By Dr David Laing Dawson
Schizophrenia is an illness, a disease afflicting a finite number of people in each and every culture, language and country. We have medical treatment that usually works. Relapse and re-hospitalizations are almost always the result of stopping medication or not receiving the right medication in the first place.
Of course family support, housing, meaningful activity and good relationships are important components for achieving and maintaining recovery. But we know the numbers. They have not changed over the years except in response to changes in diagnostic criteria and data collection.
Because of this, devising programs with sufficient numbers of hospital beds for acute illness, and community programs (involving families) for long-term care should not be difficult.
On the other hand drug abuse and addiction are social phenomena albeit with serious medical ramifications. The incidence and prevalence of drug addiction and death by overdose vary dramatically from culture to culture, country to country, and era to era. At this moment in time over six people in British Columbia alone die from drug overdose daily. We do not have a specific medical treatment. Most rehabilitation and abstinence programs have a high failure rate.
Many American soldiers became addicted in Vietnam. Those who were given, (forced into) a long period of abstinence before returning home to their ordinary communities did not relapse. Those brought back to American cities and put in drug treatment programs (i.e. in small communities with other drug addicts) relapsed at a strikingly high rate.
I am quoting this study to underscore the fact that addiction has social origins. Seldom, if ever, does a person alone, apart from peers and group patterns, decide to seek out a drug dealer and try a little fentanyl.
(Notwithstanding the fact I once asked a 13 year old how on earth she managed to get her hands on drugs. “Easy”, she answered, “You just go downtown and find some shady looking guy standing on a street corner and ask him if he’s holding.”)
I am oversimplifying and I don’t have an answer for drug addiction. Tinkering here and there doesn’t make a difference. The solutions proposed by Jinping and Donald Trump are tempting, the “war on drugs” didn’t work and adolescent education can have paradoxical effects, but we do need to closely study Portugal’s program, laws, and results, and seriously consider the social factors that lead to ghettos of drug addiction.
But I am sure that lumping schizophrenia and other serious mental illnesses together in the same planning, policy and resource boat as drug abuse and addiction will result in neither group being well served. Addictions and the consequences of addictions will continue to climb and treatable serious mental illness will go untreated.