The Report of the National Commission on Marihuana and Drug Abuse

Drug Use In America: Problem in Perspective

Commissioned by President Richard M. Nixon, March, 1972

Chapter 4 - Toward a Coherent Social Policy

Introduction

Those charged with formulating drug policy face a dilemma. Drug use is a behavior usually occurring in private and sharing much in common with personal decisions traditionally governed by individual choice. The preference for self-determination and autonomy is one of the basic principles of our public philosophy and the keystone to our entire social organization. At the same time, a free society like any other, must protect the health, safety, and welfare of the whole. Since this responsibility entails a certain amount of social engineering, there is always tension between the desire for personal freedom and the need for collective restraint.

For the most part, this country has proceeded on the assumption that the citizen's sense of personal responsibility will act as a sufficient check on individual discretion and that a certain amount of irresponsible is more tolerable than a serious abridgement of our liberties. Conflict arises when the level of irresponsibility increases or threatens to increase beyond the point of tolerance.

American drug policy, following the prevailing view that drug use undermines individual responsibility and self-control, has tended to emphasize prevention of collective harm, rather than individual freedom of choice. To some extent, however, an unfortunate polarization of perspective has made the dilemma appear sharper than it really is. On one hand, use of most psychoactive substances has been viewed as inconsistent with personal responsibility and self-control; yet, mature, stable persons could use, many of these drugs in a structured, moderate manner without individual or collective harm. On the other hand, some critics have asserted that society should base its policies purely on the assumption that individuals will behave responsibly; yet, history demonstrates that widespread exposure of a populace to psychoactive substances frequently exacts a heavy social cost. A significant portion of those groups most vulnerable to excessive and irresponsible use will be drawn to the drug, magnifying the harmful impact of the drug's availability.

The policy maker must try to understand and reconcile these opposing points of view, combining the valid elements from each. Much of the debate, regarding drug policy has been strident and unsatisfying precisely because participants tend to approach the fundamental issues from different perspectives. For example, many social scientists, attorneys and pharmacologists emphasize the harmlessness of the behavior of the majority of experimental or recreational users who never go on to intensified or compulsive use, while many physicians, particularly psychiatrists, educators and spiritual leaders focus on the drug casualties with whom they must deal more than anyone else. The Commission does not believe that the two viewpoints are necessarily mutually exclusive, as long as neither is taken as a complete analysis of the problem.

The issue of perspective, which is really a problem of description, leads to an issue of philosophy, which is a problem of prescription. As we noted in Chapter One, the decision whether or not to use drugs is fundamentally a question of values. The question is: whose values should determine the answer?

The American value system prizes self-reliance, productivity and community involvement. From this perspective, resort to drugs for unnecessary purposes poses undesirable risks, whatever immediate benefits the individual user may perceive. Ideally, then, use of psychoactive substances in this society would be restricted to a very few purposes. There are some, of course, who do not entirely subscribe to this ideal while others profess the ideal and live by it as well. In reality, however, most Americans aspire but do not measure tip to the standard. The use of different drugs and motivations for use may vary, but reliance on chemical substances is a common feature of American life.

So a second dilemma is posed. Should public policy toward drug use reflect the prevailing morality of aspiration or the realities of individual and group behavior? This issue is most important when policy toward one substance, for example marihuana, invokes the moral ideal, while policy toward another, alcohol, accommodates the way most people behave. Such uneven application of principle explains why some critics believe that present drug policy is no more than an assertion of majority preference.

While the details of social policy need not be the same for all substances, the Commission believes that differences must be justified in terms of one general set of principles. An apparent double standard compromises the integrity of social institutions and interferes with efforts to deal with the consequences of excessive drug use.

The Commission also believes that semantics must not blur the basic philosophical dilemma: when policy restricts individual choice for the common interest, the decision should be stated unequivocally. A determination that society suffers more from an existing restrictive policy than from the use of a particular drug should be stated with equal candor.

THE PROCESS

The Commission has attempted to formulate a set of general principles, as well as a process for applying them. The policy-making process we have employed consists of five steps:

• Definition of the problem.
• Definition of goals and premises.
• Determination of conditions under which specific, psychoactive substances should be available within the society (the "availability" decision).
• Determination of circumstances under which society should intervene in the life of an individual who has chosen to consume a substance outside the prescribed channels of availability (the "consumption-intervention " decision).
• Allocation of responsibility for implementing policy among various institutions, public and private, formal and informal.

These determinations can also be framed as a series of questions, none of which can be answered solely on the basis of empirical data, and observation. On some issues, the data will weigh most heavily; on others, the answers will depend primarily on value judgments and philosophical perspectives. For this reason, we have not tried to skirt the difficult questions of philosophy and perspective raised earlier. They are examined at every point in the policy-making process where they are relevant.

