Cohen, Peter (1990), Some critical remarks on the concept of "social rehabilitation" of drug addicts. In: Peter Cohen (1990), Drugs as a social construct. Dissertation. Amsterdam, Universiteit van Amsterdam. pp. 8-14.
© Copyright 1990 Peter Cohen. All rights reserved.

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II. Some critical remarks on the concept of "social rehabilitation"of drug addicts[1]

Peter Cohen

Table of contents

II.1 Introduction

One of the popular subjects in the field of the so called drug problem is the "social background" of illegal drug use, "social background" perceived as a complex of causal factors.

Since social scientific reflections have entered daily life we can no longer circumvent the notion that particular social backgrounds exist for those who start the use of illegal drugs. Furthermore, these "backgrounds" are claimed to be causes of this drug use and play a role in all kinds of arguments, e.g. about prevention.

Often, so we are taught, drug users or addicts have had a particularly difficult time when young because of alcohol-abusing parents, divorced parents, uncaring or over-caring parents, or because of having no parents (when raised in institutions). When investigating addicts concerning these "backgrounds" one indeed finds them, but unsystematically distributed among a small minority of them.1

An almost insurmountable problem of these studies is that comparison with control groups of similar persons who have not become addicted to some drug is usually absent, or impossible because of lack of data. How to constitute a control group is moreover not at all so clear as one would assume at first sight, even in circumstances when many data would be available.

In short, although (family) backgrounds are at the moment very fashionable in aetiological thinking about drug use and addiction, they have little practical relevance from a scientific point of view.[2]

II.2 Magical ideologies

One can find many more "backgrounds" associated with drug use apart from the family related ones. During the sixties the social backgrounds of then emerging deviancies (like drug use, political rebelliousness, greater sexual freedom) were allegedly to be found in sociopolitical changes like greater affluence among youths, absence of real challenges, the cold war, etc.

At the moment we find present day culture-pessimistic backgrounds associated with the use of illegal drugs, like no future for youth, unemployment, racism etc. Even in Lasch's theories we find very elaborate postulates about the aetiology of drug use, as published by Faccioli and Simoni.3 For them, the increasing pluriformity of society, and the difficulties of finding one's identity which arise from it, shape todays background to illegal drug use. The experience of having "an empty identity" is countered by taking drugs. Faccioli and Simoni state very emphatically that these conditions actually exist for every one of us. But why then elaborate so much on their being the present day background for drug addiction? Clearly, not all of us belong in this category. Don't they see their work is quite irrelevant if the conditions for drug use are general and all encompassing?

This rhetorical question leads me to the assumption that often the search for the causes of drug use is not a proper scientific inquiry but more a magical activity of ideological control.

We look for backgrounds and causes of illegal drug use because finding them exerts a soothing action. But we confuse looking for causes with expressing specific and historical preoccupations, valid during a certain period. These preoccupations are projected onto things considered threatening, like drug use. Is one's major preoccupation our overdeveloped welfare state, then drugs are taken because of too much welfare state. Is one's preoccupation unemployment, then drugs are taken because of unemployment. And when one's preoccupation is pluriformity of culture, or uncertainty of about where to go in the world, the backgrounds or causes of illegal drug use and addiction are there. It is a ritual providing us with an ever new deus ex machina, one which is every time as impotent as any other.

This last remark is added because I can not conceive of how such knowledge about social backgrounds could be of any political relevance. Just assume that affluence among youth was a cause of drug use, would economic measures be taken to curb wages? Or assume that poverty among youth was a cause, would wages be made higher? And what if both were true for different groups? And continuing this argument, let us assume identity problems are a cause, will we facilitate identity searching? And what about family conditions? Will we be able to improve them in such a way that severe problems will no longer or less often occur?

So, thinking about social backgrounds has, apart from the enormous scientific problems involved, the disadvantage of being totally irrelevant to social policies. It seems there is more than enough justification to start looking at the problem of social rehabilitation of drug addicts in a completely different way. But there is more to it than the reasons I just stated. It is not only a counter reaction.

