Addiction Research,1996. An Editorial.

ACCIDY, ADDICTION and the PROHIBITION

by Dr John Marks

Separator

Accidy (ak'sid-ee), the eighth deadly sin, was first described by Cassian in 415(1). It is better known to us today, variously, as 'alienation' (Marx), 'anomie' (Durkheim), exist-ential nausea (Sartre), etc., etc., and is a significant contributor to psychopathology(2)and, says Gibbon, to the decline of Rome. Indeed, Weil (3) elevates the avoidance of accidy to a fourth basic drive, after hunger, thirst and sex. For this reason Huxley wrote (4) that human beings were likely to continue to use "artificial paradises" (ie drugs) to assuage this "principal appetite of the soul" and there is no society anywhere in history that has not used a psychoactive drug. Usually it is used as a social oil to promote fellowship and occasionally sacramentally to promote wonder or awe.

Havelock Ellis (5) wrote at the turn of the century (on his visit to America) of the zeal of the Christian missionaries during the 19th century religious reaction against the secular revolutions of 1776 and 1789. It has given America "the Bible Belt" and its coin "In God We Trust". In an obscure southwestern state he happened across some upset missionaries who, aware of their salesman-like success, had come up against some Amerindians who ate cacti as part of their sacrament much as the Christians use wine. The hallucinogen in the cacti, which the Indians interpreted as putting them in communion with their God, rendered them, said the distraught missionaries, "resistant to all our moral suasions". The missionaries had recourse to the state legislature and cactus eating was forbidden.

Between the turn of the century and the first world war these laws were generalized to all states of the Union and to all substances, including alcohol. The Americans adopted the Prohibition in response to a strong but atavistic religious lobby for whom all intoxicants were direct competitors for control over the minds of men. It is thus not surprising that a strong moral stricture has been applied to drugs. In response politicians have cravenly pandered to the demagogic demands of the Prohibition, retreating before populist pressures down the path of least resistance behind more and more prohibitionist measures. They have eventually painted themselves into a corner where the increasing expense of a costly and counter-productive Prohibition and consequent ruinous crime wave are compelling reappraisal: but the image they and the media have painted and encouraged makes following a sensible route politically suicidal.

The Huxleyan demand for drugs, as might be expected, has continued unabated and, as society has relaxed and powerful ideologies such as Christianity and Communism have waned, drug use has risen to being normative (6) in some northwestern schools. Curiosity about drugs is fuelled by laughably inaccurate Government propaganda: for example one campaign set out to warn against addiction and improve the low self-esteem of drug-takers in schools, when evidence showed (7) that such drug-taking was correlated with high self-esteem. For want of a better word, "addiction" is as good as any to describe that use of drugs, whether subjectively volitional or not, which leads users to have problems with their society, their families or themselves. But problematic use (which, for convenience, I use the term addiction) is as unrepresentative of drug users as the skid-row alcoholic is unrepresentative of alcohol consumers, and this is true even for the allegedly addictive opium (8). Drug addicts are therefore but a small fraction of the totality of drug users. Now, if ten years' imprisonment were the penalty for possession or sale of wine (or any other form of alcohol), most recreational wine users would suddenly vanish. All we would see of alcohol use would be the experimenting teenage 'lager-louts' and the sad, alcoholic derelicts in the gutter, for all socialized, recreational use would become clandestine. There would be a strong tendency also, for economic reasons, to use the most concentrated form of the drug to avoid detection. Thus Al Capone's Chicago tended to produce meths injectors, just as the opium prohibition has produced heroin injectors (9). By contrast, alcohol injecting is seldom seen now because beer and wine are available. Similarly, heroin injecting and cocaine injecting would all but disappear if opium to smoke and coca to chew were allowed.

For every addict there is an order-of-magnitude greater number of socialized drug users and, as Huxley has pointed out, there will always be such a demand. Since he who controls the supply controls the market, if society is to control the supply of drugs to this demand it must actually have (ie legally own) a supply. If the legal supply is too lax we get the problems now seen with alcohol and tobacco. If the legal supply is too restricted criminals meet the demand. This is especially the case if society is so restrictive as to deny itself a supply altogether. This does not get rid of the supply: it simply makes it criminal by abdication. It thus hands the whole lucrative market to gangsters and gangsters are ruthless, dynamic marketeers. 'Regulation' means a controlled, but legal, supply. The great fallacy of western drug policy has been to equate 'Prohibition' with 'Control'. Prohibition produces the opposite, as in Chicago in the 1920s - chaos. Free markets promote consumption, prohibitions peddle consumption, only regulation controls consumption.

