Thursday, April 14, 2011

Part 5 – It’s time to negotiate an end to the war on drugs!

Addiction is a disease. I am not speaking of experimentation with drugs nor even abuse. When people first use illicit drugs, they are making a choice to experiment or even abuse the substance. True, some may have a genetic predisposition to addiction but early use is always a choice, a bad choice at that.
Some but not all of those who choose to use will become addicted as a result of continued use. Most do not. Most experiment but at some point discontinue the use because of negative impacts. However, for others, there comes a time when continued use actually rewires the brain’s circuitry resulting in what we call addiction.
 At that point a person has an unnatural compulsion to find, obtain and use drugs despite all the negative consequences. This is the person who is placed on probation for a crime and ordered not to use but does so in spite of a threatened prison sentence. We are talking about the parent who knows the next time he or she uses, the court will take their children away…and still uses.
These are people whose brain scans demonstrate a significant change in the way their brain functions as a result of continued, excessive drug use. We are now talking about addicts.
The American Society of Addiction Medicine defines addiction as a primary, chronic, neuro-biologic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. Addiction is characterized by behaviors that include one or more of the following:
·        Impaired control over drug use
·        Compulsive use
·        Continued use despite harm
·        Cravings
The War on Drugs has seldom distinguished itself by using the science to develop public policy. Indeed the science and the mountains of helpful research is overlooked or obscured by conflicting public policies and popular notions. The science is largely ignored not only by the legal system but even the clinicians. Yet the science is absolute.
This has seriously impaired the ability of the country to effectively meet the challenges of drug addiction. Why? If lawmakers or judges view the addict as someone who should just say no or as character flawed person, the conclusions they reach about the war on drugs is skewed. If a person engages in harmful drug use because they simply make bad choices and have no concern for the well-being of others, punishment is the appropriate penalty. More and harsher laws can be seen as the best recourse. Spending more millions on building prisons is then a sensible policy.
But if that person is addicted, i.e. has a brain disease, what sentencing alternatives should be used? How should that reality change the way the person is supervised on probation? What clinical practices should be employed?
The courts are not alone in failing to recognize the science. Some clinicians fail to use all the tools available to treat their patients because of their own prejudices against, for example, the use of effective prescription drugs or virtual therapy, or other best practices denying their clients the best chance at recovery.
What if the science is correct? What if we could wipe the slate clean and start over knowing what we know now rather than continuing to impose practices based on what we didn’t know about the science when the War was declared? What then would be the best policy? What laws, sentencing practices and treatment regimes would make sense? Let’s begin there.
Please share your thoughts.

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