Archives for posts with tag: drugs

I am a drug and alcohol counselor. I am at least okay at my job; clients will occasionally tell me they feel better after having spoken to me, which is as good a metric as any, and the odd client might even stop using drugs and/or alcohol if the stars are aligned just so. It’s a complicated career in which the measures of success are vague, yet regardless of whether or not I’m successful (whatever that means), a new client will always come in. This new client with their new idiosyncrasies are, more often than not, fundamentally similar to the old one. The tide comes in, the tide comes out, then, as per the pull of the moon, the tide comes back in again.

There will always be drug addicts, right? One must imagine Sisyphus happy in order to avoid the soul-crushing burnout of facing off against the boulder of the opioid crisis. And yet, even in the name, its immutability is questioned. It is called the opioid ‘crisis’, not the opioid ‘way of life’. A crisis is temporary. Solutions are possible. Causes can be identified.

Of course, a crisis can simply be an act of God or a natural disaster. There might be those who argue that nothing can be done about this crisis since its causes are out of our hands. Fentanyl is a thing now, so people will just die more because of it. There is some merit to this argument: Fentanyl is certainly deadly and more prevalent which is going to inevitably lead to more deaths. As any consumer advocate would tell you, the solution to a deadly product is of course a well-regulated market, but this ignores why people might seek out Fentanyl in the first place. Even if people take healthy doses of untainted heroin (or meth, or crack, or all the other drugs now laced with Fentanyl), this still doesn’t change the tide.

There are several theories about the causes of addiction. Trauma is a big one, and yet trauma is not preordained. The trauma of neglect is often predicated on poverty which can be alleviated through wealth redistribution (consider that there is more than enough housing for everyone, despite large numbers of homelessness. Similarly, we have enough food to feed the planet. Supply is not the issue, distribution is), livable minimum work standards (since many of those in poverty do indeed work), and so on. Trauma based on domestic abuse can also be curtailed if we shift masculine culture away from domination and violence.

There is also the lack of connection that drives addictive behaviour. This connection has been driven out of society by the cultural forces of individualism and competitiveness, and can just as easily be reduced by the imposition of their opposites. Solidarity with coworkers and neighbours, an emphasis on community values, respect for nature, and a reignition of hope; these too will reduce the need for the synthetic connections induced by narcotics.

Of course, there is also simple education. Not the education that tells us that drugs are bad. Drugs are actually amazing. Drugs offer solutions to problems when nothing else seems to have worked before. An individual, often having gone through trauma or who is suffering from mental illness, does not know how to cope with that trauma or illness. Along comes drugs, and all of a sudden the baggage associated with those things don’t seem so awful now! What needs to be taught are healthy coping skills as well as information on mental health that will help identify and then deal with these developmental dangers before addictive alternatives become the norm.

You may note that none of these things involve cognitive behavioural therapy, nor harm reduction, not even admitting you are powerless over your addiction and that your life has become unmanageable! The methods of dealing with those in addiction (with their varying degrees of effect) are only ever reactive, and ignore the systemic issues that produce drug addiction in the first place. Social fixes ought to attack the root of the problem rather than focus on managing its aftermath.

One of the stories I tell myself to endure the Sisyphean drudgery of endless addiction is the story of the curmudgeonly old man and the beach full of starfish:

Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.

Off in the distance, the old man noticed a small boy approaching.  As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea.  The boy came closer still and the man called out, “Good morning!  May I ask what it is that you are doing?”

The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”

The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”

The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”

This metaphor does help me feel better about the work I do, because ultimately helping one person live a better life is a worthwhile goal. It matters. However, the metaphor fails because a tide is by definition unstoppable, and drug addiction is not. The starfish have not been washed up onto the beach by some immutable fact of nature, they have been pushed by cultural ideologies, economic oppression, and brutish stigma.

Why bother with drug counselling? It does help, but it will never stop the tide.