Particularly in the last three steps in the policy-making process, decision-making cannot be determined logically. First, we are, dealing with a limited, inadequate base of information, a factor which increases the weight of intangible considerations. Second, drug policy cannot be isolated from the overall social context: the effects of drug policy on the entire society, the impact of change on institutionalized belief systems and parallel social developments, all are part of the analysis of the problem. Even if prohibition of alcohol was judged logically and philosophically desirable, for example, it could not be achieved in a manner tolerable to the majority of our citizens. Even if a long term societal goal were to reduce circumstantial drug use, this kind of drug-using behavior may be so closely tied to current economic and social developments that any present attempt to deal with it separately would be counterproductive.

Concern about the larger context in which drugs are used is particularly important when policy decisions, and perhaps policy-making premises as well, require rethinking. New policies which offend deep-seated beliefs may convey messages other than those intended, exacting a heavier social cost than temporary perpetuation of error. Thus, even if a policy of regulated availability might be otherwise appropriate for marihuana, the Commission believes that such an approach would inevitably signify approval of the drug, exacerbate conflict and frustrate the overall objective of de-emphasizing marihuana as a problem and discouraging its use.

In this Chapter, the Commission recommends a course of action for immediate implementation. Accordingly, we have taken into account the impact of policy making as well as the impact of drug use. The recommendations, if followed, will establish new priorities, reorganize the present institutional response and reorient policy to the realities of the problem. We hope that adoption of these recommendations will replace the present confusion with a coherent response, focusing on drug-using behavior rather than on drugs themselves and minimizing rather than aggravating the adverse consequences of use.

We recognize that the number of policy options is limited at the present time. In the future, we hope that these, proposals will facilitate the process of informing popular attitudes toward drugs and, where, necessary, change them, so that the long-term response may be, selected from the widest possible range of alternatives.

We emphasize again that information alone does not tell the policymaker what to do. However, he, cannot stand pat by pleading an inadequate database. Absence of complete knowledge may dictate caution, but not immobility. Knowledge is always incomplete and always expanding. Recognizing this, policy makers must make decisions from the existing information base, then reconsider previous decisions when new and better information becomes available.

So that reconsideration is possible, the Commission is anxious to ensure that the mechanisms and policies now employed do not become permanent features of this society's response to drug use. All aspects of present policy must be continually reevaluated in terms of their costs and benefits to society. Eventually, these policies must be replaced or modified to fit more, consistently with new information, new operating premises and the changing roles of societal institutions.

GOALS AND PREMISES

Our society seeks to create and maintain conditions in which each of its members may develop his or her potentialities to the fullest extent. A premium is placed on individual choice in finding self-fulfillment. Whether or not this goal is attainable, however, depends upon the capacity of citizens not to abuse their freedom and upon their willingness to act responsibly toward others and toward society as a whole. Responsible behavior, through individual choice, is both the guarantor and the objective of a free society.

Drugs and Social Responsibility

Use of drugs, in itself, is not an irresponsible act. Medical uses are often important in restoring physical and mental health. Sacramental use in connection with bona fide religious ceremonies may enhance rather than impair the celebrant's spiritual well-being.

In therapeutic and religious settings, the purposes of drug use are defined precisely by specified persons who, through tradition and training, have the expertise and authority to structure the experience and minimize the risk. In contrast, when the individual defines his own need, whether it be pleasure, relaxation, escape or an effort to expand awareness, there are no external limits on his drug use. Although most individuals can be expected to structure their drug taking, the, risk of irresponsibility and adverse individual and social consequences increases with self-defined use.

While the use of drugs for self -defined or group-defined purposes is not inherently irresponsible, neither is it purely a matter of personal choice. The potential public impact of drug-induced behavior and drug dependence is great enough that society cannot afford to be neutral. On the other hand, the fact that all drug taking poses some risk does not mean that all use poses the same risks, and official policy should not pretend that it does.

Irresponsible Use

The primary goal of drug policy must be to minimize irresponsible drug-using behavior. The Commission finds that the use of drugs is clearly irresponsible:

• when the manner or circumstances of use, pose a threat to the safety or welfare of others;
• when the pattern of use substantially impedes or risks the impairment of the individual's social and economic functioning - and
• when the pattern of use reduces the individual's options for self-fulfillment by impairing his faculties or retarding his development.

Discouragement and Social Tolerance

A secondary aim of public policy must be to discourage the use of drugs for self-defined purposes, or at least to remove, those institutional and social pressure, which motivate an individual toward such use. Policy should incorporate the ideal of drug-free living in the context of establishing those conditions in which each individual is free to realize his or her potentialities. In this sense, society should encourage individual choices of means of fulfillment which do not present undue risks to the individual's own welfare or the welfare of others.

