The Best Defense: Seeking Solutions to Alcohol and Other Drug Abuse
Alcohol and other drug (AOD) abuse has become a problem of global proportion, a great deal of attention is being paid to the matter by governments and citizens alike. For decades, the traditional line of defense has been an aggressive offensive by law enforcement officials; combining a prohibition/criminalization approach to suppliers and users of illicit drugs and statute provisions for users of legal drugs such as alcohol and tobacco. Recent analysis of the true costs of blanket criminalization has led many countries and communities to adopt the ‘Harm Reduction’ model which treats the afflicted for an illness while directing the thrust of criminal enforcement toward suppliers and profiteers.
This modern approach is a bold step in the right direction; such work has revealed the psychosocial nature of this issue, and society’s contributing elements. The problem of AOD abuse is complex; its hidden roots stretch far and wide, vastly entwined with the structure and function of society. We cannot successfully treat the problem by waiting to lop off its head where it appears – such is the practice of imprisoning or treating the afflicted as they become apparent. Proper resolution of AOD abuse includes a thorough appraisal of the social factors that contribute to the problem. A proactive strategy that addresses the contributions of society as a whole must be put into practice in order to effectively influence the patterns associated with alcohol and other drug abuse.
The negative aspects of AOD abuse are many. The financial burden of control of illicit drugs alone for western societies is tremendous; in 1998 in the United States, “Of the $620 billion total [that individual] states spent, $81.3 billion--a whopping 13.1 percent—was used to deal with substance abuse and addiction (Boyd 2001, ii).” Social costs of AOD abuse are immense—“In Europe, alcohol was responsible for over 55,000 deaths among young people aged 15-29 years in 1999” (WHOb 2003, par. 2). It permeates almost every aspect of life, impacting individuals, families, and governments through an intricate weave of connections; “Untreated substance abuse increases, for example, the cost of every state's criminal justice system; elementary and secondary schools; Medicaid; child welfare, juvenile justice and mental health systems; highways; and state payrolls (Boyd et al. 2001, 2).” Although this is an assessment of the situation in the United States, it is no doubt relevant to Canada, Europe, and every country with the problem; “…illicit drug use cost Canadian society $1,371B in 1992, or 0.2% of Canada’s GDP. This cost is considerably less than the amounts estimated in the study for the abuse of alcohol [$7,472B] or tobacco [$9,528.5B]” (Jackson, sec. A). The burden of AOD abuse is fueling the momentum of the shift toward other models of treatment. The 2003 annual report of the European Drugs and Drug Abuse Monitoring Centre describes this shift: ”Healthcare, educational and social policies are becoming more important in reducing drug-related problems in the widest sense, and it is increasingly recognized that the criminal justice system alone is not always capable of handling the problem of drug use” (ECCDA 2003, PAR. 3).
The World Health Organization has provided data on psychoactive drug use around the world, which tells us the relationship between modernization and AOD abuse is direct, the worst effects are in the developed countries (WHOa 2004, par. 1). Such evidence lends support to structural functionalists’ social disorganization theory that rapid change in society causes normlessness (Mooney 2004, 10) – the rapid changes of the Technology Age in western society has reduced the need for manpower, increased unemployment, and rendered the skills and education of many obsolete. Failure to adapt to these changes results in stress, family breakdown, displacement, and economic decline for the affected population. The nature of technological growth generally concentrates wealth to a smaller segment of society, widening the gap between the ‘haves’ and the ‘have-nots’. These facts also support the Marxist conflict perspective theorists’ alienation theory of powerlessness (Mooney 2004, 12). Concentration of wealth also leads to migration of those in need of new opportunities to economic centres, which in turn increases urbanization – thus the concentration of have-nots into the core and ghettos of cities. The high visibility of this population constitutes a problem for a successful society, which identifies them as such, perpetuating their isolation. This cycle reinforces the symbolic interactionists’ ‘labeling theory’ (Mooney 2004, 14) which indicates that although individuals are constantly changing, labeling an individual or group as a problem interferes with the ability to change.
Plainly stated, alcohol and other drugs are here to stay, and creation of new psychoactive substances is both on the increase and increasingly profitable. The ultimate approach to the problem cannot ignore that fact (through criminalization) or the fact that today’s society embraces these substances. Commitment to resolution of the problem must go beyond questioning the values of those afflicted and address the values that society as a whole holds with regard to its members. A bulletin from the Federation of American Scientists urges expanding discussion with school kids to include secondary effect behaviours such as sexual promiscuity, “Broadening the topics addressed has the benefit of giving children a better picture of the full range of health-risk behaviors with which they are likely to be tempted (Lynskey 1998, par. 5)”. This is a valuable approach at the individual level, and goes toward establishing a set of personal principles; however, the greater problem of society’s treatment of its underprivileged is not being addressed. Reconciliation of inequalities is vital to a healthy society and would go a long way toward easing AOD abuse; “…risk factors … include … social disadvantage and exposure to adverse family living conditions” (Lynskey 1998, par. 4). At the same time we are given a clue to the appropriate direction necessary to address the problem: “Drug prevention also has a lot in common with positive interventions designed to get people to invest in their own well being, including health promotion, encouraging exercise, encouraging good nutrition, promoting good school performance, etc.” (Caulkins 1998, par. 15). The term ‘positive interventions’ itself frames a sense of confrontation, and perhaps it reveals the potent temptation to continue to treat the problem at the individual level rather than address social inequities. Indeed, in order for people to benefit from all of the tools we must address the problem of accessing them.
