The Drug War as Political Theater

Most people think that drug prohibition laws were a response to social problems caused by out-of-control drug use.  The real story is that these laws came from political zealotry. Most of the problems with drugs today—crime, decadence and swelling prison populations—are largely the result of prohibition laws.

The politics behind drug prohibition began when early 20^th century political leaders linked drugs to minorities. Cocaine was linked to Negroes who were said to commit deviant sex acts under the influence. Marijuana was linked to Hispanics and was said to cause insanity. And opium was believed to be corrupting white women, who then desired black men for sexual purposes. Protestant missionaries in China wanted anti-opium legislation for the same reasons they wanted anti-alcohol legislation:  intoxicated peoples tend to be less receptive to the teachings of Christ.  Finally, politically influential corporations like DuPont and Hearst viewed hemp as a threat to their bottom lines.

Eventually prohibition laws came under the authority of the United Nations’ Single Convention on Narcotic Drugs (1961).  This treaty shifted the conversation from race-baiting to concerns about health. Advocates of the drug war began to see themselves as guardians of public health.

The theatrics only got worse. If you set yourself up as a guardian, you have to view your charges as helpless, sick or both. This is why we hear fantastic claims that drug abuse is a brain disease and that drugs overtake the human will to resist them. That many people behave that way is true enough, but it has less to do with drugs than with human opportunism. Addicts behave the way they do because they can. They are endlessly enabled by being told that they can’t control themselves and by the many social programs available to them (welfare, rehab, medical care, disability payments, etc.)

In my new book, Blowing Smoke: Rethinking the War on Drugs without Prohibition and Rehab (Rowman & Littlefield, 2012), I suggest that the solution to the drug problem is to legalize drugs for adults and let people bear the consequences of their own behavior. If we took these bold steps we’d see a transformation in how people use drugs and we’d silence some of the histrionic fits coming from the political class.

The Mind and its Minders

(Note: A version of this post initially appeared on the blog of the Rowman and Littlefield Publishing Group. You can view it here.)

The history of psychology is littered with fads and fallacies: the four humors of Hippocrates, phrenology, Freudianism and behaviorism to name a few. More recently we’ve seen the “biochemical imbalance” theory of emotional problems, which has led to a robust pharmaceutical industry to “treat” imbalances.

These seemingly disparate movements share a similar perspective on mental life, namely, that the mind is controlled by mechanistic forces. Whether the forces are hormones, genes, unconscious dynamics, reflexes or neurotransmitters, human consciousness has always been viewed as a byproduct. According to the theory, you may think you’ve been making independent decisions in life, but in reality you’ve been a marionette, performing a scripted dance.

In college I remember thinking that many psychological theories bore an uncanny resemblance to Marxism: reductionistic explanations of human behavior followed by grand prescriptions that seemed to benefit the theorists more than they helped the stated beneficiaries. Centrally-planned economies fail because they misjudge human nature. Creativity and productivity flourish only when there is political and economic freedom. When people feel they can control their destiny, they begin to create it.

Modern psychology is on the cusp of a scientific revolution and it’s long overdue. Neuroscience has recently shown that the brain is highly plastic and constantly changes to meet the demands that individuals place on themselves. Challenge yourself mentally or physically and your brain changes to improve your efficiency and accuracy.

The field of genetics is also undergoing a revolution. Both thoughts and behaviors can open access to genes, which then send instructions throughout the body to reinforce whatever it is we are doing. This heretofore unknown function of genes—what we call “epigenetics”—appears to mediate the plasticity we find in the brain. It’s now more accurate to say that the mind controls biology, rather than vice versa.

In my book, Blowing Smoke: Rethinking the War on Drugs without Prohibition and Rehab, I address one area of old-school psychology—the disease model of addictions—and argue that it neither fits nor helps the problem of drug abuse. Neuroscience and the Berlin Wall teach us something important about the human condition: people thrive when they are not held back. After working for years with substance abusers, I’m convinced most of them would move toward moderation if we quit telling them they are diseased, and instead give them their freedom.

Drug abuse: choice or disease?

The correct answer is neither.

Drug abuse is a habit. Some habits are trivial, but other habits are complex--they require time and concerted effort. Drug habits are the latter kind. So is mastering a musical instrument.

