Focusing on Addictive Disorders Rather than Drug Use Thomas Nicholson, PhD David F. Duncan, DrPH John B. White, PhD

Abstract How professionals and societies deal with substance abuse is premised on how abuse is defined and on distinguishing disordered drug taking from non-disordered drug use. Evidence from the Epidemiologic Catchment Area Study (Robins & Regier, 1991) revealed that only 20.27% of all users of illicit drugs in the US population had experienced a period of abuse at some time during their drug use history. Among users of illicit drugs the current prevalence of substance abuse disorders was only 4.19%. Our own data from the DRUGNET survey shows that there are many users of illicit drugs who are not only free from substance use disorders, but who are well-adjusted and productive members of society (1999). Drug users responding on the DRUGNET survey, for instance, had scores on the General Well-Being Schedule that did not differ from US national norms. The persistent failure to differentiate use from abuse where the currently illicit drugs are concerned undermines effective prevention and treatment of the addictive disorders we are really concerned with.

War On Drugs A century of the war on drugs has proven to be a largely ineffective and maladaptive policy The 1909 Shanghai Conference Harrison Narcotic Act, USA Nixon declares ‘War on Drugs’ – Public enemy number one in the United States $150 - $400 billion global trade in illicit drugs at the end of the 20 th Century

Defining Abuse How professionals and societies deal with substance abuse is premised on how abuse is defined War on Drugs promotes belief that ‘Any Use is Abuse’ – Not consistent with current clinical/behavioral definitions (DSM IV, ICD 9/10)

Profile of Use The typical DRUGNET respondent was well educated, employed full-time, a regular voter, participated in non-drug recreational/community activities and described their physical health status as good. Their mental well-being is similar to the general adult population as a whole. Their consumption is generally mild to moderate in both frequency of use over time and the level of altered consciousness typically experienced.

Failure to Differentiate Undermines Prevention – Leads to telling “Prophylactic Lies” thereby losing credibility – Trying to prevent “Normal behavior” Undermines Treatment – Bias towards ineffective treatment models – Abstinence Only – Wrong populations referred for treatment Lack of resources for effective treatment Stigmatizing users who are referred to treatment Undermines Criminal Justice

A Century of Waste We’ve spent 100 years trying to control normal behavior We should be focusing on the prevention and treatment of abuse The global “War on Drugs” wastes resources that could be spent on this more useful purpose

Methods Problems with studying hidden populations – Captive Populations (school, clinical, prison) – Snowball sampling – Street Outreach Use of the Internet