The War on Drugs has Unduly Biased Substance Use Research

Introduction

The War on Drugs propaganda in the United States may have profoundly biased scientific literature on substance use. Before 1914, substances were widely available and regulated over the counter. There was little risk of organized crime trafficking tainted substances leading to the deaths of thousands of people (Brecher, 1986). The general attitude of United States citizens was forthright and matter-of-fact about the benefits and dangers of widely used and currently illicit substances such as cocaine, opiates, and amphetamines (Crocq, 2007). Though, with the onset of the War on Drugs, individuals were bombarded with a myriad of propaganda suggesting that all recreational substances are strictly harmful at any dose and should be fervently avoided (Farber, 2021). Propaganda began circulating among children who were not old enough to understand substances and their implications. For example, children were exposed to programs such as D.A.R.E. (i.e., Drug Abuse Resistance Education), teaching them phrases such as, “just say no” and “not even once,” and fearmongering pseudoscientific commercials such as “this is your brain on drugs” (DARE, 2022; The Paley Center in New York, 2022). This propaganda potentially led to a generation of children growing up with these misguided and deeply ingrained attitudes towards substances and those who use substances, which may have affected substance use research.

I argue that these biases have manifested in the literature and persist today, as clear trends suggest that no good can come from the substance use. These trends include that (1) substances can only be harmful, (2) people who use substances need treatment because of personal behavioral failures, and (3) abstinence and sobriety are the only ways to live a healthy life. These scientifically inaccurate trends may come from the War on Drugs propaganda (e.g., Lipari et al., 2015; Miroddi et al., 2014; Sherman et al., 2021). The problem with these trends is that they perpetuate an unduly pessimistic view of substance use that is politically motivated and not entirely scientifically-supported (Yang et al., 2017). As a result, researchers in the United States may be unintentionally contributing to the War on Drugs, thus impeding research on the potential benefits of using substances to treat mental illness, promote a healthy quality of life, and improve the way we the United States government and citizens treat individuals with SUDs; although work is slowly moving past this bias (Avanceña et al., 2022; Bradberry et al., 2022; Hill et al., 2022). Yet, a quick search of the literature demonstrates the dearth of research on illicit substances helping people live better lives or how stigma affects individuals with SUDs.

The problem with this missing literature is that it not only limits the discovery of the positive contributions of substances, but it also contributes to the stereotype and negative image of people who have SUDs or use substances recreationally (Nieweglowski et al., 2019; Wallace et al., 2011). Without robust literature on the benefits of using substances, it appears that people who use substances must be unintelligent, weak-minded, or ignorant because it appears as if substances can only cause harm. However, this view of substance use is not accurate. The reality is that substance use has countless potential benefits (e.g., Avanceña et al., 2022; Bradberry et al., 2022; Hill et al., 2022) and that SUDs develop as a complex interaction involving environment and biology (see Ystrom et al., 2014 for twin studies). If substances were completely unbeneficial and strictly harmful, individuals would feel no need to use them (Griffin et al., 2001). Though, the message that recreational substance use can be beneficial in certain circumstances is somewhat lost in the scientific literature, but quite apparent in the personal testimonies of those who use substances. For example, people in online forums like Twitter or Reddit frequently report that using substances allows them to cope with stress, process and understand their life better, escape boredom, enhance their performance in work or school, relax, cope with mental and physical health concerns, enhance joy and pleasure in mundane activities, help with personal growth, and promote sociability and social connectedness. Yet, these benefits are rarely explored in the literature, and I argue that the War on Drugs has taught substance use researchers from a very young age that all recreational substance use is strictly harmful in any dose.

