How Do You Like Your Disease Model Now?

Jacob Sullum | March 6, 2009

In today's Wall Street Journal, Bush administration drug czar John Walters responds (obliquely) to the recent condemnation of current drug policy by three former Latin American presidents, Fernando Henrique Cardoso of Brazil, César Gaviria of Colombia, and Ernesto Zedillo of Mexico. As the addiction psychologist Stanton Peele (who pointed me to the op-ed piece) notes, advocates of a "public health" approach to drug policy, including Cardoso et al., should pay close attention  to the way Walters turns their disease model against them:

Substance abuse is a disease. Until recently, we failed to grasp the nature of this disease and how to reduce the suffering it causes.

For decades, we did not want to believe that alcohol or drugs could have the power to take over our lives, despite the evidence we witnessed when our loved ones grappled with drug addiction. We did not understand how this disease could alter personality and steal individual freedom. We have paid a high price for this confusion....

The criminal justice system has become the most powerful force in the country supporting addiction treatment, exactly the opposite of the critics' depiction.

In other words, because "substance abuse is a disease," we need to arrest drug users and threaten them with prison, since otherwise they would resist entering treatment. They have already lost their freedom to drugs, so locking them up does not take away their freedom; it restores their freedom.

That approach is consistent with forcible psychiatric treatment of people who, due to "mental illness," are believed to pose a threat to themselves or others. Yet people who could be diagnosed as suffering from "substance abuse" or "substance dependence" are not routinely treated against their will, unless their substance of choice (nonchoice?) happens to be illegal. Walters, who above includes alcohol with the intoxicants that supposedly "have the power to take over our lives," senses this inconsistency. He even seems to acknowledge that alcohol abuse is no different in principle from abuse of illegal drugs:

We have made the kind of compromises with alcohol that some suggest making with illegal drugs. Nonetheless, roughly one in 10 of the more than 100 million Americans who drink each month suffer from alcoholism. Illegal drug use touches roughly 19 million Americans each month with more than one-third of those suffering from abuse or addiction. Will these people be better off if drugs are legalized?

Well, yes, they will be, because they will avoid all the problems created by prohibition, including black-market violence, unreliable drug quality, artificially high prices, and the risk of arrest and imprisonment. But notice that Walters implies repealing alcohol prohibition was a mistake, one that would only be compounded by repealing the prohibition of other drugs. At the same time, perhaps because he is not prepared to advocate forcible treatment of heavy drinkers, he implies that the currently banned drugs are different in a morally and legally relevant way, calling them "disease-causing poisons that are more powerful than alcohol and that profoundly attack the user's capacity for free action." As I show in my book Saying Yes, there is little basis for such assertions.

Walters wants us to believe there are no good reasons to use drugs, since use inevitably escalates to abuse and addiction:

We will not quickly change the powerful forces that have for decades presented drug use as thrilling and fun. For most drug addicts, the first foray into drug use begins when they are young and have no expectation of becoming addicted. Nonetheless, they do become addicted and their denial increases as dependency worsens.

The thing is, drug use is fun, sometimes even thrilling. And while it's undeniable that addicts become addicted, it's also undeniable that the vast majority of users do not. By celebrating survey data indicating that "since 2001 the number of young people using illegal drugs has dropped by 900,000 to about 2.7 million," Walters (as usual) elides the distinction between use and abuse. Those numbers refer to past-month use of illegal drugs (mostly marijuana), which causes serious problems only in a small minority of cases.  

Critics of the war on drugs, including Cardoso et al., often make the same mistakes that Walters makes: They equate addiction with a disease that steals one's freedom, which they imply is the typical outcome of drug use. As Walters' argument shows, these beliefs are a pretty firm basis for using force to stop people from using drugs. They are not a very firm basis for ending the war on drugs.

Comments

|3.6.09 @ 1:55PM|#

Let me say this as a person who has gone through alcohol treatment and was a regular attendee of AA meetings for months:
The people who believe that substance abuse is a "disease" almost always have a monetary or professional interest in people accepting that one stupid fucking idea.
AA is filled with petty Eichmanns and control freaks who spew that shit to vulnerable drunks and uneducated booze hounds desperate for a solution.
If you're a drunk, you have nobody to blame but yourself. I drank myself into a stupor for years before I pulled my head right out of my drunk ass and took responsibility for my life.
Fuck AA, fuck drunks, and fuck the people who spread the poisonous idea that being addicted is a disease.
Filthy cunts.
Soberly yours,
Jamie Kelly

|3.6.09 @ 2:07PM|#

Correcting John Walters on specifics is not worth my effort. He lies, he dissembles, he's a moralistic busybody who has no concept of freedom or the rights of people to fuck up their own goddam lives.

