Drugs including alcohol and tobacco products are a major cause of harms to individuals and society. Some drugs are therefore scheduled under the United Nations 1961 Single Convention on Narcotic Drugs and the 1971 Convention on Psychotropic Substances. These controls are represented in UK domestic legislation by the 1971 Misuse of Drugs Act (as amended). Before 1971, the UK had a relatively liberal drugs policy and it was not until US influence had been brought to bear, particularly in the aforementioned circles, that controlling incidental drug activities was employed to effectively criminalize drugs us. Other drugs, notably alcohol and tobacco, have long been regulated by taxation, sales, and restrictions on the age of purchase.
On 3rd June 2007, I was admitted to the Royal Free Hospital at the end of several years suffering from a severe alcohol dependence syndrome 2003-2007. Alcohol treatment for me is now obligatory. I have been in recovery for 40 months, living a very fulfilled life in the abstinence of alcohol, and I now have insight into the disastrous effect it had on my personal and personal life. I was admitted to the Royal Free having sustained a cardiac arrest and an epileptic seizure, spent two months in a coma, but then emerged – not brain-damaged, but disabled.
I completed my postgraduate medical training as a physician in 2005. Whilst I am not a practising physician, I have passed all my exams that prove that I understand medicine, and alcohol-related medicine. However, I must admit to not understanding the impact of alcoholism until my recovery. I used to wake up in the morning, and have to have a ½ bottle of gin. I used to go to the news agents to buy alcohol at 11am in the morning, and I couldn’t function at all. I had lost my job in 2005 anyway, and got erased from the General Medical Register in 2006/7. The General Medical Council were aware of my problem as far back as 2003, but I was left on the general medical register until 2006 when I was provisionally erased. I resent this lack of treatment, but it was not for the General Medical Council to treat me under any legal obligation of ‘duty-of’care’. I would argue that they have some sort of quasi-moral one, simply because of the Hippocratic Oath which governs the behaviour of all doctors to patients, even if their patients are other doctors. Therein lies the conundrum of treatment for professionals – you don’t wish to admit you have a problem, and you don’t have insight anyway; obviously, you have nobody apart to blame, apart yourself, if you go down this route. In recovery, on the other hand, the paradox is that you certainly need the help of others, but you can’t make it on your own. Anyway, ‘every cloud has its silver lining’. I was able to complete both my Bachelors and (nearly) my Masters of Law, where my interests in law and philosophy have converged on the notion that legal responsibility is very hard to define where the extent of a defendant’s voluntariness has been compromised by mental illness. That issue is for another day but I have much enjoyed analyzing (and agreeing with) the arguments of LJ Sedley of the House of Lords (now the Supreme Court).
Enough about me suffice to say that I love my life, and indeed proselytizing about recovery to others. I am always taken aback by how common alcohol problems are, as a member of society not as a doctor, ahead of problem drinking or alcoholism. The vast majority of people are capable of being social drinkers, and do not benefit from interference with their lifestyles. I am different. If I have another drink, it will kill me, because I wouldn’t be able to stop drinking until I drop. I would just keep going on, and going, and going. I have seen others do it every night in Clerkenwell Road, vomiting in the streets, but they wake up the following with the hangover; some may even go as normal to work. I now detest this lifestyle. I used to be a ‘revolving door’ patient, but I don’t wish to pay Russian Roulette with my life. Last time I did, I woke up on the top floor of the Royal Free, having been written off by the superb NHS consultants, disabled, having received a catheter and tracheostomy, but alive.
