Addressing Addiction When Drug Use Is Part of Life

Regardless of the negative consequences of substance abuse, and despite ongoing education and prevention campaigns, many people still use drugs. The evidence suggests that stigmatizing or locking up drug users does not solve the problem—or the other problems related to addiction, such as the spread of HIV, overdoses, or drug-related crime.

drug pills
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

Evidence of Stigmatization
Some of the evidence includes:1,2
  • Health providers holding negative, stereotyped views of people who use drugs (viewing them as violent, manipulative, and not motivated), leading to poor care for these patients
  • The ongoing use of derogatory terms such as junkie, druggie, and crack head
  • Negative views and stigmatization among people who use drugs. For example, people who use socially acceptable substances such as alcohol may hold adverse or stereotyped views of people who use marijuana

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.

Factors such as biology, environment, and development also play a role in whether a person will become addicted.3

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

treatment over punishment
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

These programs recognize that many people will continue to use drugs despite education and prevention efforts. Such programs also acknowledge that people who are addicted need treatment, yet many of them cannot access or simply do not want to seek help.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

The goals of harm reduction programs include:12

  • Reducing overdose, overdose deaths, and other early deaths in people who use drugs
  • Preventing the transmission of HIV and hepatitis in drug-using populations
  • Reducing crime and preventing incarceration
  • Improving opportunities for employment
  • Reducing injection of drugs in public places
  • Educating people about safer drug use practices
  • Educating people about safer sex and increasing condom use
  • Increasing referrals to treatment and other social services

Some of the types of harm reduction programs include:12

  • Needle distribution and recovery programs, which provide sterile needles and other harm reduction supplies, help to recover used needles, and offer information and containers for safe disposal
  • Supervised injection sites, which are facilities where people can use injection drugs at a safe and supervised location to help prevent overdose and other harm
  • Medication-assisted treatment, which uses counseling and medication, like methadone and naltrexone, to treat addiction to opioids and alcohol
  • Take-home programs for naloxone, a drug which is an opioid overdose antidote that can quickly restore respiration and prevent brain injury

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

needle use heroin
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

Legalization has been proposed as another way to deal with drug use.

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

legal marijuana
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

Some of the potential pros of legalization of marijuana and other drugs include:

  • Fewer overdose deaths, as shown in countries like Portugal, which has decriminalized possession and use of drugs and has one of the lowest overdose rates in Europe, and Switzerland, where minor marijuana offenses are treated like administrative offenses such as a parking ticket.20
  • A reduction in resources spent on law enforcement. In 2016, more people in the U.S. were arrested for marijuana possession than for all crimes classified as violent by the FBI, such as murder, rape, robbery, and aggravated assault.21
  • Reduced crime, as demonstrated by countries like Portugal and Switzerland.17, 20 One report asserts that increased enforcement of drug and alcohol prohibition in the U.S. was associated with an increased homicide rate.22
  • Increased revenue from marijuana tax collections for federal, state, and local governments.23
  • Increased research for medical use—potential benefits of cannabis based on research studies include treatment for inflammation, pain, diarrhea, glaucoma, and epilepsy.24
  • Possible decrease in prescription opioid problems as suggested by some studies, though there is not currently enough research to confirm this finding.25

Some of the potential cons of legalization can include:

  • A possible increase in health and addiction problems. Marijuana is linked to cognitive problems like memory loss, as well as other health concerns.26
  • More school problems, such as increased suspensions and expulsions, as evidenced by a report in Colorado, where marijuana is legal.27
  • Increased risk of psychiatric problems, such as schizophrenia, anxiety, and depression. Studies have shown that marijuana use is linked to these conditions, though it’s not entirely clear to what extent it causes them. The strongest evidence shows a link between marijuana and mental health disorders in people with a genetic predisposition or other vulnerability.28
  • Increased accidents and injuries. For example, one study showed that fatal crashes involving marijuana more than doubled after legalization in the state of Washington.26 Marijuana-related traffic deaths in Colorado increased by 154% between 2006 and 2014, and emergency room visits likely related to marijuana increased by 77% from 2011 to 2014.27
  • Increase in private industries concerned only about profits (like Big Tobacco) and not public health, and potential increase in advertising geared toward vulnerable populations like minorities.26
  • Revenues from marijuana taxes not being as high as anticipated.26

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.

