Friday, May 11, 2012

Wash My Mouth with Soap

          For some time now – at least a decade – I have been dissatisfied with the language used to describe the use and regulation of controlled substances.  So it’s time to wash my mouth out with soap (at least figuratively) and clean up my vocabulary.

What is wrong with our current vocabulary, based on the concepts of addiction, drug abuse, and controlled substances?  It has four fundamental flaws that prevent rational discussions of the issues involved.  It turns inanimate, morally neutral chemicals into immoral destructive agents; it creates a dichotomy between abstinence and addiction, overlooking all other behavior patterns; it also dichotomizes medical applications and abuse, ignoring a universe of other motivations for consumption, turning all users not following strict medical instruction into criminal Others; and it improperly reifies “dangerous drugs” from a legal category into an actual substance. 

Demon Rum invaded political thinking during the 1830s.  Alcohol was personified as an active agent of evil, lurking to pounce on – and destroy – any innocent soul who fell into his trap.  This personification carried over into the concept of drugs as an aggressive enemy in a War on Drugs.  The problem is that drugs are neutral chemicals and may be used for either good or evil.  Just as Nobel’s dynamite could be used both to build railroad tunnels and to raze cities through bombardment, morphine could be used both to enable life-saving surgery and to satisfy an addict’s compulsion.  Methamphetamine is both a bane on the street corner and a path to a normal life for a child with an attention disorder.

The reaction to harmful alcohol consumption began as a temperance movement, memorialized by the still-used name of the Women’s Christian Temperance Union.  Dr. Benjamin Rush, the Founding Father from Philadelphia, was one of the first to recognize that harm could result from excessive consumption of distilled spirits; but he also recommended beer, wine, and cider as healthy beverages.  By the end of the Civil War the idea of temperance had been replaced by that of total abstinence forcibly insured by the absolute prohibition of alcoholic beverages.  This goal of forced abstinence through legally mandated prohibition was then made the mechanism for controlling all drugs.  This limited view of intoxicating behaviors has led to common acceptance of myths like the claim that a single taste of crack cocaine can create a lifelong addict.

This kind of binary, all-or-nothing, thinking about the effects of drug use led naturally to another binary concept.  The accepted wisdom became that all use of drugs that was not medically mandated and under a doctor’s supervision was abusive or addictive use.  This belief has persisted even in the face of centuries of social and personal use of drugs like alcohol, nicotine (tobacco), and caffeine (tea and coffee).  One consequence is that a person experimenting with a single marijuana joint is viewed as a criminal other and treated as a dangerous stranger to be punished and expelled from common society.

Dangerous drugs do not exist although the use of many, if not all, drugs may have dangerous consequences.  Aspirin may cause gastric bleeding and prevent blood clotting while many have used heroin or marijuana for decades with no adverse consequences (except for those imposed by the criminal laws).  On the other hand, the human body does not distinguish between heroin and morphine.  These two drugs can be used almost interchangeably as medicine, but the law interposes an unbridgeable chasm between them.  Heroin, marijuana, and LSD have nothing in common, but “Just Say No” thinking treats them as if they were a single substance.

The concepts and ideas behind this traditional vocabulary limit thinking about management of drug taking behavior to a few worn-out concepts.  It also prevents considering alternatives outside of the Prohibitionistic all-or-nothing, heaven-or-hell sloganeering.  It is time for developing new ways of talking so that new ideas can enter the discussion.

Having thoroughly cleaned my mouth (and hopefully my brain as well), I resolve to change my way of talking.  No longer will I talk about addiction, addicts, or drug abuse.  No longer will I refer to “dangerous drugs”.  

“Dangerous Drugs” do not exist.  The problems (and benefits) accompanying opioids are different from those around stimulants, anti-anxiety drugs, hallucinogens, or marijuana; and they should be dealt with separately.  If they must be discussed as a group, “controlled substances” may be the best way to aggregate them.

Drug addiction and drug abuse refer to two different concepts and need to be replaced with a different organization of ideas.  Instead of the all-encompassing “addiction” I hope to present a more analytic range of drug-using behaviors ranging from experimental use through casual to social use.  Most users would fit into one of these categories.  Those into heavier or more routine use would be either habitual or compulsive users, the last category including many of those now counted as addicts.

I have never seen anyone abuse a drug (the image that phrase calls to mind is that of a poor, innocent pill strapped to a post while some meanie lashes it with a big whip).  Some drug users do use them in ways that are damaging either to themselves or to those around them.  The paradigmatic examples are tobacco users whose compulsion leads about 400,000 of them to death each year and those who drink alcohol in ways that facilitate their killing others in car wrecks and indulging in domestic violence.  This distinction also provides for a way to analyze the differences between heavy and repeated use and binge use that frequently leads to harmful conduct.

Simply cleaning up the way people talk not only removes harmful and false myths from our discourse; it also opens the door to explore new solutions for long-standing problems.

I hope my newly-cleansed mouth will lead others to follow my example.