Student: Greg Lewin, n8300984Tutor: Abbey Diaz, Friday 3-4PM
'The Junkie's Prayer'


Illicit Substance Use, Criminalisation and the Overlooked Cycle


An analysis regarding the social, cultural, political and philosophical implications of substance abuse and criminalisation in Australia and related contexts





"The Junkie's Prayer" by Johnny Cash, 1971
Originally by Statler Brothers in 1970, this cover version of “The Junkie’s Prayer” by Johnny Cash was recorded live in 1971. Although Cash is referring to America in his opening monologue, the lyrics resonate within an Australian setting:

My mind's filled with torture, my body's in pain

But the needle is warm as it sinks in my vein

Just a matter of seconds then my mind will be free

From the coldness and darkness that dominate me


But the freedom is short lived and then I'm alone

I must find the pusher but my money's all gone

Then the cycle of horror starts over once more

Oh God, let me suffer this misery no more

Not only does the song express the hollow, recidivistic nature of substance addiction, but the introductory speech by Cash provides insight into his well-documented battle with substances, expressing his concerns about the agonising issues surrounding substance abuse.
‘...after the thrill that you get from the pill, or from the pot, or from the shots... there is a horror that comes later.’



The Public Health Issue
The World Health Organisation Constitution states “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being" (WHO, 2006). Substance abuse is negatively impacting on the health of Australians, with significant individual physiological and psychological issues resulting from a dependence of substances including both illicit and licit drugs (WHO, 2013). However, the detrimental physiological outcomes of illicit substance abuse are coupled with more complex issues. Despite the 659 alcohol and other drug treatment agencies providing assistance for 153 668 episodes in 2011-12 (AIHW, 2012), the stigma surrounding illicit substance use results in a large number of social, cultural and political opposition towards illicit substance users, leading to an increasing number of criminal convictions (AIHW, 2011) and more evident social and systemic alienation (Carroll, 2003). Subsequently, individuals with a history or current engagement involving illicit substance use are commonly mistreated within social contexts and the criminal justice system, resulting in continued substance use and significantly poorer social, economic and overall health outcomes.

What is the Current Literature Saying?
Substance Use Negatively Impacts at an Individual Level
The prevalence of substance use across Australia is substantial. As of 2010, At least 46% of Australians consumed alcohol weekly, 15% smoked tobacco daily, 10.3% recently used cannabis at the time of the study and users of cocaine and amphetamines equated to 2.1% (for each respectively) of the total population (AIHW, 2011). However absolute percentages are hard to determine as many of these substances are illegal and/or heavily stigmatised (Dolan et al., 2005). The specific physiological and psychological repercussions of this drug use can range from short-term loss of autonomous function, loss of sensory ability and temporary incapacitation, to long-term effects such as a decline in memory capacity, increased social isolation and relapse (or addiction) (WHO, 2013; Robinson & Berridge, 2001). Quantitative research has also found that heroin users alone are 14 times more likely to die from suicide than the general population, promoting the implication that there are paramount psychological issues related to addictive substance use (Darke & Ross, 2002). A study by Robinson and Berridge (2001) also proposed the term 'incentive salience' in relation to this addictive substance use, which implies that potentially addictive substances share the ability to alter brain organisation, eventually leading to the prioritisation of a 'want' or 'need' for substances, rather than the acquisition of euphoric satisfaction from the use of these substances.

Substance Use Positively Correlates With Criminalisation
Criminalisation and subsequent imprisonment have strong associations with substance use. A 2010 report by the Australian Institute of Criminology found that 73% of female and 65% of male detainees at time of arrest tested positive to any illicit substance (AIC, 2011), similar to the 62% of incarcerated males who self-reported being under the influence of alcohol or illicit substances at the time of their arrest (Makkai & Payne, 2003). Evidence by Dolan (2010) suggests that up to 90% of Injecting Drug Users (IDUs) have been in prison at any time in their lives, while the same study shows that 34% of IDUs continue to inject once incarcerated. The previously mentioned study by Makkai and Payne (2003) suggests that consistent empirical evidence has found minor offences precede drug use, leading to the cycle of initial crime, subsequent substance use and eventual incarceration. Although exact causation has not been accounted for in most of these studies, it is evident that there is a parallel link between the factors which cause substance abuse and the factors which cause crime.

minor offence.jpg
Minor offences precede drug use.