To pursue educational aspects of AOD abuse prevention it must be ensured that all members of society have complete and unfettered access to education and educational facilities. The same can be said for health care and shelter. It is vital that a social philosophy, with the intention of establishing such access, be developed to remove as many obstacles as possible. A policy of inclusion must start at the most rudimentary levels, encompassing universal health supports, family supports, and economic supports; for all members of society. On the surface such propositions may appear unreasonable and unattainable; however, one need only weigh the perceived benefits against the perceived costs. Consider the magnitude of one small component of AOD abuse described in the World Health Organization’s fact sheet on worldwide substance abuse: “Injecting drug use reported in 136 countries; 93 countries report having HIV infection among this population. … [f]or every dollar invested in drug treatment, 7 dollars are saved in health and social costs” (WHOb 2003, 1). The significance of these facts becomes apparent when one ties them to a report for the ‘General Progress Index for Atlantic Canada’ that, while speaking of the changing face of Canadian AIDS victims and the $2 billion associated costs, tells us the sick are, “…now less likely to be middle-class gay men …much more likely to be vulnerable groups -- aboriginal, poor, unemployed, homeless, and intravenous drug users” (Dodds, Colman, Amaratunga, Wilson, 1999, 1). This information is prophetic when we consider the natures of HIV and injection drug use – and the inherent tendency of psychoactive drugs to obscure rational thinking, thereby elevating risk. Financial burdens aside, the effects on the physical and emotional well-being of each afflicted person’s family affects the functioning of society as a whole, creating satellite cost scenarios of their own. Neutralizing social imbalances is vital in the response to AOD abuse. However, they are varied from one society to the next, whether characterized by classes or norms, and for that reason social structure cannot singularly define the approach to the problem.
The definition of psychoactive drugs has only expanded in recent years to include alcohol and tobacco; therefore, response to the problem of AOD abuse is in part, a symptom of that contradiction. In 2002 there were estimated to be about 185 million illicit drug users globally, 2 billion alcohol users, and 1.3 billion tobacco users (WHOa 2004, par. 1). AOD abuse cost the Canadian economy more than $18.4 billion in 1992, of that illicit drugs amounted to $1.4 billion, alcohol $7.5 billion, and tobacco $9.6 billion (CSSA 1999, par. 32). The hypocrisy of classifying drugs according to the values of one sector of society cannot continue. Today, inclusion of alcohol and tobacco statistics in government reports is little more than an appeasement and generally superficial, considering the lack of government action to directly recoup the costs of these substances. The 1930’s should have taught us the perils of prohibition; however, history is repeating itself with marijuana. Preferred by many as an alternative to alcohol or tobacco, marijuana is outlawed by those in power, many of whom are products of an era saturated with alcohol and tobacco promotion. Proponents of legalization assert that abolitionist risk claims are embellished, condemning the association of users of the drug with the commission of a crime, something that occurs each time they obtain or possess the illegal drug. Some also contend that forcing the user of marijuana to obtain the drug from underground sources exposes them to other more consequential illicit drugs sold by the same trafficker. The debate over legalization or decriminalization of marijuana has society wrestling with its own conscience; meanwhile the hypocrisy of condoning and absorbing the damage of other psychoactive drugs goes on. Indeed, the problem is further complicated by introducing prescription drugs into the equation, as illustrated by research on Americans; "An estimated nine million people aged 12 or over reported using [prescription drugs] for non-medical reasons in 1999” (NIDA 2001, par. 5). Clearly the legal or illegal status of psychoactive substances does not prevent their misuse.
It is true, then, that solutions to drug and alcohol abuse are as complex as the problem itself. Governments respond superficially through policies of criminalization, medicalization, and neglect of social inequalities, in spite of the efforts of sub-groups who are left to repair the damage. Equally liable are government policies of responding to empirical data by advancing class values – standards that shamefully tolerate the social costs and effects of psychoactive substances like alcohol and tobacco – an action which, in itself, demonstrates the power of those drugs’ addictiveness. Reparation for inequalities vis-à-vis proactive delivery of education, health care, and shelter regardless of social status would help alleviate AOD abuse in the long term. Social programs are, however, a political hot potato, highly controversial to the uninformed tax-paying public. Making the public informed requires consistency and dedication. Nonpartisan commitments to educating society about the true cost distribution of AOD abuse, and officials with the courage to endorse and execute a long term plan are the foundation of the best defense; a proactive strategy to overcome alcohol and other drug abuse, addressing the contributions of an inequitable society.
References
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Dodds, C., Colman, R., Amaratunga, C., & Wilson, J., The cost of HIV/AIDS in Canada. at http://www.gpiatlantic.org/pdf/health/costofaids.pdf accessed April 9 2004.
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Lynskey, M. T. (1998). Broadening the target of drug prevention. FAS Drug Policy Analysis Bulletin #5. retrieved from: http://www.fas.org/drugs/issue5.htm#2 accessed April 4, 2004.
Mooney, L. A., Knox, D., Schacht C., Nelson, A., 2004. Understanding social problems. Second Canadian Edition. Thompson/Nelson, Canada.
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