A Case for Promoting Treatment Over Criminalization to Solve the Problem of Drug Abuse

In the United States, millions of individuals are addicted to both legal and illegal drugs. While this is a rampant problem in American society, the efforts that are made to address the problems created by drug addiction are still inadequate. Originating from the 1970s, current legal trends in the United States favor imposing strict penalties on drug addicts, individuals who often face significant psychological and medical barriers that contribute to their addiction. Despite the sophistication of many developed treatment programs, the reality is that the majority of individuals who need treatment do not receive it. In order to reduce incidents of drug abuse, the United States needs to reverse its policy stance on illicit substances and replace the criminalization of drug users with a support system that recognizes the physiological, genetic, and social factors that must be addressed in order to effectively treat a drug addict.

The Problem of Drug Addiction in the United States

In the United States, millions of individuals use or experiment with drugs annually. According to the National Institute on Drug Abuse, in the year 2011, approximately 22.5 million Americans used an illicit drug or abused a pharmaceutical product (Drug Facts: Nationwide Trends). This figure increased by 8.3 percent from 2002 (Drug Facts). Further, the Institute reports that while the use of drugs such as cocaine and heroine has remained steady or decreased over a four-year span, marijuana use increased by 7 percent between the years 2007 and 2011. Further, drug use rates are highest among individuals who are in their teens or twenties, while drug use rates are increasing among individuals who are fifty years of age or older (Drug Facts). The research finds that marijuana use is becoming increasingly problematic among the general population. While the rate of alcohol dependence and abuse declined by 7.7 percent between 2002 and 2011, marijuana dependence and abuse rose to the second-highest rate of drug abuse and is four times the rates of dependence and abuse of cocaine (Drug Facts). As these trends demonstrate, while the use and abuse of harder drugs are declining, abuse and dependency upon drugs such as marijuana are beginning to increase.

In their most recent report, the Substance Abuse and Medical Health Services Administration reviewed national survey findings on the prevalence of substance abuse in American society. They found that in 2010, 22.1 million individuals were classified with substance dependence or abuse during a one-year period (Substance Abuse and Medical Health Services 6). The evaluation of dependency was made using the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (6). Further, the illicit drugs that had the highest levels of dependence included marijuana, with 4.5 million cases of dependency, pain relievers, with 1.9 million cases, and cocaine, with 1 million cases (6). According to these findings, the rise in marijuana use is corresponding with increased dependency upon the drug. Further, dependence upon marijuana is drastically higher than dependency upon other illicit substances. However, this still leaves millions of Americans who are dependent upon harder drugs, such as cocaine or heroin.

The Causes of Drug Addiction

To enact an effective drug policy, it is important to understand the causes of drug addiction. One challenge in treating individuals with drug dependencies is that there is a strong biological component to addiction that impacts the user’s moods and behaviors. From a medical standpoint, drug addiction can be understood by evaluating the impact of a drug on the central nervous system. The United Nations Office on Drugs and Crimes utilized this approach, classifying drugs into three categories: 1) depressants of the central nervous system, 2) stimulants of the central nervous system and 3) modulators of the central nervous system (Mousseau 40). Depressants of the central nervous system include drugs such as morphine, barbiturates, or heroin, stimulants of the central nervous system include drugs such as nicotine, cocaine, and amphetamines, and modulators of the central nervous system include drugs such as LSD, cannabis, and mescaline (40). As further discussion will reveal, not all categories of drugs produce the same levels of dependency on the user.

Tolerance and dependence are two central concepts that explain the phenomenon of drug addiction. Drugs from any category have the effect of stimulating dopamine, which is a chemical that creates reward systems by increasing the feeling of pleasure upon activation (40). It can be found that any drug that causes addiction increases the release of dopamine in the reward pathway of the brain while creating intense sensations of pleasure in the user (40). Tolerance is said to take place when an individual becomes accustomed to the physiological effects of the drug and require increased amounts of the drug in order to achieve the same effects that resulted from lower doses (40). When an individual’s tolerance levels build, they must increase their use to experience the same reward system response that they achieved before. However, when an individual attempts to discontinue the drug, they might experience withdrawal symptoms when the reward system fails to become stimulated (40). An individual is said to have developed a physical dependence on a drug when they need to continue the use of a drug in order to satisfy the physiological pathways that have developed as a result of their drug use (40). The implication of dependence is that it enhances the negative physical reactions that an individual experiences when they attempt to discontinue the use of a substance.

The category of drug that an individual uses determine the level of physical dependence they will experience. For example, all depressants of the central nervous system generate physical dependence and can result in severe withdrawal symptoms including insomnia, sweating, and vomiting (40). The physical reaction to withdrawal from heroin is believed to be strong because the drug produces enkaphalins, a naturally occurring opiate, in the brain with repeated use (40). Thus, many experts believe that heroin users continue to use the drug in order to combat severe withdrawal symptoms associated with the reduction of enkaphalins, rather than to experience the effect of the drug (40). However, it is also found that the central nervous system modulators and stimulators, including cannabis and cocaine, do not produce withdrawal or lead to the development of tolerance (40). Yet, these drugs can produce a psychological dependence that causes the individual to experience frequent cravings for these drugs.

