Pubdate: Sun, 17 Sep 2000
Source: San Francisco Chronicle (CA)
Copyright: 2000 San Francisco Chronicle
Page: 4
Contact:  http://www.sfgate.com/chronicle/
Forum: http://www.sfgate.com/conferences/
Author: Tim Vollmer
Cited: Proposition 36 - Drug Treatment Diversion Program: 
http://www.drugreform.org
California Voter Foundation: http://www.calvoter.org
Bookmark: MAP's link to Proposition 36 items: http://www.mapinc.org/prop36.htm

NEW VIEWS PROMPT CALLS TO CHANGE DRUG LAWS

Given its rather self-evident nature, "self-medication" is not exactly a 
new concept. Public-health researchers have long been studying how people 
use alcohol to reduce stress or sexual inhibitions. But a new appreciation 
of the notion that illegal drug users may be "self-medicating," for good or 
ill, is changing minds and, in some cases, even laws.

 From the use of marijuana in HIV treatment to the spreading abuse of 
methamphetamine which one researcher calls "the millennium drug," due to 
its performance enhancing appeal the view is challenging the long dominant 
views that drug use is criminal or biologically predetermined. Beyond that, 
proponents of the "self-medication" theory of drug use are warning that a 
society that "just says no" to some drugs but gives a resounding yes to 
others is headed for trouble.

Perceptions about drug use in America have never been simple. Our Puritan 
legacy says that drug use outside very narrow confines is hedonistic and 
dangerous, corrupting both individuals and society. This view drove 
Prohibition in the '30s and fuels "the war on drugs" now.

A more modern view sees drug abuse as the result of a biological propensity 
to addiction. The most widespread treatment of drug use, Alcohol Anonymous' 
12-step program, is based on this belief and its corollary, that only 
abstinence can help people who are inherently unable to control their drug use.

Then there is the belief that drugs are chemical tools to achieve specific 
goals. This, of course, is the view that has made pharmaceuticals a 
fundamental aspect of modern medicine since the invention of penicillin in 
the late '40s.

It is also the view fueling the country's seemingly endless drug epidemic. 
"'Magic elixir' is a good term to describe the belief," said G. Alan 
Marlatt, professor at the University of Washington in Seattle and director 
of its Addictive Behavior Research Center. Marlatt says that many people 
self-medicate with alcohol and illegal drugs because they hold unrealistic 
beliefs about the drugs' effects and dangers. "People are looking for 
immediate relief and not attending to the delayed negative consequences."

The main trigger for relapse among abusers "is the need to cope with 
negative emotions"' he said. "With men, it's typically anger; with women, 
it's depression; with both, anxiety problems. One sees it across the 
various addictions...alcohol, stimulants, heroin, even gambling. These 
behaviors are seen as a form of stress management."

This image of the self-medicating addict or user now offers a vivid 
contrast to the bar-room bred notion of the out-of-control, and often 
criminal, drunk. "Even binge-drinking among young male adults can be seen 
as self-medication," contends Marlatt. "Young men report that drinking 
makes them feel more attractive, less anxious. Binge-drinking to get drunk 
is seen as way of preparing for dating and partying." Given the widespread 
practice of prescribing the stimulant Ritalin for childhood cases of 
Attention Deficient and Hyperactivity Disorder, it should not be surprising 
that many researchers now see older users of methamphetamines to be 
self-treating, however misguidedly, for undiagnosed cases of the syndrome. 
Some researchers also say that stimulants are being used by people as a 
means of coping with depression.

"We see it with clinical depression and with depression related to HIV," 
explains G. Michael Gorman, a faculty member at the School of Social 
Welfare at San Jose State University. Gorman is a principal investigator of 
a National Institutes of Health study looking at methamphetamine use on the 
West Coast.

Methamphetamine, or speed, has been called a "poor man's Prozac." Gorman 
agrees with the analogy. "Poor or working people can't afford not to have 
energy," he said, referring to a major symptom of depression. "They have a 
house mortgage to make and kids to provide for. This is especially true of 
rural, economically deprived areas experiencing a `'peed' epidemic. There 
you find the truck driver driving all night or the waitress with two jobs."

