Still (drug) Crazy After All These Years
I realise I’ve been arguing for alternative approaches to illicit drugs for a few years now:
Back in 1987 [Please forgive the language used back then]
Promoting a Risk Reduction Approach
‘..from an abstentionist viewpoint … the expectation to give up is pressed from the outset of contact, the client either succumbs to that pressure of expectation and attempts abstinence through ’cold turkey’, ’detoxification programme’ or ’rehabilitation unit’. Unfortunately the degree of success achieved is minimal with by far the majority failing and returning to the drug scene, increasing [probation] officer, family and self, frustration, and feelings of failure. … We have come to believe that a different philosophy should be adopted which incorporates both apparently irreconcilable views onto a scale or ladder of achievable targets. This philosophy begins with the pragmatic statement that ’If it is, at a particular moment in time, impossible to ‘cure‘ a drug addict, one can at least try to create an environment for harm reduction.’
‘The implications of such a statement are that first one must identify those drug ‘abusers’ who are dependent and differentiate from those who are experimental or recreational users. One must also seek to ascertain what clients themselves wish to do, for whilst we might see their drug abuse as problematic, they may see it as the answer to a problem or may not wish to change their abuse for a variety of reasons. If one begins with the stance of ’Risk Reduction’, many more doors are open to engage with the client and discover ways of helping them.’ (Buchanan & Wkye 1987 pp. 123-124)
The Need for Empathy, Respect & Care
‘Unfortunately, it seems that when faced with a dependent drug user practitioners have too often assumed they know what the client wants to do (get off heroin), and how it should be done (dry out and go to a rehabilitation centre). Van Billion and Van Emst poignantly highlighted the problem many dependent drug users faced: ‘Heroin addiction seems to elicit from the therapist so much concern, that there is nothing left for the client!’ (1989, p.37). Basic social work principles, which have so often been neglected when working with dependent drug users, should form the foundation of any assessment.’
‘Remaining non-judgemental isn’t easy when working with dependent drug users, but clients must feel understood and accepted. The worker needs to accept and support clients who have no intention of giving up drugs, but simply want help to curb associated lifestyle difficulties. Listening is crucial, but may be inhibited if the worker has preconceived ideas of what the client ought to be saying. This may then lead to jointly agreed goals which reflect more the workers’ expectations than any desires of the clients. Change is unlikely to occur without the full support of the client, and the worker may be guilty of setting the client up to fail.’
‘Relapse back into a chaotic lifestyle needs to be discussed and seen as a real possibility. With each client it should be possible to identify potential high risk situations (triggers). For some clients it may be a particular day of the week when they are likely to have cash in their pocket, for others it may be a particular mood, person or social situation. This would form the basis of future work with the client, assisting and equipping them to develop alternative coping strategies. However, it is important that relapse or struggle is not viewed as a failure, but instead as a learning experience from which greater insights can develop.’ (Buchanan 1991)
Discrimination of Women Drug Users
‘The first conclusion to be drawn is that the assessment of these women drug users in the courts was heavily determined by a gender stereotype which stresses both traditional roles (as wife, mother, carer) and assumed feminine attributes (passivity, irrationality, emotionality) as the components of ’normal’ womanhood.’
‘Decision-making based on such thinking begins with the remand decision and results in the provision of a relatively large pool of women offenders who may be considered for probation administered disposals, particularly probation. Secondly, probation officers appear willing to offer and sentencer’s ready to accept constructions of women drug users which portray them as passive victims of their own irrational behaviour and emotional instability. Whatever the reasons (tactical or otherwise) for probation officers’ collusion in this process, such professional depictions are dangerous in that they pre-empt rather than enlighten a serious examination of women’s actions and responsibilities’ (Buchanan, J., Collett, S. & McMullan, P. 1991 p61)
The Misguided War on Drugs
‘… the myth that it is possible to win a war on drugs. It gives the illusion that we can eradicate illegal drug use from our society, if only we are willing to try hard enough. The evidence indicates entirely the opposite conclusion – the more you prohibit drugs and push them underground, the more conducive the economic and social environment for a lucrative illegal drug trade.’
‘It is difficult to understand how waging ‘war on drugs’ can continue to be justified, though quite possibly the alternatives may be politically too challenging for this government to consider. Sooner or later an influential western nation will have to lead the way in a radical rethink of international and national drug policy.’ (Buchanan & Young 1998 p. 220)
Decriminalisation Must be Considered
‘Sooner rather than later, the government must address decriminalization seriously, especially in relation to cannabis. Failure to do so is, we believe, creating more problems. Thousands of otherwise ’law-abiding’ citizens are criminalised and they are forced into an underworld of criminal networks and secrecy, which then exposes them to other drugs and other criminal activity.’
‘Ultimately, this [war on drugs] will lead to the same mistaken policies seen in Northern America, where the authorities have effectively been waging war against their own socially excluded communities. Our war on drugs is in danger of becoming a war on drug users – a civil war.’
