Demedicalising and decriminalising drugs

Is drug addiction a disease? Substance Dependence appears as a diagnosis in the influential Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV). There are medical specialists in the field who use a range of different drug and non-drug treatments for patients who are addicted. There are hospitals and clinics where those who are addicted can seek help. But if it is a disease why is it treated as a crime? After all we do not lock people up because they have cancer, or hepatitis, or heart disease.

Former president of the Royal College of Physicians, Ian Gilmore, yesterday added his voice to the chorus of prominent figures in the UK who have recently called for a change in policy towards drug addiction. He appeared to draw on the model of addiction-as-disease in his comment

"I'm not saying we should make heroin available to everyone, but we should be treating it as a health issue rather than criminalising people,"

If addiction is a disease, then it would make sense, as recently argued by Evan Wood in the British Medical Journal, for our response to it to be guided by scientific evidence. Given that there appears to be substantial evidence of harm associated with prohibition there would be a strong incentive to examine, and potentially trial, an alternative approach. It would be appropriate to pay attention to the views of eminent doctors, and appropriate that discussion of treatment and regulation options occurs in medical journals.

However, some philosophers, including contributors to this blog have argued that addiction is not a disease. Addiction is simply a strong appetite. Heroin is simply a potent activator of the reward system. They have cited neuroscientific and psychological evidence in support of there being no difference in kind between regular desires and addictions. Julian Savulescu has argued that we should demedicalise drug addiction – take it out of the arena of health professionals and psychiatrists and medical textbooks.

But if we accept that addiction is *not* a disease does that undermine the case for decriminalisation? It may, but only a small part of that argument. One reason for decriminalising personal use of drugs is that addiction undermines the individual’s ability to choose. They have diminished responsibility because of their addiction, and consequently should not be held (fully) accountable for taking drugs. An addict can’t help smoking or shooting up, and consequently should not be punished for doing so – in the same way that it would be unfair to punish someone for a crime committed while they were psychotic. Foddy, Savulescu and others suggest that addicts are still responsible. They are still able to choose. As a consequence they may be liable to punishment.

However, the more significant arguments against prohibition would remain, even if we stopped thinking of addiction as a disease. Whether or not addiction itself is an illness it is responsible for a huge amount of secondary morbidity – both directly, and as a consequence of the policies that have been adopted to deal with it. That is one reason why doctors and medical journals have something to contribute. Whether or not it is an illness it is appropriate and vital that we carefully consider the existing evidence and the consequences of our legal approach to drugs.

The current approach to the classification and prohibition of drugs is focussed on the wrong question. We should not be asking 'Are they harmful?' and making them illegal if the answer to that question is yes. Rather we must ask – which is more harmful – regulated access or prohibition?