Kurt Cobain,
Janis Joplin,
Jimi Hendrix,
and Michael Jackson to name but a handful; and now Amy Winehouse.
The death list of popular idols grows, and these ones are just from the 'Recording' arm of the Entertainment Industry alone. The Entertainment Industry's "See No Evil" response to their contracted Artists' problems with alcohol or other drugs has to be brought into check. It is heart-breaking to see these troubled human beings being milked like a commodity cow while they obviously are not capable of making healthy choices for themselves. Is it possible to have conditions of self-care included in their contracts; perhaps under the heading of "Safety?"Political correctness in the guise of human rights might arguably be the first deadly overdose for these artists - and society in general - preceding the alcohol and other drugs.
Yet I wonder, are we, Society, any less guilty of the "See No Evil" artificial ignorance by way of our complacency when it comes to holding our politicians responsible
for their job - that of working to create a safe and productive society for the benefit of its people. We close our eyes to the fact there are proven approaches that have far-reaching social benefits and radically superior financial benefits over the approaches of old to Alcohol and Other Drug problems that still reign today.
Here is a paper I wrote a short time backthat demonstrates those benefits. Although some of the empirical evidence will have been updated, the essence endures and the over-all impact is likely greater rather than diminished.
Its called "Up Your Alley"
Up Your Alley: Alcohol and Other Drug Abuse; Approaches
The most commonly accepted image of the problem of Alcohol and Other Drug Abuse (AOD) is that of the seemingly unabashed outcasts in the back lanes, alleys, and on the skid rows of the world’s cities. We steal a look at them from our cars or glimpse them on the Evening News as we rest somewhat assured by the insulating glass of our windshields and television screens. Objectionable and provocative, this problem of intoxication and mayhem is not easily answered, some feel it is better left for Law Enforcement to deal with; we hasten through a few more traffic lights or click the remote control to free ourselves; but does that free us? In fact, the beginnings of the problem may lie much closer to home, within our homes, and our failure as individuals to participate in addressing this issue only serves to perpetuate the problem. The Legal System may be the last people we need leading the charge to resolution.
The prevalence of AOD has steadily increased since the Second World War, and the ways that Society has looked at the issue have been evolving as well. In the 1950’s cocktails and cigarettes were somewhat glamorized. In the 1960’s, for a while, some recreational drugs such as LSD and Methedrine were actually legal (less than 10 ‘hits’ and [a few] grams) but in 1969, everything was suddenly criminalized. Although there were studies underway by health researchers since the 1980’s, it wasn’t until the late 1990’s that overflowing prisons, skyrocketing enforcement costs, and backlogged criminal justice systems forced policy reviews and the practice of viewing AOD as a treatable health problem came into its own. Society now has two prevalent approaches to the problem of AOD, directly through the legal system and through the harm reduction model, which incorporates treatment, social programs, and enforcement that is more specific.
AOD, sometimes also called Substance Abuse, is a topic of global interest. One need only search the phrase on the Internet to find a multitude of links to not only U.S and Canadian Federal Government sites, but European, African, Australian and other nation sites, as well as State, Provincial and Local Governments, Military sites, Teen sites, and various Institutional and Organization sites - private and public (www.google.ca). Concern may be a better choice of word than interest, given the scope of the attention to this subject. The World Health Organization (WHO) deals with all psychoactive substances, regardless of their legal status, and claims that since its inception in 1948 to have played a leading role in supporting countries in prevention, harm reduction, and recommendations for regulation, of same (http://www.who.int/substance_abuse/en). Europe has undergone rapid changes recently in re-evaluating the intention of International Borders, and has organized the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), which currently has a sixteen-nation membership (http://www.emcdda.eu.int/).