There is a moderate consensus in the scientific community that the War on Drugs has failed and is causing great harm, which is why the way researchers talk about substances and SUDs is important (Godlee & Hurley, 2016). Many note that felony conviction, criminalization, and punishment are not just ineffective at treating SUDs, but these actions can exacerbate SUD severity and adaptive functioning (Carroll et al., 2021; De Vogel et al., 2021; Gallagher et al., 2015). Despite the high rates of recidivism and harm caused by criminalizing substance use (e.g., job loss, poverty, loss of social support), many governing bodies in the United States continue to (1) push for and successfully criminalize substances (e.g., United Nations Human Rights Office of Higher Commissions, 2022, United States Drug Enforcement Agency, 2022) and (2) refuse to legalize certain substances with low risk profiles (e.g., cannabis; Duff & Erickson, 2014; Mikuriya, 2004). The War on Drugs has also lead to great harm to families and lives through several other indirect effects, including contributing to fatal overdoses through unregulated street substances (Gottschalk, 2023), high pricing of substances leading to poverty and financial stress (Dobkin & Nicosia, 2009), facilitation of criminal organizations (Coyne & Hall, 2017), racist targeting of Black people (Cooper, 2015), and stigmatization leading to social and vocational challenges (Mendes et al., 2019). Despite these well-documented consequences, the United States government has not enacted substantial changes since the War on Drugs began. Careful attention to how we research and talk about substances is important so that substance use researchers do not unintentionally contribute to this harm caused by the War on Drugs.

As a scientific authority, researchers with biases may contribute to the propaganda keeping the War on Drugs alive by publishing research that is somewhat in line with the messages propagated by the War on Drugs, and largely fail to publish research that essentially goes against the propaganda of the War on Drugs. Thus, governing authorities can cite this biased literature base as evidence that the War on Drugs must continue; thus, further harming those who use substances, promoting organized crime, and hurting marginalized communities who are disproportionately targeted by authorities for substance offenses (Bagley & Rosen, 2015; Provine, 2011; Robey, 2000). I argue that we have a responsibility to correct the misinformation, promote movements and research that treat individuals with SUDs humanly, and fight to reduce the social and economic costs of the War on Drugs.

The United Nations recently took a firm stance against a War on Drugs legal model, suggesting that the model causes more harm than benefits, leading to excessive punishment, racial profiling, and exacerbation of substance use problems in the country. The United Nations decided to push for treatment and rehabilitation policies that work to alleviate the environmental risk factors of SUDs (e.g., poverty; United Nations Commission on Narcotic Drugs, 2022). Researchers can help these efforts in their work in a few ways. First, I encourage researchers to limit discussions of SUDs as personal or simple psychological (e.g., willpower) failures or deficits while also neglecting the importance of environmental and biological causes of SUDs (Ystrom et al., 2014). Second, reducing stigmatizing language in scientific papers and promoting research that shows the harm of substance use stigma (e.g., eliminate phrases like drug users, drug addict, and drug abuse; see U.S. Department of Health and Human Services, 2022, for how to talk about substance use). Finally, promoting and conducting work on how recreational substances have therapeutic and medicinal benefits may help reduce the stigma around illicit substances and create reasons for the United States governing bodies to reduce the scheduling of the substances, thereby reducing criminal offenses for possession. Substance use researchers have power and authority on the matter of how the public and United States governments view substances. These changes may correct the bias that currently exists in the literature and may aid in reducing the harm from the War on Drugs.

I am calling attention to this bias not to argue that substances are inherently good for individuals; in fact, I acknowledge that SUDs can result in great harm (e.g., the lifetime prevalence of SUDs is about 10%, yet, only 25% of people with SUDs receive treatment; U.S. Department of Health and Human Services, 2015). Although some illicit substances may help treat mental illnesses, without professional help, SUDs and self-medication can lead to significant consequences in some individuals. However, the propaganda that all recreational substances are strictly harmful in any dose is unscientific and politically-motivated. The way substance use researchers talk about substances and those with SUDs matters. I do not think this attitude has any place in the scientific community, given the smaller but growing research areas showing the benefits of using substances (e.g., psilocybin [mushrooms] and MDMA [ecstasy] for trauma or ketamine for depression; Averill et al., 2020; Bird et al., 2021). I call on researchers to check their own biases towards substances, especially those who may have been markedly influenced by the War on Drugs, and approach their work on substance use from a more unbiased, scientific perspective, noting the benefits and dangers of substance use. I want researchers to appreciate the complex, nuanced interaction of set, setting, and dose to draw more realistic, accurate, and fully developed conclusions from the substance use data.