Silent drug menace

The inappropriate prescription of psychoactive
drugs barely creates a ripple outside the professional press, but
it is at least as big a social problem as that of illegal drug use,
writes Peter Beresford.

The mere mention of drugs seems to have weird,
mind-altering effects on the public and policy debate. Out go
reasonable discussion and rational decision making. In come
self-serving moralising and the crassest kind of populism. Yet in
the UK and the West, we don’t have a drugs problem. We have at
least three. Only one, illegal drug use, is a headline banker. The
second, cigarettes and alcohol, is more important as a revenue
collector, while it also generates death, disease and mayhem on a
massive scale. The third, the inappropriate prescription of
psychoactive drugs, barely creates a ripple outside the
professional press. Yet a strong claim could be made that this is
at least as big a social problem as the others, even if it is a
silent one.

To
talk about the misuse of psychoactive drugs is a bit like talking
about the mis-selling of private pensions. It sounds a lot less
awful than it actually is. Those victimised by it have few
advocates. Some of its expressions are better known, for example,
the disproportionate prescription of major tranquillisers and other
psychoactive drugs to mental health service users who are members
of cultural and ethnic minorities and who are denied more valued
alternatives.

What
is most shocking, however, is how widespread the use and abuse of
psychoactive drugs is. There barely seems to be a group unaffected
by it. From the children routinely prescribed Ritalin in the USA to
the legions of older people dosed up in nursing and residential
homes here, the problem is pervasive. Too often it is the knee-jerk
response to bereavement and in some cases to people facing
life-threatening illnesses as a cheap alternative to counselling
and support. It’s rapidly used when people have or acquire
physical, sensory and intellectual impairments and are not seen to
have “adjusted” adequately to a disabling world. It’s the ready
response to people with learning difficulties, labelled with
“challenging behaviour”.

If the
19th and early 20th centuries were the age of physical constraint
and segregation for groups identified as dependent or deviant, we
seem to have moved unthinkingly since to acceptance of the chemical
cosh and straitjacket, without apparently realising that the
increasing subtlety and sophistication of drugs is still no
justification for their wrongful use. Service users say “they just
gave me the pills” and talk of tiredness and lethargy, an inability
to concentrate, feelings of disorientation and being divorced from
themselves. For mental health service users, “side effects” range
from vomiting to tardive dyskinesia and death.

I can
speak from my own years of experience of a solution worse than the
problem, which set back my own chances of sorting things out and
took more years to resolve. No one is saying that psychoactive
drugs are necessarily bad, but there are some basic rules to be
followed. Recipients need accurate information and a real say in
their use. They must be used strictly in accordance with
established guidelines and never as an alternative to preferred
options.

There
is no question that psychoactive drugs serve as a means of social
control, but that’s only half the story. They are also used
routinely to save time, money, effort, skill and emotional
commitment. Perhaps the real question is: what would a world look
like where their misuse was no longer possible, where convenience
chemicals were no longer an option?

It is
likely to be a very different world, a richer, brighter one, where
people could work through difficulties and come out the other side,
instead of being forced to put them on hold, possibly for the rest
of their lives. Of course, we could expect to see powerful
resistance from a globalised drugs industry, fearful for its profit
base, but we could also look to a radical shift from the
medicalisation of difference and distress, and the current
proliferation of diagnostic categories.

We
could look forward to a new determined search for the social
origins of problems and the reconnecting of personal ills with
public policy. Budgets could be more readily revised upwards to
take account of the real costs of prevention and support. We would
be better placed to connect the physical, mental, spiritual, social
and political in Western societies like ours. Most of all, it would
mean the generation of new opportunities to achieve, contribute and
create social wealth, as people are liberated from psychic storage
to become their full selves, in all their diversity.

Peter Beresford is professor of social
policy at Brunel University and is active in the psychiatric system
survivor movement.