Where is the Crime in Addictions?

Person ThinkingCrime comes from ‘addicts’ feeding their addictions? Or… people take drugs to self-medicate past trauma, mental-health issues and (increasingly) help them deal with the reality of an unfair, unjust and inherently disparate and divided society, all of which can and do lead them into crime to finance their medication of choice?

One thing is for sure, apart from most of the initial experimentation, hedonism actually plays a relatively small part in substance use.

Chicken & Egg Conundrums

Like some other issues I’ve discussed in this blog before, the correlation between drugs and crime is, in many ways, another Chicken & Egg conundrum.

But the prominent part of the ongoing debate that frustrates me the most is; irrespective of which side of the argument you choose to hang your hat, policy makers have a tendency to dictate process that is based around short-term reactionary self-interest. Delivering interventions, services and procedures that present significant life altering impacts for some of the most vulnerable in our society. But hey that’s ok, that’s the ‘choice’ of the ‘dirty addict’ …isn’t it?

Addictions: Criminology

Criminal: The Truth About Why People Do Bad Things – The way we see and understand crime falls into two types of story that, in essence, have been told and retold many times throughout human history – in fiction, as in fact.

Criminality is either a selfish choice, an aberration; or a forced choice, the product of social factors. These two stories continue to dominate both our views of and responses to crime. So says Tom Gash.

'Drug Wars'The further away policy makers are from the stark realities of the situations they create, the more likely they are to follow their entrenched thinking, often perpetuating the problems. Rather than looking at the long-term investment in those methods that support the delivery of evidenced-based solutions. Whichever way you choose to look at causal factors of either crime or addictions, they are inextricably linked.

But many drugs were medicines lone before prohibition. Despite the causal links, many argue that prohibition and purely punitive measures are no longer the way forward, assuming they were ever thus. Criminalising those impacted by substance use disorders can barely mitigate against the problems caused by the trade in illicit drugs, let alone solve any of them.

Addictions: The Politics & Science

It could be argued that our current national political direction, and the fall-out from that process, is creating addiction problems… both directly and indirectly. Depression and anxiety are now at epidemic levels. Why? Across the world, scientists are providing evidence for for the causation factors. Some are in our biology however; most are in the way we are living our life today.

When you start to examine the widening chasm of wealth disparity across our social classes, arguably created by (wealthy) career politicians in the so-called Westminster Bubble, and you should start to see the problems.

In 2018 a study showed that; (1) ‘career politicians’ are more likely to adopt policies for strategic political reasons to win over swing voters and win elections. Whereas in contrast, (2) politicians with a ‘working-class’ background are more likely to support policies that benefit working class communities (read more).

The decline in working-class MPs and rise of career politicians shifted the Labour Party towards a more right wing policy stance on welfare (Dr Tom O’Grady, Lecturer Comparative Political Studies UCL)

Not that many years ago it did feel like the politicians and purse-string holders had finally grasped the nettle of addictions treatment and support. Sadly, the euphoria of a win on the addictions recovery playing field turned out to be a short-lived period of celebration. The [funded] moves that were starting to deliver harm reduction within a recovery focused support framework are again in decline.

It’s worth noting that the scientist Prof David Nutt, once employed by our government to advise on drugs policy and strategy, got sacked from his job because the science didn’t dovetail with the political rhetoric.

Politically based austerity, misguided beliefs, self-promotional and commercial thinking have all had a significantly negative impact on public services and social support structures recently.

As with many areas of health and social support, professionally made clinical decisions and procedures are being undermined or dictated by arbitrary targets set by politicians, accountants and administrators. And meanwhile our police, who have also suffered at the hands of political austerity, are being left to try and clear-up the social mess and detritus created by self-important politics and greed.

But this blog is not about politics or the politicians, despite the fact they now impact (usually adversely) upon nearly every aspect of how well we live… or don’t.

Addictions: Malady or Normality

The self-appointed morality police, emboldened by politicians, (some) clinicians, the media and the remaining ‘establishment’ of the Western world have branded addiction a brain disease, based on evidence that brains change with drug use.

