The cause of people getting addicted to substances usually cannot be pinpointed to one. There are multiple levels of reasons – the drug itself, the person's genetic predisposition, the family environment, the bigger social environment as a whole, and many other aspects. Therefore, in the episodes of the Drug, Inc I watched, they talked about the specific kind of drug through the sequence of growers, traffickers, dealers, users, medical and research personnel, and governments. This way, they cover all levels (bio-psycho-social) of reasons that lead to addiction for that specific drug.
Season 1 Episode 1: Cocaine
In this episode, the documentary talked about cocaine in six dimensions: dealers, traffickers, growers, addicts, researchers, and police departments. In the film, cocaine is introduced as a strong neuro-stimulant that provides intense pleasure.
From a dealer's perspective, cocaine is sold in two ways: powder cocaine for snoring and crack cocaine in the rock form. Snoring is usually used by the rich people because the pricing can be as high as 100 dollars per gram. Many people who use snoring cocaine consider themselves not addictive but just use it recreationally. The rock form is usually smoked by the poor people. With the pricing as low as 5 dollars per gram, the crack cocaine creates an intense high for these people to escape the reality for a short while.
In two different countries, the US and UK, the situations of the dealers are utterly different. Dealers in the US mostly sell crack cocaine to the poor people, such as street gang members in major inner cities like Chicago or Miami. The dealers themselves also live in a dire situation, facing robbery, gang fights, policeman and other emergency situations, just to make enough money to survive.
While in the UK, dealers usually sell powder cocaine to middle classes. The income of these clients decides that they can afford the expensive snoring cocaine as a recreational drug. In the UK, dealers usually sell their drugs in a more decent way and don't need to worry excessively about getting caught. This industry is also much more lucrative comparing to the situation in the US.
In this episode, two kinds of addicts corresponding with these two kinds of dealers are also presented. One addict lives in downtown Chicago. Growing up in the street gang, he lives in a poor environment. After he grow up, he chose cocaine over his boxing career as he described cocaine as "the best high is the first hit, afterward, you'll be chasing that first hit over and over again". His words speak to the essence of crack cocaine. This drug creates intense pleasure for the poor to escape from their daily lives without a loss of control over themselves, unlike heroin or amphetamine. Moreover, cocaine is a neurologically dependent substance - it triggers a massive amount of dopamine release into the brain that creates the sense of euphoria. Therefore, there appears to exist three factors that contribute to the use of cocaine for the poor: the reality that one tries to escape from, the sensation of pleasure, and the neurological dependence. The speaker mentioned that he is aware of his addiction and tried to quit smoking for 18 months but ended up relapse. He admitted that he cannot live a day without smoking.
The other addict appeared in the episode lives in the UK, where most people who use cocaine here are middle classes. This person uses snoring cocaine on a daily basis and considers himself a recreational drug user, meaning that he thinks his use of cocaine is no different from drinking beer. However, he still spends around 500 hundred dollars on cocaine weekly and admits that he has to smoke three lines after work everyday. Without him admitting that he cannot quit smoking, researches show that snoring cocaine is just as hard to give up as crack cocaine.
On a face level, it appears that this person is less addictive than the one in the US, as his drug use doesn't affect his ability to work. The UK person also appears to have fewer contributors to his use, as he might only have two factors: the sensation of pleasure and the neurological factor, as he considers cocaine to be a recreational drug but not necessarily a tool to escape daily life.
The addictive nature of cocaine has also been the center of argument by politicians and policymakers. In the US, the authority tends to consider cocaine as non-addictive, resulting in law enforcement seeing people with cocaine addiction as criminals instead of people struggling with a strong addiction disease. This wrong impression results in people getting incarcerated instead of being treated for their addiction. However, given the addictive nature of the drug, without being properly treated, incarcerated individuals are highly likely to relapse and go back to jail, resulting in the ineffectiveness of incarceration. Therefore, researchers use evidence to prove that cocaine is addictive and can cause neurological changes to human brain. This finding further proves that treatment is necessary for cocaine users.
On the prevention side, although the US government invested millions against the cocaine industry from its origin, destroying the cocaine production system hasn't been very effective, given that it is such a lucrative industry. Therefore, the amount of cocaine on the market is not decreasing so far.
Season 1 Episode 3: Heroin
In this episode, heroin is introduced as the deadliest drug on the planet. It is usually injected into the vein, so from a public health perspective, the way heroin treatment and prevention is different from other drugs.
