Working in the field of addictive and compulsive behaviours for over 30 years, my stance on drugs and their uses has moved in many different directions, most significantly from abstinence, to harm reduction, and ultimately to recognising all drugs simply as medicine. I say ‘medicine,’ because in many cultures, tobacco, alcohol, psychedelics, and food were used in ceremony and medicinally. However colonizers exploited the use of these substances, by creating trade markets, opening up the flood gates for every day use.
I also say ‘medicine’ because whenever someone turns towards a substance, whether food, alcohol, drugs they are self-medicating. Initially this self-medication works, it soothes the pain. However, like all medication (prescription, alcohol, bought on the streets), when used compulsively, it can cause harm and sometimes death. As someone who has struggled with disordered eating for many years, where food became a poison, I am learning to relate to food as medicine. Too much of anything can become poison.
The academic, professor and neuroscientist, Carl Hart, challenges the narrative of addiction. His book Drug use for Grown ups, Chasing Liberty in the land of Fear (1), challenges the whole notion of addiction: “You should be able to take drugs as an adult, and if you choose to do that, what business of that is mine?” While Hart is vocal about his drug use, he does not consider himself as someone with an addiction.
This view provokes reflection on the term ‘alcoholic’ and how we use it. If someone drinks a few glasses of wine or beer every weekend we don’t call them an alcoholic. However, if someone takes heroin, fentanyl, or cocaine every weekend, the presumption is often that they are in the grip of a substance problem and fall into the category of ‘addicts.’
So how do we define addiction?
Eckhart Tolle says: “Addiction begins with pain and ends in pain”. Gabor Maté says: “All addiction is an attempt to soothe the pain”. However, because most drugs affect the brain circuits, emitting dopamine and causing euphoria, Hart believes that: “A properly functioning reward system motivates a person to repeat behaviours needed to thrive.”
So while it may be clear for some that addiction is an adaptive behaviour in response to the pain of trauma, for others, the underlying cause may be more difficult to discern. Their journey with drug use may have begun from the initial pleasure of experiencing substances, perhaps through peer pressure; wanting to be part of a group having ‘a good night out.’ For others, it could start with an impulsive choice under the influence of alcohol or marijuana, paving the way for heavier substances. But for all, as Carl Hart says, it ultimately comes down to, “Drug use in pursuit of happiness.”
Traditionally, addiction has been defined by the 4 C’s of: Loss of Control, Habitual Using despite the Consequences, the Compulsion to Use, and Craving. Within the mindfulness teachings, it’s simply seen that human nature has a tendency to turn away from painful experiences.
Addiction and Racism
Drug use has been strongly influenced by institutional legislation in the USA. The crack epidemic in the 1980s was largely facilitated by the unemployment epidemic in low income neighbourhoods, with the impact predominantly felt by African American communities. There, drug barons capitalized on the disempowered, disenfranchised youth to cultivate an industry of young drug dealers who had, before that point, few options to make a living, and were eager to earn.
Here in Canada where I live, when I’ve visited First Nation Reserves of various indigenous populations, the only shops I’ve found in the vicinity have been liquor stores, gas stations and maybe a single food store.
There’s no doubt that addiction in the Canadian indigenous communities, as well as those in America, Australia, and Africa has been caused by the colonization of these populations; through enslavement, land theft and prohibition on native languages.
For example, in Canada the indigenous populations make up 5% of the overall population, and 13% of overdose deaths in Canada are within the indigenous and First Nation Communities. It’s a grim figure, but sadly unsurprising if we remember the Residential Schooling system that forcibly removed indigenous children from their families, placing them in boarding schools for ten months of the year. There they were often physically, psychologically and sexually abused, starved and sometimes even beaten to death. In the ‘60s when residential schools were being phased out, a new phase called The ‘60s Scoop took place, where children were again taken from their families and placed into white foster homes.
In the UK during the ‘60s, black children were often placed into white foster homes, as Black and Asian parents were not considered fit enough to foster or adopt, and at times not fit enough to look after their own children. Can you imagine the impact of that? Unsurprisingly, the result is that many who were trans-racially placed in the ‘60s, ‘70s, and ‘80s, have been those to suffer the most from addiction and mental health maladies today.
In fact, to this day, black and brown bodied-people living in the west are still disproportionately incarcerated for addiction-related activities and petty crime; far more than their white counterparts. People of African descent are incarcerated five times more than white people. In the USA, 57% of prison inmates are from this community, along with 77% of those in federal prisons for drug offences. What’s more, those people incarcerated may go into prison addiction-free, and due to the immense weight of that experience, come out addicted. This in itself then perpetuates the cycle.
The Impact of Colonialism
When we talk about addiction, we must also acknowledge the impact of colonialism. From the outset, colonizers have stigmatized drug use through misinformation, bad policy and the use of misleading language.
Indigenous populations throughout the world have utilised plant medicines for ceremony, health and wellbeing for thousands of years. In Precolonial Africa and Asia, marijuana was traditionally used as a medicine and has been revered by the Rastafarians, the Sufis and the Hindus for centuries. Today these substances have become illegal drugs, yet what pharmacies sell are considered ‘good,’‘safe,’ drugs. This movement first began when the Colonizers prohibited the use of cannabis, heroin and cocaine in the 1900s.
