Addiction, community and state: a review

As clinicians, we are well aware of the importance of drug supply, price, availability, and access in propagating and maintaining illicit drug use, abuse, and addiction. However, we tend to be silent on these topics, leaving them to elected and appointed government leaders. The author proposes that our remaining silent is analogous to an infectious disease expert remaining silent on water supply and sewage in the midst of a cholera epidemic. It is not only unseemly for us to remain silent, it is unprofessional at best and unethical at worst. Governmental means of addressing the social genesis of addiction and illicit drug supply falls under the general rubric of statecraft. Our elected leaders, our appointed governmental leaders, and our publicly supported workers (e.g., police, courts, schools, health care workers, social agencies) can and do exert influences either favoring or counteracting illicit drug supply, use, abuse, and addiction. Public officials can and do learn the exercise of statecraft in addressing a large range of social needs, such as housing, transportation, security, a safe food supply, and so forth. They can and should develop knowledge, skills, and experience in the exercise of statecraft vis-a-vis drugs. This article reviews the relevant literature on this topic. In addition, the author reflects on his observations on "addiction statecraft" in several countries over the past three decades. He underscores the need to consider elements such as community deterioration, corruption of police and other officials, and social anti-drug strategies that have worked as well as those that have not worked. Public leaders must also take stands regarding intervention and treatment programs that are not widely popular, such as those involving methadone. The author argues that we speak out authoritatively on "addiction statecraft." In undertaking such social roles, we must take care to speak out of our own collective wisdom and experience, rather than out of personal bias or personal agendas.