The term ‘addict’ carries with it great stigma, eliciting images of either a helpless human being caught in the poisonous clutches of a deadly substance, or a moral deviant, choosing to throw away their lives in vain hedonism. The term ‘drug’ shares that stigma, to the point where the phrase ‘legalize drugs’ seems almost an oxymoron. Yet it is not so farfetched, as even the Surgeon General advocated for an inquiry into the benefits of legalization in 1993 (Stares, 1996). Virtually all North Americans consume a psychoactive substance of one type or another, be it caffeine, alcohol, or sugar (Nadelmann, 1992), so demarcating one as illegal over another seems almost arbitrary. Given the measurable harm of some legal drugs compared to some of the illicit ones, this arbitrary labelling becomes even more bizarre. The consumption of alcohol within some Aboriginal communities is comparable to the cocaine use in some inner-city populations (Nadelmann, 1992), yet one is legal while the other is not. Legalization remains extraordinarily controversial, and, given the devastating impacts that both alcohol and cocaine ravage on their respective communities, quite rightly so. This paper will overview the recent history of drug prohibition, analyze prohibition and its legal opposite, observe some obstacles to implementing an alternative system, and finally review the impact of culture on drug use.

History of ‘The War On Drugs’

It was in 1973 that the infamous War On Drugs began to dictate the dialectic surrounding psychoactive substances under the leadership of President Richard Nixon (Hughes, 2012). The so-called ‘war’ refers to the use of a punitive law system, emphasizing the incarceration of sellers, producers, and users, as a deterrent against the influence of drugs on American society (Scherlen, 2012). This is an influence of weighty concern, as a 2007 poll shows that 73% of Americans feel that the drug problem is either very or extremely serious (Gallup, as cited in Scherlen, 2012). Presidents since Nixon have rallied to the fight. Ronald Reagan signed the Anti-Drug Abuse Act in 1986, and George H. W. Bush signed an updated version of the act in 1988. Bill Clinton signed the anti-drug Plan Colombia legislation which George W. Bush expanded during his regime (Scherlen, 2012).

Trends away from legalization are immediately quashed. The aforementioned Surgeon General, Jocelyn Elders, became ostracized by the Clinton administration after her announcement concerning even the research into drug legalization, and bills have been brought to congress that would prevent future administrations from following similar trains of thought (Kugler & Darly, 2012). The United Nations have made similar declarations, forbidding any nation states from the “cultivation, manufacturing, sale and possession” (Hughes & Stevens, 2010, p. 1000) of illicit drugs. In Canada, an attempt was made to decriminalize marijuana in 2003, but pressure from the United States eliminated that possibility at the time (Raaflaub, 2004).

The drug war has focused almost exclusively on the supply side of the narcotics industry. If addiction is a hereditary disease, then no amount of social programs will eliminate a person’s drug problem save complete abstinence (Rosenbaum, 1989), so focusing on demand would be unnecessarily gratuitous. Bush Sr.’s Anti-Drug Abuse Act was intended to address supply and demand in equal measures, but when passed it was a 70/30 split favouring the supply side (Jarvik, 1990). Yet given the continued prevalence of drug abuse in North American societies 40 years after Nixon’s declaration of war and the convincing arguments against the hereditary nature of addiction (Maté, 2014), the emphasis on supply and the stubborn enforcement of prohibition are clear failures.

Prohibition

LaGrange (2000, p. 513) argues that if the benefits of prohibition were outweighed by its costs, then “rational utility-maximizing taxpayers would not choose to pay for policies of this sort.” Though LaGrange admits the contentiousness of this claim, it is truthful in that some aspects of prohibition must be palatable, or there would be massive protests against it. Prohibition is seen to be necessary because drug use can lead to violent and nonviolent crime, decreased productivity, the harm of unborn children, an increased burden on the federal purse, etc. (Miron, 2001). These effects are indeed seen in the use of legal drugs such as nicotine and alcohol, and in turn, society tries to limit the use of these substances as well through age restriction and public health campaigns (Hughes, 2012). Prohibition does succeed to some degree in its mandate of reducing consumption, as seen in the decrease of alcohol use during the Volstead years of the 1920s (Jarvik, 1990).

