donderdag 18 oktober 2012

Drugs - without the hot air: Minimising the harms of legal and illegal drugs (David Nutt) [3]


Humans have always deliberately consumed psychoactive substances, and our brains are adapted to respond to them. However, although in this sense drug-taking is “natural”, the purified drugs we now have access to, and the speed with which we can get them into the brain, make many of them far more potent than the drugs we evolved with. This makes them more effective and potentially more harmful. We need to understand both our natural impulses and the contemporary cultural context of drug-taking if we want to reduce these harms.

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There is also an entirely practical reason for accepting that a level of excessive drug use is always going to be part of human society: we simply don’t know how to stop it. Humans are natural pleasure seekers. As part of our brain’s normal functioning, it releases endorphins and dopamine to generate feelings of wellbeing from doing a job well, spending time with people we love, meditation, prayer, and collective activities like singing and dancing. These feelings of well-being create memories which teach us which experiences we should repeat. Drugs interact with these natural learning systems in a very powerful way, often creating some of the most intense experiences a person ever has. We are programmed to enjoy these experiences, and even very severe punishment doesn’t necessarily act as a deterrent, though it will create all sorts of other kinds of harm.

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The drinks industry wants to portray itself as having the same aims and interests as people who want alcohol policy to be guided by a concern for public health. But there is a fundamental conflict of interest: however much the industry wants to pretend otherwise, you can’t reduce harm without reducing the amount people drink, whereas companies looking to maximise profits need to sell as much alcohol as possible. There is a lot of evidence that the drinks industry relies upon hazardous drinking as a major source of income. In fact, it has been calculated that if everyone who drinks more than the recommended daily limit started drinking moderately there would be a 21drop in total alcohol consumption of 40% – equivalent to over £13 billion in sales.

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It’s probably partly because khat chewing has not really caught on in Western countries, as much as the fact that it’s not very harmful, that has allowed it to avoid legal controls, by and large. Two exceptions are the USA and Canada, which, because they still cling to the belief that banning drugs reduces use, made it illegal some years ago. This led to predictable increases in price, in criminal activity, and even gang deaths, without obvious improvements in public health – a reprise of the situation with alcohol prohibition 70 years earlier.

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It’s pointless making policies assuming that people will behave how we want them to behave when we know they behave otherwise. We have to look at reality, decide what we want to achieve and what it is possible to achieve, and evaluate our policies honestly, in terms of our aims and any other perverse effects. One country which has done just that is Portugal.



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