Laws were introduced based on moral judgements and racist ideas about specific groups of people. For example, Canada introduced the first formal drug legislation, The Opium Act, in 1908, which was directed towards the Chinese migrant workers who were brought in to build the Pacific Canadian Railways. The workers used opium for pain relief and relaxation, however, when they rioted for better pay and work conditions, the government imposed this law. Similarly in the USA, laws around crack cocaine were introduced as part of the War on Drugs, targeting African American Communities. Crack was associated with Black Communities and powder cocaine with white America. If you were caught with 5 grams of crack the minimum sentence was 5 years, where a person caught with 500 grams of cocaine was given the same minimum sentence. This prejudicial injustice of punitive laws geared towards Black America led to harsh social consequences.
In 1914, the New York Times published a story stating that if a black person ingested cocaine it gave them superhuman strength, and even unloading a 32 caliber weapon on them could not control them. Instead, only a 38 caliber weapon would suffice.
Direct racism is not the only issue. Drug policy and laws have stigmatized what were once known as medicines, leaving them marred with the label of ‘dangerous drugs.’ In less than a century, drugs have gone from being an essential part of European colonial trade to—in the words of the Single Convention—a “serious evil” that “leads to personal degradation and social disruption”- (3) people into the American vision of ‘civilized, sovereign subjects’. – (4)
Nowadays, drugs bought on the streets are seen as the ‘bad drugs’. However, it could be argued that, in a country with little or no public health system, what can a person on the poverty-line do but self-medicate? Buying drugs from the street provides quick, cheap relief from emotional and physical pain, and is an almost inevitable response to an unsupportive social environment. It is no wonder people choose to take their emotional well being into their own hands.
In addition, it’s common knowledge that the War on Drugs operated more effectively as a system of racial control than as a mechanism for combating the use and trafficking of narcotics. UN experts have explicitly stated that “The fight against the world’s drug problem must address the unjust impact on people of African descent”.
Narratives need to change
The narrative of addiction is also in need of great change. The use of terms like ‘addict,’ or ‘alcoholic,’ label a person’s character, and such language problematizes a person rather than seeing that the person has a problem. Using the term ‘A person with a substance-use disorder’ or ‘patient’ are more compassionate, and do not attempt to fix the person, unlike the label ‘user,’ which is punitive, blaming, and full of negative associations. Words like ‘junkie,’ and ‘drunk’ are harmful and disparaging and disregard that the person has a name.
In addition we often hear ‘clean’ and ‘dirty,’ which are stigmatizing terminology, as well as labels like ‘addicted baby,’ which also imply that a baby can be born with an addiction. However, if we agree that addiction is a behavioural disorder, then a baby cannot be born addicted, but may experience withdrawal symptoms. Moreover, their physical experience may make them more susceptible to developing an addiction in later life, but should not define them.
If we are to have a more compassionate system that works in the field of addiction and compulsive behaviours, it is clear that much needs to change. While we may have come a long way from the headline: ‘Negro Cocaine “Fiends” are a new Southern Menace: Murder and Insanity Increasing Among The Lower Class Blacks Because They Have Taken To “Sniffing” Since Deprived of Whisky By Prohibitions.’ The New York Times, 1914 – (2), mass incarceration of the Black community still happens, and the myth of the Black child as ‘superpredator’ still exists in drug courts. Prison sentences of 10, 20, 30 years for the possession of drugs still fail to raise eyebrows, so it’s evident that providing needle and substance testing sites and changing our language around addictive behaviours, although good, are nowhere near enough.
We need to dismantle the prevailing view of drugs by getting rid of mandatory sentences for drug use, and instead, invest in more compassionate approaches to substance use disorders in general. This approach would focus on the root cause in people’s lives driving their addiction, rather than simply labeling them as an evil force in society and locking them up. In addition, it may involve destigmatizing substance use disorder by ending and releasing all those who are serving life without parole for being in possession of substances.
A whole community is in need of recovery, rather than its individuals being endlessly scapegoated by the authorities. This would start with law enforcement agencies, including judges, recognizing that addiction is not a choice, but often a symptom of the environments that people have grown up in.
“Only by dismantling unjust systems can we imagine a future that is safe, healthy, and truly free.” – Colin Kaepernick, American civil rights activist and former footballer
Finally, the question for us, as those working in the field of mental health and addiction, is, is it possible to reframe our view of substance use to one that sees it as a form of medicine? Medicine that, at some point, stopped curing that for which it was initially used, and became destructive, to the extent that some individuals are now struggling to survive in its grip. Instead of perceiving it as only a disease, or a genetic predisposition, and considering social factors; that substance use disorder has also been influenced by colonization, racist government policies, and the mass incarceration of certain populations, can we develop a more holistic viewpoint in relation to the issue and thus approach it with less judgement and more compassion?
References
- (1)Hart, C. (2021). Drug use for grown-ups: Chasing liberty in the land of fear. Penguin Press.
- (2)The New York Times: https://www.nytimes.com/1914/02/08/archives/negro-cocaine-fiends-are-a-new-southern-menace-murder-and-insanity.html
- (3)9.The Cameron report: https://pmc.ncbi.nlm.nih.gov/articles/PMC8626718/
(4)10.Decolonizing Drug Policy: https://pmc.ncbi.nlm.nih.gov/articles/PMC8626718/
