_________________________________________________________________ VOLUME 3, ISSUE 1 PSYCHNEWS INTERNATIONAL March 1997 _________________________________________________________________ SECTION E: THE FIFTH COLUMN -------------------------------------------------------- Note: The Fifth Column is a regular, independent column written by Jeffrey A. Schaler, PhD Opinions and comments are invited. Please send them to the PsychNews Int'l mailboxes at: firstname.lastname@example.org and email@example.com -------------------------------------------------------- 1 THE DRUG _POLICY_ PROBLEM Jeffrey A. Schaler, PhD _________________________________________________________________ Policies are based on values and on explanations for events. To evaluate the efficacy of our federal drug policy in a comprehensive and responsible way, we must examine the values and explanations that are associated with various possible courses of action. To that end, we must ask and honestly answer a question that challenges the status quo: What values and beliefs about illegal drugs and drug addiction are embraced and acted on by the leading drug policymakers, and what are the alternatives? The reasoning behind current drug policies is often unstated for moral, political, economic, and even existential reasons. The reticence of policymakers on this subject is remarkable, given that the current institutional forms of the "war on drugs" are justified by the claim that drugs are destroying the "moral fabric of American society." Americans tend to take at face value the unproved theories about drugs that are the foundation of current drug policy. For example, many Americans accept as fact the theories that drugs cause addiction, that they cause crime, and that addiction is a treatable disease. Most people are not aware of the existence of conflicting theories based on the results of empirical research. Yet abundant and convincing evidence exists to support the view that illegal drug use has more to do with choice, values, and expectations than with addiction, compulsion, or disease (see, for example, Schaler, 1997). With each new class of students at American University, Johns Hopkins University, Montgomery College, and Chestnut Hill College, I am asked, "Why weren't we told about this before?" Drug policy is always based on explanations for drug use. Because there are diverse explanations for drug use as an event and these explanations differ _radically_ from one another, drug policy can be implemented in ways radically different from current practice. But the average American citizen, like my numerous college students, has not been exposed to a range of views on drugs and addiction. The less people know about the range of theories, the more likely they are to be influenced by the status of the individuals who present a particular message (scientists, doctors, public health officials, law enforcement professionals, politicians, and so on) rather than by the rationality or irrationality of the message itself. In order to exert democratic control in the drug policy debate--based on what is being said, not on who is saying it--Americans need to know the facts about drugs and addiction. Without complete information they cannot comprehend the meaning and implications of various proposed policies. Therefore, they will continue to assume that all qualified professionals in the field hold essentially the same views. The prevailing policies can be faulted not only for their disregard of research but also for fundamental logical errors. The contradictory reasoning of drug policymakers needs to be subjected to public scrutiny. For example, many policymakers attribute abstinence from drugs both to the exercise of free will and to circumstances imposed from outside the individual, such as drug prohibition. They overlook the fact that, by definition, self-control cannot be the result of formal institutional controls backed by the threat of legal punishment. The same individuals typically assert that drug addiction is situational--that it is caused by the addict's physiological disposition or by the drug itself; thus they further contradict their avowed belief in free will. When confronted with inconsistencies in their views, people often produce further theories or beliefs, perhaps to reduce the sense of dissonance and discomfort, or else they simply minimize the importance of a contradictory belief or policy. This simply creates more problems. QUESTIONS WE NEED TO ASK AND ANSWER To understand the values and beliefs behind our federal drug policy, it is necessary to ask some unpopular questions: * Do illegal drugs cause crime? Given that drugs are inanimate objects, are they capable of causing a human action? Can drugs "act" in the way that people can? * Does drug use in the form of "addiction" encourage people to commit crimes other than the purchase and use of the drug itself? And if so, do the crimes stem from the addiction or from circumstances involved in the trade in illegal drugs, such as competition between dealers? * Should drug policies that are based on the relationship between drug use and crime be consistent with legal precedents? Should drug policies reflect court opinions regarding the nature of addiction and criminal responsibility, and vice versa? For the most part, U.S. drug policies are based on the assumption that drugs cause addiction. But many leading researchers and thinkers question the very existence of addiction as an empirical entity in the sociological "positivist" sense, viewing it rather as a social construct. Does addiction exist? Do drugs cause addiction? The answers to these questions depend on what we mean by "addiction." If by addiction we are referring to _what drugs do to the physical body_, then the answer to both questions is yes. We know for a fact that drugs create changes in the body, a physiological dependency