I recently came across a tweet suggesting that stress is like an unwelcoming rat cage that predisposes to drug use, and that a stress-free environment is like the drug-averse rat paradise presented in scientific research and described in a Ted talk by Doctor Carl Hart, Professor of neuroscience at Columbia University. The tweet also offered a link to a thought-provoking piece reporting on other experiments with rats that correlate stress hormone levels and cocaine use relapse, published on the website of the National Institute on Drug Abuse (NIDA), a US government Department of Health agency. 

The “rat cage – rat paradise” dichotomy is worth closer consideration. 

According to UN estimates, widespread drug use continues world-wide. Up to around 7% of the population take drugs at least occasionally. Looking at global figures, the drugs death toll is roughly ten times that of terrorism. Europe counts not less than 16,000 drug-related deaths per year, with opioids leading among the primary illicit drug of concern. 

The most vulnerable in society, especially children and other persons who have been physically or sexually abused, refugees, migrants and displaced persons, as well as those suffering from discrimination and marginalisation, are the most likely to experience substance use disorders. The prevalence of by non-medical use of prescription drugs is particularly high among women. Meta-research conducted for the Pompidou Group – the drug policy think-tank and cooperation platform facilitated by the Council of Europe – reveals that stress-related settings may well be conducive to this type of disorder. All of these circumstances are compounded by the stigmatisation of drug use, often presented as a vice, with addiction as the extreme expression of self-gratification or indulgence, and the fallout of the drug control regime, in particular illegal trade and drug related crime.

Like stress or trauma, substance use and related disorders have no social boundaries. But their acceptability has often apparently evolved, with use of psychoactive substances being embraced for recreation or relief by distinct social groups or élites to be demonised later when broader segments of society took to them. Psychedelic substances, opium and other plant-based psychoactive substances, and also alcoholic beverages, have a long history. Recounting the 100 years of the war on drugs which commenced with the International Opium Convention in 1912, the BBC reported on 19th century beer laced with opium or drug use by queen Victoria, including accompanied by a young Winston Churchill; the BBC quoted Victorian Britain having been “awash with opium”. 

Many more recent examples can be found across the world of reported substance use, whether problematic or not, among statesmen and women, and their siblings, celebrities and many others. A few days ago we were treated by media with footage of a supposedly successful finance sector City worker ostensibly snorting white powder in a crowded London Tube carriage. 

The “rat cage – rat paradise” dichotomy might explain to some extent the commonalities between these different scenarios, and also the obsession with drugs in many prison settings. What if Doctor Carl Hart and others who advocate the rat cage paradigm were right? Would this also explain the success (rat paradise) and failure (return to the rat cage) sequences of rehab?

According to the European drugs observatory (the EMCDDA) the drug-related death rate in the European Union ranges from three per year per million inhabitants in Portugal to more than 120 in Estonia, a forty-time factor that may at least in part be explained by policy choices that gravitate towards a rat paradise (e.g. through decriminalisation of use, harm reduction and treatment) or towards a rat cage. Spain reports five times the death rate of Portugal and the UK fifteen times. The drug-related death rates in the US appear to be even higher, with as much as 100 times the Portuguese figures for some states.

If we are confronted with different décors for drug-prone stress, neglect and hopelessness, against a possible backdrop of trauma – should the response not address the root cause with empathy, understanding and human warmth (the stereotypical: confront drugs with hugs) rather than stigmatisation and punishment? Even recreational and feel-good use may be explained by the rat cage setting, when drug is use as a means of instinctively muffling feelings or emotions, or yielding to peer pressure in an attempt to fit in and overcome fear of loneliness.

We must continue looking for longer term answers that will pass the test of time, unlike the war on drugs that many people claim has failed and has caused considerable collateral damage. As the UN Secretary General says on the occasion of the international day against drug abuse and illicit trafficking “We must consider alternatives to criminalization and incarceration of people who use drugs and focus criminal justice efforts on those involved in supply. We should increase the focus on public health, prevention, treatment and care, as well as on economic, social and cultural strategies.” 

Indeed, it seems sensible to embrace the “support, don’t punish” approach – one step closer to paradise and one further from cage – that some 150 civil society organisations across the world promote together with many political and other personalities of global notoriety. The 26 June is a day to reclaim drug policies that prioritise public health and human rights. This may be the best chance of survival we can offer to the next thousands of potential lethal victims of drugs.