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Key points
- Individuals' choices to use drugs or alcohol are always shaped in a social and political context.
- Our more familiar models of care are important but inadequate in addressing drug use.
- Political care is necessary for engaging the systems and structures in which drugs are used.
Drug use and addiction are simultaneously a person-level phenomenon (individuals use drugs and may become addicted), an inter-person or social-level phenomenon (using is a social practice often done with others that creates and reinforces meanings and values), and a politic-level phenomenon (economic, medical, political, legal, religious, and military powers create, maintain, and reinforce oppressive structures, institutions, and practices). The person, inter-person, and politic levels are woven together so that it’s impossible to untangle their elements.
Examples of drug use and addiction as politic-level phenomena
In the late 1830s, the British demanded that China open its markets to opium imports. Chinese unwillingness was met with British military and naval authority. China was forced to pay exorbitant fees to the British government, which wreaked havoc on the Chinese economy, creating large-scale poverty and driving Chinese migration to the U.S. West.
In the U.S., the Chinese often worked digging mines and putting down railroad tracks. “Chinatowns” began springing up across the country as railways were laid. Within these towns were dens that were akin to social clubs where Chinese laborers would smoke opium for relief and pleasure. Reporting on these “Chinatowns” by white-owned newspapers created a moral panic and perhaps drew more white people to them.
White people had been consuming “medically-approved” morphine in a variety of ways, most commonly in the form of laudanum, which is morphine in an alcohol tincture. The tenor of newspapers and politicians was toxic, claiming that the Chinese were taking “our” jobs, corrupting “our” youth, ruining cities, and causing moral rot. The anti-Chinese furor resulted in the Chinese Exclusion Act of 1882, which was reauthorized and made permanent in 1904 and enforced until 1943.
In the post-Civil War period, cocaine was ubiquitous in a variety of beverage products (sodas and colas) and offered as cures for a variety of maladies, including allergies and fatigue. It was also used as anesthesia and in ophthalmology procedures.
While many in the United States were consuming cocaine in some form, Black Americans were singled out for their consumption. The stereotype of the “Black cocaine fiend” supported a narrative that Black people were especially susceptible to its effects and, therefore, posed a risk to society. This false stereotype of Black people as cocaine, dope, or crack fiends persists as a staple in American drug policy today.[i]
The War on Drugs was initially launched by Richard Nixon but fervently embraced and expanded by Ronald Reagan. The rhetoric remade “the drug problem” as a moral issue. Drug use or possession was the justification for a variety of punitive programs, including mandatory minimums and three strikes in sentencing.
Drug use was portrayed as all or only a matter of individual choice and, hence, individual responsibility. The mid-1980s found us in the midst of “the crack epidemic,” which was a production of majority white media perception and replication. While plenty of white Americans were using cocaine in various forms, crack became coded as Black and as the most dangerous drug because of its addictive qualities.
What I hope is clear in these brief snapshots is the ways that racism is the mother of invention and reinvention of drug policies. The War on Drugs is really a war on certain people who use drugs; drug policies are a means to control populations.
Types of care
Drug use and addiction are person-level phenomena but are simultaneously an inter-person and politic-level phenomena as well. Care will look different on these three levels, with the first two involving the more familiar ways we tend to think of care.
On the person level, emergency departments (EDs) in hospitals have become ground zero for overdosing patients, thereby providing an opportunity for intervention and treatment. Emergency department physicians may administer buprenorphine, which significantly reduces cravings. Physicians in prescribing, social workers in assessing, and psychologists in diagnosing must come to have a more nuanced understanding of the reasons why people are using and abusing the drugs they are. Unless and until these reasons and patterns of use are understood by both medical and legal professionals, the chances of any form of treatment being effective are slim.
On the inter-person or social level, friends and families need a great deal of support and care. The children of those who have overdosed may be traumatized; teachers are on the frontline, offering triage. Social workers find themselves in the position of making recommendations about whether to remove children from their homes and where to place them. On the person level and inter-person or social level, all of us must be more attuned in understanding the staggering burdens that many powerless, marginalized, and exploited people carry every day.
Focusing primarily, if not solely, on these two levels continues to obscure the politic-level dimensions of drug use and addiction. This, in turn, will reproduce, normalize, and reinforce those structural dimensions that contribute to maladaptive drug use and addiction. These structural dimensions require systemic forms of redress, which is a political form of care.
Political care involves social, economic, and governmental practices and policies that help to transform the conditions that make drug use seem attractive or inevitable for some groups of people. Some suggestions include:
- Provide better access to childcare, early childhood education, and after-school programs.
- Provide better access to elder care.
- Create more affordable housing.
- Provide more accessible and affordable treatment options with medication-assisted therapies. It should be as easy to get drug treatment as it is to get drugs.
- Make fentanyl testing strips widely available.
- Undertake law enforcement reform and training with mental health professionals.
- Advocate for more criminal justice reform on drug laws and sentencing.
- Make drug courts and treatment options, including medication-assisted therapies, more available for incarcerated individuals.
References
[i] My knowledge of this example comes from Carl Erik Fisher’s book, The Urge: Our History of Addiction (New York: Penguin, 2022). See chapter six, "Junkies." I highly recommend this book for providing an insightful and exhaustive examination of the economic, moral, and political roles drugs and drug use have played throughout history.
