Transcript Focusing on Addictive Disorders Rather that Drug Use

Focusing on Addictive Disorders
Rather than Drug Use
Thomas Nicholson, PhD
David F. Duncan, DrPH
John B. White, PhD
Abstract
How professionals and societies deal with substance abuse is premised
on how abuse is defined and on distinguishing disordered drug taking
from non-disordered drug use. Evidence from the Epidemiologic
Catchment Area Study (Robins & Regier, 1991) revealed that only
20.27% of all users of illicit drugs in the US population had experienced
a period of abuse at some time during their drug use history. Among
users of illicit drugs the current prevalence of substance abuse
disorders was only 4.19%. Our own data from the DRUGNET survey
shows that there are many users of illicit drugs who are not only free
from substance use disorders, but who are well-adjusted and
productive members of society (1999). Drug users responding on the
DRUGNET survey, for instance, had scores on the General Well-Being
Schedule that did not differ from US national norms. The persistent
failure to differentiate use from abuse where the currently illicit drugs
are concerned undermines effective prevention and treatment of the
addictive disorders we are really concerned with.
War On Drugs
• A century of the war on drugs has proven to be a
largely ineffective and maladaptive policy
• The 1909 Shanghai Conference
• Harrison Narcotic Act, USA 1914
• 1971 Nixon declares ‘War on Drugs’ – Public enemy
number one in the United States
• $150 - $400 billion global trade in illicit drugs at the end of
the 20th Century
Defining Abuse
• How professionals and societies deal with
substance abuse is premised on how abuse is
defined
• War on Drugs promotes belief that ‘Any Use is
Abuse’
– Not consistent with current clinical/behavioral
definitions (DSM IV, ICD 9/10)
Profile of Use
• The typical DRUGNET respondent was well
educated, employed full-time, a regular voter,
participated in non-drug recreational/community
activities and described their physical health
status as good.
• Their mental well-being is similar to the general
adult population as a whole.
• Their consumption is generally mild to moderate
in both frequency of use over time and the level
of altered consciousness typically experienced.
Failure to Differentiate
• Undermines Prevention
– Leads to telling “Prophylactic Lies” thereby losing
credibility
– Trying to prevent “Normal behavior”
• Undermines Treatment
– Bias towards ineffective treatment models
– Abstinence Only
– Wrong populations referred for treatment
• Lack of resources for effective treatment
• Stigmatizing users who are referred to treatment
• Undermines Criminal Justice
A Century of Waste
• We’ve spent 100 years trying to control
normal behavior
• We should be focusing on the prevention and
treatment of abuse
• The global “War on Drugs” wastes resources
that could be spent on this more useful
purpose
Methods
• Problems with studying hidden populations
– Captive Populations (school, clinical, prison)
– Snowball sampling
– Street Outreach
• Use of the Internet