Since marijuana, followed by prescription medications, is the fastest growing abused substance, it is necessary to consider the factors that can lead to addiction to central nervous modulators and stimulants. Despite the fact that these substances do not cause physical dependence, the psychological dependence that individuals experience can be quite significant. As physicians, Jordi Cami and Magi Farre note, personality and psychiatric disorders can contribute to the propensity to become addicted to drugs (976). While it is determined that risk-taking and thrill-seeking are among the personality characteristics of individuals who use illicit substances, underlying mental health problems can increase an individual’s propensity to become psychologically dependent upon a substance (976). As the physician's note, mental conditions such as schizophrenia, bipolar disorder, depression, and attention-deficit disorder are all linked to increased risks of substance abuse (976). Further, research determines that over 80 percent of those experiencing addiction or dysfunctional behavior problems originate from a dysfunctional family, indicating the impact that a traumatic upbringing can play in influencing drug use and behaviors (Shults 26). Thus, there are strong psychological factors that can make it difficult for an individual to discontinue the use of a drug.

Additionally, genetic factors can determine an individual’s propensity to use or become addicted to drugs. For example, research demonstrated that men who had parents who suffered from alcoholism were more likely to become alcoholics themselves, even if they had been adopted and removed from a social environment that featured drinking (976). Also, researchers identified that a gene that impaired the metabolism of nicotine contributed to nicotine dependence in smokers (976). Further, research points to genetics as one of the reasons that some individuals are more likely to experiment or use drugs (977). As this research demonstrates, drug addiction is a personal experience. Though generalizations can be made about the addictive potentials of certain types of drugs, the genetic profile of an individual can be a strong determinant of how one experiences drug tolerance and addiction.

The Political Response to Drug Abuse

Though recent research has validated the biological and psychological factors that contribute to drug addiction, United States drug policy primarily treats drug addiction as a personal moral failing. As analyst Eric Jensen notes, the most recent legislative measures addressing drug use in America include the Nixon-era drug war during the 1970s and the 1986 War on Drugs, which both sought to reduce drug use in society by expanding punitive policies (Jensen 233). Yet, Jensen asserts that shock campaigns exaggerating the threats of drug use informed the political reaction to this issue rather than sound research (236). For example, while surveys demonstrated that illicit drug use had reached a peak and was on the decline between 1979 and 1982, politicians engaged in a national anti-drug campaign that resulted in a shift in the public perception of the dangers of drug use in society (236). As a result of these alarmist actions, the public supported political leaders who held that the solution to drug addiction was criminal prosecution rather than treatment (236). As a result, several legislative measures have been implemented that serve to penalize rather than treat the drug user.

An explosion in incarceration rates for drug users was the most immediate impact of the 1980s War on Drugs. Between 1985 and 2005, drug arrests increased from 811,000 to over 1.8 million (238). Further, rather than targeting individuals who distribute or sell drugs, the enforcement climate targeted individual drug users. During the period, 82 percent of drug rests were made for possession of drugs while only 18 percent were made for distribution and manufacturing drugs (238). Further, the largest number of arrests was for the possession of cannabis, which arrest rates for cannabis possession increasing by 143 percent (238). The impact of the War on Drugs is that it processed millions of individuals into the criminal justice system and treated drug use as a criminal matter rather than considering the medical needs of individuals impacted by drug use.

Though the incarceration of drug users and addicts is a widely discussed consequence of the War on Drugs, the 1980s also led to a series of laws that undermined the stability of drug users in nearly every aspect of life. For example, the Comprehensive Drug Abuse and Control Act of 1970 were expanded to enable courts to seize the assets of individuals who were convicted in drug-related cases (240). Thus, the addict faced the risk of having their valuables confiscated upon arrest for a drug-related crime. Further, the Drug-Free Workplace Act of 1988 led to the widespread use of drug testing in the private sector by requiring businesses that received government contracts of $25,000 or more to demonstrate that they were maintaining a drug-free workplace (242). Yet, the National Research Council determined that there is no evidence that drug-testing programs serve to deter drug use or facilitate rehabilitation (242). However, the result of increased workplace testing is that an individual seeking treatment faces barriers to maintaining gainful employment and might face economic hardships that undermine recovery.

Since the introduction of the War on Drugs, the federal government has taken several steps to restrict the ability of drug users to gain social services and support. Additional restrictions placed upon drug users by federal law include the denial of public housing to individuals implicated in drug crimes, the pressure upon states to restrict the driver’s licenses of individuals who are implicated in drug crimes, and the restriction of food assistance and student aid to individuals implicated in drug crimes (245-247). These actions seem logical if the use of drugs is considered to be a personal moral failing. However, because of the strong genetic, psychological, and physiological factors that contribute to drug use and addiction, these laws only serve to exacerbate the problems that are faced by individuals receiving treatment.