II.3 Consequences of drug policy

The issue of social backgrounds of drug use and their possible relevance for rehabilitating drug addicts can also be approached from a complete different perspective on background factors. To illustrate this I would like to present here a few results of an analysis of drug problems, made by the Joint Commission on Alcohol and Drugpolicy in its recent report Drugpolicy on the move.4

In this report the Joint Commission uses a distinction taken from criminological and sociological theory about primary and secondary deviance. The Joint Commission does not use exactly the same concepts, but speaks about primary and secondary problems of drug use. The similarity is clear however. Primary problems are defined as those that are strictly related to toxicological aspects of a particular drug. Secondary drug problems are caused by drug policies that determine to a large degree the conditions under which drugs are consumed.

This distinction makes sense because it contributes to a more objective picture of the risks of using a particular drug. The fact that experts do not always agree about the category to which a "problem" belongs is interesting, but is not the subject here.

The Joint Commission states that the secondary (drug policy related) drug problems consist of:

  • problems of public order
  • health problems with users, like infections
  • marginalization of drug users
  • criminality and prostitution
  • blocking the institutions of Justice.
I do not disagree with this rather dramatic summing up. All these problems are not drug related but drug policy related. And what is the core of our drug policies? The maintenance of the illegality of a number of drugs for any purposes other than medical or scientific ones.

The topic I have been asked to address here is the rehabilitation of drug addicts. We seem to believe that such a rehabilitation is something the addict has to do himself, in some cases with the help of state financed institutions who use our knowledge about "social backgrounds" of illegal drug use. But when state officials who coordinate drug policies in this country indicate that the larger problems of illegal drug use are mainly caused by drug policy, we may find much more potential for the rehabilitation of drug addicts by changing this policy. And this is something we should do.

So, we would no longer use our resources to find out about the "social background" of drug addiction, but would direct some attention to the question of what social backgrounds maintain illegality for a number of socially used drugs. We change our perspective away from drug addicts in order to direct it towards drug policy.

Why do we keep some drugs illegal?

II.4 A historical analysis of our drug policy

Because eminent social scientists have preceded me on the road of this analysis I am able to present some of their findings.

It should be clear from the beginning that our present way of prohibiting some drugs is relatively new, although none of us have ever known anything else. Our present drug policy was conceived in the latter half of the last century and first implemented in the first decade of this century in the U.S.A.

The goals of this new policy can only be understood in the context of the social and global relations of those days. Of these goals I want to focus on the three most important ones.

II.5 Poverty

The first and most prominent goal was to counter poverty and cultural backwardness, conditions in which drugs were seen as contributing factors. The miserable paupers that emigrated to the U.S.A. from China, Eastern Europe and Russia took with them patterns of drug use that were incompatible with adaptation to the then existing American way of life. Above all, drinking patterns of Irish and Polish immigrants were far removed from the behavioural discipline that the anglo-saxon elite associated with the American Dream.

In short, the first goal of the new drug policies -- including a rigourous ban on alcohol -- can be seen as a direct and progressive confrontation with social misery.

II.6 Economic power and world market

At the end of the last century the U.S.A. started to present itself as an emerging economic power looking for spheres of influence and markets outside its own territory. Although the U.S.A. clearly had a huge potential, its world position was minor to colonial empires like England, The Low Countries or France. But by a strong anti-opium policy the U.S.A. hoped to win for itself, to the detriment of England, one of the most promising markets in the world: China. Most of the scarce foreign exchange the Chinese had available was used for the import of very expensive opium the English provided on a completely monopolistic basis. The import of English opium[3] prevented the import of many other commodities into China, a state of affairs clear to both the Americans and the Chinese.

From those days stems one of the the most resistant myths about opium: that it caused famine and poverty in China. This is a myth that is still one of the cornerstones of the orthodoxy that says opium should be illegal.[4]

The very aggressive opium policy of the U.S.A. was led by a bishop, but both Musto6 and Scheerer7 cite the possibility that economic policy was the most influential motive for the federal American government to support a foreign anti-opium policy.

In short, at the turn of the century the U.S.A. used both an external and an internal anti-opium policy, with motives of conquering foreign markets and influencing the home labour market (cf Helmer8, 9).

II.7 Medical power groups

A third and, for this paper, last goal of the new drug policy which emerged in this century can be found in a completely different field again. This is the field of medical organisation, or the monopolistic role emerging medical power groups demanded for themselves in the mass public health institutions of the 20th century.