Substance Users in Prison Experience Poor Health Circumstances
Although there is a heightened opportunity to improve the physical and mental health of a significantly disadvantaged population group, incarcerated Australians are still experiencing poor health outcomes (Kinner et al., 2012). A 2006 study found that the 12-month prevalence of any psychiatric illness was 49% higher amongst prisoners than the general population, notably higher amongst sufferers of personality and substance abuse disorders (Butler et al., 2006). Hingston (2006) discovered that 56% of the 60% of prisoners who had a history of drug injecting were positive with Hepatitis C, 25 times more likely than the general population. Although the AIHW (2012) has found that intervention programs and health care services such as Methadone clinics, Opioid Replacement Therapy and Hepatitis vaccinations are essentially effective from a theoretical perspective, a study by Kinner et al. (2012) found that there is a therapeutic relationship issue between many prisoners and health professionals due to judgemental approaches to care, with many prisoners reporting negative previous experiences resulting in present feelings of disenchantment towards health care. When linked with the 32% of prisoners who report having a chronic condition (AIHW, 2012), this provides for an overwhelmingly unhealthy environment. To compound this, an older yet applicable study by Carroll (1995) suggests that some health professionals' believe substance users are a 'threat to society', re-enforcing the situation of indifference between health professionals and prisoners, regardless of whether or not the intervention programs or health facilities are effective in theory

Mental illness stock photo.jpg
Psychiatric illness is prevalent amongst Australian prisoners, particularly amongst substance users.
addiction_heroin.jpg
Substances which are highly addictive, such as heroin, have the potential to alter brain organisation, leading to a 'want' or 'need' of substances, also known as addiction.


The Cycle of Drug Use is Ongoing Post-imprisonment
Although prison treatment can provide health benefits when applied successfully, there is lacking maintenance in effect to assist prisoners once they return to the community (Kinner et al., 2012). The Australian Institute of Health and Welfare (2012) found that 35% of prisoners reported being homeless in the four weeks prior to incarceration, and that 43% of prisoners who were to be discharged in the next four weeks expected to be homeless. Baldry et al., (2006) uncovered ex-prisoners in unstable living conditions, such as highly populated households or community shelters, were more likely than other ex-prisoners to return to prison, and homeless ex-prisoners were significantly more likely to be re-incarcerated. Findings by Kinner et al., (2011) provide consistent evidence to support international literature suggesting that there is a far higher risk of death amongst ex-prisoners within the first four weeks of release, notably due to substance-related causes. Subsequently, a separate study by Kinner et al., (2012) notes that 44% of prisoners released in Australia return to the system within two years, with 38% of those returning to prison; recidivistic imprisonment rates are as high as 85% for IDUs (Stoové, 2012). These findings are further supported by a 2006 report stating that poverty and lack of support is prevalent amongst ex-prisoners, re-enforcing this pandemic cycle (Baldry, 2006).

From a Social, Cultural, Political and Philosophical Viewpoint
Moral panic cycle.jpg
Figure 1: Cohen's model of moral panic (Source: Taylor et al., 1995, p. 478) - Originally described in 1830, moral panic is also applicable to scenarios from the 16th and 17th centuries and earlier; infamously evident in the Salem Witch Trials between 1692 and 1693.
Social, Cultural, Political Explanations and Implications
In order to understand the underlying cause for many social and cultural issues, including the cycle of substance addiction and criminalisation, theories are often applied to provide a deeper qualitative explanation. The social theory of moral panic was believed to be first suggested in the quarterly Christian Spectator (1830) (now known as the Yale Review), although academically pioneered in McHulan's Understanding Media (1964):
“Our Western values, built on the written word have already been considerably affected by the electric media of telephone, radio, and TV. Perhaps that is the reason why many highly literate people in our time find it difficult to examine this [media] without getting into a moral panic.” (Mchulan, 1964, p. 94)
STANLEY_COHEN_1.jpg
Sociologist Stanley Cohen.


And possibly more importantly, explored by Cohen (1973, p. 9):

“Societies appear to be subject, every now and then, to periods of moral panic. A condition, episode, person or group of persons emerges to become defined as a threat to societal values and interests; its nature is presented in a stylized and stereotypical fashion by the mass media; the moral barricades are manned by editors, bishops, politicians and other right thinking people; socially accredited experts pronounce their diagnoses and solutions, ways of coping are evolved.”