The two addicts in this episode have very different experiences comparing to the ones appeared in cocaine episode. The pattern for heroin addicts is that they often start with something light, such as marijuana, and that later turn into something more hardcore, like cocaine. Eventually, they get to heroin. The first addict in this episode said that she had a great childhood and had a family before she started to get addicted to heroin and living on the streets. After some years dabble with heroin, a large prescription of morphine she got from her doctor after a surgery got her addicted to opioids drugs. When the prescription ran out, she shifted her opioids addiction to heroin. All these years she tried to give it up, but she failed.
Heroin addiction is, indisputably, a disease, not a moral decision, described by multiple people in the film. One-quarter of the population who tried heroin ended up getting addicted to it. As a kind of opioids, heroin changes the way brain works, resulting in a large amount of dopamine release in the brain. This effect leads to chemical dependence, just like the way cocaine works. Because of the chemical change, when addicts are deprived of this drug, they get physically sick, including muscle pain, vomiting, diarrhea, low blood pressure and sometimes death. Therefore, heroin overdose death composed the largest proportion among drug-related deaths.
Because heroin is directly injected into the bloodstream, it's effect is immediate. The chemical goes to the brain from bloodstream and creates a huge amount of dopamine, creating the euphoric state for the user. Therefore, when addicts don't shoot up the drug twice a day, they go through the withdrawal phase. This withdrawal phase is called dope sick. When people are dope sick, they are experiencing low blood pressure, making it very hard for themselves to find veins to inject heroin.
The high is so intense that makes the low that follows unbearable. Therefore, many users later also become heroin dealers or prostitutes to support their use. The disease made them incapable of maintaining a regular job, but they still need lots of money to pay for the expensive drug.
Therefore, in Canada, some clinics are offering addicts with clean needles and a safe place to shoot up, because shared needles increase the chance for HIV infection and the spread of other diseases. In other places, researchers and doctors also try to reach out to the community, retrieving dirty syringes and redistributing clean syringes. They also distribute the "opioid antidote", which is the antagonist that reverse the chemical process of opioids drugs. In these activities, the helpers are not trying to get the addicts to treatments or tell them to stop, but simply just teaching them how to safer inject. They know that almost every heroin addicts want to get rid of this disease, but they are just not capable of. Therefore, they are only taking a harm reduction stance instead of preaching to the addicts.
In Switzerland, free heroin program is offered to these addicts. The person responsible for the program claims that as long as they are able to make people stay, they can help these addicts with their mental health and other issues. Apparently, the most efficient way to gather addicts is to offer them free heroin. Although it remains controversial whether the authority should be handing heroin to the addicts, it is found that this measure lowers the rate for drug-related crime and overdose death.
However, on a government level, most money is spent on law enforcement. Attacking and incarcerating heroin producers, traffickers, dealers, and users are the main solution to minimize the spread of heroin. But these measures aren't very effective. Incarceration without treatment usually will not lead to the ideal outcome for controlling substance use. Traffickers and dealers make their way not to be caught, and, unlike other drugs, international terrorism is one of the main sponsors behind international heroin transactions. Violence often goes hand in hand with transactions.
Season 02 Episode 02 Hash
Hash comes from the same plant that produces marijuana. Therefore, just like marijuana, hash is a highly controversial substance. Unlike heroin or cocaine users who know very well that they should not be engaged in their drug of choice, hash and marijuana users often think there is nothing wrong with using cannabis products.
The demand for hashish is lower in the US comparing to European, because in the US, there has already existed a steady supply from America continent, so it doesn't need a long supply chain from Morocco, where the majority of supply in European comes from. Morocco historically plants hashish because cannabis plant survives very well in their terrain. Thus, hashish is considered a natural plant here and growers can make more profits by growing cannabis crops. Nevertheless, even though it is banned by the government, this land is still occupied by cannabis plants.
Dealers usually smuggle the hash from Morocco into other countries physically. In England, the longest time in jail the smugglers need to serve is 14 years, if they got caught. The dealers usually accept this risk. Many of the sellers are also users, and they think there's nothing wrong with smoking hash.
Holland, on the other side, made hash a partially legal substance by giving certification to stores for selling a small amount (less than 5 grams) of weed and hash. In Amsterdam, one can simply purchase it through the coffee shops on the street. Therefore, many customers consider hash as a recreational drug that is even less harmful than alcohol.
