Treating drug addiction like a criminal issue has failed. Everywhere. Not just here, but in every part of the world from the U.S. to South East Asia. It is as proven a failure as any policy worldwide, and there isn’t much of a public good case to be made for it.
People seem to feel that people who would use drugs deserve some form of punishment, but if your reasoning is punitive, you should be able to see whether that argument stands on its own instead of conflating it with the public good or well-designed public health policy. I personally don’t think that drug use should be punished: the whole problem with addiction, for those susceptible to it, is that it takes hold in the brain and makes quitting absolute hell, regardless of whether your original use was a mistake you now deeply regret.
Have some empathy: do you believe that there’s no possible path your life could have taken- not if you’d fallen in with the wrong people while young, not if you’d spiraled into horrible decisions during grief, not if you’d just been a dumbass kid and your adult self wishes you could scream at that kid to never do it? If you’d made any of those mistakes, you’d now be on the hook for it indefinitely, because that’s addiction. And instead of trying to help you get back on your feet, the state and society punishes you for the way your mistakes changed your body into something that craves a chemical like it craves food or water.
But let’s leave that aside for now. Where has drug policy worked? Portugal’s a good example. Portugal was hit by a drug epidemic in the 1980s that resulted in one of every ten people being heroin users. In 2001, Portugal decided to treat addiction seriously as a public health issue.
Portugal decriminalized the possession and use of drugs (to be clear, just possession and use, not dealing). Drug users were directed towards treatment, not into the prison system where they would only further excluded from common society, fall behind on getting work and rebuilding their lives, and fall in with hardened criminals. People caught with a small amount of drugs weren’t arrested. Instead, they had to meet with a small local commission made up of a doctor, lawyer, and social worker, who worked with them on treatment and provided support systems during recovery. Drop-in clinics in quiet and anonymous unmarked locations provided counseling, clean clothes and a shower, blood testing, and help with finding rehab, jobs, or re-integrating into society.
The drug crisis eased. Drug use, HIV and hepatitis infection rates, overdose deaths, and drug-related crime all dropped. HIV infection rates fell by 96%.
Portugal’s policy is guided by principles of compassion and empathy: a belief in treating everyone as individuals with human dignity, as thinking of the root causes that might lead an individual towards drugs. Without the risks of legal jeopardy, clinics, pharmacies, and NGOs were able to work together to provide a safety net of services for their communities. Government endorsement has powerful effects on social views of issues, and the cultural shift on how drug users were viewed helped create a climate where prevention, treatment, and rehabilitation could be the focus.
In the early days of the crisis, Portugal, which it is important to note is quite religiously conservative a country, responded by demonizing drug users as a stain on society and drugs as a manifestation of Satan. But that didn’t work, just like it hasn’t worked anywhere else.
It is important to note that most medical organizations describe addiction as a disease:
Like diabetes, cancer and heart disease, addiction is caused by a combination of behavioral, environmental and biological factors. Genetic risks factors account for about half of the likelihood that an individual will develop addiction.
Addiction involves changes in the functioning of the brain and body. These changes may be brought on by risky substance use or may pre-exist.
Why is willpower often not enough?
The initial and early decisions to use substances reflect a person’s free or conscious choice. However, once the brain has been changed by addiction, that choice or willpower becomes impaired. Perhaps the most defining symptom of addiction is a loss of control over substance use.
Are people with addiction responsible for their addiction?
People with addiction should not be blamed for suffering from the disease. All people make choices about whether to use substances. However, people do not choose how their brain and body respond to drugs and alcohol, which is why people with addiction cannot control their use while others can. People with addiction can still stop using – it’s just much harder than it is for someone who has not become addicted.
People with addiction are responsible for seeking treatment and maintaining recovery. Often they need the help and support of family, friends and peers to stay in treatment and increase their chances of survival and recovery.
Why some people say addiction isn’t a disease
Some people think addiction cannot be a disease because it is caused by the individual’s choice to use drugs or alcohol. While the first use (or early stage use) may be by choice, once the brain has been changed by addiction, most experts believe that the person loses control of their behavior.
Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.
Others argue that addiction is not a disease because some people with addiction get better without treatment. People with a mild substance use disorder may recover with little or no treatment. People with the most serious form of addiction usually need intensive treatment followed by lifelong management of the disease. However, some people with severe addiction stop drinking or using drugs without treatment, usually after experiencing a serious family, social, occupational, physical, or spiritual crisis. Others achieve sobriety by attending self-help (12-step or AA) meetings without receiving much, if any, professional treatment. Because we do not understand why some people are able to stop on their own or through self-help meetings at certain points in their life, people with addiction should always seek treatment.
The real question: would decriminalizing drugs sell as a policy in the Maldives, or would the very phrase itself cause an uproar by people horrified at the prospect of some lawless Mad Max: Fury Road style situation? Yes, probably. It might be a step too far to start with. But I think that there are little steps we can take. In a remotely just society, drug users facing any kind of mandatory incarceration should at the very least do so exclusively in rehabilitation facilities, separate from violent offenders, where users will get treatment and have a chance at re-entering society ready to be a part of it instead of further isolated from it. I don’t think that’s enough, but it’s a start.


