A Simple Truth About Drugs That Punctures Decades of Drug War Lies
What is the most dangerous activity you can engage in? If you guessed doing illegal drugs, you would be wrong. Extreme sports like big wave surfing, heli-skiing, cave diving, white-water rafting and mountain climbing all have a higher rate of risk to life and limb. Yet the question of a ban on these behaviors beloved by "adrenaline addicts" is viewed as ludicrous, even when the risk of death, say, in climbing Mount Everest once (until recently, about 1 in 3) is greater than the annual risk of dying from heroin addiction (around 1% to 4%).
Or consider mundane activities like driving: Car accidents are responsible for 1% of annual deaths nationwide. Cigarettes and alcohol do at least as much, if not more, harm to each user than heroin or cocaine. Alcohol, cocaine and heroin have a 3% to 15% rate of addiction, depending on how it is measured—and tobacco's rate is higher. Yet the risks don't align well with their legal and social status, especially when you consider that marijuana is safer than any of the legal drugs.
The reasons for this inconsistency around risk are complicated. Driving has huge personal and economic benefits. Risky sports are seen as noble challenges that foster the human will toward exploration, adventure and growth. When it comes to nonmedical drug use, however, discussion of benefits tends to be either dismissed as delusional or stifled in favor of “risk” talk.
I mention these facts not to promote drug use. That I feel compelled to immediately include such a disclaimer underlines my point: Our values shape our perception of risk and the way we make drug policy. If we recognize only the risks and ignore the benefits, we fail to understand that the real problems are addiction and harm—not the substances themselves and the people who use them.
For instance, when we talk about the “epidemics” of Oxycontin, methamphetamine or heroin, we rarely acknowledge that the majority of users never become addicted: Over the course of a lifetime, only about 10% to 15% ever get hooked. That risk is not insignificant: Few people would fly on a plane that crashed every tenth flight. But focusing on use as the main factor in addiction obscures what is actually at stake.
There are, decade after decade, headlines about the fall of one drug and the rise of another. Yet the overall rate of people with addictions remains fairly constant. Although population differences and other variables make the numbers hard to compare exactly, a large national survey in 1990 found a 3.6% rate of illegal drug problems (DSM-defined “abuse” or “dependence”) in people ages 15 to 54 during the previous 12 months. The most recent National Survey on Drug Use and Health, which includes people from age 12 to those in their 80s or older, found a 2.5% rate of abuse or dependence in 2011. While that rate may seem much lower, the difference is probably due to the later survey’s inclusion of people over 55, who are numerous and had a 2011 addiction or drug misuse rate of a mere 0.8% or less. It is worth noting that 1990 was the peak of fears about a non-ending crack epidemic; by contrast, today, while there are concerns about growing prescription opioid addiction, the actual rates have been steady since 2006.
Now, this fairly constant long-term rate of drug use problems isn’t the end of the story. There are periods when dangerous drugs like opioids that have serious effects on people’s health replace the use of comparatively low-risk ones like marijuana. Similarly, addiction rates can sometimes change dramatically—for example, populations with a high exposure to early-life trauma are more likely to become addicted than those who have happier childhoods. Fashions can also pull large groups of people to use at dangerous levels (alcohol and cigarettes in the Mad Men era, for example, or the coke-happy early ‘80s).
What the real prevalence of addiction does signify, however, is that a policy of prevention that focuses mainly on a particular trending drug isn’t likely to solve the problem. If 10% to 15% of people are at high risk for addiction because they have significant life problems like mental illnesses or social or economic dislocation, fighting one drug will generally steer many of them to another drug while deterring those who wouldn’t have suffered harm anyway. And if the drug we spotlight as the current “bad guy” is in fact less harmful than some of the alternatives, we will only increase harm rather than reduce it.
The other problem is that targeting use itself alienates the majority of recreational users who don’t have problems—and makes anti-drug campaigners appear to be opposing pleasure rather than danger. (AA did itself an enormous favor when it chose to avoid claiming that alcohol is inherently problematic for everyone—but instead sought to fight alcoholism.) Similarly, campaigns against drunk driving have been effective because they don’t stigmatize drinking, but fight alcohol-related harm. Indeed, their most effective component was the creation of the “designated driver,” which solves the practical problem of transportation for a group that wants to drink and gives an important social role to someone who is abstaining, either permanently or temporarily.
The media often implicitly endorses an abstinence-only line. Last week’s New York Times report was a classic example of inaccurate anti-pleasure fear-mongering. Headlined “Designated Drivers Often Drink,” it said that a study found that “only” two-thirds of young designated drivers in Florida had no alcohol in their blood and another 17% had less than 0.05. In other words, 82% of designated drivers were safe to drive even under the most stringent standards, which is hardly a result indicating a “really ineffective” policy, as an “expert” source claimed. Indeed, the rate of drunk-driving deaths has fallen dramatically since the designated driver policy was introduced.
Unfortunately, those who have focused on illegal drug issues have tended to seek to stamp out drugs, not addiction. Consider the original name of the Partnership for a Drug Free America (now Partnership at Drugfree.org) and the Drug Free America Foundation, to take just two. By trying to eradicate drugs themselves, they have, intentionally or otherwise, allied themselves with political forces that not only stigmatize addiction as criminal behavior but use drug policy to send unrelated political messages. Two recent, widely praised books—Michelle Alexander's The New Jim Crow and David Musto's The American Disease, make a powerful case that American drug policy originated in racism. Cocaine, for instance, was banned first by state laws due to fears that it literally made black men impervious to bullets and caused them to rape white women; opium was banned in the states in part because of panic that it would allow Chinese men to rape white women.
Anti-drug organizations have therefore denied themselves the clarity of purpose that tends to make activism effective. By only fighting “drugs,” such advocates tend to undermine any claims they make of addiction being a disease, particularly when they highlight the use of marijuana. Consider that if you tried to fight alcohol by highlighting drinking as a disease: It just doesn’t work.
Although most users can easily think of someone who has gotten into trouble with cannabis, they also know from personal experience that such people are the exceptions, not the rule, just as with alcohol. The same goes for opioids, methamphetamine and cocaine, although this fact is widely obscured because many people who really like the drugs immediately realize their risk and avoid regular use.
To truly take on addiction, then, we need to focus on why some people have serious problems with them. There can be reasons to also focus on a particular drug or risk—for example, the overdose risk of opioids—but to deal realistically with the fact that people have always sought (and probably always will seek) chemical pleasure, we need to find effective ways to manage this human desire instead of ignoring it.
That means fighting addiction and drug-related harm—and facing inconvenient truths, such as the fact that addiction risk increases with poverty, unemployment and trauma. Addressing drug dangers is, of course, less simple than declaring “war on drugs.” But it has the benefit of suggesting measurable and attainable goals—with some of these efforts already shown to help the people the drug war has most harmed.
Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).