As young people now grow up increasingly free of a particular ideology, those who cannot find their life's purpose in their careers or other temporal pursuits confront more and more the problem of accidy which religion so successfully remedied for the thousand years from Cassian to the Renaissance. The last four centuries have seen the steady retreat of religious ideologies from dominion over society as psychology has exposed them as anthropomorphic cosmologies. Since they continue to be used as stores of ethical, moral and social rules, considerable emotion still attaches to them. Hence the moral stricture and political timidity when the question of drug legalization is raised. The destruction of the Serapion in 391 and the murder of Hypatia in 415 by a Christian mob marked the final demise of the civilization of classical antiquity and the descent of Europe into the Dark Ages and those events are prescient comment upon the religiously inspired intolerance of drug taking today. However the Prohibitionists maintain that it is drugs that will somehow destroy civil society and its delicate freedoms. Therefore even their scientific investigation, as dangerous fruits of the tree of knowledge, should be forbidden.

When Columbus sailed the Atlantic, despite the Church's condemnation of any challenge to the flat earth, he was dismissed by many authorities as a dangerous fool who would 'fall off the edge'. But Columbus returned saying he had discovered a new world. Many adolescents exploring drugs respond similarly saying they've discovered the new worlds of their own neurochemistries and quoting "explorers" such as Huxley and Havelock Ellis. It must be no surprise that Balding found that these adolescents had higher self-esteem: confidence and courage are required for curiosity and exploration. These are among the most cherished mental attributes. They are the hallmark of 'Renaissance Man' and are characteristic of healthy adolescence. Sailing the Atlantic in 1492 was, like drug-taking now, fraught with dangers. But we didn't ban shipbuilding nor prohibit sailing. We built lighthouses and mapped the globe to make sailors' lives safer. We should be making it safer for those of our citizens who will use drugs. The curiosity shown by Havelock Ellis would have cast him into prison today. It is inconceivable that a free society would wish to crush these essentially human drives in its citizens. Fortunately they are very difficult to crush which explains the abject failure of the infantile "Just say No" campaign which equates to "Just don't think". The well-intentioned but hopeless attempt of the Prohibition to stifle these very human drives has simply increased accidy and created the market for "artificial paradises" which provides international organized crime with its financial base. Gangsters thus have a vested interest in the return of prohibitionist governments.

Viscount Falkland described (10) the Government's published rejection of criticism of the Prohibition as "the most absurd and disgraceful piece of logical thinking that I have come across in any document which has the authority of government in the 11 years that I have been here. It would be a disgrace to a 10 year-old to come up with reasoning of that kind". If only for the selfish reason of preserving our own civilized discourse and secure, free societies we should take seriously the enormous financial muscle the drug Prohibition gives to international organized crime. It is destroying Colombia, Italy and America and we would be foolish to assume we were immune. The recent upsurge in violent crime (in London, Manchester, Bristol, ... ) with accompanying use of firearms may be a sign of the problem spreading to us. All this because we forbid a man to smoke opium rather than tobacco or forbid him to drink coca rather than wine. It is as arbitrary as Lilliput's war with Blefuscu over which end to open a boiled egg.

Any hardware store has more dangerous items for sale than drugs. Prohibiting drugs may thus lead to the erroneous supposition that objects not prohibited are not dangerous. From this it is clear that it is what is done with knives or drugs that makes them dangerous, not the objects themselves, if properly used. Just as citizens learn the dangers of knives and how to control and use them for benefit, so the Prohibition denies them this opportunity in the case of drugs. Most of the damage done by drugs is the result of this lack of learning, and so Zinberg (11) justly holds that ultimately only culture will control drugs.

This all raises the question, eloquently answered by Graham (12): is it just to condemn the 99% who can use a drug appropriately for the incompetence of the 1% who cannot? Especially when it drives the 1% (who continue to use anyway) to the hardest stuff? This question is important for, as treaters of addiction, we seek to alleviate the problems of addicts but the Prohibition peddles them adulterated concentrates of unknown strength in the most insanitary and criminal circumstances.