Prohibition promises to reduce the availability of drugs, to defend society from the irrational behaviour of addicts, and to protect the populace from the harmful effects of the drugs themselves (Jarvik, 1990). Societies are built upon a respect for the law, so prohibition can be seen as a motivator against drug use. It also increases the cost of the drugs by forcing producers to take extraordinary measures to manufacture and sell their product, which further reduces availability (Miron, 2001). LaGrange (2000) theorizes that prohibition is essential, despite any negative aspects, because a state with lax drug laws will become a haven for drug users who will flee areas with more stringent enforcement. This would propel neighbouring states into a spending frenzy on enforcement to avoid this undesirable influx of addicts. A federal ban on drugs becomes an economic necessity to prevent this state competition. Finally, there is simply the view that drugs are an evil scourge, and prohibition is a country’s way of expressing their disapproval (Miron, 2001).

Miron (2001, p. 847) then argues that if a country does take a moral stand, that “statement must be weighed against the costs of any policy that makes this statement.” There is also a moral hypocrisy in condemning certain substances while accepting others, all of which can alter consciousness, transform social behaviour, or form dependent relationships (Nadelmann, 1992). The morality of prohibition as a deterrent must also contend with the immorality of prohibition as an exacerbation of crime.

By eliminating the conventional means of acquiring a desirable commodity, prohibition creates a demand with no supply, thereby inducing opportunistic individuals to seek gains in a hugely profitable market (Hughes, 2012). Nadelmann (1992, p. 116) argues that during the alcohol prohibition of the 1920s, “tens if not hundreds of thousands of Americans with no particular interest in leading lives of crime were drawn into the business of illegally producing and distributing alcohol,” and when prohibition ended, these individuals merely went back to their previous lives. The promise of prohibition to completely eliminate drugs becomes disingenuous, as the ban of drugs, alcohol, gambling, and prostitution all have demonstrated that prohibition will only ever create a black market (Miron, 2001).

This black market creates greater offenders than the merely opportunistic individuals seeking to make enormous amounts of money. Those who enter prison for drug-related offenses are exposed to crime as a way of life, and become indoctrinated into that lifestyle (Jarvik, 1990). Violent crime is also increased as a result of prohibition, as traditional means of resolving disputes become inaccessible and violent mediation is the resulting solution. This violent method of dispute resolution was rampant during the bans on alcohol and gambling, and rare both before and after (Miron, 2001). Prohibition also increases pettier crimes, as the inflated drug prices under prohibition force users into thievery or prostitution in order to pay for their addiction (Miron, 2001).

There is a racial element to prohibition, as drug-related violence more often occurs in minority communities. This is despite much of the demand originating in middle-class neighbourhoods, and whites being significantly more likely than blacks to use illegal drugs (Kornblum, 1991). This problem began during the inception of America, as racial minorities were segregated into the less desirable areas of town. These minorities were then blamed for the vice that occurred in these areas, furthering the racist stigma attached to drug use (Kornblum, 1991). Systemic racism forced an “availability of large numbers of racially outcast, superfluous, undereducated teenagers and young adults [who provide] a ready source of manpower for illegal industries in and outside the ghettos” (Kornblum, 1991, p. 429-430). The moral condemnation of drugs thus carries over to the moral condemnation of racial minorities, which hinders their integration into the larger economy (Kornblum, 1991).

The prohibition promise to protect society from the irrational behaviour of drug addicts rests on a key assumption that drug users are irrational. If drug users are rational, then a reduction in drug use becomes a cost of prohibition rather than a benefit (Miron, 2001). Pisani (2010) argues that what may appear irrational to an outside perspective is entirely rational based on individual circumstances. Young drug dealers, such as those in minority communities that are coopted by the drug trade, are found to be rational in their choices based on the upward financial mobility garnered by their illicit careers against the apathy of their disenfranchising environment (Kornblum, 1991). Even hardcore drug addicts are aware of their situation and do not actively seek death, and would willingly seek ways to reduce harms to themselves if those opportunities arose (Pisani, 2010; Nadelmann, 1992). The drug user is often seeking ways to escape their reality, and will use drugs to provide emotional necessities that they find are lacking in their lives (Maté, 2014). “People choose those drugs that give them what they want” (Nadelmann, 1992, p. 106), which illustrates a rational decision making process inherent in the drug addict’s judgment.

