In the first instalment of his monthly editorial, SMART Recovery Australia Executive Director Ryan McGlaughlin shares his perspective on our national conversation around drug policy.
Recently, sitting in the studio audience of the ABC’s Q&A, I witnessed a panel of guests and audience engage in a healthy debate around drug policy in Australia. I was inspired by former Australian Federal Police Commissioner Mick Palmer, AO APM, and Dr Marianne Jauncey from the Kings Cross Medically Supervised Injecting Drug Centre, and their moral leadership in this debate with pragmatism and compassion.
I was disappointed to see that when some panellists made inaccurate statements, they were not challenged enough. As the Executive Director of SMART Recovery Australia, an organisation that prides itself on evidence and education (having informed choices), I felt compelled to respond to some of these inaccurate statements, mention key issues that were overlooked, and present the evidence that informs our approach.
One such statement was the idea that the use of marijuana is a slippery slope to the use of heroin. I remember this statement being made when I was a child, and some 40 years later it is still being thrown around in a generalised fashion. While it may be true in some cases, it is not at all the case across the board. As with most things in life, patterns of drug use are not homogenous. The debate was at its best when the argument was backed up by evidence and not over-generalisations based on anecdotes or previously held misconceptions. I was disappointed that not enough was said about the critical role stigma plays in this issue. People who have problematic behaviour around the use of drugs are the most stigmatised health condition globally1.
SMART Recovery Australia does not condone drug use. We do, however, strongly believe in harm minimisation principles. Simply put, this advocates for policy and practice which results in the least harm. Punishing people who use drugs increases stigma, which is a barrier to them seeking help (Dabrowska et al. 2017)2.
A law and policy focus on the criminality and the morality of drug use contributes to stigma and creates further harm. The portrayal of drug use, preoccupation with criminality and social deviance without a health framework3, dehumanises and alienates people battling serious mental and physical health issues associated with addiction. To reduce this significant impact, drug use should be treated as a health issue4&5. The majority of people that use unregulated drugs are not engaged in criminal behaviour, even though they are generally seen by others in the community as criminals, which adds to stigmatisation6. The suppliers of illegal drugs should be the focus of the criminal response6. Furthermore, only a small proportion (16.6%) of the people that have a problematic behaviour with drug use are presenting for treatment, and this tends to be when there is an acute problem. Note the large proportion that are not presenting for help.: this avoidance is partly due to the stigma attached to drug use7. Compounding the already significant obstacles to the ability of drug users to seek help is that the majority of people with problematic addictive behaviours also have a mental health problem, especially anxiety and depression8. Research has similarly demonstrated that people who use drugs in countries where drugs are not decriminalised would be more confident in seeking help with problematic behaviours around drug use if there was decriminalisation policies in place in their countries9. It will likely be a while before Australia regulates and/or decriminalises the use of other drugs similar to countries such as Portugal, New Zealand, and the Netherlands, which in doing so has seen more people seeking help.
That said, it was good to hear on Q&A that NSW has taken a step in the right direction by giving police discretion to issue a penalty notice and on-the-spot fine for small possession of prohibited drugs without a criminal conviction being recorded. There is talk that these fines can be avoided if the person agrees to go into treatment. This concerns me, as not all of these people have problematic behaviour around the use of drugs. Chief Superintendent Stuart Smith of the NSW Police estimated there are thousands of people that could fall into this category. There is no doubt these people could benefit from being exposed to interventions that assist people with addictive behaviour, however the treatment waiting list for a person with problematic addictive behaviours can be up to 12 months, or longer. Those who truly require support for drug dependency issues will be pushed further back in the massively backlogged treatment queue10. SMART Recovery Australia is currently doing a feasibility study to develop an early intervention programme which would be undertaken by people who receive penalty notices. This would not only help those who need information and strategies early, but it has the potential to open up treatment opportunities for people with acute problems.
Stigma is an indelible part of what prevents people from seeking help. We must deal with any language or actions that contribute to stigma for this very reason. The evidence tells us that the enormous impact of stigma around people with lived experience through public policy, media, and community can cause a person to internalise these perceptions and start believing they are a bad person. This causes feelings of shame, self-loathing, and a belief that they are not worthy of help11. This can further leave them to identity with the fear of the stereotype leading them to perform the stereotype, thereby perpetuating harmful behaviour12. The SMART Recovery program has many proven tools such as problem solving and values alignment, and emerging tools such as mindfulness and Acceptance Commitment Therapy which the evidence shows increases self esteem and empowers the individual to reject stigma13.
SMART Recovery Australia endorses an evidence-led harm minimisation model when it comes to drug policy. It is vital that any action to combat addictive behaviours take the evidence into account, and that any public commentary on this issue is both informed and educational. Individuals living with problematic addictive issues must feel safe to seek the help they sorely need, and this help must be made available as broadly as possible. Continuing to stigmatise and alienate these vulnerable Australians will only serve to exacerbate the drug and alcohol problems plaguing our country.
1Kelly, J.F., & Westerhoff, C. 2010, ‘Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms’, International Journal of Drug Policy, vol. 21, no. 3, pp. 202-207.
2Dabrowska, K., Moskalewicz, J. & Wieczoreck, L. 2017, ‘Barriers in Access to the Treatment for People with Gambling Disorders. Are They Different from Those Experienced by People with Alcohol and/or Drug Dependence?’, Journal of Gambling Studies, vol.33, no.2, pp.487-583.
3Hughes, C., Lancaster, K. & Spicer, B. 2011, ‘How do Australian news media depict illicit drug issues? An analysis of print media reporting across and between illicit drugs, 2003-2008’, International Journal of Drug Policy, vol. 22, no. 4, pp. 285-291.
4Global Commission on Drug Policy 2017, The World Drug Perception Problem: Countering Prejudice about People Who Use Drugs 2017 Report, Geneva.
5Australia 21 Ltd. 2016, Can Australia Respond to Drugs More Effectively and Safely?, Weston, ACT.
6International Network of People Who Use Drugs 2014, drug war peace, industry report, London.
7United Nations Office of Drugs and Crime 2014, 2014 World Drug Report, New York, United Nations Publications.
8Australian Government National Mental Health Commission 2013, Contributing life: the 2013 National Report Card on Mental Health and Suicide Prevention, National Mental Health Commission, Sydney.
9Benfer, I., Zahnow, R., Barratt, M.J., Maier, L., Winstock, A. & Ferris, J. 2018, ‘The impact of drug policy liberalisation on willingness to seek help for problem drug use: A comparison of 20 countries’, International Journal of Drug Policy, vol. 56, pp. 162-75.
10National Mental Health Commission 2014, Contributing Lives, thriving communities: Report of the National Review of Mental Health Programmes and Services, 30 November 2014, National Mental Health Commission, Sydney.
11Luoma, J.B. & Platt, M.G. 2015, ‘Shame, self-criticism, self-stigma, and compassion in Acceptance and Commitment Therapy’, Current Opinion in Psychology, vol. 2, pp. 97-101.
12Inzlicht, M., McKay, L. & Aronson, J. 2006, ‘Stigma as Ego Depletion’, Psychological Science (0956-7976), vol. 17, no. 3, pp. 262-9.
13Cama, E.J., Wilson, H., Mackenzie, A. & Brener, L. 2015, ‘Hepatitis C Stigma and Empowerment Through Positive Speaking in Sydney, Australia’, Journal of Community & Applied Social Psychology, vol. 25, no. 5, pp. 418-31.