To develop a complex habit one must have a passion for it. Drug addicts don’t wake up and make a simple choice to consume drugs; they consume drugs because it is their passion. They arrange their lives around drugs, they hang out with other drug users, and they cut themselves off from respectable society. When they experience craving and withdrawal symptoms they simply do more drugs. They always do. Drugs haven’t overtaken them; they’ve overtaken drugs—passionately.

All habits change the brain. Whether you practice the piano or deliver cocaine to your brain, the human brain adapts to the demands that are placed on it. The changes are predictable and consistent. Stop practicing a habit and those changes are dismantled.

Shawn Vestal of the Spokesman-Review interviewed me about my book, Blowing Smoke: Rethinking the  War on Drugs without Prohibition and Rehab (Rowman & LIttlefield), which is scheduled for release later this month. In his column he accurately reflected my criticisms of the disease model of substance abuse and he captured the fears most people have about drug legalization. He interviewed one Grace Creasman, director of addiction studies at Eastern Washington University. As if on cue to any criticism of the disease model, she assumed the only other position was that drug abuse is a choice: “Why would someone deliberately ruin their lives? Why would anyone do that to themselves? Why would they lose their jobs, their husbands or wives, their whole lives, unless there was something more to it?”

Indeed, there is something more to it. Passions are not driven by choices, passions drive choices. Addicts don’t make choices to ruin their lives, their passions ruin their lives. Passions change only through pain. Becoming a drug abuser is a long, dark road. One comes out of it only through deep, personal pain.

This is why drug rehab doesn’t work, a topic I cover in Blowing Smoke.  The rehab industry uses the disease model to market itself, but rehab is really little more than subtle appeals to addicts to make better choices.  Thought-experiments, though, are not capable of changing passions. Passions change only with pain. Only when addicts hit bottom, and hit it hard, do they begin to change their ways.

My solution to the drug problem is to accept responsible drug use as a cultural norm (legalize), but let irresponsible users experience the pain of there passions. In most cases this can be done with a simple laissez faire approach--quit rescuing addicts from the consequences of their behavior.

Prohibition causes drug abuse

The main reason that people support prohibition is because they support public health. People believe that prohibition prevents drug abuse. In the real world, though, prohibition enables drug abuse.

Consider the forbidden-fruit élan. Under prohibition, drug consumption becomes a badge of independence. Substance abusers are not just drawn to drugs; they are drawn to illegal drugs. Prohibition also creates incentives to overindulge. Efforts to avoid detection drive production toward more concentrated drugs and forces consumption into smaller time slots. Consumption is necessarily done on the sly with more dangerous substances. Nothing about prohibition fosters moderation. Even Marxists, who were never loath to remove rights and freedoms, understood this basic concept. Writing in the British socialist magazine in 1908, labor leader Harry Quelch noted that “experience has proved that any form of prohibition has but stimulated that worst form of the drunkard’s vice, secret drinking.”[i]

Prohibition also comes with expectations that lead to irresponsible consumption. These laws are based on the notion that drugs are dangerous and can take over the human will to resist them. Expectations like the “fried brain” and “loss of control” all contribute to the likelihood of self-fulfilling prophesies. The power of expectations was demonstrated years ago in research[ii] where drinkers were given unlimited access to alcohol in a “tasting” test. They were served drinks that contained vodka but were told that they contained only tonic water, or they were served drinks that contained only tonic water but were told that they contained vodka. The results showed that for both alcoholics and social drinkers, subjects who expected to drink vodka (but received none) drank almost twice as much and acted more inebriated than those who expected to receive only tonic water (but actually received vodka).

Another problem is that prohibition professionalizes control of consumption: law enforcement professionals strive to stop people from selling drugs, and treatment professionals attempt to keep people from wanting drugs. This ensures that drug use occurs outside cultural norms and sends those with unruly habits to “addiction experts” who coddle and enable them.

In my upcoming book, Blowing Smoke: Rethinking the War on Drugs without Prohibition and Rehab (Rowman & Littlefield, 2012), I argue that the only effective way to control substance abuse is to de-professionalize its control. Let’s remove the forbidden fruit, change the expectations, and get the medical profession out of the rehab business. Let’s then subject substance abusers to common-sense embedded cultural controls.

