I was going to write a post making a philosophical point about what it means for something to "cause" something else. It is very hard to identify the cause of a human being's behavior, because the cause is buried somewhere deep inside their skull where we can't observe it. In intelligent creatures, behaviors have a lot of internal, unobservable causes. To kick off this philosophical post, I'll start with some gossipy bullshit about people I know on Facebook.
Sometimes I'll post something on Facebook arguing for the end of drug prohibition. Someone I know will occasionally pop up with some bland skepticism, we'll argue for a little while, and he'll cordially suggest we discuss it over a few drinks. I find this maddening. This is someone who puts people in prison for drug charges, and he's effectively saying, "Let's get together for highballs and discuss how the stupid plebs can't handle their shit. I'll bring the cigars."
I'm sure a person in his position could tell me about all the criminals who did stupid shit after using way too many drugs way too often. It would be easy for someone in law enforcement or the healthcare profession to get the impression (wrongly) that the drugs themselves are causing the social problems, rather than the drug use and social problems being symptoms of some other dysfunction. Could poor impulse control cause both, perhaps? Could poor impulse control be exacerbated by drug use, which leads to other problems? Is it possible that drugs are no problem at all for people with normal impulse control? Isn't it likely that people with impulse control problems don't respond to the threat of legal sanctions? And doesn't this render the entire enterprise of drug prohibition moot, given that the deterrent effect is probably small or nil?
I want to recite to my friend a summary of all the social ills caused by excessive alcohol consumption. Tens of thousands of traffic fatalities each year. Comparable numbers of cirrhosis deaths and alcohol poisonings. Sick days. Job loss and unemployment. Domestic abuse. Child neglect. Excited delirium. All because of the alcohol you're holding in your hand right now.
Such an accusation would be hysterical. If someone occasionally indulges with some top-shelf scotch or with a hand-crafted micro brew, that certainly doesn't mean he's to blame for all the social problems cause by excessive drinkers. Those scary statistics about tens of thousands of cirrhosis deaths and traffic fatalities are in no way a function of my moderate drinking, one might legitimately protest. And such a defense would be perfectly fair.
Moderate drinking is not the cause of social problems. Drinking in general is not the cause of social problems in general, or even alcohol-related problems in general. You can't simply aggregate "all drinking" and make it responsible for "traffic fatalities related to drunk driving" and "cirrhosis of the liver". Most drinkers cause no social problems at all. A few cause enormous harm. And so it is with other substances, too. Sometimes it is best to remove temptation. I have known people who deliberately don't drink and don't socialize when others are drinking, because in the past they have gone ape-shit after a few drinks. They know that one drink will become ten, and they will do property damage by the end of the night, if nothing else. I admire people who realize when they need to be tied to the mast. But likewise I know people who can sip on a beverage all night and never have a problem.
Cocaine kills a lot of people (~5,000 in 2014), but there are millions of cocaine users. Most of them are safe about it. Heck, many of them are one-time-only users. But a few of them persist recklessly, day in and day out, and destroy their hearts. It's not that the millions of users are all rolling dice in some game of chance, where death and survival are determined entirely by The Fates. Most users have essentially zero chance of dying from their habit, but a few indulge so stupidly and recklessly that they kill themselves. Suppose you tracked down some Bolivians who chew coca leaf as a low-dose stimulant, as is tradition in that culture. You try to accuse them of killing 5,000 Americans. They would scratch their heads and scowl at you. "You see," you continue, "the chemical that you chew daily is the same one that millions of Americans snort, in super-concentrated powdered form, into their noses. Most of them don't have any problems, but a few of them develop nasty habits and a small fraction of them die from it!" They shrug at you, ignore your idiotic hyperbole, and keep chewing coca into old age.
You can make exactly the same point about other substances. Methamphetamines are basically the same chemicals as drugs that treat ADHD. ICD-10 (cause of death codes found on death certificates and in CDC data files) uses the same code for both, and the annual SAMHSA survey on drug abuse uses the same category for both (see here, page 8 for details). Some people are on ADHD medication 24 hours a day, and some people take very high doses of methamphetamine in a way that instantly crosses the blood-brain barrier (smoking, snorting, injecting). But it would be ludicrous to accuse ADHD patients of causing the skin lesions, poor dental health, and heart problems suffered by chronic methamphetamine abusers. An ADHD patient could rightly protest, "I use my medication as prescribed. The result is that you have an upstanding, well-functioning citizen that you otherwise would have lost to an intractable attention-span problem. What some other idiots do with their bodies is not on me." This would be a perfectly fair defense of an Adderall patient, or for that matter of a moderate methamphetamine user.
You can do this same exercise with any other substance. There are 200 million legal prescriptions of opioid painkillers each year. The death rate per prescription is less than 1 in 10,000. If you were suffering from chronic or acute pain, you would probably say, "I like those odds!" More so if you realize that you can choose willingly whether to take stupid risks, like taking way too much or swallowing pills with alcohol and benzodiazepines (to name two of the biggest risk factors for overdose). The decision to take a substance does not automatically subject you to the base mortality rate for users of that substance. For that you have to do something foolish and risky, and usually you know if you're doing it or not. Statistics that merely divide the number of drug-related problems by the number of total users (such as "X% of drinkers become alcoholics" or "Y% of heroin users become addicts" or "Z% of prescription opioid users eventually overdose on their painkillers") are completely meaningless. They deny any agency to the human beings who suffer from these problems, just as they deny agency to the ones who resist temptation and the ones who indulge moderately.
It's simplistic to generically blame "drugs" or "alcohol" for social problems. Any fool can see there are specific risky behaviors and specific solutions. To blame drugs in general would be to miss the point. Issuing a general prohibition is unlikely to get at the root causes of the problem.
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