Decriminalisation Or Denial – Rethinking The UK’s Approach To Addiction

When we think of addiction, be it to drugs or alcohol, the immediate image that often springs to mind is one of personal turmoil. However, the ripple effects of this struggle traverse beyond the individual, weaving into the societal fabric, economic dynamics, and the very essence of human rights.

For those trapped in the spiral of addiction, the challenges are multifaceted. At the heart of their ordeal lies a fundamental right to health. Article 25 of the Universal Declaration of Human Rights states that:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

With the International Covenant on Economic, Social and Cultural Rights furthering this, noting:

“The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.”

Yet, access to healthcare, particularly for individuals dealing with addiction, often due to a stigma of this being self-inflicted, remains a struggle for many in the UK. Whilst the NHS Constitution asserts a right to access health services without discrimination, in practice, this is not always observed. Leonieke Boekel has noted that:

“Negative attitudes of health professionals towards patients with an alcohol or other drug addiction are known to lead to poor communication between professional and patient, diminished therapeutic alliance, and misattribution of physical illness symptoms to substance use problems.”

As such, it is unsurprising that almost half a million people struggling with dependencies on drugs and alcohol are not receiving any form of treatment for their addictions, with only half of those who use opiates and one in five dependent on alcohol actually seeking support.

Addiction is not a personal failure or lapse in judgment; it is a profound health concern. Yet, access to healthcare remains a distant dream for many, either due to scant resources or societal prejudices. The scarcity of health services is further exacerbated by the stigma attached to addiction. It’s a burden that denies individuals their inherent dignity, pushing them to the fringes of society and subjecting them to both overt and covert discrimination. The UK Drug Policy Commission has noted that:

“The continuing stigmatisation of people with drug dependence will undermine the Government’s efforts to help them tackle their condition and enable recovery and reintegration into society. If people with drug problems are seen as ‘junkie scum’ and ‘once a junkie always a junkie’, people will be reluctant to acknowledge their problems and seek treatment, employers will not want to give them jobs, landlords will be reluctant to give them tenancies and communities will resist the establishment of treatment centres.”

Similarly, with respect to seeking support for alcohol use disorders, it has been stated that:

“The most common perceived barriers were all person-related barriers, rather than treatment-related barriers, and they were mainly associated with stigma and shame: admitting to others of having a problem, being labelled, fear of the consequences and that others would find out […] They also reiterate stigma as an important and strong barrier to seeking AUD treatment.”

However, the challenges don’t end at the individual level. Addiction sends shockwaves through society at large. Public health facilities, already strained in many parts of the world, grapple with the repercussions of widespread substance usage. Shared needles become conduits for diseases like HIV/AIDS, and hospitals bear the economic brunt of addiction-related ailments. With alcohol-related crime making up a significant proportion of violent offences in the UK. This public health concern subtly intertwines with security issues. These concerns often lead to a single question at the heart of the debate: do we treat people struggling with addiction as patients or criminals?

The economic underpinnings of this dilemma cannot be ignored. Lost productivity, unemployment spikes, and rising healthcare expenditures all contribute to a nation’s economic strain. However, as noted above, in all likelihood, the loss in productivity, lower employment rate and expenditures regarding healthcare and welfare are consequences not of the addictions themselves, but of societies response. In the UK, the approach to drug addiction and alcoholism has historically been rooted in criminalisation, with laws like the Misuse of Drugs Act 1971 categorising substances into classes and imposing penalties based on possession, production, and supply, with sentences for simple possession being as high as 7 years’ custody and being under the influence of alcohol whilst committing most offences being an aggravating factor leading to higher sentences. Whilst the Governments 10-year drug strategy does outline support for recovery, including increased funding for support services and tackling drug use in prisons, a detailed analysis of this strategy in the Journal of Public Health reporting that:

“The Strategy suggests that decriminalization risks increasing drug use; however, this is not supported by evidence. Whilst criminalization has no clear benefits, it causes significant harm to people who use drugs. Since the Misuse of Drugs Act 1971 was introduced, more than three million criminal records have been generated for drugs offences.  In 2017, 60% of prosecutions for drug offences in England and Wales were for possession rather than supply, including 36% for the possession of cannabis.”