The promises of prohibition all seem to fall short, or in fact increase the harms inflicted on society in the forms of brutal violence and harsh stigma. They are established on irrational moralizing and ignore evidence-based theories on drug use (Maté, 2014). Even the promise to reduce drug use is relatively minimal in its success, and “the high incidence of drug-related crime shows that the threat of prison today has a very limited deterrent effect” (Jarvik, 1990, p. 388). The only justifiable promise of prohibition is the reduction in harmful drug use, and “if prohibition fails to reduce consumption, it is unambiguously inferior to legalization” (Miron, 2001, p. 843).

Legalization

Legalization is a misnomer that is often confused with other alternatives to prohibition. Decriminalization is the removal of criminal sanctions against drug use, though administrative punishment remains optional; depenalization is the non-prosecution or non-arrest of offenders, and legalization in its proper sense is the complete removal of sanctions and legalization of the practices surrounding drugs (Hughes & Stevens, 2010). This is not to be confused with a complete deregulation, as most legally available drugs are still subject to controls (Stares, 1996).

Legalization as an alternative to prohibition is not without its own share of problems. Drug tourists from neighbouring countries take advantage of the liberal drug policies of the Netherlands, and a similar situation happened in the failed “Needle Park” open drug market experiment in Zurich, Switzerland (Stares, 1996). Legalization is also argued to increase drug consumption, with evidence being given regarding “the prevalence of opium, heroin, and cocaine addiction in various countries before international controls took effect, the rise in alcohol consumption after the Volstead Act was repealed in the United States, and studies showing higher rates of abuse among medical professionals with greater access to prescription drugs” (Stares, 1996, p. 19). Legalization would also reduce prices, making cheaper drugs available for foreign markets (Jarvik, 1990). While needless incarceration would certainly be reduced, the hyperghettoization of minority communities would remain as seen in the current prevalence of alcohol in low-income communities (Kornblum, 1991).

Just as much as those in favour of prohibition speculate about the ramifications of increased access to harmful drugs under a legal framework, those in favour of legalization speculate about the kind of society within which a legal model would function appropriately (Nadelmann, 1992). For example, those who prefer legal alcohol now might reduce their consumption in favour of the less harmful marijuana, or those who enjoy their caffeine might switch to a more harmful line of cocaine. As speculation, it is impossible to measure the outcomes that legalization might produce in society, and if it were found that legalization was a mistake, it would be difficult to revert back to the previous model, just as it is difficult to alter the current prohibition model (Jarvik, 1990). It is also possible that greater accessibility would allow for greater experimentation, and people might complement their current drug use with newly available drugs which in turn increases the probability of misuse (Nadelmann, 1992). In coming to a conclusion, the negative speculation must be weighed against the positive speculation as well as the negative realities of the current methods.

The incentives to legalize are the negations of the harms of prohibition: the elimination of the cost of policing and incarcerating millions of drug offenders, the reduction in black market crime associated with the drug trade, and the mitigation of the dangers of unregulated drugs and the associated health costs (Stares, 1996; Nadelmann, 1992). Consumers would be able to address concerns with regulatory bodies, and business disputes would be handled within the court system (Miron, 2001). Beyond the negation of harms is the benefit of an increase in tax revenue, revenue that was previously being distributed to drug lords and gangsters (Miron, 2001).

Fears of a deluge of drug use in a legal system are quite likely unfounded, as most studies have found either no change in use or only a small increase when societies have attempted decriminalization (Hughes & Stevens, 2010). For example, neither the decriminalization of cannabis in eleven US states during the 1970s, nor the regulated outlets of the Netherlands showed a significant boost in drug usage, and public opinion polls within the United States show that most people would “not rush off to try hitherto forbidden drugs that suddenly became available” (Stares, 1996, p. 19).

