NEW VIEWS PROMPT CALLS TO CHANGE DRUG LAWS

Given its rather self-evident nature, "self-medication" is not exactly a
new concept. Public-health researchers have long been studying how people
use alcohol to reduce stress or sexual inhibitions. But a new appreciation
of the notion that illegal drug users may be "self-medicating," for good or
ill, is changing minds and, in some cases, even laws.

From the use of marijuana in HIV treatment to the spreading abuse of
methamphetamine which one researcher calls "the millennium drug," due to
its performance enhancing appeal the view is challenging the long dominant
views that drug use is criminal or biologically predetermined. Beyond that,
proponents of the "self-medication" theory of drug use are warning that a
society that "just says no" to some drugs but gives a resounding yes to
others is headed for trouble.

Perceptions about drug use in America have never been simple. Our Puritan
legacy says that drug use outside very narrow confines is hedonistic and
dangerous, corrupting both individuals and society. This view drove
Prohibition in the '30s and fuels "the war on drugs" now.

A more modern view sees drug abuse as the result of a biological propensity
to addiction. The most widespread treatment of drug use, Alcohol Anonymous'
12-step program, is based on this belief and its corollary, that only
abstinence can help people who are inherently unable to control their drug use.

Then there is the belief that drugs are chemical tools to achieve specific
goals. This, of course, is the view that has made pharmaceuticals a
fundamental aspect of modern medicine since the invention of penicillin in
the late '40s.

It is also the view fueling the country's seemingly endless drug epidemic.
"'Magic elixir' is a good term to describe the belief," said G. Alan
Marlatt, professor at the University of Washington in Seattle and director
of its Addictive Behavior Research Center. Marlatt says that many people
self-medicate with alcohol and illegal drugs because they hold unrealistic
beliefs about the drugs' effects and dangers. "People are looking for
immediate relief and not attending to the delayed negative consequences."

The main trigger for relapse among abusers "is the need to cope with
negative emotions"' he said. "With men, it's typically anger; with women,
it's depression; with both, anxiety problems. One sees it across the
various addictions...alcohol, stimulants, heroin, even gambling. These
behaviors are seen as a form of stress management."

This image of the self-medicating addict or user now offers a vivid
contrast to the bar-room bred notion of the out-of-control, and often
criminal, drunk. "Even binge-drinking among young male adults can be seen
as self-medication," contends Marlatt. "Young men report that drinking
makes them feel more attractive, less anxious. Binge-drinking to get drunk
is seen as way of preparing for dating and partying." Given the widespread
practice of prescribing the stimulant Ritalin for childhood cases of
Attention Deficient and Hyperactivity Disorder, it should not be surprising
that many researchers now see older users of methamphetamines to be
self-treating, however misguidedly, for undiagnosed cases of the syndrome.
Some researchers also say that stimulants are being used by people as a
means of coping with depression.

"We see it with clinical depression and with depression related to HIV,"
explains G. Michael Gorman, a faculty member at the School of Social
Welfare at San Jose State University. Gorman is a principal investigator of
a National Institutes of Health study looking at methamphetamine use on the
West Coast.

Methamphetamine, or speed, has been called a "poor man's Prozac." Gorman
agrees with the analogy. "Poor or working people can't afford not to have
energy," he said, referring to a major symptom of depression. "They have a
house mortgage to make and kids to provide for. This is especially true of
rural, economically deprived areas experiencing a `'peed' epidemic. There
you find the truck driver driving all night or the waitress with two jobs."

Gorman contends, however, that the functional appeal of methamphetamines
goes beyond the poor and mentally ill. "I like to call this drug the
'millennium drug,'" he explains. "It's the drug for people who never feel
like they have enough time or energy. People believe that the drug extends
their ability to perform, whether in the workplace, social occasions, or
sexually."

One of the main benefits of looking at drug use as "self-medication" is
that it focuses attention on underlying problems and the need to address
them, rather than on the drug use. "Our approach stresses teaching new ways
of coping with negative emotions such as anger management and meditation,"
Marlatt said. "Most drug users won't go to abstinence programs and feel
there's no other type of drug treatment. Our approach gives them options."

In the realm of law enforcement and drugs, the self-medication perspective
has had success in challenging governmental policy on marijuana. Though
widely used medically in America during the 1800s, the federal government
in 1937 classified marijuana, which had become associated with Mexican
immigrants and bohemian African Americans, as an intoxicant as dangerous as
heroin, thus criminalizing its use.

In recent years, medical marijuana proponents have strenuously challenged
this view, claiming that people like AIDS patients use marijuana to ease
the nausea and appetite loss incurred by their medications. The general
public has been increasingly supportive of this view and has in the last
four years passed laws allowing medicinal marijuana use in eight states,
including California and the District of Columbia.

In mandating treatment, and not prison, for first- and second-time
nonviolent offenders of drug laws, Proposition 36 on California's Nov. 7
ballot is another assault on the criminal view of drug use. As Marlatt
argues, "We need drug courts that provide treatment options for drug abuse
and the concurring medical conditions. Prison is clearly not helping not
when 88 percent of all prisoners say they have easy access to drugs."

Of course, the "self-medication" view of drug use has its detractors. Many
say that self-reported data cannot be trusted and that more statistically
based research has not always backed up the theory. People who claim to be
self-medicating are said to be rationalizing their use. Even if abusers are
found to be mentally ill, this school argues that mental illness follows
substance use rather than precedes it. Supporters of tough laws punishing
laws dismiss medical marijuana as a front for legalization.
Decriminalization and the transfer of resources to prevention are seen as
encouraging the use of illegal drugs and unleashing dangerous people on
society. Crime has fallen, this side argues, because the people who commit
it, often to support drug habits, are incarcerated.

Although many experts in public health predict that future research will
ultimately reconcile the views of the school espousing the theory of
biological predisposition and that of the school of self-medication, it is
harder to imagine a successful reconciliation with the criminal view of
drug use. One outcome: It would become increasingly unpopular to impose
severe sanctions on a drug like marijuana that might have legitimate and
important medical uses. Or it may become politically difficult to defend
laws harshly punishing those who use methamphetamines in a society that
simultaneously spends enormous sums promoting Ritalin and Prozac.

Yet confronting the contradictions in society's views on drugs may all be
to the good. "It's ridiculous to have a zero-tolerance war on drugs on one
hand," Marlatt warned, "and the promotion of a pill for every problem on
the other. All of the promotion of instant and easy relief on television
feeds the notion of a 'magic elixir'. It really does set up conflicting
expectations with kids who end up not knowing what to believe. As a result,
they go out there and experiment to find out who is right."

According to San Jose State University's Gorman, such experimentation can
be disastrous when there are powerfully seductive "millennium drugs" out
there. "For a variety of reasons, people are self-medicating with this
drug," he warns. "It's a broad-scale phenomenon. Speed use is overwhelming
rural communities practically overnight with terrible consequences. Use is
also breaking out into new populations, like Latinos and Asians.
Authorities need to wake up to the fact that we could have the equivalent
of another crack epidemic out there."

[sidebar:]

PROPOSITION 36

The Substance Abuse and Crime Prevention Act of 2000 is designed to stop
the revolving door of drug addiction by mandating treatment. It is expected
to save the state of California $100 million to $150 million a year in
prison costs. For information online, go to: http://www.calvoter.org