This contrasts sharply with countries like Portugal and Switzerland, which have pioneered public health centred approaches to addiction. In 2001, Portugal decriminalised the possession of small quantities of drugs, reframing addiction as a public health issue rather than a criminal one. This shift led to a significant increase in those accessing treatment, coupled with a decline in drug-related deaths, HIV transmission rates, prison population, and ‘high-risk’ drug use including injecting. Similarly, Switzerland has implemented a four-pillar harm reduction policy, including taking proactive health focused approached such as supervised drug consumption rooms and heroin-assisted treatments for high-risk users. These approaches prioritise health and social reintegration, yielding positive results in terms of reduced drug-related harm and societal costs. The comparison underscores the impact of policy perspectives on addiction outcomes and the benefits of viewing the issue through a public health lens.

Similarly for alcohol, the approach in the UK is, essentially, non-existent. The last alcohol strategy was published over a decade ago, this strategy was steeped in denial, rather than looking to the evidence and guidance on what works, the policy made vague commitments such as consulting on multi-buy promotions and minimum unit prices (most of which were not implemented or resulted in a lax implementation). Critical of this lack of approach, The Lancet have reported that:

“The UK Government has abdicated responsibility, relying on voluntary schemes based on industry goodwill rather than evidence-based policies. The bizarre position on alcohol labelling in the UK […] reveals the flaws of this voluntary approach: there is more nutritional information (including calories) on a typical container of milk than on a bottle of wine. Furthermore, having tasked the Chief Medical Officers to revise the low-risk drinking guidelines on the basis of best available and most up-to-date evidence, the UK Government has not required the alcohol industry to display this information on their products.”

This approach again is in direct contrast with other countries like Norway and Sweden. While there are treatment programs available for those struggling with alcohol addiction, often accessible through government funded charities, there is no state monopoly on alcohol sales, and regulation on advertising is more lenient. In contrast, countries like Norway and Sweden adopt a more rigorous public health approach. Both nations employ state-run monopolies on the sale of alcoholic beverages — Norway’s ‘Vinmonopolet’ and Sweden’s ‘Systembolaget.’ These monopolies aim to curb excessive consumption by removing the profit motive from alcohol sales. Advertising restrictions in these countries are also stringent, and alcohol is typically more expensive due to high taxes intended to deter excessive consumption. Additionally, both countries invest heavily in holistic treatment programs, placing a strong emphasis on early intervention and rehabilitation. This combined strategy of restriction, public education, and robust treatment options exemplifies a comprehensive public health approach to addressing the challenges of alcoholism.

Whilst cultural perceptions play an influential role and individuals have every right to take actions that may be harmful to their health, there remains a balancing act, addiction and high-risk behaviours are not impactful in isolation, the wider impact on society from numerous perspectives, including: healthcare, crime, homelessness, child development and more is striking. As such, it is a proportionate response to restrict the rights of some to see less advertising on alcohol or to ban super-strength beverages.

In navigating the intricacies of addiction, the UK finds itself at a pivotal crossroads, grappling with historical decisions that often prioritise criminalisation over compassion. Despite the irrefutable evidence pointing towards the efficacy of a public health-driven approach, as evident in nations like Norway and Sweden, the UK’s hesitant steps towards comprehensive reform reveal a persistent resistance to change. While individuals undeniably possess the right to make personal choices, the broader societal implications of addiction — from strained healthcare systems to escalating crime rates — highlight an urgent need for recalibration. This doesn’t entail encroaching on personal liberties but instead demands a nuanced understanding of the ripple effects of individual actions. Embracing evidence-based practices and mitigating the societal impact of addiction is not just a matter of policy reform; it’s a testament to a society’s commitment to upholding the dignity, health, and well-being of all its citizens. This approach must be unapologetic and fully committed, the evidence on the impact of decriminalising drug use and harsher controls on alcohol is too strong to ignore any longer.

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