The Alternative Solution to Drug Abuse

Rather than criminalizing drug users, it is necessary to expand treatment options in order to successfully reduce the rates of drug use in society. According to researcher Avram Goldstein, research guidelines on drug treatment reveal that there is no single treatment program that will work best for all individuals, effective treatment needs to be made readily available to individuals, and effective treatment must meet multiple needs of the user, such as addressing additional psychological or social problems that contribute to drug abuse (Goldstein 250). As Goldstein notes, while nearly all drug addicts attempt to quit “cold turkey,” this method of discontinuing drug use is unsuccessful because individuals experience strong withdrawal symptoms (251). Thus, Goldstein concludes that it is critical for individuals facing addiction to seek a solid support environment (252). Further, receiving treatment at a specialized facility is critical for individuals facing physical dependency because such facilities can provide detoxification and pharmacotherapy programs to ease withdrawal symptoms (252). One danger of a hasty recovery program is that the presence of a substance can remain in the brain for years after a drug was last used, which can cause an individual to relapse even after remaining abstinent from the drug for years (Mousseau 40). Thus, because the factors that lead to drug abuse cannot be easily controlled by the individual, it important that they seek help from experienced professionals who can assist them in the withdrawal process.

While resources are devoted to incarcerating drug users, the majority of individuals fail to receive treatment for drug addiction. National Institute on Drug Abuse figures reveal that 21.6 million Americans needed treatment for drug abuse and dependency, yet only 2.3 million people, accounting for less than 1 percent, actually received treatment at a special facility (Drug Facts: Nationwide Trends). Further, the Substance Abuse and Medical Health Services Administration found that while 23.1 million individuals above the age of 12 needed treatment at a special facility, only 1 million individuals perceived that they needed treatment and only 66 percent of individuals made no effort to get treatment for their addictions (Substance Abuse and Medical Health Services 6). It is also often mistaken that incarcerating drug users will facilitate their recovery process. Though the economic costs of incarcerating a drug offender costs an average of $25,000 per year, research has found that fewer than one-fifth of inmates who are incarcerated receive treatment for drug abuse despite findings that treatment programs are highly effective (Goldstein 250). These findings point to two main barriers to receiving treatment for substance abuse. First, access to special facilities might be limited for individuals who are in need of special services. Second, the social climate imposed by criminalization might make the topic of treatment for drug addiction secondary among both substance abusers and authorities that work with substance abusers. Thus, it will take a shift in how society views and treats drug abuse in order for more individuals to recognize the merits of enrolling in a treatment program.

It is often argued that criminalization should be kept in place as a deterrent to drug use and in conjunction with treatment. Yet, in order to effectively reduce drug abuse, a climate must be adopted that enhances the success of treatment. As physician and drug rehabilitation specialist Dr. Gaber Mate notes from his experience, the majority of those who are severely addicted to drugs experienced servile trauma that compels their compulsive behaviors (Leslie 34). Yet the criminalization of drugs contributes to an environment that undermines treatment efforts. According to Dr. Mate’s assessment, the criminalization of drugs turns severely traumatized individuals into criminals and makes rehabilitation impossible by introducing stressors that serve to further fuel their addiction (34). Thus, in order for treatment to be effective, a trade-off must be made between criminalization and treatment.

Recommendations and Conclusion

Though recent research has highlighted the physiological, psychological, and genetic roots of drug addiction, the social policy fails to reflect the implications of these findings. Upon understanding the strong biological and environmental forces that compel addictive and destructive behaviors, it is inadequate to merely treat drug abuse as a “bad choice” made on the part of the drug user. Yet, due to the punitive environment created by the 1980s War on Drugs, federal policy has acted to criminalize drug users and compromise their ability to access the support and social networks that they need in order to recover from their addiction. Further, while an emphasis is placed on incarcerating individuals for drug-related crimes, the majority of inmates and drug abusers in America never receive specialized treatment for their addictions. In order to effectively decrease drug abuse, the policy must reflect the latest findings on addiction and treatment by increasing the availability of treatment to individuals who are impacted by drug addiction.

Works Cited

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“DrugFacts: Nationwide Trends.” National Institute on Drug Abuse. Dec. 2012. Web. 9 Dec. 2013.

Goldstein, Avram. Addiction: From Biology to Drug Policy. Carry, NC: Oxford University Press, USA, 2001. Print.

Jensen, Eric. “Drug Wars in the United States: The Construction of Problematic Conditions.” Reading in Drug Policy: History, Theory, and Consequences. Eds. Bagga Asmussen Bjerge and Vibeke Houborg Esben. Arhus, Denmark: Aarhus University Press, 2008. 233-255. Print.

Leslie, Colin. "A Front-Row View of the Battle Against Drug Addiction." Medical Post 46.17 (2010): 34,35,38. ProQuest. Web. 9 Dec. 2013.

Mousseau, Marie-Catherine. "Drug Addiction: The Paradox of Evolution." Irish Medical Times 44.15 (2010): 40. ProQuest. Web. 8 Dec. 2013.

Shults, Charley. "Trauma Resolution - the Key to Addiction Treatment." Drugs and Alcohol Today 4.1 (2004): 25-9. ProQuest.Web. 8 Dec. 2013.

Substance Abuse and Mental Health Services Administration. Result from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. Web. 9 Dec. 2013.