often characterized by tolerance, withdrawal symptoms, and death. However, if by addiction we are referring to _how drugs get into the body_, the answer is less clear. In this sense, research has produced no empirical evidence for the belief that drugs can cause drug users to lose control of their behavior. Furthermore, from a logical point of view, behavior is by definition a matter of choice. Do the bodily changes effected by drugs _cause_ people to ingest more drugs in the same way that epilepsy causes people to have seizures? Most people would say no. The two cases are categorically different. It is important to be clear about the meanings of words. When applied to human action, the term "behavior" refers to a mode of conduct or deportment. Human behavior _is_ moral agency and as such can never be caused. _Things_ are caused; _people_ make choices. This difference is what makes us human. To speak of human behavior as caused makes no more sense than to speak of things as capable of choosing. Such confusion of language is inaccurate and irrational. The English philosopher Gilbert Ryle called this kind of mistake a "category error." Shall we then create and implement policy on the assumption that addiction is simply a metaphor--that drug use is a moral issue ruled by choice? In that case, how much policymaking is called for? If we agree that drug use is a choice--one that harms no one but the user--should the government make any effort to control it? Philosophical as these questions are, they should not be confined to the ivory tower as some politicians and academicians may prefer. If the advocates of a particular drug policy invoke science to justify their actions, they should be required by a discerning public to examine all available evidence, not just that which supports their political, economic, or moral interests. If they invoke moral principles, they should be challenged to defend those principles in a clear and rational manner. Any meaningful discussion of the values expressed in drug policies raises large philosophical questions. We might begin by asking which is more important, health or liberty? Is it better to be sick and free from coercion in a society where medicine and state are separate, or to be healthy under the control of a therapeutic state? Can we trust our medical guardians to refrain from the paternalism and the persecution of "undesirables" exercised by theocracies throughout history? Who will guard us from the guardians? The issue might be rephrased this way: Does the constitutional right to life, liberty, and the pursuit of happiness include the right to harm oneself? We accept the need for government to protect us from one another, and we agree that the exercise of liberty at the expense of another's freedom constitutes crime. But should the values of the majority dictate the personal behaviors of a minority when such actions harm no one else? Is it constitutionally proper for the government to protect us from ourselves? Finally, can institutional methods of social control such as those advanced by our current federal drug policies increase responsibility and decrease liberty simultaneously? Or are these outcomes logically incompatible? If they are incompatible, what is actually going on in the field of drug control--and _cui bono_ (who benefits)? Could it be that any drug policy short of total repeal of prohibition is simply a problem masquerading as a solution? These are questions we rarely hear discussed in a public forum. PLAYERS IN THE DRUG POLICY GAME The principal contenders in the current U.S. debate represent three perspectives on drug policy in a free society: the prohibitionist or "drug warrior" perspective, the public health perspective, and the classical liberal or "libertarian" perspective. DRUG WARRIORS The "drug warrior" perspective is the foundation of our present drug control policies. The drug warrior values a paternalistic state, which plays the role of protective parent in relation to vulnerable citizen-children. His focus is on strict enforcement of prohibition and on the regulation of currently legal drugs (for example, prescription drugs). Many drug warriors also advocate the expansion of sanctions to include tobacco and alcohol. General Barry McCaffrey and William J. Bennett--current and past "drug czars" respectively, former director of the National Institute on Drug Abuse Robert J. Dupont, and Congressman Charles B. Rangel are drug warriors sharing this point of view. They typically believe that drugs cause addiction and crime. In their view, public policies should aim to limit supply and punish users and dealers. Thus we have the "war on drugs." Illegal drugs such as heroin, cocaine, crack, LSD, "speed," and marijuana, and the people who profit by selling them, are the enemy. Here are some questions we need to ask in evaluating the "drug warrior" perspective: Do drugs cause crime and addiction? Does prohibition itself create lawlessness? Is it proper for government to regulate behavior if that behavior harms no one but the user? Do people have a right to own and use drugs as personal property? Is drug supply the best predictor of use? Are social, economic, and psychological problems related to drug use ignored and thereby perpetuated when policy focuses on eliminating supply and punishing drug users and dealers? Is the war on drugs a scapegoating device to distract citizens from other social problems which they may feel helpless to solve? Does prohibition serve the economic interests of prison builders, policymakers, and drug dealers? Can drugs ever be controlled? If drug prohibition can work outside a total police state, why is the drug trade flourishing in prisons, the most totalitarian institutions of our society? LEGALIZERS The public health perspective on drug policy is represented by people who advocate the legalization and medicalization