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The Problem With Viewing Addiction As Inevitable

I won’t deny that accepting the one real inevitability in life (i.e., that all mortals must eventually die) is philosophically sensible. However framing what is possible as if it were inevitable can be a dangerous practice.

If someone uses drugs problematically, that doesn’t mean they are doomed to overdose or go mad. Telling yourself – or, worse, a loved one – that their use will inevitably lead to their death, insanity, or imprisonment can easily become a self-fulfilling prophecy. After all, why should someone bother to look after their physical or mental health if their fate is already certain, with no hope for change? Such thinking breeds unproductive pessimism and a fatalism around drugs that serve neither the individual nor society.

I understand that this kind of framing is meant to compel people to quit drugs and, perhaps, find God through the 12 Steps. However, this approach may not be appropriate for everyone, and, for those whose drug use isn’t an issue in the first place, it is also not necessary. Even people with addiction don’t have to abstain from all recreational substances to recover, as I’ve discussed previously.

I feel that with the right tools and support, anyone can improve their situation.

Unfortunately, “God” is not a legitimate solution to the adulteration of illicit market products, the stigma faced by people using drugs, or even addiction itself. People dealing with these various issues need a safe supply, a society free from such prejudices around drug use, or help from qualified medical professionals; rarely do they need to be converted by people posing as priests of the Church of Sobriety. I understand that the fellowship found in 12 Step meetings really does help some people, but many of the ideas put forth by the group cause legitimate harm and the environment can be dangerous, especially in the United States where the poorly-regulated, unethical rehab industry relies heavily on the Minnesota Model. In the same way that people are free to choose their faith, they should also have the opportunity and support to choose what their relationship with drugs looks like.

For the record, I don’t think there’s such a thing as a truly hopeless case. Perhaps I am a blind optimist, but I feel that with the right tools and support, anyone can improve their situation to an extent, and possibly recover the functionality lost due to problematic patterns of drug use. That’s what harm reduction is – working with people to help them improve their lives on their own terms and at their own pace, something that really does work. Insisting that there’s no point to anything aside from a total conversion to sobriety and 12 Step meetings flies in the face of evidence.

On the flip side, assuming that all those using drugs will inevitably develop addictions can lead to measures like forcing people who don’t have an issue and likely never will into treatment, which in many parts of the world can mean a sentence of forced abstinence, religious pathologising, corporal punishment, and separation from loved ones for indeterminate periods. The common assumption that any drug user is in denial if they insist they don’t need help exacerbates this issue. Considering that some 70-90% of people who use drugs do so unproblematically, it’s statistically more likely that they’ll never develop one. We need to stop treating adults who use drugs like foolish children who don’t know what’s best for them. This denial of agency helps nobody, and may force people into seeking treatment when they neither want it or need it. Filling up drug treatment spots with people with no problematic use is both a waste of resources and demotivational for those within treatment. Arguments about wanting to “nip the problem in the bud” don’t really make sense, because if a person doesn’t yet have an issue, we cannot know for sure that they will in the future either.

It would be far more sensible to regard addiction as a health issue and drug use itself as merely a common human behaviour which requires precautions.

Whether they are addicted or not, forcing people – especially young people – into rehabilitation or troubled teen programmes can create or exacerbate problematic patterns of use. The same is true with the criminalisation of drug use. Incarcerating youth for the “crime” of experimenting with drugs is far more likely to push them into a life on the margins than compel them to quit. The alternative of forced or coerced treatment of any kind can harm patients – this is especially true with addiction treatment, which is rarely evidence-based and at times fraudulent. This carceral approach to drug use creates problems, rather than solving them.

Although I understand the reasoning behind treating drug use as a health issue instead of a crime, I do think it would be far more sensible to regard addiction as a health issue and drug use itself as merely a common human behaviour which requires precautions. Yes, virtually any drug can be used in a problematic way, but that does not mean every person who uses drugs will do so. I won’t deny that in the wrong context, even supposedly “soft” drugs, such as cannabis, can create harm. Yet the same could be said of a variety of popular recreational activities, such as bungee-jumping or horseback riding (to use David Nutt’s famous example). Only recently a relative of mine was temporarily knocked unconscious when her horse threw her, but I’ve yet to hear anyone argue she needs an intervention or claim we need a public health approach to horse-riding.

Just as the Epicureans believed people must free themselves from the burden of superstition in order to live in tranquillity, so I believe we must free ourselves from the absurd idea that drugs have a demonic force which possesses and inevitably destroys. Drugs are simply tools, wielded – for better or worse – by humans. Waging war upon them makes as much sense as battling the ocean. We don’t frame a hammer as a tool only for destruction when so much can be built with it. Rather than assuming that the use of drugs leads to a life of degradation and suffering, we must have the information on potential uses and risks for substances to make informed decisions and reduce harms.

Harms such as fatal overdoses, injection-related infections, and problematic patterns of use aren’t inevitable, they are a product of context, and can therefore be alleviated or avoided – if we are given the opportunity and resources to do so.

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