How Do You Like Your Disease Model Now?


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.