Philosophical issues in the policies of substance abuse treatment

Abstract

While in search of a definition of health, we describe the spectrum covering the philosophical continuum between the extremes: the professional definitions of health vs the lay belief; the objective vs the subjective accounts of health. In other words, we describe the notion of 'being healthy' as opposed to 'feeling healthy'. Health is defined as a collection of states in which the individual's perceived feelings and needs are fulfilled, and good life is achieved rationally and knowledgeably. This definition of health cover the whole make-up of a person, that is, the physical, psychological, social and spiritual dimensions. 'Being healthy' is actually a knowledgeable 'feeling healthy'. In this context, substance abuse is described as a 'feeling' and, at the same time, a state of 'being' unhealthy in all factors that make up well-being. Be it a disease, illness or sickness, substance abuse, especially in its very extreme - dependence and addiction - disrupts all that the humans consider as health, including his/her own human dignity and free-will. It is a known fact today, that a substance abuser is one who has a problem, as opposed to the traditional definition of a substance abuser as merely one in the pursuit of pleasure. The substance abuser is a sick person, so he/she has more than one thing 'less' in his/her personhood. Philosophically, such a person is: 1) abnormal (when compared to the majority of society), 2) carrying out an activity that disrupts one's 'self'; and 3) potentially considered as a 'patient', and therefore needs to be treated. However, before we tum to the philosophical issues of treatment, we discuss how substance abuse and dependency, even though out of personal choice, go against the moral ideal of autonomy and dignity of the individual. In response, and with one's consent, many health professionals have tried to offer a plausible holistic approach to substance abuse, to its assessment and towards the restoration of the healthy state. In this work, we demarcate the methods used so far: treatment interventions, control efforts and the contemporary harm reduction approach. All these methods have treated the issue in an individualistic manner where the substance abuser and his/her individual choices are at the focus. All put knowledge as a key factor in their attempt to restore health, and at the same time, all have tried to eliminate or minimise illicit substances and abuse but have failed to do so. We have not offered anything new in arguing that any policy should be based on the belief that encouraging healthy living is better than fighting illicit substances and substance abusers. What is new, in this work, is that traditional treatment and control methods, including the harm reduction approach, are put forward as merely politically correct. Most of these, we argue, are short-term. We justify the suggestion of a holistic community-based approach - as a long term strategy - and consider the individual as a member and part of a wider context: a healthy society.