As Australia toys with heroin injecting rooms, Dr J.N. Santamaria explains the hazards of such policies and argues that a drug free society is achievable.
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.
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 recognised by law and custom, the probability is extremely high that we shall find the rest of the social order characterised 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 of future generations.
The modern growth of the environmental movement bases its existence on such obligations. We recognise 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 s/he is expected to do, and what s/he 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.
When we turn our attention to 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 sex education, birth control, population control, anti-discrimination legislation, 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 explosive development of the Rights Movement, which promotes personal autonomy as the basic human right, has captured the minds of our legislators and many members of the judiciary. This movement has deeply infiltrated some of the operations of the United Nations and resulted in some outlandish formulations which are now included in the so-called international instruments that bind nations which unwarily ratify such documents.
This evolution of changes, which undermines the integrity and role of the natural family, has been associated with the loss of religious values and the adoption of Moral Relativism. This concept of moral behaviour is an inevitable outcome of the concept of personal autonomy exercised in a moral vacuum, which has no sense of the restraints of the Common Good. Even the demands of the common good of the basic social unit – the natural family – are eroded by the Convention of the Rights of the Child.
The same applies in the field of drug abuse. The individualistic model appeals to compassion for the drug user and ignores 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 co-dependents and discourages the use of mind-altering drugs.
We have reached the stage where the term Harm Minimisation should be abandoned. It has become highly politicised 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 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.
It is important to realise 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.
We should also realise 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 and not a drug maintained society.
1 Robert Nisbet. The Twilight of Authority. 1975.
2 Daniel-Rops. Jesus in his Time.Eyre & Spottiswoode London 1956.
3 Universal Declaration of Human Rights. Proclaimed in December 1948.
4 John Stuart Mill. On Liberty. Penguin Classics 1988.
5 J. Jackson in Society, Culture and Drinking Patterns. Pittman & Snyder 1962.
6 Nadia Solowij. Cannabis and Cognitive Functioning. Cambridge University Press 1998.
7 Solis C. Treatment for every Child and Family. Familia et Vita Year II, 1997, No. 3; p.66-71.
8 Drucker E. Harm Reduction :A Public Health Survey. Current Issues in Public Health 1 (1995) 64-70.
9 Santamana J.N. Commentary on the Occasional Paper-Harm Minimisation. July 1999.