Opiates and the people

Geoffrey Wheatcroft

No other subject debated at this week's Conservative Conference arouses such passions as drugs. If the popular press is to be believed there is an epidemic of heroin addiction sweeping the country. We read of the Prime Minister's 'personal anxiety about the issue'. The Health Minis- ter has announced a new, expensive cam- paign against drugs. Fierce laws already on the statute book against the use of drugs are to be made even fiercer; those who use and sell drugs can expect no mercy from the courts. Within the last couple of weeks the same sentence — seven years' imprisonment — has been meted out to someone who had sold narcotics and to someone who had committed a particularly brutal rape, an interesting example of legal priorities. Now the popular press merely joins in the chorus: Monday's Times de- scribed a rock singer's 'crusade to beat the drug menace' alongside a shorter feature called 'Heroin: the facts'.

The facts are generally held to be that there is a conditon of 'drug addiction'; that addiction is a disease; that heroin is a poison and a killer; that the answer to the problem is further social — which is to say state — intervention. Few of these facts are challenged in political or journalistic de- bate. The subject is indeed surrounded by a superstitious aura and carries one of the few genuine taboos of public discussion. Almost any solution to the problem may be advocated — more money to be spent on the treatment of addicts, more severe sentences still for dealers — except one: that all narcotics should be legalised and 'drug addicts' left alone. There are very few things which it is impossible to pro- pound in the columns of the national press. This is one.

Before going further it is best to antici- pate and deflect misconception and mis- understanding. I do not deny the objective reality of the disaster that drugs have meant for many families. I do not advocate the use of heroin. On the contrary, it seems to me that our culture is drug-mad in a much broader sense and that we all use far too freely far too many mood-altering drugs of one sort or another, whether heroin with a few teenagers, cigarettes and gin with many of us, Valium and Librium with millions of depressive housewives. To say that something should be allowed is not to commend it, and the liberal individualist argument is often misrepresented. When a century ago in the course of the temper- ance debate (and in an age of happier prelatic intervention in public affairs) Archbishop Magee of York said that he would rather see England free than Eng- land sober he was not advocating mass drunkenness; he was saying just what he meant.

Let us look harder at the facts. Heroin is a narcotic, which word comes from the Greek to benumb. That is a fact. The morphine, and before that opium, from which it derives are also narcotics; so is alcohol. Like those, heroin is in one sense a poison. But what sort of poison? A good old medical phrase speaks of 'poisons that heal'. Aspirin and antibiotics are poisons in that strict sense. Like them (though not of course in the same manner or degree) heroin has its beneficial uses. It is, as is cocaine also, a powerfurpain-killer which many cancer doctors swear by for the treatment of gravely ill patients. (A mark of the superstitious horror which the word 'heroin' causes is that when writing on the subject some years ago for a liberal news- paper I was forbidden to mention this undoubted fact.) But don't patients so treated become addicted? Doesn't anyone who uses hard drugs? Isn't addiction a form of disease?

These are not easy questions but broadly speaking the answer to each of them is No.

The whole concept of 'addiction' reflects the medicalisation of questions of social or personal conduct. To be sure, we are all creatures of habit and some habits are easier to break than others. But however hard to break, however formed, a habit may be, that does not make it a disease.

In Sunday's paper that great footballer of the 1960s Mr Jimmy Greaves talked about his drinking habit and how he had conquered it. He thinks it is .`pointless to be guilty because you have been devastated by a terrible sickness'. Now, one can be glad for Mr Greaves's sake that he has stopped drinking, and guilt is his own business, but he is utterly wrong. He did not suffer from a disease. One British critic of the concept, Dr Trevor Turner, Lectur- er in Psychiatry at St Bartholomew's Hos- pital, says succinctly: 'The idea that addic- tion is a disease is a myth,' and adds that it is a disgraceful myth by which people can absolve themselves of personal responsibi- lities.

True diseases have several defining char- acteristics. One of the most important is that they are psychologically uncontroll- able. 'Which of you by taking thought can add one cubit to his stature?' Or cure yourself of pneumonia, or leukemia? But that is just what the 'addict' can do. There are plenty of cases of men and women who have ended their habit by reflection and will. This is a unique 'disease' which is socially conditioned — and cured.