Gorman contends, however, that the functional appeal of methamphetamines 
goes beyond the poor and mentally ill. "I like to call this drug the 
'millennium drug,'" he explains. "It's the drug for people who never feel 
like they have enough time or energy. People believe that the drug extends 
their ability to perform, whether in the workplace, social occasions, or 
sexually."

One of the main benefits of looking at drug use as "self-medication" is 
that it focuses attention on underlying problems and the need to address 
them, rather than on the drug use. "Our approach stresses teaching new ways 
of coping with negative emotions such as anger management and meditation," 
Marlatt said. "Most drug users won't go to abstinence programs and feel 
there's no other type of drug treatment. Our approach gives them options."

In the realm of law enforcement and drugs, the self-medication perspective 
has had success in challenging governmental policy on marijuana. Though 
widely used medically in America during the 1800s, the federal government 
in 1937 classified marijuana, which had become associated with Mexican 
immigrants and bohemian African Americans, as an intoxicant as dangerous as 
heroin, thus criminalizing its use.

In recent years, medical marijuana proponents have strenuously challenged 
this view, claiming that people like AIDS patients use marijuana to ease 
the nausea and appetite loss incurred by their medications. The general 
public has been increasingly supportive of this view and has in the last 
four years passed laws allowing medicinal marijuana use in eight states, 
including California and the District of Columbia.

In mandating treatment, and not prison, for first- and second-time 
nonviolent offenders of drug laws, Proposition 36 on California's Nov. 7 
ballot is another assault on the criminal view of drug use. As Marlatt 
argues, "We need drug courts that provide treatment options for drug abuse 
and the concurring medical conditions. Prison is clearly not helping not 
when 88 percent of all prisoners say they have easy access to drugs."

Of course, the "self-medication" view of drug use has its detractors. Many 
say that self-reported data cannot be trusted and that more statistically 
based research has not always backed up the theory. People who claim to be 
self-medicating are said to be rationalizing their use. Even if abusers are 
found to be mentally ill, this school argues that mental illness follows 
substance use rather than precedes it. Supporters of tough laws punishing 
laws dismiss medical marijuana as a front for legalization. 
Decriminalization and the transfer of resources to prevention are seen as 
encouraging the use of illegal drugs and unleashing dangerous people on 
society. Crime has fallen, this side argues, because the people who commit 
it, often to support drug habits, are incarcerated.

Although many experts in public health predict that future research will 
ultimately reconcile the views of the school espousing the theory of 
biological predisposition and that of the school of self-medication, it is 
harder to imagine a successful reconciliation with the criminal view of 
drug use. One outcome: It would become increasingly unpopular to impose 
severe sanctions on a drug like marijuana that might have legitimate and 
important medical uses. Or it may become politically difficult to defend 
laws harshly punishing those who use methamphetamines in a society that 
simultaneously spends enormous sums promoting Ritalin and Prozac.

Yet confronting the contradictions in society's views on drugs may all be 
to the good. "It's ridiculous to have a zero-tolerance war on drugs on one 
hand," Marlatt warned, "and the promotion of a pill for every problem on 
the other. All of the promotion of instant and easy relief on television 
feeds the notion of a 'magic elixir'. It really does set up conflicting 
expectations with kids who end up not knowing what to believe. As a result, 
they go out there and experiment to find out who is right."

According to San Jose State University's Gorman, such experimentation can 
be disastrous when there are powerfully seductive "millennium drugs" out 
there. "For a variety of reasons, people are self-medicating with this 
drug," he warns. "It's a broad-scale phenomenon. Speed use is overwhelming 
rural communities practically overnight with terrible consequences. Use is 
also breaking out into new populations, like Latinos and Asians. 
Authorities need to wake up to the fact that we could have the equivalent 
of another crack epidemic out there."

[sidebar:]

PROPOSITION 36

The Substance Abuse and Crime Prevention Act of 2000 is designed to stop 
the revolving door of drug addiction by mandating treatment. It is expected 
to save the state of California $100 million to $150 million a year in 
prison costs. For information online, go to: http://www.calvoter.org

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MAP posted-by: Terry Liittschwager