Drug Use, Addiction, and Subcultures: A Law Enforcement View

Introduction

Today, tens of millions of Americans routinely use some type of illicit drug, and the search for ways to help those who become addicted continues in earnest. In the interim, growing numbers of law enforcement organizations have taken assertive steps to help individuals who have developed an addiction receive the interventions they need to overcome these potentially life-threatening behaviors. This paper provides a review of the relevant literature concerning drug use and addiction in the context of deviant behavior, the subculture that exists among drug users and addicts, and their potential for participation in illegal activities. It also examines why an understanding of this subculture is important for those involved in law enforcement and how that understanding can facilitate prevention, recovery, community service, and more effective policing.

Overview of Drug Use and Addiction

In modern American society, the use of a wide range of drugs is regarded as acceptable behavior that does not deviate from the norm. For instance, people drink alcoholic beverages and coffee, which contains caffeine; smoke cigarettes, which contain nicotine; and a majority of Americans take some type of over-the-counter medication such as aspirin without violating any social norms (except for tobacco use, which is increasingly restricted and viewed as unacceptable in some contexts). While these behaviors are not considered deviant, the line is crossed when people continue to use illicit drugs or misuse prescription drugs even when such behaviors cause them enormous problems — including the loss of family, employment, and involvement with the criminal justice system.

It is important to note, however, that humans have been using mind-altering substances since time immemorial, so views about deviant behavior are temporally and culturally specific. This is evinced by changing social views about cannabis use, with Mexico and Canada as well as a majority of U.S. states having legalized medical marijuana in recent years, and growing numbers legalizing it for recreational use as well. This stands in sharp contrast to just a few years ago, when the possession of even small amounts of marijuana carried stiff fines and even incarceration. It is also important to note that the harm reduction model — used by many countries and placing a higher priority on helping those who have become addicted achieve recovery rather than penalizing them criminally — is a fairly recent trend as well (Pereira & Scott, 2017). Notwithstanding these considerations, and for the purposes of the discussion that follows, drug use and drug addiction will be operationalized as involving illicit substances such as nonprescription opioids.

While intensive research continues into the antecedents of drug use and eventual addiction, a growing body of evidence indicates that the condition is a medical disease rather than a personality deficit that compels certain people to abuse various substances, most of which have some type of addictive quality. In this regard, Miller (2009) emphasizes that "most scientists now consider drug addiction a biomedical rather than a psychological condition, or a failure of will, as many laypersons still believe" (p. 14). The rationale supporting the harm reduction model is therefore based on the same thinking that applies to diseases such as diabetes or cancer, wherein sufferers are not treated as criminals but are instead provided with the interventions they need to survive and restore their health to the maximum extent possible.

The American Psychiatric Association and the American Medical Association, along with numerous other healthcare organizations, currently define drug addiction as "a brain disease that causes an uncontrollable, compulsive drug craving, seeking, and use even in the face of negative health and social consequences" (Miller, 2009, p. 14). This definition further underscores the baffling nature of drug addiction for people who have never suffered from the disorder — a point consistently stressed by twelve-step organizations such as Alcoholics Anonymous and Narcotics Anonymous.

It is also important to differentiate drug addiction from drug dependence. The latter refers to the potential for "drug sickness," or the psychological and physical withdrawal symptoms that occur when use of the drug is discontinued (Miller, 2009). In cases where drug sickness is not a potential outcome and the primary adverse reaction to discontinued use is psychological, the condition is considered drug addiction. As Miller notes, "certain drugs, such as heroin and alcohol, create physical dependence, while other drugs, such as cocaine, produce very few symptoms of physical dependence and are therefore referred to as primarily creating psychological dependence" (2009, p. 14).

DSM-5 Criteria for Substance Use Disorders

Some additional definitional clarity is available from the DSM-5 criteria for substance use disorders, which also takes into account the fact that some individuals appear to be psychologically predisposed to developing drug addictions (Hartney, 2018). The DSM-5 criteria further include the tendency for affected individuals to continue their drug use despite the problems that result from these behaviors (Hartney, 2018).

The substance use disorders covered by the DSM-5 encompass a wide range of problems that tend to result from continued substance use, including the following:

Furthermore, the DSM-5 criteria provide a framework in which clinicians can specify the severity of the behaviors along a continuum depending on the type and duration of problems caused. As Hartney (2018) advises, "The DSM-5 allows clinicians to specify how severe or how much of a problem the substance use disorder is, depending on how many symptoms are identified. Two or three symptoms indicate a mild substance use disorder; four or five symptoms indicate a moderate substance use disorder; and six or more symptoms indicate a severe substance use disorder" (para. 4). In addition, the DSM-5 diagnostic criteria allow clinicians to specify whether the disorder is "in early remission," "in sustained remission," "on maintenance therapy," or "in a controlled environment" (as cited in Hartney, 2018, para. 3).

Taken together, it is clear that an enormous amount of scholarship has been focused on drug use and drug addiction, due in large part to the profoundly adverse effects these behaviors have on individuals and the larger society. Just as clinicians continue to seek a better understanding of the etiology of drug use and addiction in order to formulate more efficacious interventions, so too do law enforcement authorities need to understand the subculture that exists among these individuals.

Conclusion

Although tens of millions of Americans routinely use legal drugs of all types, including powerful prescription medications, these behaviors are not regarded as deviant because they fall under the umbrella of what is socially acceptable. When drug use transforms into drug addiction, however, affected individuals can suffer a wide array of psychological and even physical problems, including an increased potential for experiencing violent crime while in search of their drug of choice. The research consistently emphasizes the need to view these behaviors as part of a disease — and that people suffering from a disease should not be treated as criminals but should instead receive the assistance they need to restore their lives to a healthy condition. Because of their direct involvement with drug subcultures, law enforcement authorities are well positioned to facilitate this assistance, provided they gain a genuine understanding of the underlying factors that cause drug addiction.

References

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Hartney, E. (2018, September 26). A guide to DSM-5 criteria for substance abuse disorders. Dotdash Publishing. Retrieved from

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Miller, R. (2009, February). Advancing understanding of drug addiction and treatment. Science Scope, 32(6), 14.

Pereira, M. & Scott, J. (2017, January 1). Harm reduction and the ethics of drug use: Contemporary techniques of self-governance. Health Sociology Review, 26(1), 69–73.