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Introduction
There
is today, throughout the whole world, but particularly in the Western
world, a grave concern about the impact of mind-altering drugs on the
state of society. In establishing a policy to combat such a serious
health and social problem, nations have tended to adopt one of two
possible responses—the harm minimisation model or the restrictive, harm
prevention model. The first model is based on an individualistic
approach whilst the second rests on the concept of the Common Good.
Within either model, there are modulations to the extreme positions of
some of their advocates and at times, a national policy has a bit of
both worlds.
To
determine how society should respond, we need to present some important
concepts and understand the principles of a public health approach.
The
Basic Social Unit
Because
we are social beings and not isolated individuals, it is important to
remember that it is the family, not the individual, that forms the basic
unit of society. The flourishing of society and of cultures depends on
the flourishing of its basic units. Robert Nisbet, the American
sociologist, says it this way: “We can use the family as an almost
infallible touchstone of the material and cultural prosperity of a
people. When it is strong, closely linked with private property, treated
as the essential context of education in society, and its sanctity
recognized by law and custom, the probability is extremely high that we
shall find the rest of the social order characterized by that subtle but
(powerful) fusion of stability and individual mobility which is the
hallmark of the great ages.”[1]
This is an observation made by other historians, such as Daniel-Rops, in
a classic study published in 1945.[2]
This is
not to deny the rights of individual persons. These rights are enshrined
in the Universal Declaration of Human Rights.[3]
But human beings are social beings. By nature, they live in communities
and even the libertarian philosophers, such as Locke and Mill,
acknowledge the concept of the Common Good.[4]
This means that we are willing to forego some liberties in the interest
of the whole community and its future generations. The modern growth of
the environmental movement bases its existence on such obligations.
We
recognize that personal autonomy is not unqualified and that there are
some social institutions, such as the family, which need protection.
In an
interesting article on “Alcoholism and the Family, Jackson had this to
say: …when persons live together over a period of time, patterns evolve
of relating to one another and of behaving as a unit. In a family, a
division of functions occurs and roles interlock. For the family to
function smoothly, each person must play his (or her) role in a
predictable manner and according to the expectations of others in the
family. When the family as a whole is functioning smoothly, individual
members of the family also tend to function well. Each member is aware
of where he (or she) fits, what he (or she) is expected to do, and what
he (or she) can expect from others in the family. When these
expectations are not met, repercussions are felt by each family member
and the family as a whole ceases to function smoothly.[5]
Jackson
was writing on the impact of the excessive drinking of alcohol by one
member of a family. In fact, she was drawing our attention to the
significance of the effect of alcohol intoxication on the cognitive
functions of the brain and the flow through of these effects on human
behaviour and social functioning. This is not peculiar to alcohol.
Mind-Altering Drugs the Effects on Cognition
When we
turn our attention to the mind altering drugs, we must appreciate that
these chemical substances do alter the way that the brain functions.
They affect not only the pleasure centre which gives a sense of euphoria
but they also act upon the memory centres and other areas associated
with our faculties of cognition— the receipt of information, our state
of consciousness and self-awareness, the processing of information, of
analysis and synthesis of data received, of linking it with previously
acquired data, of the power to perceive, to concentrate our attention,
and the power to think rationally.[6]
Solowij
has written a splendid monograph about her scientific studies measuring
effects on the cognitive activity of the brain when cannabis is taken
over an extended period of time. The findings indicate that there is
significant impairment of memory and the ability to focus attention on
learning and this is related to the use of the drug over an extended
period. Those familiar with the half life of the drug in the body and
its distribution in fatty tissues such as the brain are not surprised
but this does not deter the advocates of the Harm Minimisation policy to
persist with the demand for “use-tolerance” or the normalisation of drug
use.
Those
who have worked in the alcohol and drug field have now confirmed what
families always knew, that the mind remains befuddled for some time
after abstinence has been achieved. This dysfunction of the brain varies
with the type of the drug being used but the overall effect is similar
insofar that the recovering addict needs time to regain his cognitive
capacity, his confidence and his competence to carry out skilled tasks.
These
effects on cognition carry over into behaviour, personality development
and interpersonal relationships so that the whole family often becomes
disturbed and apprehensive. This is often interpreted by psychologists
as inappropriate and a reflection of personal inadequacy in the parents
and other members of the family who are seen to be over-reacting. But
they are the ones who are living with the problem day in and day out,
and their concerns arise from the many and often subtle behavioural
patterns that constantly disrupt the family.
In
reality, when a member of the family is constantly or regularly under
the influence of a mind altering substance, there is what some have
called a “family disease.”
To
foster the growth and function of the family is a formidable undertaking
as it presupposes definitive roles for each of its members. These must
be exercised with a sense of fine balance, of tolerance of individual
differences but with a sense of purpose and of obligations—for children
to achieve maturity and for the family to act as a mediating structure
between the individual and the wider society. It can be so easily
threatened by both internal and external pressures, by the disruptive
behaviour of individuals, especially those who occupy key positions of
influence.
