Addictions Advisor: Addiction, Racism, and the War on Drugs: Is There an End in Sight?
By Iris Jones, LPC, LCADC, CCS, NCC
Social Work Today
Vol. 22 No. 1 P. 30

If addiction is a disease, then why are so many people incarcerated for having an illness? In 2022, why does the War on Drugs still exist?

Recent research shows that more than 65% of the U.S. prison population meets criteria for an active substance use disorder (SUD) (National Institute on Drug Abuse, 2020). Despite recognition from all the major medical associations that addiction is a neurobiological disease, millions of people remain incarcerated or have criminal records for substance use and receive little to no evidence-based treatment. Racial minorities constitute a disproportionate number of those arrested, prosecuted, and imprisoned for drug-related offenses (Miron & Partin, 2021).

With more than five decades of failed U.S. drug policy and no clear, agreed-upon path forward, addiction as a public health crisis remains largely unaddressed and unresolved. As with many of our nation’s failures, People of Color continue to bear the brunt of our inability to effectively recognize and treat those struggling with addiction.

Treat Addiction as a Chronic Disease
A staggering 93,331 people died from an overdose in the year 2020 (Centers for Disease Control and Prevention, 2021). As a nation, we have yet to figure out how to decentralize methadone treatment or increase community access to buprenorphine, both of which are the standard care for the treatment of opioid use disorder. Twenty-three million Americans are currently addicted to alcohol and/or other drugs, but only 1 in 10 (2.6 million) receive any treatment (Substance Abuse and Mental Health Services Administration, 2020). People of Color are the least likely to receive evidence-based treatment (Saloner & Lê Cook, 2013) and are more likely to be punished than their white counterparts, even though they have slightly lower rates of overall substance use (Earp et al., 2021).

The problem isn’t in how addiction is defined—the American Society of Addiction Medicine recognizes addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

Also, the American Psychiatric Association concluded that SUD “is a complex condition in which there is uncontrolled use of a substance despite harmful consequence. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs to the point where the person’s ability to function in day-to-day life becomes impaired.”

With those definitions in place, it is impossible to argue the legitimacy of addiction as a chronic disease.

It is also well documented in the medical literature that SUD prevention and treatment approaches are as successful as those of chronic diseases such as hypertension, diabetes, and heart disease. Yet incarceration is still used as the primary “intervention” for those with SUD. These individuals far exceed those who receive medical care. According to the Drug Policy Alliance, the United States arrests more than 1.5 million individuals every year, 85% of whom are apprehended solely for possession. Once incarcerated, individuals have limited access to evidence-based SUD treatment and experience increased health risks that result in reduced life expectancies (Earp et al., 2021).

While none of the research supports incarceration as an effective form of intervention, policies continue to criminalize substance use rather than provide access to quality medical and behavioral health care. The negative behaviors associated with addiction are emphasized and punished, and there’s a failure to recognize that these very behaviors are a direct result of having an SUD rather than a moral failing.

To understand why the War on Drugs continues, one only has to go back to the early narratives and policies that formed around drugs, addiction, and People of Color.

A History Filled With Racist Narratives
As the fight to move the United States toward the legalization of cannabis and decriminalization of other substances continues, it’s important to note that all drugs were legal prior to 1914. Politicians of the early 1900s, powered by a very influential press, created negative narratives about drugs rooted in racism, fear, and purity culture. They linked those narratives with minorities and crime.

For example, opium was associated with the Chinese and rolled into the Yellow Peril narrative that misrepresented peoples of Asian culture. The Latinx community was paired with PCP (phencyclidine) and cannabis that supposedly led to “reefer madness.” Blacks were associated with cocaine, sparking the myth of the “negro cocaine fiend.”

These narratives promised that crime, violence, and sexual immorality would flood the nation and destroy the very fabric of American society were these drugs permitted; according to them, substance use needed to be criminalized and harsh punishments put in place for those who violated the new laws. By 1971, the Nixon administration had publicly declared a War on Drugs, filling the prison system with minorities and decimating communities of color.

The War on Drugs or the War on Minorities?
The Civil Rights Movement spanned more than two decades as Blacks and those who supported them fought for racial equality. This fight, viewed by many as a form of social unrest combined with historically racist narratives, gave way to national crime policies that have disproportionately affected People of Color. Last June marked the 50th anniversary of the government-led initiative to stop illegal drug use, reduce the illegal drug trade, and prevent crime. And although the War on Drugs has yet to achieve its objectives, funding continues at an annual cost of more than $1 trillion (Levins, 2021).

 In part because of the policies of the War on Drugs, the United States sports the highest incarceration rate in the world (Neuspiel, 1996). Substantial legal and punitive efforts were employed to quell the inner-city drug trade, locking up millions of People of Color into for-profit prisons, while the pharmaceutical industry made billions selling and marketing addictive drugs that resulted in the worst drug crisis in U.S. history.