Until far into the 19th century the practical possibilities of medicine were rather restricted. Skin burning, bleeding and amputation were not the most appropriate methods to fight the many diseases that plagued humankind. But little else was available. All kinds of incurable disease were accompanied till death by pain and anxiety. Many hundreds of drug store "medicines" had become available in the last century, almost all containing some opium which was indispensable for the treatment of pain and anxiety.

After the introduction of modern scientific medical method based on the discoveries brought about by the microscope, the practical possibilities of medicine began to grow. Drug store "medicine" was more and more associated with backwardness and embezzlement.

In spite of the fact that opium was then used by about 0,2% of the American population (one tenth of the prevalence it had among medical personnel. cf Musto, 1975 p. 42), the leading medical organisations participated rigourously in outlawing the use of opiates in non medical settings6.

They claimed that "medicines" should only be available via licensed doctors within types of treatments agreed by them. The success of this claim is at the same time one of the most fantastic success stories of one particular social group in this century.

In short, the historical roots of our present day drug policy can be found in the U.S.A. at the beginning of this century when the new drug policy served three main functions:

  1. adapting the 19th century immigrant to the image of the non-catholic anglo-saxon elite;
  2. acquiring economic power in the markets of the Far East and
  3. helping the monopoly of medication by the modern doctor, by outlawing "self-medication".

To analyse the historical roots and functions of the present oppressive drug policy is a fascinating activity that merits a far better treatment than given to it in the few lines above. Our drug policy comes from a long-gone historical period and is therefore no more than an anachronism.

But such a historical view on drug policy does still not answer the question why the basics of drug policy have not changed during the last eighty years, although the conditions that gave birth to it have already long passed away. Unfortunately I do not have the answer, although one aspect of a full answer would have to deal with the potential of this policy to legitimize itself continuously.

By making some drug inaccessible via legal prohibition, in spite of many people finding these drugs important for their own well being, a clear class of violators of the law is created. As a result, a minority of these will show conspicuous forms of criminal or otherwise immoral behaviour.

Pointing to these phenomena, one can then legitimize the illegality of these drugs by saying "look what happens to their users". The public supports this policy out of fear. They will then have a continuous need to be protected from "the consequences" of illegal drug use. Moreover, the prejudices lay people have against drugs are perfectly mirrored by the prejudices of many of our professional drug experts, thereby reinforcing each other. All of these circular processes look surprisingly like the circles within a dependence as outlined by van Dijk12. Would our eighty year old drug policy remain unchanged because it produces an attachment to it, which if it were towards a drug we would define as dependence?

References chapter II

  1. Gimpel, M. and de Jong, R.: De voorgeschiedenis van problematisch druggebruik. Unpublished Manuscript. Psychologisch Lab. Universiteit van Amsterdam, 1981
  2. Fazey, C.: The aetiology of psychoactive substance use. Unesco, Paris, 1977
  3. Faccioli, P. and Simoni, S.: Identità e droga nella società complessa. Dei deliti e delle pene, 2. 1984, p. 577-594
  4. Interdepartementale Stuurgroep Alcohol en drugbeleid: Drugbeleid in beweging. Staatsuitgeverij, Den Haag, 1985
  5. Kramer, J.: Speculations on the nature and pattern of opium smoking. In: Zinberg, N. and Harding, W. eds.: Control over intoxicant use. New York, 1982
  6. Musto, D.: The American Disease. Origins of narcotic control. Yale-University, 1973. Cf in particular chapter 2.
  7. Scheerer, S.: Die Genese der Betäubungsmittelgesetze in der BRD und in der Niederlände. Göttingen, 1982
  8. Helmer, J. and Vietorisc, Th.: Drug use, the labor market and class conflict. Drug Abuse Council, SS-2, 1974
  9. Helmer, J.: Drugs and minority oppression. New York 1975
  10. Morgan, Wayne H.: Drugs in America. A social history 1800-1980. New York 1981
  11. Van Dijk, W.: Alcoholisme, een veelzijdig verschijnsel. Tijdschrift voor Drugs, Alcohol en andere psychotrope stoffen, 1976. p. 26-32

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