The United States Government has its policy on drugs, one surmises from their literature that it is two-pronged, on one hand; “…the drug trade is not an unstoppable force of nature but a profit-making enterprise … that can then be attacked.” (Office ¶10), while on the other hand, President Bush’s 2003 message to Congress puts the onus on children and addicts themselves: “Our children must learn early that they have a lifelong responsibility to reject illegal drug use…. [w]hile those who suffer from addiction must help themselves…” (Bush ¶1,2). Canada’s Government policy has evolved to a harm reduction model; “Our efforts aim to prevent the use of drugs by those not currently using them, reduce the harm for those who use them, and promote effective and innovative treatment and rehabilitation for those affected by substance abuse” (Canada ¶3).
Several governments now concede that they cannot arrest/incarcerate their way out of the substance abuse problem; “Indeed, despite the massive increase in drug admissions to prison for young people during the 1990s, a recent Center for Disease Control Study found that drug use among high school children increased during the 1990s, with twice as many kids reporting have used cocaine” (Schiraldi p. 17). These conclusions, although slow in coming, have encouraged by research from the likes of the World Health Organization. Long concerned with global health and welfare, they give us an economic pearl to consider in their 2003 ‘Management of Substance Abuse Team Fact Sheet’: “…[f]or every dollar invested in drug treatment, seven dollars are saved in health and social costs” (WHO p. 1). With a return on investment of approximately 700%, one might speculate that the recent swing in government opinion may not be motivated by the compassionate pleadings of the front-line workers in this struggle. Nonetheless, positive moves are being made and coalitions are being formed. In turn, studies, programs, and treatment are replacing imprisonment and abandonment for AOD sufferers, as in Texas where; “…bitter enemies on issues such as the death penalty and abortion came together in an uneasy partnership to put money into drug treatment and rehabilitation programs…” (Hall ¶10).
Vancouver has adopted, as of 2001, a plan of action called ‘The Four Pillars Drug Strategy’, under a coalition originally initiated in 1997 as the ‘Coalition for Crime Prevention and Drug Treatment’. The guiding principles listed on their website are, in order; Harm reduction, Prevention, Treatment, and Enforcement. As a community partnership of over 60 organizations the now named ‘Four Pillars Coalition’: “…brings together a diverse group of concerned local business, government, and non-governmental organizations, and acts as a forum for ongoing dialogue and collaboration…” (Vancouver ¶2). London England approaches the problem from a structurally similar strategy. Their website presents the ‘London Drug Policy Forum’ (LDPF); of particular note on that page under the section heading ‘Past conferences’ is a link to the report from the 11th LDPF annual conference of October 2002, appropriately titled ‘It's a Family Affair’ (LDPF p.1). The British, it seems, have the right idea, focussing some attention back into the home. A family affair, a community problem; there is a risk of misinterpreting those terms, but put things back into the global spotlight and the problem gains some perspective. WHO figures from the previously mentioned Fact Sheet indicate that worldwide 91.5 million persons are diagnosed with alcohol or drug use disorders; “… [i]njecting drug use reported in 136 countries; 93 countries report having HIV infection among this population” (WHO p. 1).
To narrow the perspective, we can speak in terms of costs. A Washington, D.C. based think-tank tells us that in the 1990s U.S. jail and prison inmate population grew by approximately 816,965 – twice as many as in the 70 years from 1910 to 1980 – and was expected to surpass 2 million by 2001;
“Americans will spend nearly $40 billion on prisons and jails in the year 2000. Almost $24 billion of that will go to incarcerate 1.2 million nonviolent offenders. …one in four (23.7%) prisoners in America is incarcerated for a non-violent drug offense. …the price tag for incarcerating nonviolent drug offenders (458,131) comes to $9.420 billion annually” (Schiraldi p.2).
To breathe a sigh of relief because our population is so much smaller would be premature; our situation has its own miserable reality. According to statistical evidence from The Source Newsletter, ”the cost of substance abuse in Canada in 1992 was $18.45 Billion or $649 per capita. In British Columbia this translates to $2,2 Billion or $654 per capita….” They further add that in 1996 1,841 deaths in British Columbia were related to alcohol (Prevention 1).
