Last Tuesday I gave a rather rambling lecture at
LJMU about how although the big picture in substance misuse policy in terms
of national and international developments is interesting and important, it’s
also crucial to think about local decision-making. (Of course, I’m bound to say this as I’m
involved in that local decision-making, and I am of course terribly important…)
Rather than summarise the whole thing here, though, I wanted
to reflect on points that arose in the discussion afterwards. I was asked a very perceptive question about
the nature of drug misuse and public perception, with particular reference to
users of performance and image enhancing drugs (PIEDs) such as steroids. The point is that such substances don’t fit
neatly into standard understandings of drug misuse.
Of course, that isn’t news to harm reduction professionals,
who’ve been grappling with this particular issue for decades (though maybe it’s
got a new face with ‘smart’
drugs and things like injectable
tanning enhancers). And to some
extent this is precisely the issue I’ve drawn attention to in my academic work,
when I’ve tried to highlight that what
we find problematic isn’t simply health harm, but intoxication, pleasure and
disorder, combining in some kind of class and gender infused carnivalesque.
Writing that in that way makes it sound particularly
pretentious, but the point is something more than the fact that society and
users think and worry about PIEDs in a different way to substances where the
attraction is ‘recreation’, ‘pleasure’ or ‘intoxication’. I actually want to make a fundamental point:
this difference actually undermines the very idea of what we mean by a drug.
What ties all these things together? It’s not that they’re mind altering or
intoxicating – tanning enhancers needn’t be.
And it’s not that everything that’s mind or body altering is a ‘drug’
according to this definition – nutmeg and various other unexpected substances
are listed on Erowid.
So we often fall back on the terminology of ‘substance’
use/misuse/abuse. But practically
everything’s a substance – and this word makes me think back to my attempts to
understand philosophy.
And this isn’t just a game of semantics. These definitions and understandings, even if
they’re only implicit, shape national and local policy. There’s a drug treatment budget within local
public health teams, but is this the right place for interventions to address PIED
use? Should separate facilities be
provided for users of PIEDs? These sorts
of questions come down to our definitions of what a ‘drug’ is.
The facetious way out of this impasse is to say that (at
least in this context, rather than a medical one) a drug is simply something
that is disapproved of. That is, ecstasy
is a ‘drug’, but alcohol isn’t. And
people do often refer to the area I work in as being about ‘drugs
and alcohol’, and now sometimes ‘alcohol,
drugs and tobacco’.
And to be honest, perhaps this is the unspoken truth of drug
policy: yes it’s
an incoherent fudge, but would a coherent, solely evidence-based rational
policy work any better? It’s not just
policymakers and the public who see PIEDs as different from other ‘drugs’ –
it’s also the users themselves.
Not for the first time, I’m uncomfortably leaning towards a
position the likes of Michael
Oakeshott and Edmund
Burke would be happy with, but I think I’d actually welcome a politician or
policymaker – and perhaps especially an academic – who stepped forward and
said, well it’s not perfect, and it’s not rational, but maybe this is makes as
much sense as we can handle.
