The idea that people who use drugs are ‘out of control’ or ‘can’t control themselves’ is a well-established part of both popular and medical understandings of addiction. But where does this idea come from? It may come as a surprise that the way we think about addiction today is rooted in structurally racist approaches to drugs and those who use them.
There is a well-known history of racist ideas used to justify drug control measures, including the idea that Chinese people were using opium as a tool to overcome the sexual inhibitions of white women in order to ‘infiltrate’ the West, the way cannabis and traditions of black music like jazz were associated with ‘reefer madness’, and how terms like ‘marijuana’ were introduced by the US government to associate cannabis with anti-Mexican sentiments.
While it is well documented that this racism was central to the establishment and expansion of regimes of drugs control, less has been said about the colonial and racist history of addiction as a way of explaining people’s drug use.
Addiction, colonialism and protecting the ‘savage’ native
Ideas about addiction developed alongside colonial narratives about the ‘savage’ native. The idea that Indigenous peoples were ‘uncivilised’ and therefore needed to be protected from themselves by colonial powers was (and in many ways still is) foundational to Western imperial projects all over the world.
There are strong parallels between the way settler-colonial states have controlled the lives of First Nations peoples and the way addiction is dealt with today. Being Indigenous and having an addiction are both seen by the state as compromising your ability to live safety in the community, to be a productive citizen and even to take care of your own children.
In the early colonial era of what is now called Australia, the control of First Nations peoples’ lives and drug control measures employed the same tools. This is seen in legislation that explicitly targeted opioid use among Aboriginal and Torres Strait Islander peoples, like the Aboriginals Protection and Restriction of the Sale of Opium Act 1897 in Queensland. This Act implied that First Nations peoples could not be trusted to control their consumption of opium, and required state intervention – when none was in place for the majority of the white population of the time. Legislation like this was common across the newly established commonwealth nation and had serious consequences, like the removal of the basic liberties of Indigenous peoples.
These strategies of targeting race and drug use helped to usher in a range of policies that rested on the idea that First Nations people needed to be ‘protected’ from themselves. Protectionist-era policies, as they have come to be known, involved the establishment of missions, practices of indentured servitude (or slavery), the forced removal of Indigenous children from their families and forced adoption into white families (known as The Stolen Generation), and the restriction of the free movement of Aboriginal and Torres Strait Islander peoples.
During the same period, addiction was emerging as a concept in North America and was used to justify and promote policies which associated drug use with Black, Indigenous and other people of colour and their ‘moral failures’. As settler-colonial societies began to reform policies that explicitly targeted race, they developed ‘colour-blind’ strategies, like addiction-related policies, that made near identical judgements on people of colour, and recommended the need for state interventions and ‘care’.
Race, agency and medical models of addiction
Race has played an important role in understandings of addiction from the start. During the 1920s, when Western psychiatrists established addiction as a medical issue, most people dependent on opioids in the US were white, middle-aged housewives and doctors. Their work established then an important distinction between “normal persons who have become addicted accidentally or… through medical treatment” and those who have an “immature, hedonistic, socially inadequate personality”. In suggesting this distinction, it was clear that white housewives and doctors were the ones who were becoming accidently addicted, while racist stereotypes were used to explain those who had become addicted because of their ‘inadequate personalities’.
As alcohol prohibition faded from public view and the prohibition of illicit drugs came to the forefront, sections of the medical profession became increasingly frustrated by having to act as gatekeepers to criminal substances, with people who use drugs becoming “undesirable patients”. As a result, stigmatising images of the urban (code for black and brown) ‘junkie’ proliferated in American society, producing a strong association between drug dependence and the racialised ‘other’ as the embodiment of the hedonistic, ‘psychopathic drug addict’.
The physical/psychological distinction survived through many iterations of public health understandings of addiction, as seen in the World Health Organisation’s use of terms like ‘addiction,’ ‘habituation’ and ‘drug dependence’ from the 1950s until today. The definitions of these terms continue to reinforce the idea that people who have become drug dependent because of ‘recreational’ drug use are the ‘real addicts.’
When we consider the long histories of Black, Brown and Indigenous peoples being systematically excluded from mainstream medicine, it is not hard to see how race dynamics might come into play here. Those with better access to medicine (white and wealthy people) are more likely to be excluded under this process, while those who have been marginalised from medical systems (the racialised ‘other’) become more likely to meet the criteria for addiction-related disorders.
While race is not explicitly mentioned, it is built into the way addiction is defined and diagnosed in practice. There is a long history of Black, Brown and Indigenous peoples being systematically excluded or abandoned by healthcare systems, with white and wealthier people having access to resources that help prevent them falling into state-controlled systems of ‘care’.
The contemporary colour-blind racism of addiction
Despite long histories of prohibition targeting communities of colour and definitions of addiction being based around distinctions that rely on race, it is now a common refrain in the media that ‘addiction does not discriminate.’ The idea that addiction is colour-blind, that it does not care if you are black or white, rich or poor, has gained popular traction.
While it is true that anyone can become drug dependent and that addiction exists in every community, this framing ignores the way that addiction is frequently weaponised against communities of colour. This includes the way drug use is used as a justification for ongoing surveillance of black and Indigenous communities, policies that involve involuntary or forced drug treatment, contemporary practices of child removal by the state, as well as the deaths in custody of people of colour.
The recent death in custody of Gunditjmara, Dja Dja Wurrung, Wiradjuri and Yorta Yorta woman Veronica Nelson is an unfortunate reminder that addiction and racism cannot be separated. On 2 January 2020, Veronica died in a maximum-security women’s prison after being taken into custody on suspicion of shoplifting. Arresting officers and prison staff were aware that she was experiencing opioid withdrawal at the time, and she called for assistance at least nine times on the night she died – this was met with a request by prison staff that she “be quiet” and an unmet promise that a nurse would be called for assistance.
In commenting on public enquiries in which recordings of this treatment were played, her mother Donna Nelson said:
“My daughter’s pleas for help haunt me every night, and I can’t stop hearing her voice.” The Nelson family also commented: “Veronica should never have even been in jail in the first place. The police officer who arrested her was off duty. She was just walking down the street minding her own business. She wouldn’t have been picked up if she was a white woman. The police target us Blackfullas.”
The inquest into Veronica Nelson’s death found both that Veronica would likely not have been taken into custody if is she was not Aboriginal, and that her treatment in state care was “influenced by drug-use stigma, and that this causally contributed to Veronica’s passing”. Veronica’s pleas for help were ignored in part because she was an Aboriginal woman dependent on opioids. This made her pain unable to be seen by those though who were charged with her care, and it contributed to her death. The conditions that led to her passing are part of a pattern that is too often repeated in settings around the world.
Radical empathy for all people who use drugs
The racist history of addiction starts with colonial narratives about the need to protect the native population, and has evolved in ways that drop the reference to the ‘savage’ but uses the same protectionist justification to target and criminalise communities of colour. But it is not only people of colour that are impacted by the stigmatising way addiction is understood today – the criminalisation of addiction has emboldened the war on drugs, expanded the carceral state and worked to dehumanise all people who uses drugs.
We must challenge the violence of addiction stigma with a radical empathy for people who use drugs, with a commitment to meet people where they are in their lives and their drug use.