The overmilitarization and overutilization of police, coupled with discriminatory tactics such as stop-and-frisk, turned urban, poverty-stricken areas into war zones. Instead of addressing the nation’s drug problem, these tactics created new racially charged abuses within communities of color.

Sensationalism in the media played an extensive role in the creation of discriminatory, punitive policies by escalating public fears and normalizing the abuse of Black and Brown bodies by overzealous police forces. Television programs such as Cops, which premiered in 1989, showed police using aggressive tactics against mostly People of Color in the inner cities, flowed into mainstream American homes. America’s Most Wanted, which had successfully launched just the year prior, featured reenactments of dangerous fugitive events with a plea to the American public to participate by calling into the tip line with information.

With no true scientific evidence, mainstream media perpetuated and popularized the “crack baby” myth, swaying public opinion toward harsh punishments and family separations for pregnant women with SUD and ultimately criminalizing Black motherhood. Eventually, urban communities were left without access to treatment, government support, or even public sympathy. They were perceived as morally flawed for succumbing to addiction, deserving of their fate.

However, when the opioid epidemic hit suburban white communities, a new narrative and call for action surged among politicians and the media. People were not to be punished for their substance use or the crimes they committed while under the influence. Monies were earmarked specifically for those with opioid use, while People of Color who have traditionally struggled with crack cocaine addiction could not reap the benefits of the new government treatment dollars.

The disparities would continue to increase as People of Color were forced to attend federally overregulated methadone clinics, while their insured white counterparts gained access to in-office buprenorphine treatment.

Moving Toward an Equitable Future
For a success story, let’s travel to Portugal, where the overdose death rate has decreased to approximately 3 in every 1 million citizens (European Monitoring Centre for Drugs and Drug Addiction, 2017). Evidence-based strategies such as the decriminalization of illicit substances, harm reduction, and the treatment of addiction as part of traditional health care rather than a criminal justice issue have halted the country’s opioid epidemic.

Increasing public awareness of addiction as a neurobiological disease that responds to treatment can reduce stigma and blame while increasing empathy and support (Volkow et al., 2017). “Addiction care needs to be inviting, intentional, and inclusive in order to provide culturally responsive services for diverse communities,” says Zina Rodriguez, MSW, CDE, cofounder of Z & D Consulting and a Certified Diversity Executive.

If there is any hope to avoid perpetuating past mistakes, the political representation of minority communities must be improved to mitigate inequities. It would be a step in the right direction and help alleviate the pain of all those who have been incarcerated for simply having a disease and the Black and Brown families and communities that have been destroyed in an ill-advised war.

— Iris Jones, LPC, LCADC, CCS, NCC, is the manager of clinical operations at the Center for Healing at Cooper University Health Care.

References
Centers for Disease Control and Prevention. (2021, July 14). Drug overdose deaths in the U.S. up 30% in 2020. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20210714.htm

Drug Policy Alliance. Policing and the drug war. https://drugpolicy.org/issues/policing

Earp, B. D., Lewis, J., Hart, C. L., with Bioethicists and Allied Professionals for Drug Policy Reform. (2021). Racial justice requires ending the war on drugs. The American Journal of Bioethics, 21(4), 4-19.

European Monitoring Centre for Drugs and Drug Addiction. (2017). Portugal: Country drug report 2017. https://www.emcdda.europa.eu/system/files/publications/4508/TD0116918ENN.pdf

Levins, H. (2021, June 7). The war on drugs as structural racism. https://ldi.upenn.edu/our-work/research-updates/the-war-on-drugs-as-structural-racism/

Miron, J., & Partin, E. (2021). Ending the war on drugs is an essential step toward racial justice. The American Journal of Bioethics, 21(4), 1-3.

National Institute on Drug Abuse. (2020, June 1). Criminal Justice DrugFacts. Retrieved December 13, 2021, from https://www.drugabuse.gov/publications/drugfacts/criminal-justice

Neuspiel, D. R. (1996). Racism and perinatal addiction. Ethnicity & Disease, 6(1-2), 47-55.

Saloner, B., & Lê Cook, B. (2013). Blacks and Hispanics are less likely than whites to complete addiction treatment, largely due to socioeconomic factors. Health Affairs (Project Hope), 32(1), 135-145.

Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-07-01-001-PDF.pdf

Volkow, N. D., Poznyak, V., Saxena, S., Gerra, G., & UNODC-WHO Informal International Scientific Network. (2017). Drug use disorders: impact of a public health rather than a criminal justice approach. World Psychiatry, 16(2), 213-214.