulties when trying to obtain employment or housing. In fact, according to the Drug Policy Alliance, addiction receives more social disapproval and discrimination than any other physical or mental health condition.¹

While the choice to start using drugs is voluntary, repeated substance use can affect a person’s self-control, judgment, and decision-making. Many types of drugs affect the reward circuitry of the brain by increasing dopamine activity and feelings of euphoria. This can reinforce a person’s desire to use again and, over time, creates an ongoing cycle of use that is difficult to break. Eventually, people may continue using despite knowledge of the negative consequences.

Of course, not everyone who uses a substance becomes addicted. Many people who drink alcohol know their limits, and not everyone who smokes a joint develops an ongoing habit. The Institute of Medicine of the National Academy of Science reports that 32% of people who try tobacco, 23% who try heroin, 17% who try cocaine, 15% who try alcohol, and 9% who try marijuana become dependent.⁴

To end stigma, people need to become more educated about drugs, drug use, and addiction and share this information. People also need to become aware of the words they choose to refer to people who use drugs and focus on the whole person, not just the behavior. People with addictions are entitled to the same level of respect and dignity as any person struggling with a difficult problem or illness, such as cancer or diabetes.¹

Treatment vs Punishment

Under current drug policy, many people are put in jail for drug offenses, which doesn’t get to the root problem of why the person is addicted.

Research suggests that the War on Drugs, started by President Richard Nixon, has been ineffective and has led to an increase in incarceration rates, which has ultimately affected more blacks and Hispanics than whites. For example, blacks make up approximately 12% of the U.S. population but represent 62% of the drug offenders sent to state prisons.⁵

Around two-thirds of prisoners have a drug or alcohol addiction (compared with 9% of the general population). Yet only around 11% receive any form of treatment, which can contribute to relapse and recidivism.⁷

Some programs aim to help offenders, such as Seattle’s LEAD (Law Enforcement Assisted Diversion) program. This alternative approach helps low-level drug offenders avoid incarceration. Law enforcement professionals are empowered to direct eligible people to community-based services.⁸

Drug courts have become another option in some communities. Instead of being sentenced to jail, adult and juvenile offenders are put into treatment and rehabilitation services and supervised by a team that includes judges, corrections staff, social workers, and rehab staff. They are monitored, given drug testing, and receive rewards or punishments based on their progress.⁹

Addiction can’t be cured. But it can be successfully managed with the proper interventions. A combination of medication and therapy is often the most successful method. ³ Medication-assisted treatment for opioid addiction—which combines behavioral therapy with medications to treat withdrawal symptoms and cravings—has been shown to not only reduce opioid use but also reduce criminal activity and improve patients’ ability to get a job.¹⁰

Harm Reduction Programs

Harm reduction refers to programs, policies, and practices designed to reduce the harms associated with substance abuse. As its name implies, harm reduction programs focus on the reduction of harm associated with drug use rather than the elimination of such use.¹¹

Finally, those overseeing and/or involved in a harm reduction program admit that, while many people who use drugs are not addicted, they can still benefit from available resources to help prevent or reduce harm caused by drug abuse.¹¹

Some studies have found these programs to be effective. A 2014 review of 75 studies found that supervised injection sites reduce overdose deaths and improve health among drug users without leading to an increase in drug trafficking, drug use, and crime.¹³ Research also shows that IV drug users are 5 times more likely to enter a rehabilitation program after visiting a needle exchange program, and they are more likely to reduce or stop injecting when using a program.¹⁴

The North American Syringe Exchange Network lists needle exchange programs by state, and you can find medication-assisted treatment programs with the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Behavioral Health Treatment Services Locator. Naloxone is available in 48 states without a prescription. Currently, no supervised injection sites are available in the U.S.

Legalization Pros and Cons

Many people view the current laws—particularly for drugs such as marijuana—as too punitive and the source of problems such as prison overcrowding and drug cartels.

Debate over legalization of certain substances is ongoing. For example, under federal law, marijuana is still treated as a controlled substance, though a number of states have legalized it for medical and recreational use (46 states have legalized marijuana for medical use and 9 states and the District of Columbia have legalized it for recreational use).^15,16

Some countries, including Portugal and the Netherlands, have legalized or decriminalized marijuana, along with other drugs. Evidence has demonstrated several positive outcomes for these countries. For example, Portugal is reported to have seen reductions in problem drug use, drug-related harm, and prison overcrowding when compared to countries with stricter drug policies.¹⁷ And the Netherlands has fewer drug arrests for minor drug offenses, lower rates of HIV among drug users, and comparatively lower marijuana use among young people.¹⁸

Activists, such as prominent neuroscientist Dr. Carl Hart, have promoted the idea that all drugs should be decriminalized. Decriminalization means that use and possession are civil, rather than criminal offenses, even though the drug is still illegal. Hart believes that it is the harsh drug laws in the U.S., not the drugs themselves, that have caused the most problems for poor and vulnerable populations.¹⁹

As with many heated legal issues, the debate over drug legalization is likely to continue for many years, especially in light of the increase in states that have legalized marijuana for recreational use.