Disease or crime?

FOR THE first time in decades, drug addiction has become the No. 1 reason for psychiatric admission in our institution. The youngest patient I have encountered was an 11-year-old boy who was introduced to methamphetamine use by his uncle. There were others like him whose heartbreaking stories I just used to hear in the news. The exponential growth in the number of people struggling with drug addiction has recently come to light and rocked our society. The report from authorities is that as many as 92 percent of barangays in Manila were involved in drugs as of February 2015. Personally, I have witnessed an unprecedented surge in the number of patients seen at the emergency room or admitted to the wards due to drug addiction.

A conservative estimate of people admitting to drug abuse or addiction is 150,000 or so, with thousands more to possibly follow suit. Jose Ma. Montelibano wrote in a recent article: “The volume of [surrenderers] is shocking … and the shock is necessary because concerted action by different sectors of society is now possible, even sought after.”

Indeed, we need this shock as an impetus to act.

Two things are being highlighted in the news: the sheer number of people who admit to drug use, and the rising number of killings of suspected drug users and pushers. I agree that the rising number of extrajudicial killings is alarming and must be addressed. The right to due process is universal and as a democratic society, we cannot afford to lose it.

Meanwhile, social media is replete with varying opinions on the war on drugs, ranging from high approval to outright disgust. The government’s initiative is far from perfect, but we cannot deny that it is one of the most willful that we have seen so far.

But while the current discussions mostly revolve around politico-moral issues, only a few are asking the important question: How do we deal with those who want to get out of this addiction?

There are many ways to view drug addiction. We can view it as a criminal act—the widely accepted perspective at the moment. But from a medical standpoint, it is not a mere crime; it is a disease. The abnormalities that produce addiction are wide-ranging, complex, long-lasting, and involve an interaction of environmental effects such as stress, the social context of initial drug abuse and psychological condition, as well as a genetic predisposition in the way the brain is wired abnormally even before the first drug dose is taken.

The chronic nature of this disease means that relapse is not only possible but also highly likely. Relapse rates for drug addicts are similar to relapse rates for those afflicted with other well-known noncommunicable diseases such as hypertension, diabetes mellitus, and asthma, which also have both physiological and behavioral components. Similarly, treatment of drug addiction involves use of appropriate medication and change of deeply embedded behaviors. If a person in treatment has a relapse, it means that treatment needs to be adjusted or another treatment should be tried.

To solve this pressing problem, the radical and popular sentiment is the elimination of the source. This solution is hinged on the simple logic of “no illegal drugs, no user.” This is laudable, if realized, but is not sufficient. In reality, curbing the illegal drug trade involves many individuals from all sectors of society and factors such as poverty, major change in social dynamics, and politics. Indeed, whether this could be realized still poses many questions because the process is slow and will address only one facet of the complex issue of the rampancy of drug use. It is obvious that the government cannot handle this issue alone and requires our help.

The way I see it, we must go full throttle if we are to combat this problem: The state needs to man up to its implementation of the existing laws on drugs, and we need the collective efforts of everyone in society.

Studies consistently show that the crisis of violence, drug addiction, and extremism is the crisis of disconnection. Isolation is often cited as an effect of industrialization. Big cities breed isolation as individuals are stuck either in competitive workplaces or in traffic, where we may be surrounded by people but still be alone and isolated, with stressful workdays leaving us little energy and less time to spend with our family by the time we get home. Slowly our social institutions that serve as protective social mechanisms are weakened, and increasing stress levels lead to maladaptive coping mechanisms like drug abuse. Thus, the value of meaningful social relationships cannot be overemphasized. If we can address this issue on an individual level—as we strengthen families and push for strong communities in our cities—then we are one step closer to prevention of drug abuse.

Graphic and effective mass education about the destructive effects of illegal drug use, including how much havoc it wreaks on our brain and body, and how dependence takes over our lives to the point that we lose our personhood, could further fortify our drive against drug addiction. We badly need to deliver this message to the general public in a manner that cuts through to the heart.

The highly needed solution is the establishment of public rehabilitation centers. In this, the state badly needs financial and logistical support from the private sector. This requires political will and a strong sense of social responsibility. Some would say this is impossible, but I saw how powerful citizens could be during the May elections, when a leader backed by a segment of the populace won by a large margin despite a lack of resources and the polarized views on the then presidential candidates, I am convinced that we can arrive at a solution if as much passion were devoted to this issue.

To repeat, government enforcement agencies may curb the supply of illegal drugs but only communities can help in the significant reduction of the demand. Other countries have done it, and it is imperative that we learn how they turned the concept of drug-free communities into reality. There are also research-based guidelines that we can use in making feasible community-based programs on how to prevent and treat drug use.

In medicine, we are taught to view a sick person as a biopsychosociospiritual being. In the same way, the drug problem is multifaceted and must be addressed from all perspectives. It entails a massive realignment of focus from person to disease, and a realignment of our moral compass—instilling a sense of purpose so that we will have the internal strength to hate what is evil and do what is right.

This battle must be fought now because it is a battle for the generations to come. Ultimately, it is a battle of our generation that we cannot afford to lose.

Faye Sinoy Travilla, RN, MD, graduated from the University of the Philippines Manila and works at a tertiary hospital.