Though not a truly legal system, the decriminalization of drugs within Portugal may illuminate possible outcomes of a society that does adopt one. The Portuguese model aims to dissuade drug use and encourage those with a dependency to enter treatment. Educational services, fines, or other administrative punishments are imposed on casual users, and those judged to have a dependency are recommended into a treatment program. Larger drug trafficking offenders are still punished within the court system (Hughes & Stevens, 2010).

While general drug use increased in the early years of Portugal’s decriminalization, this followed regional trends as noted in the upsurges of drug use in both Italy and Spain. Where Portugal differed from the regional trends was in the decrease in problematic drug use and the drug use among youths. Police and court proceedings also became more efficient as there were significantly fewer drug offenders to process. Prison populations were decreased as a result of fewer drug offenders, as was drug use within the prison walls. Harms from drug use, such as HIV, HCV, and TB were all greatly reduced, as were all drug-related deaths (Hughes & Stevens, 2010).

As successful as the Portuguese model has been, there is some concern about international transferability. Different sociocultural values within different nations could yield dramatically different results (Stares, 1996). For example, “the lifetime prevalence of cannabis use in the Netherlands for 10 to 18 year-olds is 4.2%, [in 1988] compared with the U.S. High School Survey figure of approximately 30%” (Jarvik, 1990, p. 389) shows that while the open drug policy of the Netherlands may show positive results for drug use among youth, the racial homogeny and high standard of living within the Netherlands may be skewed against America’s racialized ghettos (Jarvik, 1990).

Implementation

There is a spectrum of incremental possibilities between legalization and prohibition. Harm reduction is a model that can sit within prohibition’s grey area, utilizing needle exchanges programs or methadone treatment plans (Scherlen, 2012). Others, such as the American Bar Association, have advocated for selective decriminalization in regard to a drug’s overall harm or its medicinal purposes (Rosenbaum, 1989). Even simply a greater focus on the demand of drugs, by providing community and family support through federally sponsored social programs, is an alternative to the current punitive model (Jarvik, 1990).

Legalization in its full sense also has varying models of implementation. Fels (1998) argues that drugs would need to be sold through government stores to avoid the predatory marketing practices and profit-motives that drive private enterprise. Prices would need to be low enough to avoid the development of a cheaper black market, but high enough to prevent accidental encouragement of drug consumption. Limiting the amount one person could buy at a time may prevent the sale to minors, but only trial and error would truly create the best practice as any legal process would be beginning from scratch (Fels, 1998). Miron (2001) suggests a sin tax, common to alcohol and tobacco, that would show the requisite disapproval society has for drug consumption. It would also decrease consumption to the extent that demand reflects price. Problems might arise in a new black market as a response to the higher price, and if the demand of drugs is inelastic as an addiction might signify, then a higher price might result in less income for food or shelter among drug users. Nadelmann (1992) offers a Right to Access model, wherein a gatekeeper such as a physician would provide access, and approved users would then have the drugs mailed to them. This model would not fully eliminate the black market, as those who do not wish to wait, those who want more than the distributed amount, or those who aim to sell to minors would still operate within this model. However, it would be a significant reduction in the black market that exists under prohibition.

As mentioned, these possibilities are all speculation, and there are very real obstacles that would need to be addressed before any attempt to legalize drugs would come to fruition. For example, the source of drugs is an important issue. Would a western democracy partner with Afghan drug lords or Colombian FARC guerrillas in order to obtain their abundant supply? It seems unlikely (Hughes, 2012). Nadelmann (1992) offers four potential outcomes were drugs to become legalized: drug dealers would transition to the legal market, they would compete with the legal market, they would switch to other crime, or they would abandon crime altogether. Integration of the current market into the new one would need to be addressed if changes were to be made.

