The Medicalization of Legalization

Punish the crime, treat the disorder.

The alcoholic in A.A. and the cocaine addict on the street share a common appetite. This shared appetite, and the behaviors that come with it, are played out in a larger social context. For a practicing addict, the world is filled with risks, and some of these risks are invariably connected with the web of prohibitive laws and legislation governing the sale and use of addictive drugs. The movement for drug legalization, which began to coalesce about twenty years ago, is a collection of public voices spanning a variety of political and cultural points of view. Many prominent voices in the ranks of the legalization movement are public officials who have become disillusioned with the current state of affairs, and are now convinced that the present system is doing more harm than good.

The essential argument against legalization is that some drugs are not bad because they are illegal—they are illegal because they are bad. If alcohol and tobacco are legal, and we are only now beginning to come to terms with the health implications of that historical decision, it is insane to add heroin and marijuana and everything else to the list.

Harvard psychiatrist Robert Coles, a specialist in working with children, holds that legalization would be tantamount to a “moral surrender of far-reaching implications about the way we treat each other.” Such an act, Coles believes, would signal an acceptance of the pursuit of hedonism for its own sake.

However, the medicalization of addiction requires people to consider the possibility that drug abuse is less of a problem than drug crime--and that drug crime can be attacked differently. Very few of legalization’s adherents can be considered “pro-drug.”

Drug prohibition itself is a major part of the reason why the more potent and problematic refinements of plant drugs keep taking center stage. Since crack cocaine is more potent, more profitable, and more difficult to detect in transit, it replaces powdered cocaine, which, in its turn, replaced the chewing of cocoa leaves. Similarly, in the old days bootleggers switched from beer to hard liquor, just as modern international drug dealers switch from cannabis to cocaine whenever the U.S. enforcement engine lumbers off in the direction of marijuana interdiction and eradication. Is there anyone prepared to argue that the gruesome scenes along the Mexican border, as rival militias battle it out for control of the drug trade and the U.S. tries to interdict it, is somehow helping alcoholics and other drug addicts find their way to abstinence?

While the fact of addiction may be beyond the individual addict’s control, addicts nonetheless have a responsibility to do something about their disorder. What would we think of a diagnosed diabetic who told us there was no point in trying to treat his disease; it was all genetic and physical and therefore a waste of time to treat, and impossible to overcome? We would think they were nuts.

From a legal point of view, the biochemical model of addiction does not change the basic proposition that, with few exceptions, people must be held responsible for the crimes they commit in connection with drug or alcohol use. But simple possession should rarely be one of those crimes.

In time, it may be possible to separate out the criminals suffering from concrete biochemical abnormalities, so that they can receive medical treatment in addition to, or in lieu of, a prison sentence.

Punish the crime, treat the disorder.

Adapted from The Chemical Carousel: What Science Tells Us About Beating Addiction.

Photo Credit: NIDA