Recently, the founder of Recovery Review Jason Schwartz penned an important piece on the polarization of current drug policy, Protecting autonomy by denying it? Undermining autonomy by asserting it? He notes that at one pole, multiple states are proposing and passing legislation to allow involuntary treatment. At the other pole, normalization advocates framing drug use as a human and civil right that government should protect and facilitate. While not the focus on this piece, involuntary treatment require robust checks and balances and can only be viewed as a last chance tool to be used when all else fails and death is likely without it. More effective solutions focused on voluntarily engaged services to support healing from an SUD are in the middle of this stick. This piece is focused on the end of drug use normalization.
To normalize addictive drug use, groups seeking to do so work to minimize the very real consequences of addiction. This is very much in the interest of drug sellers. There are vested interest on the end of the stick, it is where the money is. Consider that 80% of all alcohol sales are made to the 20% of Americans who drink the most with those in the top 10% accounting for a total of 60% of all sales. In respect to cannabis, heavy users consume about 28 times as much as a light user. Sales 28 times greater! Is there really any wonder why these industries would want a focus on normalizing drug use within the community of recovering people in America? We are their meal ticket when we use.
An example of strategies to support normalization, in 2021, I was scrolling through social media, and saw a friend talking about how an alarm went off when his purchase at a store set off an anti-theft device. He noted it was a great feeling to stop and wait for a clerk to deal with the situation. He wrote about how much his experience differed from his active addiction experience. He had shoplifted daily while in the grips of his addiction. He shared on social media how positive recovery is for him because he no longer engages in illegal conduct. Entirely relatable for so many of us in recovery.
Drug use normalization advocates jumped on his thread and told him that talking about his consequences in that way was wrong. It got ugly quite quickly. They accused him of being disrespectful to people who use drugs, nothing that drug use is a coping mechanism that should be embraced. Some even asserted that there is no such thing as addiction. The normalizers asserted that not everyone who uses drugs steal so he should not stigmatize drug users by talking about how much he stole to support his addiction. Talking in this way runs contrary to their efforts to cement drug use as a human right. It is an increasingly common form of social media censorship. Vocal drug use activists shut down such perspectives to pursue their goal of normalizing drug use, especially when people talk about the harms.
There is a fine line on messaging to focus on recovery and efforts to curtail dialogue on the devastation caused by addiction, and we need to be careful here on the trend towards minimizing very real consequences. There is a lot of pressure to view addictive drug use as a normal coping mechanism to deal with societal ills. It frames harms as inevitable, ones we must accept despite negative implications. It asserts that the problem is not drugs but underlying societal deficits. Under this view, recovery is any slight positive change of risky drug use. Abstinence from drug use for those of us who need to do so to stay alive is considered elitist. Talking about consequences of drug use is seen as being judgmental of persons who use addictively. This leads to a form of subtle censorship. People sugarcoat truths to accommodate normalization. These can even be seen as subtle efforts to get people in recovery to resume use under the guise of moderation. Can we agree that these industries have no interest in us moderating our use?
We must eliminate policies that have criminalized people who use drugs, but to do so in ways that acknowledge that addiction is quite destructive. There are profound public safety considerations. Drugs can lead people to do terrible things. Alcohol is legal, yet it is commonly a contributing factor to murders, intimate partner violence, motor vehicle fatalities and a whole lot more social ills related to the erosion of family and community. Yet some US drug use advocates see any focus on the devastation of drug use as antithetical to the goal of drug use normalization. That goal is fundamentally different than the Portugal Model which emphasizes treatment and recovery. Likely a result of the influence of capitalism which is not as powerful a force in Portugal as it is in the USA. Again, drugs are quite profitable.
Normalization is not harm reduction. It is vital to support harm reduction strategies. Naloxone and drug testing supplies save lives. We must keep people alive to help them. Low threshold interventions foster engagement. Medications to support healing are fundamental to recovery for many people. We must treat all people who are addicted to drugs with respect and dignity. Yet we should also acknowledge that those of us in these circumstances often engage in illegal and harmful actions that impact our whole communities. Love the person, not the condition.
About the condition. Addiction impacts the areas of the brain associated with executive function. The reasoning areas. Addiction also impacts the limbic system, the area of the brain that deals with base functions, the four Fs of evolutionary drive. For me, it was like the area of the brain in charge of reasoning between right and wrong was the quietest of whispers and the base regions of the brain that wanted the numbing sensation of the drug were shouting in my head to do whatever it took to use drugs and ignore everything else. It is frightening lived experience of what happens to volition in the grips of addiction. As my brain healed, this dynamic reversed. The executive function regions became much louder, the limbic system a quiet whisper. It is a common experience for those of us with addiction. It is important that society understands what addiction is and we must be able to openly talk about it for that to occur.