This discouragement policy reflects the Commission's judgment that drug policy should not lose sight of social ideals. Recognizing, however, that most of us do perceive advantages in drug use from time to time the Commission emphasizes that policies and programs also must be rooted in reality. A policy of discouragement must also be tempered with a degree of understanding for those who do use drugs.

Responsible Decision Making

Society must trust its emotionally mature citizens to make intelligent decisions regarding drug use. In the context of the overall discouragement policy, institutions should motivate, and assist the individual to make responsible choices. Institutional energies should be directed toward altering the context within which the individual's decision is made. For example, public policy can reduce or stop drug use by relieving some of the environmental pressures that motivate people to use them. In particular, policy makers should focus on those social, economic and cultural factors which make certain populations vulnerable to intensified or compulsive drug use.

A policy which emphasizes discrimination in institutional response, as well as individual responsibility and prudent decision making, is more likely than a purely negative policy to foster coherent public attitudes toward drug use. By including alcohol use and self-medication with psychoactive substances as well as "street use," drug policy can promote development of sounder beliefs toward those behaviors, removing the need to hide behind semantic walls and specious distinctions. Further, an emphasis on prudent decision-making will also alert physicians, clergy, pharmacists, psychologists, teachers and others to whom individuals look for information and support, to the importance of their assisting the individual in understanding his needs and his personal responsibility for his decisions and their consequences.

This approach places the responsibility where it belong: on the individual and those institutions closest to him and not on the drugs or on the government. Indeed, policy should demythologize the drugs themselves as part of a general attempt to focus public attention on human needs and on the urgency of developing satisfactory non-drug alternatives. When drugs are regarded less often as villains, they are also less likely to be regarded as panaceas.

Risks and Perceived Advantages

Drug policy must stop dealing with only one side of an equation, the risks of drug use. In order to facilitate responsible decision-making in moving closer to the proclaimed ideal, social institutions must deal directly with the perceived attractions of drug use. With youthful users in particular, there can be no credible dialogue about drugs without admitting that there are at least two sides to the issue to be discussed.

Cigarette and alcohol policy suggests strongly that emphasis on risks has a minimal impact on the behavior of those otherwise likely to use drugs. Instead, institutions should address beliefs about the needs which drugs are perceived to fill and should attempt to influence the meaning they have on individual and group behavior. The individual, in turn, must face his actual motivation for use, with a view toward finding alternative outlets for self -expression and alternative means of altering his mood.

Designing a Differential Response to Drug Use

Policy must reflect complexity of drug-using behavior, including differences in the drugs themselves; in their interactions with the personality of the users; in the amounts, frequency and settings of use; and in the meanings and functions of drug use to the individual and the society. The tendency to regard drug use as a unitary phenomenon has been a major reason for current confusion and for ineffective individual and corporate action. To illustrate the need for a differentiated response, we will refer to the general patterns of drug-using behavior described in Chapter Two.

Youthful experimentation, for example, raises special concerns. This population is substantially more likely than adults to engage in irresponsible and unstructured drug-using behavior. Youth is generally a time of experimentation, as well as a time when peer groups exert an especially powerful influence on individual behavior. Consequently, in discouraging experimentation with drugs, society must concentrate on persuading the young that the experimental motivation, so healthy in other respects, is undesirable where drugs are concerned. In doing so, efforts must be made to act as much as possible through the peer group to reinforce the desired, non-using behavior. As a corollary, social institutions must attempt to anticipate, new forms of drug experimentation, intensifying formal discouragement efforts when sudden changes in drug use patterns increase the danger of disruptive, unstructured behavior.

Recreational use is a low-risk behavior as long it is appropriately ritualized to minimize adverse social consequences. However, policy should seek to discourage all self-defined use by removing various social incentives to recreational use (such as minimum drink requirements and the symbolic attributes of marihuana). Individuals must also assess the value of drug use, including alcohol, as a recreational behavior in their own lives.

Almost by definition, the risk of circumstantial drug use is low on the scale: the major concern is that a drug-taking response to a given situation may become recurrent. Institutions should encourage individuals to deal directly with underlying conditions or to seek nondrug coping mechanisms. At the same time, policy makers must recognize that circumstantial drug use is increasing significantly, and that, at best, the institutional response, can only partially restrain it.

The major thrust of policy should be to minimize the incidence and consequences of intensified and compulsive use. Such behavior poses significant risks to the individual and to the society and often signifies underlying problems of personal and social adjustment. These risks are maximized, of course, when the drug-taking behavior dominates the individual's life style and when absence of the drug precipitates serious behavioral disruption. Concerted effort including, where appropriate, paternalistic intervention by society, should be devoted to identifying those in need of assistance, and to providing the necessary health and social services.

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