For most drug addicts, the first foray into drug use begins when they are young and have no expectation of becoming addicted.

No shit, Sherlock. People's first foray into every goddamed thing is when they are young.

This crap from a moron who thinks gun battles in the streets and the rare honest cops getting gunned in broad dayligh south of the border is evidence that we're "winning" the War On Drugs Sanity.

He's a fucking idiot.

libertarian democrat|3.6.09 @ 2:07PM|#

I'm not addressing substance abuse as disease, as it is certainly worth arguing about.

In an unrelated note:

Every time you put "mental illness" in scare quotes, you hurt the libertarian cause. That 9-11 troofers hang around us is bad enough.

|3.6.09 @ 2:13PM|#

Hi Jamie. You and I should have an obscenity contest some day. Aimed at a camel cocksucking, infected pimple on a crack whore's unwiped ass like John Walters some time.

|3.6.09 @ 2:16PM|#

Every time you put "mental illness" in scare quotes, you hurt the libertarian cause. That 9-11 troofers hang around us is bad enough.

Yes, mental illness exists.
.
.
.
However, in a time and place where shyness is considered a disorder, the phrase mental illness desrves scare quotes. Blame the shrinks, not the skeptics.

|3.6.09 @ 2:17PM|#

Re: Typos and html fuckups in my previous. Que, sera, sera.

|3.6.09 @ 2:19PM|#

I have a Mom and Dad and the government is NOT THEM! It is the parents jobs to educate thier kids about the dangers of drugs not the governments.Dealers do not ask for I.D.s so anyone who has money will be served. If it taxed and regulated it will be much harder for kids to get thier hands on it then it is now.I as an American ADULT should have the right to decide what I can and cannot do in the privacy of my own home!
When is the government going to finnally get it through their thick skulls that prohibition DOES NOT WORK! They can lock up 3/4 of the nation and burn 50,000 acres of marijuana but at the end of the day, there will still be growers,buyers, and users. Marijuana is not going anywhere so why delay the inevitable and legalize it already!?

enough is enough!

libertarian democrat|3.6.09 @ 2:23PM|#

I agree too much shit is shoved into the label, but people like Sullum actually think the very concept is illusory.

On the other hand, I love that the article he links to (near "mental illness") has a title that could have been written by lonewacko. Szasz defenders and lonewacko both take on TheirCritics.

jtuf|3.6.09 @ 2:53PM|#

Moving from drug enforcement to drug treatment could have some very bad consequences. It would take policy out of the hands of elected officials and into the hands of unelected "experts". Commitment hearings don't include many of the protections given to people accused of a crime, because they aren't criminal hearings. Want to plead the 5th in a commitment hearing? The doctor will list it as being "uncooperative and paranoid" and then use that as justification for forcing a "cure" on you.

jtuf|3.6.09 @ 2:55PM|#

Why do we still have the War on Drugs? Because locking up non-violent pot heads is a lot safer than locking up murderers.

SIV|3.6.09 @ 3:03PM|#

Walters is using the concept of "mental illness" to,quite logically, advocate for maintaining criminal penalties for drugs.The Szasz-bashers "enable" his case for the Wods.

|3.6.09 @ 3:12PM|#

the rare honest cops

But you repeat yourself.

|3.6.09 @ 3:14PM|#

"For decades, we did not want to believe that alcohol or drugs could have the power to take over our lives"

or hot rods,
or pink floyd
or Saints football
or pussy
or cutting edge journalism (jamie kelly comes to mind)

|3.6.09 @ 3:24PM|#

"Nonetheless, roughly one in 10 of the more than 100 million Americans who drink each month suffer from alcoholism."

I wouldn't exactly say I've been SUFFERING, Bob.

Must be said|3.6.09 @ 3:29PM|#

Yo, fuck John Walters.

|3.6.09 @ 4:17PM|#

"Nothing was your own except the few cubic centimeters inside your skull."

|3.6.09 @ 5:21PM|#

I guess it's good that sad, angry little people like those posting comments on here have somewhere to vent. -- The majority of Americans do not want drugs legalized (and yes, that includes marijuana). As long as the majority rules on this (and that will be forever by the way) illegal drugs will remain illegal. So sober up, put away the pot, get a job, get a life and get over it.

engineer|3.6.09 @ 5:31PM|#

Calm down, Jamie.

engineer|3.6.09 @ 5:35PM|#

We use scare quotes because everything's a mental illness these days. Kid's a brat: He has ADD, so give him ritalin or amphetamines. Somebody tends to be rather glum: He's clinically depressed, so let's put him on Prozac. Someone's shy: He's autistic.