Certainly then the universal trend is away from viewing AOD as being a criminal problem and toward viewing it as a health related problem, an argument supported even by some of the unlikeliest of believers - such as the [supervisor] of Chicago’s notorious Cook County Jail –“… as many as 60%… [of current prisoners’ incarcerations] are related to drugs…”— using the word illness in his further description (Gates). Although this transition of perspective has not been an easy one, at its relatively young stage, there has been significant headway in policy and program initiatives and implementation, at local levels at least.
Underlying the drive for changes in attitude has been the realization that, like most illnesses, the afflicted do not make a conscious choice to be sick. Even the sternest approach contains some acknowledgement of that suggestion; “…most of those whose drug use has progressed—more than five million Americans—do not even realize they need help” says the President in his 2003 Message to Congress (Bush ¶2,3). In a Los Angeles Times article co-written by the LA Chief of Police, key points in assessing the traits of the street population are identified; they tell us that problems of the homeless are far more severe, “Many are mentally disturbed or chronic alcohol and drug abusers. …many of this group are not homeless in the traditional sense. They …have been kicked out of the homes of families and friends—for stealing from them for drugs, for instance…” (Manhattan ¶6,7).
“Many of the issues that are seen to be a threat to mental illness have also been linked to substance misuse, including such things as family dysfunction, low self-esteem, poor coping skills …many of the characteristics associated with poor mental health serve as motivations for increased reliance on substance use. …many individuals "use" substances to “self-medicate” ongoing mental distress or illness.” (Hood p. 8)
“Non-problematic use of substances is often seen to have positive impact on mental health, such as relaxation, increased social comfort, and temporary disengagement from life responsibilities. However, this style of substance use may have impacts on individuals that vary greatly …not always positive (such as increased depression and emotional or social withdrawal). Of course, substance use — with or without addiction — can have detrimental effects on mental health, not only for the user but [also] for others. For example, the relationships between alcohol abuse and alcoholism and family functioning and family violence are well documented, not to mention such outcomes as employment difficulties, family and relationship problems, poor physical health and poor self-esteem[;] all of these impact on overall mental health. ” (Hood p. 9)
There seems to be mixed messages in the above quotations, one might ask – if it’s socially acceptable to consume a mind-altering substance, i.e. alcohol, for ‘the right reasons’, do individuals now form their own social groups to support group-specific reasons, or acceptable degrees of consumption, or chemical of choice? This is, of course, what happens both directly and indirectly, social classes have defined their standards and an individual will seek out or be accepted into the level that applies to them or be cast from one for which they can no longer maintain status. The problem lies in the very nature of AOD itself. A mind-altering substance impedes one’s ability to make sound judgements, is physically or psychologically addictive, and often can be ingested in privacy and/or secrecy for long periods which can cause an individual to be in serious trouble before the problem is detected. The question of their mental capacity when they were first introduced to the substance is important during treatment, but no longer important in determining the need for treatment. So when does one go over the edge? It is safe to say that the edge is discovered too far from the beginning, and the bottom is that tragic pit called ‘the street’ – for some the end.
Mentally ill, substance abuse, and street people are three phrases common in much of the progressive literature referenced for this paper. Anyone sincerely considering the problem recognizes that at some point these people were connected to family and homes. That connection is broken or damaged; the missing link rests in the answer to the question: Why? Were these people making choices that caused society to reject them; have they made choices because they felt rejected by society – for mental or physical differences; does society reject them because of its own choices; or have they rejected society? Certainly it is difficult to process the problem on a personal level, as a ‘here and now’ issue, and to become involved. It’s a giant leap in the average person’s mind to get from a drink or two after work to skid row. It takes effort to overcome the general tendency to accept as hopeless the plight of afflicted strangers, a trend that fed the criminalization process. Thankfully, we have reached an era wherein the causes of the problem are being investigated and addressed; hopefully a chain of events can unfold leading to the healing of individuals and a recuperation of the burdened criminal justice and social welfare systems. With the harm reduction model, laws and statutes that are more appropriate will endure, AOD abusers/consumers are seen as afflicted, traffickers are targeted, and resources for law enforcement can be better appropriated and more effectively applied.