Taken together, fighting back against stigma, promoting treatment over punishment, offering harm reduction programs, and legalization are possible tools that can be used to help people with addiction feel more comfortable about seeking care and to deal with some of the societal problems related to drug use, such as HIV, overdoses, and overflowing prisons.

Sources

  1. Drug Policy Alliance. Stigma and People Who Use Drugs
  2. Van Boekel, L.C., Brouwers, E.P.M., van Weeghel, J.V., and Garretsen, H.F.L. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug and Alcohol Dependence, 131, 23-35
  3. National Institute on Drug Abuse. (2018). Understanding Drug Use and Addiction
  4. Brody, J. (2003). PERSONAL HEALTH; Addiction: A Brain Ailment, Not a Moral Lapse. The New York Times.
  5. Coyne, C. and Hall, A. (2017). Four Decades and Counting: The Continued Failure of the War on Drugs. Policy Analysis, 811, 1-28.
  6. Federal Bureau of Prisons. (2018). Offenses
  7. Vestal, C. (2016). Helping Drug-Addicted Inmates Break the Cycle. Pew
  8. LEAD. Law Enforcement Assisted Diversion
  9. National Institute of Justice. (2018). Drug Courts
  10. Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment
  11. Harm Reduction International. What is harm reduction?
  12. HealthLink BC. (2015). Understanding Harm Reduction: Substance Use.
  13. Ducharme, J. (2018). The Country’s First Safe Injection Facility May Soon Open in Philadelphia. Here’s What You Need to Know. Time
  14. Center for Disease and Control Prevention. (2017). Reducing Harms from Injection Drug Use & Opioid Use Disorder with Syringe Services Programs.
  15. Americans for Safe Access. (2018). Federal Marijuana Law
  16. Robinson, A. (2018). Where states stand on legalizing recreational and medical marijuana. ABC News
  17. Hughes, C. and Stevens, A. (2010). What Can We Learn From The Portuguese Decriminalization of Illicit Drugs? The British Journal of Criminology, 50 (6), 99-1022.
  18. Malinowska, K. (2013). For Safe and Effective Drug Policy, Look to the Dutch. Open Society Foundations
  19. Winerman, L. (2014). Paying a high price for the war on drugs. Monitor on Psychology, 45 (3), 32.
  20. Csete, J. (2013). From the Mountaintops: What the World Can Learn from Drug Policy Change in Switzerland. New York: Open Society Foundations
  21. Ingraham, C. (2017). More people were arrested last year over pot than for murder, rape, aggravated assault and robbery — combined. The Washington Post.
  22. Miron. J. (1999). Violence and U.S. Prohibitions of Drugs and Alcohol. Cambridge: National Bureau of Economic Research
  23. Ekins, G. and Bishop-Henchman, J. (2016). Marijuana Legalization and Taxes: Federal Revenue Impact. Tax Foundation
  24. Greydanus, D. E., Hawver, E. K., Greydanus, M. M., & Merrick, J. (2013). Marijuana: Current Concepts. Frontiers in Public Health, 1, 42.
  25. National Institute on Drug Abuse. (2018). Marijuana as Medicine
  26. Kennedy, P. and Sabet, K. (2017). Don’t let Big Marijuana prioritize profits over public safety. The Washington Post.
  27. Schipani, V. (2016). Unpacking Pot’s Impact in Colorado. FactCheck.Org
  28. National Institute on Drug Abuse. (2018). Marijuana
Last Updated on January 2, 2020
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