Letters

From the June 1998 issue

(Page 2 of 4)

We recently witnessed the ungainly spectacle of L.A. City Councilman Mike Hernandez running off straight away to "rehab" after being caught in a cocaine sting. Until he was caught he wanted drugs, not "treatment." Thomas Szasz has made this sort of point repeatedly.

Just last week Newt Gingrich was at it again, calling for mandatory drug testing of all college athletes, and demanding
that all who test positive be remanded to "treatment." This is an apparently untreatable policy tic.

Bobby Gladd

Your roundtable on drug policy reform is a great collection of articles, but there are some aspects of this issue that deserve more attention. One is the fact that--even in the liberal Netherlands--many doctors are ambivalent or plainly unwilling to prescribe methadone, and even more reluctant when it concerns heroin, cocaine, and other illegal psychoactive substances.

Another is the disruptive influence this kind of medicalization has on the patient-doctor relationship, as can be witnessed in many methadone programs around the world. Still, an argument can be made in favor of this kind of med-icalization, because it can be an instrument in changing the attitudes of the medical profession and of the general public, and in the development of more rational, nonprohibitionist drug policies.

I discussed this argument in an article in the Dutch medical journal Medisch Contact in 1994, which in English translation is titled "The Medicalization of (Problematic) Intoxicant Use and the Medical Provision of Psychoactive Drugs." It can be found online at www.drugtext.nl/articles/freek2.html.

Freek Polak, M.D.
Amsterdam, Netherlands

I have a difficult time understanding the comments of Thomas Szasz regarding the recent drug medicalization initiative that was rejected by voters in the state of Washington. Szasz refers to the World Health Organization's definition of drug abuse as the use of any prohibited drug, and then seems to apply that faulty definition to drug addiction. I agree that drug use is not a disease, but drug addiction most certainly is. Improper diet (which can include the ingestion of drugs) is not a disease either, but it can lead to any number of diseases.

If Szasz is simply pointing out that it would be idiotic to arrest people for possession of drugs and force them into treatment for drug abuse, I have no problem with his reasoning. At the same time, however, it would be more compassionate to force them into treatment than to continue putting them in prison. Does Szasz think the drug war is just going to end overnight?

Carl Olsen
Des Moines, IA

Thomas Szasz replies: I wish to thank Mr. Olsen for his comment. Having a chance to reply gives me an opportunity to clarify some important points.

Mr. Olsen says that drug addiction "most certainly" is a disease. I disagree. Habits--whether deemed bad by others or the self--are not diseases.

Mr. Olsen believes that it is "more compassionate" to force so-called drug abusers to submit to what he calls "treatment" than to imprison them. I disagree. Imposing an indefinite, legally unregulated treatment on a person (especially one who has no disease) is not, ipso facto, more compassionate--meaning, I assume, preferable for the subject--than imposing a finite, legally regulated prison sentence on him. In any case, that choice would have to be made by the subject, an option Mr. Olsen doesn't mention.

Mr. Olsen accepts that forced treatment is a treatment. I do not. In medicine, the law regards treatment without consent as assault and battery. I regard forced "treatment" (rationalized as serving the "patient's" own best interests) as torture disguised and justified as treatment, a contention supported by the 300-year history of the psychiatric holocaust and its denial by the victors who write history. Using the coercive apparatus of the state to force people to submit to the ministrations of doctors of medicine is persecution in the name of health, exactly as using the coercive apparatus of the state to force people to submit to the ministrations of doctors of divinity was persecution in the name of God.

Neither Mr. Olsen nor I knows how the drug war will end, but end it will. We do know that alcohol Prohibition did not end by giving some Americans booze by prescription and others involuntary treatment for booze abuse. I feel confident that drug prohibition will not end by giving some Americans marijuana by prescription and others involuntary treatment for marijuana abuse. Indeed, I fear that compounding the prohibitionist zeal of the drug warriors with the therapeutic zeal of the drug medicalizers will only intensify our flight from reason and responsibility.