‘Unless the [drug] strategy changes, the next ten years will see the Government increasingly out of touch with youth culture. Large numbers of drug users will continue to be forced into criminal activity, and a continued policy of prohibition will lead to more dangerous and hostile environments. The illegal drug industry will thrive and becoming increasingly more established and organisationally more business-like.’ (Buchanan & Young 1998 p. 222)
The Problem with Coercive Push to become Drug Free
‘[The promotion of] populist drug policies that seek to uncover drug users by urine testing and then `offer’ compulsory abstinence-orientated treatment programmes have further isolated problem drug users from mainstream society’ (Buchanan & Young 2000 p.18)
Overhaul Misuse of Drugs Act 1971
‘The war on drugs rhetoric is creating a fracture in society as thousands of otherwise `law abiding’ citizens are criminalized for recreationally using `soft’ drugs, while problem drug users, who tend to be dependent on `hard’ drugs such as cocaine and heroin, are stigmatised and kept isolated within drug subcultures.’
‘A bold and radical rethink of UK drug policy is needed. This should include an overhaul of the Misuse of Drugs Act 1971, a rational and non-emotive examination of recreational drug use (legal and illegal), serious consideration to decriminalise the possession of any substance for personal use, and the development of strategies that tackle inequality, disadvantage and discrimination to enable social reintegration for problem drug users. … [The] government appears reluctant to engage in an open and constructive dialogue, and unwilling to develop a rational drug policy fitting for 21st century Britain. The consequences are not insignificant.’ (Buchanan & Young 2000 p.19)
‘This process of recovery can take many years, with relapse occurring frequently. Once the ‘control phase’ has been reached, recovering drug users who seek social reintegration are frequently prevented from gaining access to non-drug-using social networks and are subtly denied opportunities that are available to others, such as voluntary work, educational courses, employment and housing. This process of structural discrimination we describe as a ‘wall of exclusion’. (Buchanan, J. & Young L 2000a p.161)
Buchanan, J. & Young L (2000a) ‘Problem Drug Use, Social Exclusion and Social Reintegration – the client speaks ‘Understanding and responding to drug use: the role of qualitative research Greenwood G & Robertson K (eds.) pp155-161 EMCDDA, Lisbon, ISBN 92-9168-088-5
Demonising illicit drug use
‘It is clear then many problem drug users have experienced social exclusion and disadvantage prior to drug taking. For this group the onset of excessive drug taking in early adulthood may be a form of escape when there appears to be no legitimate way of accessing what appears to be widely available to the rest of society. In this sense social exclusion has led to problem drug use. Problem drug use does however, lead to further social exclusion as drug users become subject to ‘othering’ – presented as if they are somehow different to the majority in society (who prefer legalised recreational drugs such as alcohol and tobacco). Yet ironically and hypocritically, compared to some illicit drugs, alcohol and tobacco are potentially more dangerous substances and some of the most serious risks from illegal drugs are caused by their illegality. This othering of illicit drug users is reinforced and institutionalised as the government portrays problem drug users as a menace to society, and seeks to protect ‘us’ from the dangers ‘they’ pose.’
The Harm Caused by Criminalisation is Greater than the Harm Caused by the Drug
‘Additional risks arise when drugs are made illegal and driven underground:
1. Has no idea of the strength of the drug – it could be so strong it could result in risk of overdose or death.
2. Has no guarantee about the purity or indeed content of the drug – it could contaminated or even mixed with toxic ingredients that could cause serious harm even death.
3. Has to buy the drug ‘underground’ – exposing the person to the vagaries of a potentially dangerous criminal underworld.
4. Buying, using and sharing illegal drugs puts the person at risk of serious criminal sanctions such as a community sentence with a drug rehabilitation requirement or even imprisonment.
5. A person using an illegal drug risks acquiring a criminal record for a drugs offence – which could have lifelong consequences upon employment prospects, opportunities for world travel and housing.
6. Has to use the drug in secret. For some people this may mean using in an isolated location which could be potentially dangerous especially when intoxicated – such as a condemned building, under a railway bridge, a canal etc.
7. Has to hide the use of illegal drugs making it more difficult to manage and harder to seek help, support or advice if a problem arises.’
Buchanan J (2009) Understanding and misunderstanding problem drug use: working together, in R Carnwell & J Buchanan (eds) Effective Practice in Health, Social Care & Criminal Justice: A partnership approach, Open University Press, Maidenhead.
Missed Opportunities and Historic Mistakes in Managing and Controlling Drugs
In decades to come future generations will look back to this period in history with incredulity and disbelief at the: inconsistencies and stark contrast in approach towards legal and illegal recreational drug use; at the individual, local, national and global damage caused by prohibition of specific recreational drugs; at the way the war on drugs has become a civil war fuelling stigma, prejudice and discrimination upon particular drug users; and at the hypocrisy as we can sit back and read this article while enjoying a glass of red wine, while at a nearby neighbourhood someone might be facing a prison sentence having been caught smoking their home-grown cannabis. Governments sometimes need to take responsibility and introduce forward-thinking changes for the good of the country that might not always at the time attract popular appeal – this was a real opportunity for the New Labour government – but sadly instead they delivered a rehashed and failed US drug policy which has only prolonged the misguided war on drugs and resulted in a burgeoning prison population. Whichever party is elected on 6 May 2010 there is an urgent need for a fresh approach to drug policy, one which is scientifically evidence-based and informed by experts in the field, rather than one which is populist-based and informed by the tabloid press. (Buchanan 2010 p.259)
Buchanan, J. (2010) Drug policy under New Labour: Prolonging the war on drugs, Probation Journal: The Journal of Community and Criminal Justice, Special Edition: Criminal Justice under New Labour, Vol. 57, No.3,