The
family is the forgotten factor in the formulation of national drug
policies. There are many studies which confirm the importance of the
family in the recovery process of drug addicts. One of the most
interesting is that of George Vaillant in his classic description of the
natural history of alcoholism. He studied the factors that help the
addict to recover. Connectedness to a supportive family structure is
most important but such families need support and counsel to play an
effective role in recovery and to come to terms with their grief and
disillusionments from past experiences.
There
is however an important issue that must be addressed, for parents and
other family members are being ignored and disenfranchised. There are
several movements, operating in different fields, which are trying to
sever the relationships between parents and their children that are
essential to the proper growth of the natural family. We see it in the
fields of sexuality, birth control, population control, the transmission
of values and the promotion of Individualism. The International
Convention on the Rights of the Child demonstrated this fact more
blatantly than usual by the use of seductive language to confound the
unwary.
The
same applies in the field of drug abuse. The individualistic model
appeals to compassion for the drug user and evades the rights of parents
and concern for the common good which includes the good of succeeding
generations. It has no appreciation of the destabilising effect on
families of impaired cognition and erratic, often criminal, behaviour of
the drug affected person. It is true that many drug addicts come from
dysfunctional families but it is not true that all parents of drug
addicts are primarily dysfunctional or irrational.
In an
interesting article on the development of the brain, its plasticity and
the development of its functions, the famous American psychologist,
Solis, had this to say: We professionals need to stop looking at parents
as the problem and we need to start to see them as the solution. We need
to stop trying to intimidate parents and we need to start treating them
as equals in the fight for their children’s lives. Certainly parents
need our guidance but they are the key to victory. In short, we need to
start treating parents with the respect that they deserve. From the
poorest to the richest, from the most ignorant to the most educated,
they deserve no less. We should do so because...children’s lives depend
on it.[7]
It is
true that we must show compassion for the drug addicted person. We
should not treat drug use primarily by imprisonment or stigmatisation of
the addicted person, but neither should we treat it as an unavoidable
fact of life, an acceptable alternative lifestyle, a free option to be
exercised without consequences for those who freely make such a
decision. Nor should we forget the family and its role in a flourishing
society. The natural family is the key to our drug problem and we should
be challenging those ideologies and public policies that erode its
vitality and endanger its survival. For it is the natural family that is
best able to give meaning to life, to inculcate virtue and a concern for
the Common Good.
From
this foundation, each individual has the greatest chance to flourish and
to control his destiny and his happiness, without sinking into an abyss
where he surrenders his mind and his will to the power of irrational
thought and a drug dependent state. It is from this vantage point that
we can develop social policy that encourages treatment for the drug
addict and the codependents and discourages the use of mind-altering
drugs.
Towards a Drug Free Society
We have
reached the stage where the term Harm Minimisation should be abandoned.
It has become highly politicized and disguises the ideological aim of
many of its leading advocates which is the legalisation of all
mind-altering drug use.[8]
Many workers in the field and many concerned public figures have never
closely analysed the use of the term which is appealing and partly true
but not in the context of the present debate which ignores a great deal
of evidence and which does not support the concept of “use tolerance” as
a component of the definition.[9]
I
suggest that the Policy should be called: Towards a Drug Free Society.
It should be based on the principles of Primary, Secondary and Tertiary
Prevention which are part of the Public Health concept.
Primary Prevention
This
means applying measures to prevent a disease or disorder from
happening—such as small pox vaccination, deterrent legislation,
identifying and treating “at risk” populations and diminishing the
number of negative contributing factors.
It is
fundamentally concerned with the issues of incidence and prevalence.
Secondary Prevention
This
means instituting measures to diagnose and treat a disease or disorder
in its earliest stages of development and by preventing relapses or
recurrences by suitable methods of surveillance and monitoring.
The
object is to promote early intervention and to maintain the highest
level of personal and family functioning.
Tertiary Prevention
This
means the management of a case at a later stage—to apply measures to
slow down progression, to reduce the number of relapses, to overcome
distress and social isolation.
The
Common Good
It is
important to realize that a public health concept is based on the
principle of the Common Good.
It is
not a good thing for a society to have a large population of people
regularly taking mind-altering drugs. Apart from the fact that such
chronic intoxication affects the ability of an individual to perform
certain essential tasks and to be capable of performing at higher levels
of intellectual and skilled performance, they require public funds to be
spent on their care-welfare and health funds. It then devolves to the
principle of Justice within the framework of the Common Good.
The
maintenance programmes sustain a state of chronic intoxication, similar
to the weekly or more frequent use of a slowly excreted drug such as
cannabis. It is interesting to me that the leading advocates of Harm
Minimisation are strong promoters of methadone and heroin maintenance as
well as the legalisation of cannabis use. It is also important to
realize that the main social harms due to such drug taking are the
dependent state, the effects on cognitive functioning, the effects on
behaviour and the effects on performance. The acute effects, such as
heroin deaths, psychotic events and accidents, are associated with a
single episode of drug taking and often in special circumstances (such
as multiple drug use), A public health policy should aim at avoiding the
main social harms and the singular acute effects, all of which point to
the adoption of Towards a Drug Free Society.
Endnotes:
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