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The big question

Is drug prohibition helping or hindering recovery, asks Neil McKeganey

Professor Dame Sally Davies, the chief medical officer for England, recently joined a growing chorus of voices in the UK calling for drugs to be treated as a health rather than a criminal justice issue. 

Earlier this year the British Medical Association published its Drugs of dependence report, which included a similar call, and in May the Royal College of General Practitioners voted in favour of decriminalising all illegal drugs at its 18th national conference on managing drug and alcohol problems, advocating that drug use should be seen first and foremost as a health issue. It’s a debate that has been aired recently in DDN, with correspondence between Dr Chris Ford and Anna Soubry MP, among others.

The belief underpinning these calls is that somehow drug users’ needs, including their recovery needs, are being impeded as a result of the drug laws, and that only by overturning those laws will it be possible to fully meet these needs. What is the evidence that their recovery is being hampered by so-called ‘prohibitionist’ drug laws? One way in which this might be occurring is if individuals are less willing to contact drug treatment services as a result of tougher drug laws.

Contrary to what you might expect, some countries with the most liberal drug policies have the lowest proportion of drug users in treatment. In Portugal, where drugs were decriminalised for personal use in 2002 and treatment has been promoted in preference to prosecution, only 14.2 per cent of problematic drug users are in contact with drug treatment services.  Similarly, in Italy, which has a policy of dealing with drug possession offences with administrative rather than criminal justice penalties, only 14.6 per cent of problem drug users are in contact with treatment services. 

Both of these countries have a lower level of contact with drug treatment services than either Sweden, known for its zero tolerance drug policies, or the UK, where heroin and cocaine attract the highest criminal justice penalty. 

On the basis of these data it would appear that there is no simple association between restrictive drug laws and the proportion of problem drug users receiving drug dependency treatment. As a result it cannot be simply asserted that the drug laws are hindering people’s access to treatment.

Recovery, though, is about more than the level of contact with drug treatment services. One of the challenges that drug users often face in their recovery has to do with avoiding the ‘cues’ that remind them of their former drug use. It is for this reason that recovering addicts often try to move to a new area as a way of reducing their exposure to the people and the places that are most closely associated with their past drug use. 

In the case of recovering alcoholics, reducing their exposure to alcohol is made that much more difficult by the near ubiquity with which the product is available within our culture. In contrast, heroin is much less available and the recovering addict has to work less hard to avoid being exposed to the drug. One of the ways in which the drug laws may actually assist individuals in their recovery is through reducing the visibility and accessibility of the drugs involved. 

There are other ways in which the fact that some drugs are illegal might impact adversely on individuals’ recovery, one of which has to do with stigma. There is no doubt that individuals dependent upon illegal drugs are highly stigmatised – but so too are alcoholics. The stigma felt by those who are drug or alcohol dependent may have less to do with the legal status of the drugs than the negative judgements around the individual being seen to be ‘out of control’ in their behaviour.

Securing employment is an important part of the process of sustaining an individual’s recovery and one that can be adversely affected by negative attitudes on the part of employers. We know that many employers are reluctant to employ a recovering drug user and that as a result, the individual’s recovery is made that much harder. However, the negative judgements of employers may have more to do with the perception of the drug user as unreliable or untrustworthy than the illegality of the drugs involved.  

There will be many occasions though when a recovering drug user’s chances of securing employment will be adversely affected as a result of them having a criminal record. This is a problem that can be dealt with without the need to overturn the drug laws through, for example, expunging drugs convictions where the individual is seen to be demon­strating a sustained commitment to recovery. 

In the calls to treat drug use as a health rather than a criminal justice issue there is an assumption that the drug laws are having an adverse impact on the delivery of health-related support and that as a result society should choose between viewing drug use as a health or a criminal justice issue. The fact that certain drugs are illegal may actually help an individual’s recovery journey and it is certainly not the case that countries with the most liberal drugs laws are necessarily the best at providing accessible drug treatment services to dependent drug users.  

Instead of viewing drug use as either a health or a criminal justice issue there is a strong case for retaining both elements in how we are tackling our drug problems; ensuring that those in recovery are assisted in every way possible, including by reducing the availability and accessibility of illegal drugs on the streets. 

Professor Neil McKeganey is at the Centre for Drug Misuse Research, Glasgow

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