The empirical evidence for this is exten- sive. The use of drugs including heroin was rife among American troops in Vietnam. Thousands of GIs were medically classified as hopeless addicts. On return to civilian life some remained addicts — but many did not. Would that other soldiers with true diseases could be cured by a demob order.

That Vietnam experience brings us clos- er to a vital truth, a fact rather than a fiction, about drugs of all sorts. The most eloquent American critic of the received wisdom on drugs is Dr Thomas Szasz. As he has said,

Powerful 'addictions' — whether to smoking cigarettes or injecting heroin — are actually both very difficult and very easy to overcome.

Some people struggle vainly against such a habit for decades; others 'decide' to stop and are done with it; and sometimes those who have long struggled in vain manage suddenly to rid themselves of the habit. Flow can we account for this? Not only is the pharmacolo- gy of the so-called addictive substance irrelevant to this riddle but so is the personal- ity of the so-called addict. What is relevant is whether 'the addiction' — smoking, drinking, shooting heroin — is or is not part of an internally significant dramatic production in which the 'patient-victim' is the star. So long as it is (and if it is, the struggle to combat the addiction is only a part of the play), the person will find it difficult or impossible to give up his habit; whereas once he has decided to close down this play and leave the stage, he will find the grip of the habit broken and will 'cure' himself of the 'addiction' with surprising ease.

In one respect I think that Dr Szasz is too sweeping in this magnificent passage.

The personality of the user is surely highly relevant in cases of drug or drink abuse. Elsewhere Szasz remarks on the way in which we see a habit and call it a disease.

One might say rather, we see a symptom and call it a disease. People who have a 'drug problem' or a 'drink problem' have in reality a 'them problem'. On a compara- tively modest level, people who smoke or drink too much do so as a symptom of other things — shyness, anxiety, boredom — which are not, for that matter, them- selves diseases either.

Among drugs users the same thing may be seen. There are tragic and disastrous cases of young people who die shortly after taking up heroin. There are also — yet another fact — undoubted cases of people who have used heroin for all their long lives. This, again unpalatable, fact is tell- ing. Narcotics are not in themselves lethal in the way that arsenic and cyanide are.

Many heroin users die from side effects — malnutrition, infection by dirty needles — rather than through direct effects. It is possible of course to die from an overdose of drugs but then it is perfectly possible to die from drinking a bottle of rum on an empty stomach and people have done so.

These then are the facts about heroin. It is an exceptionally powerful narcotic, more so than whisky, which is in turn more so than tobacco which is more so than tea. But though exceptionally powerful it is not uniquely so. It is not a true poison, though its use can be poisonous. It need not kill the user, though it may do. Its use, even its obsessive use, is not a disease.

What political conclusions should be drawn from these facts ? The case for legalising — or decriminalising — drugs is strong both pragmatically and abstractly. To claim that it would in itself end the 'drug problem' is hazardous, although it would be surely beneficial if drugs and the drug culture were stripped of illicit gla- mour. But in any case the central argument for decriminalisation is moral.

'Decriminalisation' is not a quibble: the state can only decriminalise, or legalise, that which it has criminalised in the first place. Those who dislike the 'permissive' legislation of the 1960s should remember that what happened was a reversal of the state's encroachment on areas of individual decision. Abortion and homosexual con- duct legalised? But neither was a criminal offence until the 19th century. Nor was the possession or use of narcotic drugs. These were not necessarily approved but in a saner age they were left in the realm of private moral judgement. The present government notoriously combines economic liberalism (of a sort) with authoritarian attitudes to social ques- tions. If the Prime Minister tried harder she might see that economic and social liberalism are indivisible. A last fact: 'Victorian values' meant leaving adult citizens to their own devices, recognising that certain matters are properly the field of self-control and self-discipline rather than coercive, collectivist intervention. Is it too much to hope that we may one day see England free rather than England compul- sorily 'drug free'?