Is drug addiction a mental illness?

Or, is it simply a choice?

Where you stand on that question will have a lot to do with where you stand on zero-tolerance.

In America, zero-tolerance is the policy of our military, prisons, most workplaces, and 94% of American schools.1 And our legal system: Laws against drug possession can be, depending on where you live, severe – in a state with some of the harshest penalties, Kentucky, drug possession can land you in prison for 2 to 10 years while facing a fine of up to $20,000. Even a first time offense for less than eight ounces of marijuana can get you a year. While intended to ensnare high-level distributors, mandatory sentencing guidelines, like the above, often impact low-level offenders. Zero-tolerance laws often don’t allow for extenuating circumstances such as severity or intent.

This legal tradition has a predecessor: Most religions have zero-tolerance regarding intoxicants. Buddhism, Islam, the Bahá’í Faith, Mormonism, and many other Christian denominations forbid intoxicants. Popes have spoken against the “evils” of drug use and Judaism believes that as one’s body belongs to the Creator, intoxication makes one unfit for prayer or ritual.

In this way, both law and religion have stigmatized addiction. Through the criminalization of substance use, addicts can be perceived as immoral, socially deviant, and weak of will. To this tradition, punishment is the only appropriate response.

But does zero-tolerance work?

1)   Yes

Condoning Abuse: Most advocates of zero-tolerance argue that expressions of tolerance will be viewed as condoning substance abuse – and an excuse for inexcusable behavior. This is often the position of advocates for the so-called war on drugs. In 1988, President Ronald Reagan argued that a culture of permissiveness, abetted by leaders and public figures, had also created a culture for substance addiction to thrive. Interdiction and criminalization of drug users was the answer. Under Bill Clinton this policy continued and expanded. (The federal prison population under his administration doubled.) Many see the decriminalization of marijuana as means of condoning.

Also contributing to the culture of permissiveness: Movies. According to a study2 of the top 200 films in the last 20 years, films have glorified the use of drugs including marijuana and alcohol while neglecting to show negative consequences. The study argues that these movies had shown substance abuse in both a positive light and as a social norm.

2)   No and Yes, Maybe

Sweden and Portugal are two countries taking completely different approaches to the drug problem: Sweden taking a punitive, enforcement-led approach and Portugal decriminalizing the use of all drugs – treating drugs as a public health issue and not a criminal one.

The results?

Sweden has seen historically low levels of drug use and is being held up as a model of effective zero-tolerance policy. Whether these levels are because of or in spite of the restrictive approach has been the subject of much debate. Penalties were increased, fines became prison sentences, and the ability for police to take blood and urine tests without an individual’s consent was given. The number of convictions for drug offenses has doubled over the last 10 years, most are for simple drug possession.

On the downside, illicit drug use including cannabis has increased as has drug use among the general population. France and the UK, which have also pursued a similarly punitive approach, have also seen significantly higher levels of drug use.3

Portugal had one of the worst heroin epidemics in the Western world. Since decriminalizing the possession of all drugs, the country has seen no adverse effect on drug usage. It has seen dramatic drops in overdoses and cases of HIV – Portugal had the highest rate of HIV among IV drug users in the European Union. Harm reduction efforts were expanded including state-funded needle exchange programs, substitution treatment and drug rehab programs, after-care and social reintegration. As an outcome of these programs, addiction stigmatization also declined which may explain why reported lifetime use of all drugs has seen an uptick in recent years. It’s been argued that because of a change in attitudes toward addiction, respondents are becoming more honest when drug-use surveys.

3)   No

School Punishments: Studies have shown that zero-tolerance policies make schools less safe: When schools suspend or expel students for drug use or possession it often has the reverse effect of making schools safer.4 Those caught and punished for drugs, without some attention or counseling provided to the offender, will often only continue or escalate their drug use. Such harsh disciplinary policies according to national drug surveys have failed to reduce rates of alcohol or drug use in schools.5 The report also suggests that school zero-tolerance policies also disproportionately affect minority students.

And this: A study published in the American Journal of Public Health found that “students attending schools with suspension policies for illicit drug use were 1.6 times more likely than their peers at schools without such policies to use marijuana in the next year.”

Even such invasive procedures as urine testing, drug sniffing dogs, and locker searches haven’t stopped drug use. Beyond the cost, testing can cost $10 to $70 per student, the process for those tested can be humiliating and alienating. What’s the cost in some hurt feelings and pride if it deters drug use? But according to the largest national survey of student drug testing ever, provided by the Journal of School Health, it doesn’t. A comparison of schools that tested against those that didn’t found that drug use was about the same.

When caught, even for the mildest offense (such as the Maine high school student who brought Tylenol to school to alleviate menstrual cramps), students have been stigmatized, barred from extracurricular activities, or expelled from school.

4)   No

Zero-tolerance kills people, etc: The concept of zero-tolerance is built upon enforcement. The argument can be made – and in the case of Portugal, made effectively – that approaching drug use as an issue of criminal justice issue rather than one of healthcare is both dangerous and deadly. An example: In states without “Good Samaritan” laws, drug users and others are often reluctant to call the authorities for help with apparent overdoses for fear of being arrested. As a result, in states without such laws, people die. For this reason, America’s Drug Czar R. Gil. Kerlikowske has made the case for more states to adopt “Good Samaritan” laws.

5)   Yes

Zero-tolerance programs have high public acceptance: Much of the public sees drugs as a black and white issue. Illicit drugs and legal drugs used without a prescription are illegal, therefore, follow the law and you’ll be safe – end of argument. It’s socially acceptable to stigmatize drug users and addicts: Drug addicts are lawbreakers and deviants. In this view, tolerance is condoning. This includes decriminalization of marijuana – seen as a pandering to potheads.

The verdict?

Federal drug policy in the U.S. has already begun a major conceptual shift. Automatic prison sentences and the zero-tolerance policies are being reconsidered, especially in states with the largest prison populations. This change of thinking may also be coming as a result of falling violent crime and shrinking public budgets. And despite the above, public support for “drug war” policies is waning. A 2014 report found that 67% of people said that government should focus more on treating people who use illegal drugs; 26% said prosecution should be the focus. Consensus for moving away from mandatory prison sentences is also changing, 6-in-10 believe states should end for non-violent drug offenders – this is 10% change from as recently as 1990.

It comes down to this: Any reimagining of current drug policy that leads us to a more compassionate view of addiction and more help available for the addict, whatever side of the argument you’re on, can only be a good thing.

If you or a loved one have an addiction to alcohol, contact BLVD Treatment Centers. At BLVD Treatment Centers we custom tailor our recovery programs within the safe and nurturing confines of our rehab treatment centers. Located throughout California, in Los Angeles, Orange County, San Diego and in Portland, OR, our mission is to assess the severity of your addiction to help you achieve true recovery within 30 days. Call us now at 1-866.582.9844.





Does a Zero Tolerance Approach Stop Drug Use?