Monday, February 7, 2011

The Medical Approach

Often a proponent for removing criminal penalties for drug use will propose that drug use should be treated "as a public health issue". This position seems to be more common among the left wing proponents of decriminalization than among the libertarian/conservative proponents, but from time to time I have heard it from representatives of almost every political position. To many it must sound the same as outright decriminalization. However, I will argue that not only is it not the same as simple decriminalization, but it represents an approach potentially as harmful as the one we have today.

The first problem is that the statement itself is not clear, and admits to at least two different readings. As the listener can choose the more or less extreme meaning, it allows the speaker to propose something more extreme than the listeners hear without doing so obviously. However, while I believe most of those proposing it are suggesting the more invasive meaning, I will examine both possible understandings.

The far less intrusive meaning is that we should decriminalize drugs and leave it to the state to deal with the related health problems. While I personally have a problem with a state funded health care system, I doubt it will vanish with drug decriminalization, so this seems a strange thing to propose. It would be like proposing "after decriminalization the sun will still rise in the east". However, doubtless this is how many hear the proposal, and so many support this "medical model" who would not agree with the more intrusive meaning.

The more intrusive, and far more likely, meaning is that we would remove criminal penalties, but would treat drug addiction as a disease we need to combat. Which sounds fine, until you ask about the specifics, and how it would really differ from our present system.

Now, let us look at the first problem, the assumption that every drug user is an addict suffering from a disease. Now, I have written elsewhere, and will doubtless write again, about my problem with seeing human behavior as a disease, but for purposes of this argument let us assume that drug addiction is a disease, and can be treated. Even so, these proposals seem to assume that most or all of drug users are addicts. Now, I now that some argue that anyone who has even tried a drug is on the path to addiction, but I don't think that is anywhere close to the truth. Any number of polls show that a huge percentage of the population has tried one drug or another, yet a very small percentage are addicted.

I suppose the proponents would say that they do not feel that every drug user is an addict, they would simply taker steps to prevent casual users from becoming addicts. However, as that involves treating all users as teetering on the verge of addiction, the difference seems insignificant to me. Whether we treat all users as addicts or teat them as addicts and likely addicts is not that important, it means that every drug user will be of interest to those trying to treat drug addiction.

And why does this matter? Because the proponents never quite make it clear how they plan on handling the "public health question" of drug addiction.

The problem is that there are many ways that a public health issue can be handled. When most people hear the phrase "treating it as a public health measure" they imagine public awareness advertising, clinics, treatment centers and so on. And that may even be the way some mean it. Were this what was meant, it would not be much different from decriminalization. True it would involve added money spent on all there "programs", and it would still allow drug users accused of crimes to claim sort sort of "disease" in an attempt to eschew personal responsibility, but other than that it differs little from decriminalization.

But there is the other side of public health, the sort characterized by the involuntary commitment of those who are a threat to themselves or others. And that too is a public health response. That is the possibility that troubles me, the public health approach which attempts to coercively treat.

Now, it is possible that those promoting a medical approach do not intend to use coercive means, they intend to simply use "education" and provide "treatment", but in the end I do not doubt that they will end up using coercion. At first it will probably be applied in limited areas, likely those convicted of other crimes who are also addicts will be forced into treatment. Maybe those who have interactions with family services. Or traffic offenses. But, once we have admitted that those who have legal problems can be forced into treatment, what is the argument against forcing addicts who have not run afoul of the law? Which leads us, in the end, to the same situation we have today, the only difference being that we use coercive treatment rather than jails. But ask any Soviet dissident who was found "schizophrenic" how much difference there is between hospitals and jails.

The problem with the medical approach is very simple. So long as we believe that drug use is a problem, and one with which the state must deal, we will end up adopting coercive approaches. Whether we jail or force them into treatment, as long as we think the state has an interest in the drug use of citizens we will end up with citizens being treated coercively. It is an inevitable outcome of the way we view our state. As long as the state has the right to protect people form themselves, can force them to avoid things it considers harmful, then it matters little whether we do so on moral or legal or medical grounds.

In other words, there really is no difference between our current penal system and the "medical" model in the long run. And so there is no reason to switch from one to the other. The only solution which produces substantially different results is for the state to declare that it does not care what substances its citizens ingest, for good or ill.

Any other solution is just dressing up the current solution in different terminology. Does it really matter if you are jailed, or hospitalized, if you are held against your will the name doesn't matter.

Originally Posted in Examining the War on Drugs on 2008/06 /17.

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