Bureaucratic barriers are also a great obstacle to be overcome. DeLeon (as cited in Scherlen, 2012) argues that an unwillingness to admit mistakes, a bureaucratic design for permanency, institutional backlash, political backlash, legal obstacles, and high start-up costs all combine to create a massive hurdle to any alteration to the prohibition model. Inherent characteristics of a policy, such as its longevity and complexity, as well as the political environment also factor into the perpetuation of its cumbersome legal framework.

Proponents of prohibition manipulate public opinion with the common alarming arguments, such as an increase in crime and health costs, which fabricate the termination of the drug war as an uncertain and worrisome gamble (Scherlen, 2012). This fear manifests in public opinion, and “there is a strong presumption that the public expects and demands harsh penalties for drug users, and is largely impatient with programs aimed at rehabilitating them” (Kugler & Darly, 2012, p. 217). This carries over from the media image of the drug user as driven to violence by their diminished capacity or economic necessity, and that this violence is exceptionally brutal (Kugler & Darly, 2012). Despite this fearful imagery, 63% of Americans in 2009 believed that the war on drugs was stagnant or losing ground (Scherlen, 2012). People falsely believe in a public disapproval of drug users, and the reality is that most people on the individual level prefer leniency over harshness (Kugler & Darly, 2012).

Culture of Drug Use

As drug use often persists in fads, such as the use of psychedelics in the 1960s and the use of cocaine in the 1980s, then drug use can been seen as a byproduct of its surrounding culture (Jarvik, 1990). The marginal increase in the use of cannabis in the Netherlands, for example, only occurred after the development of the ‘coffee shops’ that promoted the consumption of the drug (Hughes & Stevens, 2010). More local examples are the Amish and Mormon communities in North America that abstain in much greater numbers due to their strict cultural beliefs surrounding intoxicants (Jarvik, 1990). The major decline of tobacco use occurred without the introduction of laws regulating the manufacturing or agricultural growth of the drug, but via the impact of private advocacy campaigns and federal information campaigns that demonized cigarettes (Jarvik, 1990).

If drugs were to be legalized, it would be the structure of the culture that mitigated any explosive growth in a dangerous consumption of drugs. Maté (2014) argues that the moral and medical model of approaching the drug problem takes society off the hook when the reality is the opposite. Public campaigns would be required that are based on truths rather than the exaggerated falsehoods that make up contemporary anti-drug campaigns (Nadelmann, 1992). If a youth experiments with a drug and finds that the propaganda surrounding its use is false, then trust has been lost in the system and its subsequent efforts to help will be largely ignored.

By addressing the surrounding culture and the contextual environments as they impact demand, the supply will be reduced in turn (Jarvik, 1990). If a society celebrated mindful sobriety over reckless consumption, or adequately addressed its ghettos and the impact of poverty, neglect, and trauma on addiction, then legalization would be a superfluous addition to its drug climate. If drugs were to be legal, the same norms and interests that prevent rampant drug use in society today would persist, and those who do use would be better off under this alternative regime (Nadelmann, 1992). However, “the factors contributing to demand (such as intrinsic physiological reward mechanisms, poor social conditions, and psychopathology) are difficult to ameliorate” (Jarvik, 1990, p. 389) compared to the easily recognizable meth lab, drug lord, or crack shack that can be quantitatively expunged from society with great fanfare. Legalization, or one of its alternatives, offers a clearly superior model for dealing with drugs than prohibition, but prohibition persists because of systemic barriers, public image issues, and the social complexity of proper implementation.

Conclusion

“The evidence from a broad variety of cultures suggests that the single most important determinant of a drug’s popularity is its capacity to be integrated into ordinary lives with minimal disruption” (Nadelmann, 1992, p. 106). This quotation truly highlights the irrationality of the fearmongering surrounding the elimination of prohibition. 78.4% of people in Canada drank alcohol in 2012 (Canadian Alcohol, 2014), yet relatively few of them are considered alcoholics because they have integrated the consumption of alcohol into their lives. However, society chooses not investigate any alternatives to the difficulties it experiences under prohibition because “we do not want to take responsibility” (Maté, 2012, 19m05s). By refusing to take responsibility, a vacuum is created, and crime becomes the victor simply because there is no real opposition (Hughes, 2012). Upcoming changes in Canada’s marijuana laws are a good sign, but barriers remain and it is only one incremental step. Legalization in its full sense may not be the optimal solution, but any movement toward that end of the spectrum will inarguably be a vast improvement over the current paradigm. The reduction in use that prohibition brings is minimal enough to be insignificant against the cost of all its problems. Massive spikes of violent crime, incarceration, and health problems are all intrinsic to the prohibition model, yet nothing changes. “Arguments about economics and efficiency are not sufficient to result in termination. Apparently, failure is not sufficient either” (Scherlen, 2012, p. 72).