of drug use. They regard addiction as a disease and criminal sanctions as inhumane and wasteful of tax money. Hence they advocate treatment rather than punishment for drug use. As Mayor Kurt Schmoke of Baltimore put it years ago, "The war on drugs should be led by the Surgeon General, not the Attorney General." Today the slogan of medicalization is "harm reduction." The advocates of medicalization, e.g. the Drug Policy Foundation in Washington, D.C. and The Lindesmith Center in New York, generally also support "medical marijuana" laws such as those passed recently in California and Arizona. Ironically, prohibitionists and legalizers both embrace the medical model of addiction: they believe that drug addiction exists, that it is a disease, and thus that it is "treatable" as a disease. In examining the public health perspective, we need to raise questions like the following: does medical treatment of addiction work? Can it ever work, or is it based on a logical mistake? Will medical control (e.g., through prescription drugs) create the same problems of lawlessness that are associated with prohibition? Does court-ordered and state-supported treatment violate the drug user's First Amendment rights? The late American Civil Liberties Union attorney Ellen M. Luff addressed that issue in an important case that received national attention in 1988 (_Maryland v. Norfolk_). Luff successfully argued that court-ordered attendance in Alcoholics Anonymous constitutes state entanglement with religion. Similar cases have emerged since then (e.g. _Griffin v. Coughlin_, 88 N.Y. 2d 674, New York Court of Appeals, decided 11 June 1996; _Kerr v. Farrey_, 95 F.3d 472, 7th Cir. 1996; _Warner v. Orange County Dept. of Probation_, No. 95-7055, 1997 WL 321553, 2nd Cir., 9 September 1996, amended 14 May 1997). Should public funds be spent on moral indoctrination in the name of public health? Again, should the government control behavior that harms no one but the individual involved? Calls for state-supported treatment are echoed by prohibitionists and legalizers alike. An important point here is that whether treatment for addiction is voluntary or involuntary, state involvement in _any_ capacity--e.g. court-ordered attendance, state licensure of treatment facilities, or state subsidies for treatment programs--violates the invisible wall separating church and state. This is because _all_ treatment for addiction is essentially a religious activity. The state has no business inside a person's head. LIBERTARIANS In the classical liberal, or libertarian, perspective (represented in somewhat different ways by psychiatrist Thomas Szasz and economist Milton Friedman), drug use is regarded not as a disease but as a behavior based on personal values. It is regarded as an ethical rather than a medical issue. Classical liberals cite the scientific evidence that drug use is a function more of mindset and environment than of chemistry or physiology. They challenge the notion of "loss of control" that is integral to the prohibitionist and public health perspectives, basing their claims on studies of drug users who controlled their habits when motivated to do so. They do not believe that drugs or addiction can cause crime. In their view drugs are property and as such are protected by the Constitution; drug users need not be treated as "barbarians at the gate" requiring exceptions to the constitutional rule of law. The classical liberals believe that a free-market approach to the trade of currently illegal drugs would reduce the crime and lawlessness associated with them under prohibition. Valuing liberty over health, they criticize medicalization as paternalistic and statist. In their view, informal social controls, either relational or self-imposed, are the appropriate focus of drug policy. In judging the classical liberal perspective, we need to ask questions like the following: If drug prohibition is repealed, will there be a substantial increase in drug use? If there is, will the problems associated with increased drug use pose a greater threat to freedom than drug prohibition has? Will an American free market in currently illegal drugs create international problems in trade with prohibitionist countries? WE NEED POLICY BASED IN FACT NOT FICTION We need new ways of thinking about addiction-- ways of thinking consistent with empirical findings on addiction and inconsistent with mainstream ideas about drugs and the policies based on them. There are no easy answers to the difficult questions I have posed here. However, they _must_ be addressed in the academic and policymaking arenas. Too often, professors are penalized for even asking those questions. It is important that we choose the right course in drug policy, based on fact, not fiction--and even more important that we once again be free to choose. FOOTNOTE (to title): 1. This article is excerpted from the introduction to _Drugs: Should We Legalize, Decriminalize, or Deregulate?_, an anthology edited by J.A. Schaler, published by Prometheus Books, Amherst, N.Y. (1998), part of their Contemporary Issues series. This excerpt is reprinted here by permission of the publisher, E-mail: PBooks6205@aol.com, phone orders (24 hours): Toll free (800) 421-0351 REFERENCE Schaler, J.A. (1997). The case against alcoholism as a disease. In W. Shelton & R.B. Edwards (Eds.) _Values, ethics, and alcoholism_, pp. 21-49, Greenwich, Ct.: JAI Press Inc. Jeffrey A. Schaler, Ph.D., a psychologist, is an adjunct professor of justice, law, and society at American University's School of Public Affairs in Washington, D.C. He is currently at work on a similar book for Prometheus, co-edited with Magda E. Schaler, M.P.H., on smoking rights and federal regulation, to be released later this year. E-mail: firstname.lastname@example.org
© Copyright Jeffrey A. Schaler, 1997-2002 unless otherwise stated. All rights reserved.