Laypeople have the power to control drug habits because they own—or should own—the most valuable social assets of any society. It is the hardworking, taxpaying, and child-rearing among us who control the homes, the warm beds, the meals, and the social contacts that connect people to jobs and opportunities. Responsible people are found at every level of society. They control the goods. When this group bestows these goods on those who act responsibly and withholds them from those who do not, it wields tremendous leverage over society’s general level of civility. Responsible people can and should expect others around them to act similarly, just as they have had to do to get where they are. When faced with irresponsible behavior, responsible people naturally cut off the goods. In this way, they create incentives for everyone to do the right thing.

The medical profession is not capable of moderating this kind of tension. It is not within its nature to administer sanctions, and it tends to pathologize irresponsible behavior. The lay culture, on the other hand, deals with these tensions on a daily basis. From the time that children are taught to pick up their toys, laypeople have been shaping responsible habits. They know how to do it by instinct. Laypeople also understand that the consumption of anything (food or alcohol, for instance) is best enjoyed when linked to cultural or religious traditions, which tends to frame acceptable levels of consumption.

Prohibition laws perpetuate the temperance mindset of the 19th century: the masses are ignorant and need smart people to tell them how to live. While appeals to health are now used instead of appeals to morality, the outcome is the same: violence, lawlessness, irresponsible consumption….and the decay of public health.

[i]. Harry Quelch, “Socialism and Temperance Reform” Social Democrat 12, no. 1 (January 15, 1908): 1–8.

[ii]. Alan G. Marlatt, Barbara Demming, and John B. Reid, “An Experimental Analogue,” Journal of Abnormal Psychology 81, no. 3 (June 1973): 233–41.

The DSM and scientism

The American Psychiatric Association (APA) is planning a 2013 release of the next edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM). First printed in 1952, the manual has been a boon to the profession because it got all clinicians on the same sheet of music, and it provided diagnostic codes so that providers could bill insurance companies.

Technically, the manual is only a classification manual. It provides labels for all of the emotional and behavioral struggles that people experience. Currently there are over 400 different entries.

The problem with labels, though, is that they explain nothing. The DSM does little more than classify the symptoms that people experience and the signs that others observe. A diagnosis, on the other hand, infers that there is an underlying disease state that produces the symptoms and signs at hand. In psychiatry, there are no objective tests or biomarkers for mental disorders, a point recently admitted by a past-president of the APA, Dr. Carol A. Bernstein. In the same article, she complained that practitioners who use the DSM tend to “reify” the various classification labels; that is, they turn labels into real-world diagnoses. You won’t hear that kind of admission very often from within the field. Instead, you’ll hear that the new DSM represents a big step forward in science and then you can watch both practitioners and patients routinely reify those labels.

An example of how this works in the real world is as follows: a restless and fearless child who begins violating classroom rules (getting up out of his seat, talking out-of-turn, bullying others) will be sent to a mental health clinic where he’ll be labeled with Attention-Deficit Hyperactivity Disorder. When he begins fighting and setting fires, he’ll receive the label of Conduct Disorder. When he starts using drugs, he’ll be labeled with Substance Abuse Disorder, and when he begins to have volatile adolescent emotions, he’ll be labeled with Bipolar Affective Disorder. Along the way he’ll receive medications and talk therapies. Parents begin to see that their main job is to get their kids to therapy sessions and to make sure kids take their medications.

It shouldn’t be a stretch to imagine how children raised in this kind of label-driven, pharmaco-therapeutic climate might develop emotional and behavioral habits that keep them from becoming self-controlled, responsible adults. Indeed, they often become narcissistic, labile and entitled adults. It used to be that children who misbehaved were met with discipline and punishment, all of which was designed to make them self-controlled, responsible individuals. Fortunately, one can still find pockets where this kind of child-rearing takes place.

The rise of the DSM has correlated with a popular belief in scientism, which maintains that science is the only way to solve problems of the human condition. This faith is misplaced. Scientists are human beings, and human nature is nothing if not opportunistic. Common sense dictates that science has bounds, and when it oversteps, society can be harmed.

Why people can't wrap their brains around drug legalization

As a clinical psychiatrist I have worked with hundreds of substance abusers and their families, and I’m convinced now, more than ever, that we need to legalize drugs. Sound like a contradiction? It isn't. The main reason people fear drug legalization is because they're devoted to the disease model of substance abuse. Simply put, most people believe that if we legalize drugs—including the “gateway” drug marijuana—we’ll experience an epidemic of out-of-control drug addiction that will shake the foundations of civilization.

