Drug treatment advocates say jailing addicts and treating addiction like a crime is not working. Drug use is not simply a matter of personal responsibility. People are driven to drugs for different reasons; some do willingly go down the path of addiction, but it's impossible to make blanket statements drug abusers.
No matter the reason drug abusers begin using, the end result is the same. Drugs hijack the reward system in the brain and recruit other body function systems to keep the high going.
Using addictive drugs floods the limbic brain with dopamine—taking it up to as much as five or 10 times the normal level. With these levels elevated, the user's brain begins to associate the drug with an outsize neurochemical reward. Over time, by artificially raising the amount of dopamine our brains think is "normal," the drugs create a need that only they can meet.
Faced with its own heroin epidemic, Portugal took the radical step of decriminalizing drugs and began to treat drug use as a medical issue instead of a criminal one. Officials recognized that choice played a role in addiction but the defining factor of drug use is how it physically changes people. This new approach has proven to be wildly effective.
Cabaz's team of 10 counselors handles all of Lisbon's roughly 2,500 drug cases a year. It may sound like a lot, but it's actually a 75 percent drop from the 1990s. Portugal's drug-induced death rate has plummeted to five times lower than the European Union average.
Others argue the key factor in addiction is choice. Neuroscientists gave addicts a choice between a sample dose of their drug of choice, or cash. He found that addicts typically chose the cash over the dose and when the reward was high enough, addicts chose the cash each time.
This shows that a person's ability to choose and respond to choices and consequences is not destroyed by drugs. The changes drugs create in the brain are not as crippling as conventional wisdom says.
It is certainly true that when people have an intense urge to use, resisting is very, very hard. Yet there’s room for deliberate action in the form of “self-binding,” a practice by which addicts can erect obstacles between themselves and their drugs. Examples include avoiding people, places, or things associated with drug use; directly depositing paychecks or tearing up ATM cards to keep ready (drug) cash out of one’s pockets; or avoiding boredom, a common source of vulnerability to drug use.
That's not to say addicts don't deserve help. It's still extremely hard to stop. But it's important to recognize that addicts must choose to stop using drugs. Personal responsibility still matters. People must want to get clean in order to get clean.
Either way, most Americans agree we should be helping addicts instead of locking them up.