Hence why we use scare quotes.

engineer|3.6.09 @ 5:36PM|#

Amy Webster,
Thanks for telling us how to live our lives. I happen to have a job, am usually sober, and don't smoke pot, by the way. But I don't see it as a reason to be a domineering jerk towards others.

Robert|3.6.09 @ 6:36PM|#

"For decades, we did not want to believe that alcohol or drugs could have the power to take over our lives"

or hot rods,
or pink floyd
or Saints football
or pussy
or cutting edge journalism

Or blog commentary.

But seriously, folks, I've been hearing Walters' line for about 10-20 yrs. The line has been that alcohol should have been nipped in the bud some thousands of years ago -- that by the time prohibitions were attempted, it was already too late because too many people drank the stuff so the law couldn't be enforced fairly -- but that the chance to do so still exists with some psychoactives that have only recently become popular and whose popularity may be said, by some grouping of time intervals, to be increasing.

|3.6.09 @ 10:45PM|#

lots of people smoke weed and are fine, Cops, Lawyers, Doctors, Teachers, and Business People all are have to get their weed from sketchy people or their children's friends.

If you can't keep yourself from smoking weed and moving on to Crystal Meth, nothing is going to stop you from doing meth.

If we made weed legal, there would be no violent gangs trying to import it into the US and bringing their meth, coke and child sex slaves with them.

The war on pot cost $10B a year.

Amy Webster|3.7.09 @ 12:10AM|#

Wait! Just Kidding, guys...that john I was with this afternoon must have slipped me a roofie - I woke up a few minutes ago with a scorched poopchute and the jerk didn't even pay me! Gosh, what a ditz...

|3.7.09 @ 12:17AM|#

@ Amy Webster

Really? Show us proof of what you say! You sound very sure of yourself, which leads me to believe you have some EVIDENCE, RESEARCH, or STATISTICS to back up what you say, right?

I'm seeing more and more of your kind of posts on the Internet, and I'm loving every minute of it. You know it's over. Getting nervous? Afraid your lies are wearing thin?

The Drug War will be over soon, So sober up, put away the bible/liquor, get a brain, get a clue and get over it.

Love and kisses, babe!

|3.7.09 @ 3:17AM|#

The criminalization of addiction began long
before Walters'put forward his silly
reasoning. Warehousing drug addicts doesn't work.
The disease model argument has nothing to do with
the wrongheaded policies now in place. Indeed,
accepting the theory provides another strong
argument against current policy.

Steve Clay|3.7.09 @ 10:07AM|#

Walters is a clear liar. It's sad we have to continue to spend energy debunking this guy's arguments.

Pat Rogers Aid & comfort blog|3.7.09 @ 12:58PM|#

John Walters beloved criminal justice approach still requires that a person commit crimes against others or sell drugs, including to children, until they are caught and forced into prison based rehab.

Walters still ignores all of the crime and terrorism that are funded by the fact that prohibition creates a massive black market economy ripe for criminal, terrorist and official corruption.

The choice is simple. As long as government prohibits the responsible regulation and licensing of the drug markets the morals and ethics of drug sales to children will be dictated by users, abusers, addicts and gangsters.

Under a regulated regime the majority of intoxicant drug sales will come under the control of responsible adult supervision for the first time in nearly a century.

Drug warriors oppose responsible adult supervision of drug sales. As a result children have unfettered access to drugs though users, abusers, addicts and gangsters. Most of whom have a vested interest in growing drug sales to new generations of users.

When you support the prohibition against regulation you support free access to children by drug dealers.

John Walters supports criminal anarchy, corruption and terrorism.

|3.8.09 @ 3:03PM|#

My grandfather got drunk almost every night when my mom was growing up, and beat up his wife and his kids at the least provocation. He would never dream of harming them when sober, but lost his self control. My cousin has become addicted to meth and has lost any abiliy to take care of himself or his baby son; he's currently passing in and out of homelessness. Sure, most people who use drugs don't become addicted, and that's great, but it's not a choice whether to become an addict or not, and I honestly don't believe that anyone has the magic formula of how to use meth and stay totally in control of the habit. I support legalization, but I support it despite believing that drug use risks your freedom and your capacity to behave responsibly. Maybe there is a way to use drugs so responsibly that you run no risk of losing control of yourself, but I honestly don't believe it.

Stagman|3.9.09 @ 5:34PM|#

As someone who works in a D.A.'s office I assure you, Mr. Walters, that there are plenty of drugs in prison. In fact, I would say it's one of the worst places to send a drug addict, because they emerge a drug addict and a member of a prison gang that funds itself through large scale drug sales.