References
Bush, George. Office of National Drug Control Policy “President’s Message to Congress” February 2003 http://www.whitehousedrugpolicy.gov/publications/policy/ndcs03/message.html accessed February 8, 2004
Canada. Health Canada. “Canada’s Drug Strategy: About” 2002-07-05
http://www.hc-sc.gc.ca/hecs-sesc/cds/about.htm accessed February 9, 2004
Gates, Henry Louis Jr. America Beyond the Colour Line South: The Black Belt, Executive producer: Jonathan Hewes; Producer: Simon Chinn; Directors: Mary Crisp, Daniel Percival; Writer-host: Henry Louis Gates Jr.;
Hall, Wiley “States Starting to Reverse Get-Tough Prison Policies, Reformers Say” Associated Press November 10th, 2003 at Justice Policy Institute Newsroom http://www.justicepolicy.org/article.php?id=355 accessed February 9, 2004
Hood, Colleen Colin Mangham, and Don McGuire Exploring the Links Between Substance Use and Mental Health: An Annotated Bibliography and A Detailed Analysis at Health Canada. “Canada’s Drug Strategy: Publications: General: http://www.hc-sc.gc.ca/hecs-sesc/cds/pdf/bib_e.pdf 1996, 252 pages, Cat. H39-360/2-1996E, ISBN 0-662-24308-0
London. London Drug Policy Forum, Corporation of London http://www.cityoflondon.gov.uk/our_services/social_services/ldpf/london_drug_policy_forum.htm accessed February 8, 2004
Manhattan Institute. The LAPD Is Targeting Crime on Skid Row, Not the Homeless from the Los Angeles Times March 11, 2003 at http://www.manhattan-institute.org/html/_latimes-the_lapd_is_targeting.htm accessed February 10, 2004
NSDUH. SAMHSA 2002 National Survey on Drug Use & Health http://www.samhsa.gov/oas/NHSDA/2k2NSDUH/2k2SoFOverviewW.pdf accessed February 9, 2004
Office of National Drug Control Policy “Disrupting the Market: Attacking the Economic Basis of the Drug Trade” May 7, 2003 http://www.whitehousedrugpolicy.gov/publications/policy/ndcs03/iiidisrpt_mkt.html accessed February 10, 2004
Prevention Source B.C. The Source Newsletter “Why We Need Prevention:
Costs Associated with Substance Abuse in Canada and B.C.” http://www.preventionsource.bc.ca/statsheets/costs.html accessed February 10, 2004
SAMHSA (a). National Survey of Substance Abuse Treatment Services (N-SSATS): 1997 - 2002 http://wwwdasis.samhsa.gov/02nssats/2K2Fig3.gif accessed February 9, 2004
SAMHSA (b). National Survey of Substance Abuse Treatment Services (N-SSATS): 1997 - 2002 http://wwwdasis.samhsa.gov/02nssats/2k2chap4.htm accessed February 9, 2004
Schiraldi, Vincent, Barry Holman And Phillip Beatty Justice Policy Institute (a) “Poor Prescription: The Costs of Incarcerating Drug Offenders in the United States” http://www.justicepolicy.org/downloads/pp.pdf February 9, 2004
Tobacco. www.tobacco.org Robert Wood Johnson Foundation, 2001-03-09 excerpt in News: Comprehensive Substance Abuse Report Released Today http://www.tobacco.org/news/61248.html February 11, 2004
Vancouver. Four Pillars Coalition, January 19, 2004 at http://www.city.vancouver.bc.ca/fourpillars/coalition.htm accessed February 9, 2004
WHO. World Health Organization Management of substance abuse team fact sheet 2003 http://www.who.int/substance_abuse/about/en/MSBcurrentfactsheet.pdf accessed February 8, 2004
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[1] Dually Diagnosed – Co-occurrence of one or more Mental Illnesses and substance abuse
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