My soon to be released book, Blowing Smoke: Rethinking the War on Drugs without Prohibition and Rehab (Rowman & Littlefield, February 2012), traces the history of the disease model and argues that its roots are political not scientific, and that the model paradoxically enables substance abuse. Current neuroscientific knowledge does not support the disease model; it only shows why quitting can be hard. Human nature is more resourceful than the disease model allows, which is why prohibition laws won't stop the flow of drugs, and multiple trips through rehab won't stop consumption.

While early drug control laws, like the Harrison Narcotics Tax Act (1914) and the Marihuana Tax Act (1937), were aimed at immigrants and minorities, modern prohibition laws are based on the disease model. Prohibition is believed to be a public health initiative. The disease model informs the United Nations’ Single Convention on Narcotic Drugs (1961), which is the legal basis for the war on drugs throughout the world. The thinking behind the treaty is straightforward: if drug abuse is a disease, then drugs are pathogens that need to be banned. The U.S. implemented this treaty through the Controlled Substance Act (1970).

The disease model was part of a larger cultural trend in the mid twentieth century that began to view the masses as weak and in need of enlightened protection from the political and scientific elite. This view didn't arise from the massess, it was passed down from the elites, who were certain that they knew what was best for everyone else. During this time Americans also lost the right to self-medicate. Most medicines today are “by prescription only." Prior to 1951, you could walk into any pharmacy and buy almost anything you wanted, with the exception of those drugs controlled by the tax acts.

So what is it about the disease model that enables substance abuse? Drug rehab teaches addicts that they have a genetic brain disease and that they aren’t responsible for their behavior; the sick-role entitles addicts to a wide range of welfare and disability benefits; disease model-inspired prohibition laws create a forbidden-fruit élan; and the model creates a set of expectations that does nothing to foster moderation: drugs will fry your brain, you’ll lose the ability to control yourself and you’ll likely commit crimes to support your habit. That many drug users behave like this is true enough, but the reason has less to do with the chemical properties of drugs than with the expectations and enabling that society delivers courtesy of the disease model.

Blowing Smoke argues that the only way to effectively manage the drug problem is to meet human nature head-on: embrace drug use as a cultural norm and let informal cultural controls reinforce responsible use. Quitting isn't necessary, only moderation. Doctors can't change addicts, but addicts can change themselves, and they're more likely do so when family members and friends help them experience uncomfortable consequences for irresponsible consumption. Want to help drug addicts? Then help them face painful consequences for irresponsible use.

While repealing prohibition laws would eliminate the violence associated with the drug trade, harm reduction efforts that seek to shift control to the medical profession would be misguided. If we legalize drugs and continue to treat drug abuse like a disease, irresponsible use will continue to grow and many reasonable people would start calling for a return to prohibition.

New Book--Blowing Smoke--February 2012 Rethinking the War on Drugs

Book Description:

Alcohol, opiates, cocaine and marijuana, among other drugs, have been used and abused for millennia. Prior to the disease model approach to drug addiction, which posits that addiction is a psychological and biological problem and that sufferers are victims, societies had a workable solution: let people consume what they want, and let informal cultural controls reinforce responsible behavior. Legal sanctions were reserved for any use that affected the safety of others. Blowing Smoke proposes an approach to the war on drugs that returns us to the pre-disease-model era. Dr. Reznicek asserts that addiction is not a medical problem to be treated in rehab or by prohibiting substance use. Rather, he debunks the disease model, arguing that it has exacerbated the problem by telling drug abusers that they are not responsible for their behavior, that they are sick, that they are not to blame. He skillfully argues for a new approach to drug use and abuse that requires a shift in the way we fight the war on drugs

Dr. Reznicek provides a new framework for understanding drug abuse: the habit model. Habits are practiced as long as they provide comfort, and are abandoned when they cause pain. The habit model is more consistent with current neuroscientific knowledge and it accounts for the widely observed phenomenon that most substance abusers don’t change until they “hit bottom,” the point where the consequences of drug use finally outweigh its benefits.

Using the habit model, Dr. Reznicek suggests the solution to the drug problem is to turn back the clock, and to take lessons from societies that use social controls and consequences to deal with addiction and drug abuse. He recommends the legalization of drugs for adults, the implementation of social practices to dissuade abusers, and the end to the use of rehab as a way of handling addiction. Blowing Smoke shows how such an iconoclastic approach can work for us today.


Preorder my book at Amazon.com.