Drugs aren’t the policy problem
In this post, Dr Kathryn Daley, Associate Director, Social Equity Research Centre, RMIT University & Deputy Chairperson, Youth Workers Australia argues for a supportive approach to drug use associated with emotional pain.
Most people use drugs at some point in their life and many do so regularly. Putting aside a rough hangover, proportionately, very, few ever have problems with drug use.
Drugs are poorly correlated with drug related harm. Yet when we talk about drugs in a policy context, it is accepted as a logical corollary that drugs are bad.
Are drugs bad?
Well, probably not. At least not in and of themselves. Certainly, some people and their loved ones, experience significant harm associated with their substance use. But if we want to understand problems associated with people’s drug use, the answer lies not in their pattern of substance use but why they are using drugs in the first place.
When we understand the function of someone’s drug use, we understand their problem. Given the acceptance of alcohol consumption for everyday use, we cannot be so naïve as to contend that those whose alcohol use is heavy and daily simply landed an addiction from poor genetic luck or some individual moral failing.
Why do people use drugs?
For a variety of reasons, but generally because they make people feel good. A young man with social anxiety feels much more comfortable at a social gathering after smoking cannabis. People tend to go to a bar for a first date because alcohol helps them to feel more relaxed. People heading to South America to consume Ayahuasca are actively seeking the psychedelic effects of the natural plant used for centuries by indigenous cultures. Likewise, the professionals sharing lines of cocaine at a weekend soiree are also seeking the pleasant high the drug brings upon their nervous system.
The consistent thing all people who use drugs will attest to, is that drug use has some sort of positive effect on them physically and/or psychologically. This is true also for the heavy drug user who might be seeking to stop or reduce their drug use: despite whatever problems the drugs may have created, the drugs had some positive benefit.
The common feature for those whose drug use becomes a problem is that the function of their drug use was to numb or escape their emotions. This motivation is quite different than those seeking to heighten or exacerbate their sensory awareness and explains why so much heavy drug use tends to be drugs that are depressants rather than stimulants (>70% of treatment episodes were for a depressant drug. AIHW 2024)
What is the policy response to drugs?
Australia’s formal illicit drug policy is that of harm minimisation. This is a three-pronged approach that incorporates Supply reduction (i.e., border force, customs), Demand reduction (i.e. education), and Harm reduction (such as needle and syringe programs).
But given most people use drugs without negative consequence, the case for supply and demand reduction is not as strong as you might assume. After the prohibition era, the regulation of alcohol manufacture and sales massively reduced the harms associated with it.
Drinking alcohol generally doesn’t cause harm so if we do want to reduce harms associated with it, we need to instead look at the causes for why some drink alcohol so problematically. And for this group, the solution will not be found in drug policy, but instead through care. Care from themselves, professionals, family and even the community. This includes formal care and interventions such as counselling, detox and residential rehabilitation. But it also extends to care from loved ones and their community more broadly. Disconnection and loneliness are strong predictors of poor mental health and feeling valued and supported in ones attempt at recovery are crucial.
People who use drugs so much that they are escaping reality need help to reckon with what they are seeking to escape. This help can be material supports such as housing and access to medical care, but that alone is not enough.
Heavy drug use is a strategy for coping with emotional pain so helping people to access supports and services such as therapy offers them an opportunity to learn alternate coping strategies and help them to become reconnected to their communities. Focusing on keeping drugs out of the country is an impossible goal. It also does nothing to attend to the reasons why people are using drugs in the first instance.
Given most use drugs for pleasure, not pain, an evidenced-based approach to drug related harm would include a preventative mental health strategy that includes family-focused approaches. Working with families to help them with parenting, emotional regulation, and communication skills helps children and equips parents and children with skills to manage challenging episodes in life. Building supports around families helps them to prevent substance abuse being the only way they know to manage their emotional pain.
We will always need tertiary services that adopt a trauma-informed, whole-of-person approach. However, when we recognise substance abuse as a symptom of poor mental wellbeing, it is imperative that we can offer help to people before their presentations are acute.
Moderator: Dr Elroy Dearn, Research Fellow, RMIT University