One of the difficulties with putting across messages about drug use is that the problem is more complicated than many of us would like to believe. The drug issue usually attracts our attention through media presentations which seek to reduce the issue to a single, instantly comprehensible message but in the process an inaccurate and largely false impression is created. Even amongst many drug workers and researchers, there is an avoidance of anything that smacks of theory, and a preference for action, even if that action is based on nothing more than personal prejudice and guesswork.
Furthermore, stereotyped and inaccurate views of addiction are not uncommon even within the ranks of those who work intimately with drug problems, where there is all too frequently a lack of coherence in terms of the work carried out, and an unwillingness to consider alternative interpretations. Perhaps most of all, there is the belief that the 'truth' about the nature and causes of addiction can be revealed by methods which rely principally on asking people to answer questions or express opinions about their own or other people's drug use.
However, answering questions and stating opinions are behaviours in their own right, which have dynamics all of their own. For these reasons, it is important to consider existing knowledge on the way people answer questions and explain their actions, since understanding these processes may yield fresh perspectives on the issue under investigation. The present book attempts to provide such an alternative perspective in the area of drug use and misuse. Whilst the ideas contained are not new, they represent a species of argument which is neglected, primarily because it is slightly more complicated than the more popular theories of drug use.
The argument presented in the following pages is basically that people take drugs because they want to and because it makes sense for them to do so given the choices available, rather than because they are compelled to by the pharmacology of the drugs they take. Nonetheless, we generally prefer to conceptualise our drug abusers in terms which imply that their behaviour is not their own to control. This picture arises because it is the picture we want to have, and the view is supported by a body of data consisting largely of people's self reports, opinions and statements of belief. This body of data, whilst potentially of great value in certain respects, is frequently put to uses for which it is ill suited; it does not always mean what we think it means.
When asked questions by members of the research establishment, it is functional for drug users to report that they are addicted, forced into theft, harassed by stressful life events, and driven into drug use by forces beyond their capacity to control. The central argument of this book is that such self reports have their own internal functional logic which is independent of reality, and that other research methods and forms of analysis would consequently produce a different picture. Furthermore, the fact that the explanations people provide for their behaviour make some reference to their own motives and intentions is hardly new; it is a central feature of social interaction, and not specific to drug users.
At the present moment, the standard line taken by a majority of people in the media, in treatment agencies, in government and elsewhere, hinges around notions of the helpless addict who has no power over his/her behaviour; and the evil pusher lurking on street corners, trying to ensnare the nation's youth. They are joined together in a deadly game by a variety of pharmacologically active substances whose addictive powers are so great that to try them is to become addicted almost at once. Thereafter, life becomes a nightmare of withdrawal symptoms, involuntary theft, and a compulsive need for drugs which cannot be controlled. In fact, not one of these things is, or rather needs to be, true.
Whilst availability is probably a major determinant of the extent of drug use, the precise form taken by drug problems within any given society is determined in large part by that society's response to the problem. Consequently, if we were to observe that within some fairly limited time span a particular drug had become a matter of life-and-death on the streets, this would probably indicate that the policies we were currently implementing were extremely dangerous; more dangerous in fact than the drugs we were attempting to stamp out. Unfortunately, our own legislators look for advice with frightening regularity to nations where the attempt to control drug use has had the most grotesque and spectacular consequences, in the mistaken assumption that they have thereby demonstrated some sort of competence in this field.
If we continue to base our policies on stereotypes and inaccurate perceptions of the helpless junkie, the evil pusher, and the substance with the capacity to enslave, we are already half-way to justifying the most extreme measures in order to eliminate drug use from our midst. If we persist in this lethal spiral, we can bring death and street warfare into our midst, in a manner that will mirror similar developments elsewhere.
In fact, as the following chapters will attempt to show, our beliefs about drugs and drug users are largely inaccurate. We choose to believe in helpless junkies and evil pushers primarily because we want to believe in them, and because such beliefs serve functions for us. The helpless junkie only exists because we all want him/her to exist; and because drug research continues to make naive use of what people say about their addictions. It is now imperative that we start to view research based on what drug-users say about themselves in its true light; and in consequence, to expect something more dynamic and positive from those of us who encounter drug problems. The interrelationship of IV drug use with HIV/AIDS makes such a new dynamic and purposive perspective essential.
What the book says, basically, is that most people who use drugs do so for their own reasons, on purpose, because they like it, and because they find no adequate reason for not doing so; rather than because they fall prey to some addictive illness which removes their capacity for voluntary behaviour. The book then points out the reasons why the second type of explanation is nonetheless more popular and is generally preferred; and why scientists and practitioners frequently seek out evidence relevant to that view rather than to any other and subsequently impose it on their clientele for reasons that have nothing to do with scientific knowledge. It is then argued that a different context or 'system' is required within which an alternative view of drug use can thrive; a view which stresses volition and control deriving from the ability to make and implement personal decisions.
What the book does not say is that drugs have no pharmacological effect; nor does it deny that some individuals become terribly enmeshed in a cycle of substance use and misuse, sometimes with tragic consequences. The reader should note, however, that deaths due to illicit drug use per annum are generally in the order of 300-400. For comparison, smoking accounts for some 100,000 deaths; and whilst figures for alcohol-related deaths are more problematic, there are 17,500 admissions to psychiatric hospitals due to alcohol, and the direct effects of alcohol are implicated in three out of four of all deaths due to liver disease (The Royal College of Psychiatrists 1986; 1987). The drugs we regard as socially acceptable and that many of us use in a more-or-less habitual fashion can hardly be regarded as 'safe'.
The final message is that dealing with drug problems rationally depends on giving back to people the sense of personal power and volition which they require if they are to control their drug use for themselves; a power which existing concepts of 'addiction' frequently seek to limit or deny at the outset as a precondition to further treatment. To take this apparently simple step, however, involves a major rethinking of contemporary moral attitudes to drugs and addiction, since these shape the nature of the help that we are prepared to offer. In the meantime, the existing system does not work. There is little indication that anything on offer at the moment does better than spontaneous recovery (that is, giving up all by yourself); and some evidence that punitive legislative interventions make things worse by institutionalising the type of harmful drug use that we most wish to avoid.Chapter 1