Even if we could afford the Prohibition, it is desperately counter-productive, creating all the problems it purports to solve. It is unreasonable to starve crumbling schools and hospitals of much needed funds squandered on making problems. Prohibitionists argue more funds are needed to more rigorously enforce the Prohibition but this simply aggravates the problem further, locking policy into a vicious circle of positive feedback that I call an acute case of collective psychosis.

In the last analysis, policy should be empirically based on scientific evidence. Rational control of drug (and alcohol) supply was successfully practised by the British from 1920-1971 and its restricted version has survived in isolated pockets, in North Cheshire and elsewhere, into the 1990s. The American criticism that restricted British policy in 1971, and all but expunged it by 1991, is not based upon a whit of scientific evidence and those, such as the Swiss and the Australians, who would repeat the British experience receive nought but unsubstantiated criticism for their pains. Clearly our drug policy-makers have never heard of Karl Popper. When Einstein found in 1905 that light was not made of waves but of particles called 'quanta', others checked to refute him but confirmed the result. Again, in 1915, Einstein found Newton's law of gravity defective. In disbelief everyone repeated the experiment but corroborated Einstein. Why do Prohibitionists not test the Prohibition against a trial of the British System? Are they frightened of confirming its benefits? Their refusal to engage in scientific testing is ideological, not rational.

The Prohibitionist department of Health avoids or suppresses such empirical experiments because it fears they will confirm the British System's success and embarrass the Government's and the Americans' ideology about the inveterate danger of drugs. Because the British System remains legal, and successfully practised by a small group of psychiatrists, the department has to erect extraordinary fiscal measures to smother this embarrassment. For example, in North Cheshire health district, addicts are debarred from paying for their drug ration, even though it would be lawful for the NHS to charge them the cost price of their drug at the pharmacist's. This means the health authority can turn round and restrict the sevice saying they cannot afford the drug bill despite the fact that addicts have offered to pay it. At the same time old ladies are charged for home-helps and accident victims are charged for the ambulance fare to casualty. Alice in Wonderland was set in North Cheshire.

Although I have digressed widely into matters of international policy on psychoactive drugs, I have sought to show that the prevailing policy increases accidy by vainly attempting to crush curiosity. Accidy lends itself to nihilistic philosophies, pointless violence and the espousal of anarchy. With such mental sets around them, it is not surprising that many are driven to seek solace in drink and drugs, with greater risk of addiction. If only for this reason it behoves researchers and practitioners in the field of addiction to examine drug policy critically. For too long they have poorly served Government and politicians by serving up only the views and results they think their pay-masters want to hear. Patients in drug clinics are notorious for that sort of behaviour so addiction experts should know better than to copy it.

John Marks,
Consultant Psychiatrist
Chapel Street Clinic,
WIDNES
WA8 7RE
UK


REFERENCES

1. Altschule MD "Accidy: its evolution from deadly sin to psychiatric syndrome". Br. Jnl. Psychiatry 1965, 111: 117-119

2. Kessel N "Self-Poisoning". BMJ 1965, ii:1265, 1336

3. Weil A "The Natural Mind" Houghton Mifflin, Boston 1986

4. Huxley A "The Doors of Perception". Allen Lane, London 1954

5. Ellis H "Mescal: A New Artificial Paradise". Contemporary Review 1898, 73: 130-141

6. Parker H et al. "Drug Futures" ISDD, London 1995

7. Balding J "Young People and Drug-Taking: Facts and Trends" Education and Health 1994, 12: 49-62

8. Newman R "Opium Smoking in Late Imperial China: a Reconsideration" Modern Asian Studies 1995, 29: 765-794

9. Westermeyer J "The Pro-Heroin Effects of the Anti-Opium Laws in Asia" Arch. Gen. Psychiatry 1976, 33: 1135-1139

10. Falkland, Lord "Drug Misuse" debate, House of Lords, 1/12/1994 Hansard, vol. 559, col. 754

11. Zinberg NE "Drug, Set and Setting" Yale, New Haven 1984

12. Graham G "Criminalization and Control" in Whynes DK and Bean P eds., "Policing and Prescribing" pp. 245-260; Macmillan, Basingstoke 1991

bullgrePreventing Drug Mis-useAnother article by Dr John Marks

Last amended: 5:23 PM on 14/04/96