I sent Prof. David Nutt an e-mail this morning. He is absolutely adored by his patients, and by all the national and international experts that I have ever met in addiction disorders. Genuinely, I find him a wonderful and inspiring man. I take what he says very seriously; he is often misquoted, and he makes clear that no drug is safe. If you’re the one in the million that reacts adversely, a mass of statistics won’t impress you particularly. Nutt had his latest paper published in the Lancet around midday today. Indeed, on the Centre for Crime and Justice Studies (UK) website which funded this study, Professor Nutt today is remarked to have said:
`No one is suggesting that drugs are not harmful. The critical question is one of scale and degree. We need a full and open discussion of the evidence and a mature debate about what the drug laws are for – and whether they doing their job?‘
There is no point us burying our heads in the sand pretending there is no problem as member of the Big Society. By August 2010, David Cameron deduced a problem with very cheap alcohol being sold by supermarkets which people were drinking before heading out for the evening. The House of Commons Health Select Committee and NICE have voiced strong support for minimum pricing. Hospital admissions due to alcohol have risen by 825 a day in five years to almost a million, researchers found today. The Alcohol Commission has recommended a ban on selling drink at below the “floor price” of the cost of production, plus the cost of duty and VAT. Recent data suggest that northerners were found to be the hardest drinkers but the most alcohol-related crimes were committed in London. (from the Liverpool John Moores University’s Centre for Public Health in the “Lape Report”).
There were 945,469 admissions to hospital for alcohol-related harm in England in 2008/09. The data from CIVITAS make staggering, and depressing reading, The overall annual cost of crime and anti-social behaviour linked to alcohol misuse is estimated at £8-£13bn a year. In 2004, the approximate figure had been £7.3bn. Thankfully, detoxification is available on reception in all local and remand prisons: during 2002-3, around 6,400 prisoners received alcohol detoxification and 7,000 combined drug and alcohol detoxification. Indeed, Alcoholics Anonymous run services in around 50% of prisons currently. The use of such drugs including might not only result in physical and mental harm for the user, but can also present great burdens to society, such as aggression, car accidents, poverty, job absence, and health-care costs.
Today, Professor David Nutt’s team published their latest findings on the relative risk of alcohol. Their findings supported previous work in the UK and the Netherlands, confi rming that the present drug classification systems have little relation to the evidence of harm. They accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy. The authors argued, to provide better guidance to policy makers in health, policing, and social care, the ‘harms’ that drugs cause needed to be properly assessed, but the authors readily admitted that a major issue is how you assees ‘harm’ in the first place.
Members of the Independent Scientific Committee on Drugs (ISCD) 1-day interactive workshop were invited to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals, whereas alcohol, heroin, and crack cocaine were the most harmful to others. Overall, alcohol was found to be the most harmful drug, with heroin and crack cocaine in second and third places. The correlations between the Independent Scientific Committee on Drugs (ISCD) overall scores and the present classification of drugs based on revisions to the UK Misuse of Drugs Act (1971) is 0·04, showing that there is effectively no relation. The ISCD scores lend support to the widely accepted view that alcohol is an extremely harmful drug, both to users and society; it scored fourth on harms to users and top for harms to society, making it the most harmful drug overall.
Different regulatory approaches have therefore been used to restrict the adverse effects of licit and illicit drug use, varying from punitive prohibition, to partial liberalisation, to full legislation of the drug market. An area of work which I will be followed in the near future is whether the behaviour of addicted individuals can be ‘incentivized’ – can an alcoholic be ‘nudged’ to give up under the right circumstances? Such libertarian paternalism is of course gathering some momentum in the US and here. Notwithstanding, experts have argued that overt and explciit criminalisation of drug use has low efficacy in reducing the prevalence of drug misuse, and even seems to promote petty and organised crime
As such, these new data provide an extremely valuable contribution for the re-evaluation of current drug classifi cation in the UK. A major point not addressed in the study, because it was outside the investigators’ scope, is polydrug use, which is highly prevalent in recreational drug users. The major funding must be surely that, for the discussion about drug classification, the two legal drugs assessed — alcohol and tobacco —score in the upper segment of the ranking scale, indicating that legal drugs cause at least as much harm as do illegal substances.
For me, it’s simple. I have never touched any drug apart from alcohol, but I can’t even risk having any of these drugs for the rest of my life, including alcohol or tobacco. For me – it’s simples – if I do, I will be dead!
Dr Shibley Rahman is happily in recovery for 40 months now, has done 2 books, nearly 2 law degrees, has become a company director and an Associate of the IoD as well as a FRSA, in that time.