Where are we heading when to even acknowledge fundamental truths about addiction is dissuaded? The unvarnished truth is that addiction often leads people to do things outside of their own codes of conduct, even illegal and dangerous things. It was true for me; it is true for the vast majority of us with severe substance use disorders. There is a long list of things that I did while addicted that I would not do now with a fully functioning brain, healed, and not impacted by drugs. Telling that fundamental truth is also a central principle of harm reduction, which requires adherents to “not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use.”
I stay in recovery for two fundamental reasons. The first of which is that I can live the life I want free of drugs and alcohol. Moderation is not a choice for a person like me with the most severe form of the condition. The second reason is that my brain would quickly revert to its addicted state with attempts to use. A path of destruction as addiction hijacks the brain that those of us with the most severe form of SUD experience. I have a responsibility to myself and others around me not to allow that to happen. Like thousands of others with severe substance use conditions, I don’t use drugs, so my brain stays functional, with my reason center in charge. I remain a law abiding, productive citizen. I would not remain so if I started using again. A fundamental truth for so many of us.
We must ensure that persons who use drugs are treated with respect and offered compassionate help when they need it. We don’t treat diabetics as less than human, but we do routinely treat people with addictions in this manner in America. It must change. Destigmatizing drug users is far different than normalizing destructive drug use. There are taboos against addictive drugs for good reason, particularly in relation to addictive drug use by young people. We know that developing brains are more susceptible to addiction and that early drug use increases the risk of addiction. Who among us would want to normalize heroin use for our children? We should think twice about normalizing cannabis use for our young people, it is a far different drug, delivered to the brain more efficiently, more quickly in more potent forms than in any prior time in human history. We should follow the money in respect to normalizing addictive drug use. We should understand the reasons behind the messaging. The profit motive.
Drug use is inherently dangerous. We draw a fence around it and acknowledge it is dangerous for good reason. Look at what alcohol, a legal and normalized drug can do to a person and change their very nature as addiction takes hold. We don’t want family members experimenting with methamphetamine. Cannabis related highway fatalities are dramatically increasing. We don’t want our kids on the road impaired or sharing it with people who are. Yet the normalization of drug use across society increases risk to us all. We do not want our babysitters, airline pilots, surgeons, or truck drivers impaired for good reason. We ignore them at our collective peril.
Stigma against addiction, drug users and people in recovery is a profound problem. Drug use leads causes of death in America when you add it all up. Stigma attitudes toward people who use drugs are abysmal, particularly in healthcare. We must change these attitudes, so people like me with SUDs are viewed as human and treated respectfully. That is not where we are right now, not anywhere close. Millions of lives depend on us making progress with these issues. But removing stigma so people can be helped is far different from normalizing addictive drug use and all its consequences.
There is a great deal of things in the middle of the proverbial stick where there is widespread agreement. Lasting forward movement requires being sensitive and respectful of views on either end of the stick while focusing change efforts in the center. Points of consensus between recovery advocates and drug use advocates include:
- War on drug policies that criminalized people who use drugs were ineffective and had profound negative consequences. Consequences that were most pronounced in marginalized communities. We must do better moving forward. Solutions must work for these communities and not just more privileged communities.
- People who use drugs should be treated respectfully in our society and not discriminated against.
- Beyond public safety considerations like those that present in respect to impaired driving, addiction should be addressed not as a condition of criminal behavior but instead as a condition that people can and do heal from.
While these are important conversations as a society and as a recovery community, we seem increasingly ill equipped to have them. We are moving away from nuanced open dialogue and into entrenched, polarized camps and constrained dialogue in parallel with the rest of society. The latter dynamic is perhaps just as dangerous as destigmatizing addictive drug use. We can’t talk about these things without fear of retribution.
The other end of the stick of normalizing drug use is minimizing the destructive consequences of their use in our society.
That asserting this is provocative is a sign in and of itself we live in dystopian times. Times in which we have difficulty grappling with complex issues because we tend as a society in our age to see things as all one way or the other way, which is inconsistent with the very nature of complex problems. We have the power to reverse this if we decide to encourage an open, honest, and nuanced appraisal of all costs and benefits that address both ends of the proverbial stick while embracing the middle. It is most likely the only way to achieve lasting change that we all desire.
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