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Why Punish Pain?

A hit of compassion could keep drugs from becoming a crime problem.
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PEEK INSIDE THE SUMMER 2011 ISSUE OF YES! MAGAZINE

The early 19th-century literary figure Thomas de Quincey was an opium user. “The subtle powers lodged in this mighty drug,” he enthused, “tranquilize all irritations of the nervous system … stimulate the capacities of enjoyment … sustain through twenty-four hours the else drooping animal energies … O just, subtle and all-conquering opium … Thou only givest these gifts to man; and thou hast the keys of Paradise.” A patient of mine in Vancouver’s infamous Downtown Eastside said it more plainly: “The reason I do drugs is so that I don’t feel the f***ing feelings I feel when I don’t do drugs.”

All drug addicts, even (or perhaps especially) the abject and marginalized street user, seek in their habit the same paradise de Quincey rhapsodized: a sense of comfort, vitality, and freedom from pain. It’s a doomed search that puts in peril their health, societal position, dignity, and freedom. “I’m not afraid of death,” another patient told me. “I’m more afraid of life.” What kind of despair could lead someone to value short-term pain relief over life itself? And what might be the source of such despair?

Not Choice or Genes

In North America, two assumptions inform social attitudes toward addiction. First is the notion that addiction is a result of individual choice, of personal failure, a view that underlies the legal approach toward substance dependence. If the behavior is a matter of choice, then it makes sense to punish or deter it by means of legal sanctions, including incarceration for mere possession. The second perspective is the medical model that sees addiction as an inherited disease of the brain. This view at least has the virtue of not blaming the afflicted person—after all, people cannot help what genes they inherit—and it also offers the possibility of compassionate treatment.

What kind of despair could lead someone to value short-term pain relief over life itself? And what might be the source of such despair?

What the choice and heredity hypo­theses share in common is that they take society off the hook. Neither compels us to consider how a person’s experience and social position contribute to a predisposition for addiction. If oppressed or marginalized populations suffer a disproportionate share of addiction’s burden—as they do, here and elsewhere—it must be due to their faulty decision-making or to their flawed genes. The heredity and choice-based models also spare us, conveniently, from looking at how our social environment supports, or does not support, the parents of young children, and at how social attitudes and policies burden, stress, and exclude certain segments of the population and thereby increase their propensity for addiction.

Another, starker view emerges when we listen to the life histories of substance abusers and look at the ample research data.

Addictions always originate in unhappiness, even if hidden. They are emotional anesthetics; they numb pain. The first question—always—is not “Why the addiction?” but “Why the pain?” The answer was summed up with crude eloquence, scrawled on the wall of my patient Anna’s room: “Any place I went to, I wasn’t wanted. And that bites large.”

“A Warm, Soft Hug”

For 12 years I was staff physician at the Portland Hotel, a nonprofit, harm-reduction facility in the Downtown Eastside, an area with an addict population of 3,000 to 5,000. Most of the Portland’s clients are addicted to cocaine, crystal meth, alcohol, opiates like heroin, or tranquilizers—or to any combination of these things.

“The first time I did heroin,” one of my patients, a 27-year-old sex-trade worker, once told me, “it felt like a warm, soft hug.” In a phrase, she summed up the deep psychological and chemical cravings that make some people vulnerable to substance dependence.

Contrary to popular myth, no drug is inherently addictive. Only a small percentage of people who try alcohol or cocaine or even crystal meth go on to addictive use. What makes those people vulnerable? According to current brain research and developmental psychology, chemical and emotional vulnerability are the products not of genetic programming but of life experience. Most of the human brain’s growth occurs after birth, and so physical and emotional interactions determine much of our neurological development—which brain areas will develop and how well, which patterns will be encoded, and so on. As such, each brain’s circuitry and chemistry reflect individual life experiences as much as inherited tendencies. 

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