In The Biology of Desire, cognitive neuroscientist and former ‘addict’ Marc Lewis convincingly argues that the so-called ‘disease model’ of addictions has been both counter=productive and become an obstacle to healing.

Lewis suggests that most addiction is an unintended consequence of the brain doing what it’s supposed to do – seek pleasure and relief – in a world that fails to cooperate.

Addictions: Treatment & Support

Cuts to publicly funded drug and alcohol treatment have contributed to a 26% rise in drug-related deaths, according to statistics released towards the end of 2018. Analysis by the BBC found £162m (18%) has been cut from treatment budgets in England since 2013-14 (read more)

The number of drug-related deaths in England and Wales reached record levels last year (BBC News)

One in a long line of examples as the the negative impacts of funding cuts to services is; the proposed reduction of Opioid Substitution Treatment (OST) in Bristol. An issue which was highlighted by James Nicholls the CEO of Transform, who work to reduce drug-related harms through evidence-based reforms to policy and practice.

It is possible to argue both for and against the proposal, if you take away the politics, finances and emotion; after all, addiction support (and OST) is supposedly about helping people to (eventually) kick their habit… not simply maintain it with ‘clean’ drugs at public expense.

Some people will achieve that goal in less time than their peers, which is to be expected. Each person is an individual with differing aspirations, strengths and impacts. I agree that a reduction to OST provision could be ‘catastrophic’ (in part) but only if managed incorrectly.

A simplistic but perhaps slightly flippant analogy, for those with no understanding of the science would be; every alcohol dependent drinker has the right to receive vodka, on prescription and at public expense, whilst they take time to decide whether or not they would like to give up the booze. Harm reduction? Yes. Ethical and likely to happen? Probably not and arguably, the incorrect course of action.

Flawed Decision Making Process

When you make decisions which are mostly based around morality, religion, politics and financial factors, is when your process starts to go wrong.

Any decisions about clinical interventions must be made professionally from the medical perspective of science-based evidence, and tailored to the needs of the individual service user, unless we’re simply playing lip-service to the process. If the sticking point is the availability of funds, to pay for a clinical requirement… find the bloody money. Who has the right to put a price on a life?

Any displays of lax morality and/or ‘criminal’ activity within the field of addictions support comes from the political establishment, our society and in some cases organisational business leadership. It’s certainly not within the vast majority of those vulnerable and disconnected individuals who are impacted by the substances!

Community Cohesion

As with numerous aspects of life today, many of us tend to live within our very small personalised bubbles of reality. In general, people don’t take that much interest in other individuals, at least not the ones who exist outside their family group, business network or social circle therefore; it’s unsurprising they tend not to worry about the impacts upon our wider society… unless there is a direct (actual or perceived) impact upon their own existence.

Without personal knowledge and experience of any given situation or subject, your tendency will always be to develop understanding and opinions based solely around what you are told by others. That’s probably OK when the knowledge is being assimilated from an informed source, especially if you happen to have an enquiring mind that asks why, but not so good when it comes from the likes of politicians and journalists. These people nearly always have an agenda that dictates they only inform in such a way that satisfies the intended audience.

Politicians and the media have no desire (or need) to always tell you the whole truth. For example, research cited by Public Health England shows that 73% of patients in methadone maintenance stay in treatment, compared to just 16% of those receiving therapies with no medication.

From the brief OST statement (above) my first question would be; if OST is effective, as part of the treatment for those impacted by opiate addictions, why would anyone want to stop it?

But one question usually leads to several more; is it too expensive? if so, why and who says? Why would/could we place an arbitrary price on someone’s life? Is one individual worth less than any other? Who makes that decision? How can they? Why would they? Etc. Etc.

But all these views, opinions and stereotypical assumptions [about people who use drugs] tend to inform policy and direct strategy. Much of which is politically, financially motivated and I’m sad to say… often racially biased… usually thanks to the actions of our media, social opinion and the political elite.

Conclusion

Just like Transform along with many others like the Law Enforcement Action Partnership I believe; current drug laws damage everyone in society, especially the most vulnerable. We need to create a world in which drugs are regulated effectively, risks are reduced, and where we promote and support health and social justice… NOT disparity and exclusion!

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