It seems almost unconscionable to ascribe a moral quality to ill health. It’s absurd to think that someone who has caught the common cold is some kind of sinister deviant, but as far back as the lepers being shunned and shuttered out of society, humanity has pointed at the unwell and called them devils.

Europe blamed the Black Death on the wrath of God, who was furious over the alleged impiety of His people. The mentally ill used to be incarcerated alongside criminals, their characters indistinguishable. Even lately, the AIDS epidemic of the 1980s seemed only to punish those considered perverse. Consider how we inquire after cancer: did they smoke? Did they eat processed foods? Did they stay too long in the sun? What was their lifestyle like that earned them a terminal illness?

Disease is an unquestionable evil, but why are we so quick to point to its host as having responsibility for it? When disease becomes a moral choice, the pure among us become immortal. The myth that bad things only happen to bad people convinces us that if only we maintain our righteousness, we will be spared. Righteousness only as a veneer, of course, as compassion for the ill could only ever be a supererogatory act. Far simpler to pillory the sick and use the blind luck of our good health as evidence of our sanctity.

everything-in-your-life-is-a-reflection-of-a-choice-you-have-made-if-you-want-a-different-

A meritocracy of health. God, I hate memes.

Where this demonization of illness is most prevalent is the disease that seems to be built on a long series of choices: addiction. It’s so immoral that it is literally a crime. Mitch Hedberg satirizes this mentality with his quip:

Alcoholism is a disease, but it’s the only one you can get yelled at for having. “Goddamn it, Otto, you’re an alcoholic!” “Goddamn it, Otto, you have lupus!”

One of those two doesn’t sound right.

Addiction is a reaction to trauma, neglect, and mental illness. Addiction is what happens when reality is so brutal that the body seeks any kind of escape from it. Addiction isn’t so much of an illness as it is the medication for when life is a sickness, and then through the obsession of escape it becomes a part of that sickness. Any sense of “choice” in the matter is illusory, any kind of “morality” illegitimate.

But people continue to yell at those whose lives have become diseased. Consider the top rated comment on a CBC article saying that in the first 8 months of 2017, the number of overdose deaths in BC had reached 1,013, compared to the entirety of 2016 which was 922:

I have a real hard time feeling sympathy for these people who have died. They knew fentanyl was out there. They knew that over doses were on the rise and out of control. There’s absolutely no way they didn’t know the risk that they were taking! Yet, they chose to anyways. So no. Finding sympathy is very hard for me.

1,013 human lives extinguished. That’s 1,013 families that have to deal with the grief and guilt of a loved one they will always wonder if they could have done more to save. Of course addicts know that there is Fentanyl in the streets. Some of them ask for it directly. The “risk” isn’t the point. The cure may be worse than the disease, but for many of them it’s the only option available, and some might see the risk of overdose as a potential escape from their sickness altogether. Can we truly judge those adrift at sea who drink saltwater rather than endure the agony of thirst?

But it’s fine. Sympathy is for the bleeding hearts. That could never happen to me because I am morally righteous. I am pure. I am better than them because I wasn’t raped, or abandoned, or abused, nor do I have voices in my head that only shut up when I shoot heroin into my veins. I get to tell myself that it’s my choices that make me noble. My fear of death, a bold reminder in the face of an addict, is well hidden behind the vitriol I espouse. But death cannot come for me. I am pristine. I am immortal.