Over the past week, we’ve seen two conflicting messages about the use of crystal methamphetamine, commonly known as “ice”.
On the one hand, Independent Tasmanian Senator Jacquie Lambie has spoken about her son’s struggle with ice addiction: “I refuse to watch, helpless, as ice seizes my child and turns him into a stranger,” she said. Lambie claims her son is no longer himself, and that she is dealing with the drug, and no longer a person.
Lambie has also called for “addicts” to undergo involuntary treatment for their addiction, a stance that has been criticised by some experts.
In contrast, the federal government announced a new policy priority that would toughen punishments for people on ice who attack health workers as well as a new “Dob in the Dealer” campaign designed to reduce drug supply.
Herein lies the central policy dilemma. Are addicts sick and helpless victims with little control over their own behaviour, or brazen criminals who deserve to be punished accordingly?
These mixed messages reflect a longstanding tension in public policy and legal debates about drug use. How we respond to this dilemma depends in part on how we understand drug “addiction”.
Ice addiction as a ‘brain disease’
The view that “ice addicts” are hijacked by a drug that overwhelms their behaviour is supported by neuroscience research that suggests addiction is a “brain disease”.
The brain disease model of addiction is most prominently advocated by the United States National Institute on Drug Abuse which funds around 85% of addiction research worldwide. According to the brain disease model, addiction is a chronic medical illness. This model commonly cites differences between the brains of addicts and non-addicts to explain the compulsive and involuntary nature of addiction.
Senator Lambie’s stance is consistent with the brain disease model of addiction, in that she understands drug use to be compulsive and involuntary.
But if ice addicts are hijacked by changes in their brain due to chronic ice use, should they be held responsible for their behaviour? Wouldn’t their addiction, on this view, make them less – not more – culpable? This is where some of the tensions in how politicians speak about drug use become most obvious.
But ice users have some control
Not everyone agrees addiction is a real condition, nor that it’s a brain disease. Critics come from a variety of sources, but commonly centre on different conceptualisations of “addiction”.
Libertarian critics see drug addiction as the hedonistic pursuit of pleasurable substances, no different than other pleasures we engage in, such as sex or food. For these critics, problems arise only when people who use drugs make poor choices, prioritising immediate desires over longer-term needs.
Others, including one of us, have argued that neuroscience research does not prove that drug addiction is a “brain disease”. At best, neuroscience shows that [some individuals](http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14) have developed changes in brain function and structure that make decisions not to use drugs such as ice more difficult.
The view that individuals are unable to control their drug use is inconsistent with other sorts of evidence. Even seemingly severely addicted people are able to control, reduce or stop their drug use following changes in their life, such as marriage or the birth of a child. In fact, if people didn’t maintain some control over their drug use, it’s hard to imagine how anyone would recover, as the vast majority do.
Drug use is also sensitive to changes in the cost of drugs in ways that are hard to reconcile with the view that people who use drugs are suffering from a disease that robs them of control over their behaviour.
Other scholars question the push to conceptualise certain behaviours as “pathological” or “compulsive”, on the basis that it undermines an individual’s agency. For these scholars, models of addiction that portray individuals as “sick” and in need of state protection can be hugely damaging, creating and reinforcing the stigma often associated with drug use. It also does not account for the fact that people who use drugs are a diverse group with a range of experiences.
The need for informed, rational policy
Over the coming months the federal government’s National Ice Taskforce will develop a National Action Strategy to tackle the harms associated with ice. But so far the debates about policy priorities have been hampered by inconsistent messages about drug use, drug effects, drug addiction and the characteristics of people who use drugs.
Attributing ice addiction to a “brain disease” is not helpful to our understanding of ice use, and grossly distorts the scientific evidence. But while we’re sceptical of the “brain disease” account of addiction, the alternatives are multifaceted and complex.
Policymakers and politicians must go beyond simplistic accounts of drug use and addiction, ideally in ways that exceed notions of addicts as either sick or criminal. The emphasis should instead be on proven harm-reduction approaches, including increased access and funding to treatment and other support programs that respect the dignity and humanity of people who use drugs.