However, in the local children's hospital, there are around 300 teenagers suffering from drug abuse issues, and around 75% of them have a cannabis-related issue. The counselor who works there thinks that because it is in your face (accessible in coffee shops) and advertised by the market, it is hard to resist, especially for teenagers. Thus, the users would go down a spiral of heavier use and develop dependence towards the substance. Although for some adolescents, the effect was not obvious at first, for most teenagers who are more susceptible, in a short time, their grades will start to drop. They will start to fight at home, stay out late, and get kicked out of from school. Many are sent to the hospital by the police, but these teenagers don't think they have a problem.
Nevertheless, research shows that heavy use has an impact on teenager's developing minds. For example, it would cause a delay in social and emotional development. If the kid is constantly stoned, they cannot communicate with others on the same level and are not able to deal with anger and frustration because they are influenced by substance instead of working on these emotional problems.
At the same time, the main effective component in hash, THC, can be a trigger for multiple issues, including psychosis. hallucination, paranoid, perception abnormality, etc. Therefore, although it is not likely to cause any death, it is still likely influence one’s brain. Also, although not addictive, the hash is habit-forming. Long term use does cause harm. For example, hash has many more cancer-causing agents than tobacco. It also jeopardizes teenager's brain more than that of adults. However, most users don't agree with these warnings, holding on to the belief that hash is just a similar substance like alcohol or tobacco and ignore its long-term harm.
On the conflictual side, the hash does have applications in the medical field. It helps with chronic pain caused by injuries and reduces pressure and anxiety. Therefore, it is because we do not have a full understanding of this chemical and its effects that users and the authorities have very different views on this substance. More research is needed for relevant policy making.
Conclusion
In all three presentations of different drugs, we see that they share some commonality. From the origin, although growers and farmers are all aware of the consequences of their products and the dangers they have with growing these crops, they are still committed to growing these plants because, by doing so, they put food on their table. Another commonality is that growers are also very poor, despite the fact that their products can sell for millions of dollars. Although ideally, the most efficient way to extinct drug use is to have no one grow these plants, it doesn't seem possible given that so many people's living depends on these plants. It is hard to reproach these people when this is their only way of living and they are only making enough to sustain their lives.
The second part of the transaction, the trafficker, seems to own the most lucrative part of the supply chain. The large profit makes it irresistible to commit the crime for smuggling the drugs across borders. The varies distances, different kinds of transportation across the border (air, land, ocean), and different ways of smuggling decided what kind of drug is popular among a certain country. The traffickers are the most dangerous population in the supply chain and can get the most punishment if get caught. Therefore, most of them are armed and cooperate with gangs or other armed violence organizations.
As the third part of the chain, dealers have the most impact on people getting addicted to certain substances. One reason is that most of them sell and use their drug of choice at the same time. They also use tricks to seduce addicts to come back for more. However, most of them also can barely make a living. With the potential danger from gangsters, other dealers, police, and robberies, it's nearly impossible to live a regular life.
The users, at the end of the supply chain, fall all over the spectrum, from moderate, recreational users who can work and function just fine, to addicts who ended up being homeless and helpless. Some have lots of autonomy regarding whether to use or not, whereas some have little autonomy over that. Some are deeply affected by the family of origin and other environmental factors, while some came from a happy family but still ended up on the street. The reason behind their use is complicated and their degree of substance dependence varies. Therefore, the treatment is need on a case-by-case stance.
Due to the nature of the particular substance, the addictive reaction and treatment can be very different. For drugs like heroin, they are chemically addictive and can cause lethal damage. Withdrawal symptoms are very intense and even deadly, making addicts who use it very hard to stay clean. Therefore, the treatment is more indirect: supplying them with clean needles and safe spaces to shoot up, even offering them with free high-quality heroin so that they wouldn't be in constant danger by looking for heroin or the money to buy heroin. The most important thing for treatment is to keep them safe and lower the number of incarceration and crime related to their addiction.
On the other side, for disputable drugs like hash or marijuana, the danger is not obvious and are sometimes used in medical settings. Users can still maintain a regular job while recreationally using the drug. Therefore, the drug is also legalized in some areas. However, with some researches, although not fully examined and comprehensively studied, these drugs can still be habit-forming and can slowly be developed into addiction without a physical dependence on the chemical, especially for teenagers. Also, the use of these drugs can often serve as the stepping stone for other serious drug use, such as cocaine or heroin. Therefore, treatments for these drugs are still important. Unlike the hard-core addicts, the treatments for hash and marijuana can be more direct: educating about the potential damage, advocating for moderation or abstinence, finding meanings in life other than using the substance, etc.