When applying this theory to the discussion of substance use and criminalisation, Pearson (1983) proposed that the main sporadic ideals which form the basis of thought for moral panic is the proposition of a society which is undergoing, or has undergone, demoralisation and a disintegration in moral integrity. This alone however does not explain how people are provided with subjective opinions of morality. The deviancy amplification phenomenon, initially proposed by Wilkins (1964) (although made popular by Cohen in Folk Devils and Moral Panics) explains that by sensationalising socially marginalised issues, such as drug use, which may currently have little or no criminality enforced upon them, media outlets are able to create a moral panic. This moral panic leads to an array of moral heuristics, explained by Sunstein (2004) as “rapid, intuitive judgements [which] make a great deal of sense but sometimes produce moral mistakes that are replicated in law and policy.” When coupled with amplified, sensationalist media information and a social moral panic (see Cohen's model of moral panic, figure 1), these moral heuristics provide the basis for understanding why substance users continue to be heavily stigmatised, categorised and further criminalised in Australia, despite the overall social, physiological and psychological health benefits of decriminalisation (Douglas & Mcdonald, 2012; Greenwald, 2009).
Marx and Durkheim: Alienation and AnomieThe separation of individuals from their natural state of living – through imprisonment – leads to further alienation and poorer health outcomes (AIHW, 2012; Baldry, 2006; Kinner et al., 2012). There are many philosophical explanations for how and why substance abuse and subsequent imprisonment leads to poorer health outcomes, not just from the physiological or psychological effects but also from the social effects. Marx's theory of Alienation (made popular in the Economic and Philosophic Manuscripts of 1844) and Durkheim's theory of Anomie (made popular in his 1897 book Suicide) both express relevant concerns surrounding the social impact on communities and individuals, and how individuals outcomes are determined separate to their individualistic behaviour. Anomie is understood to be a state of misunderstanding regarding social norms or behaviours, thus leading to deviant behaviours (Jones, 1986). Alienation is the introduction of antagonistic situations, ideas, institutions or behaviours where natural function may previously have been, resulting in powerlessness, meaninglessness, normlessness, self-estrangement and social isolation (Krahn and Lowe, 1993). When these two ideologies are coupled together, they provide a philosophical reflection of how deviant behaviour originally occurs, which may be amplified through the previously mentioned deviancy amplification spiral, leading to imprisonment and eventual alienation. By understanding that the underlying causes for substance abuse, criminalisation and the continued cycle of addiction are predominantly structural rather than individual, one can begin to gather further insight into how to resolve issues which have been plaguing societies for centuries.
The following video appropriately summarises the aforementioned analyses of moral panic, with the possibility for application of philosophical theories.



Analysis of the Artefact and Learning Reflections
Not only has the literature review and subsequent analyses provided me with an overwhelmingly substantial amount of information regarding the topic of substance use and subsequent incarceration, but it has also allowed me to develop my critical analytical skills to an extent where I feel comfortable discussing any relevant topics. The originally quoted lyrics from my chosen artefact epitomise this entire topic, especially the seemingly inhumane health conditions that the 'abusers' of substances find themselves woven into. Johnny Cash himself was notably a substance addict, which adds to the experience and conviction of his monologue and lyrical expression. Before even undertaking this unit I personally believed that it would be difficult to implement programs which promote complete abstinence or reduced use of substances, whether licit or illicit, and that criminalisation of substance users would be the most effective method. However, on completion of this particular study, not only have I found these to not be viable from the perspective of neurological conditioning, evident criminal cycles and health literature, but it also evident that current legislation may actually be based off unfounded implications simply due to moral indifferences, and may in fact be causing more harm than good.

There is no easy resolution available for the issues resulting from substance use, criminalisation and the related social and cultural outcomes; one single literature review and socio-cultural, philosophical analysis by a first year university student will not yield all of the answers to the multitude of issues present. As Bukowski once wrote:

“An intellectual says a simple thing in a hard way. An artist says a hard thing in a simple way.” (1969)

The ability to educate ourselves and others in order to acknowledge individuals and entire societies who are affected by significantly negative health outcomes is a crucial step in attaining equitable health for all.

References
Andrews, J. Y., Butler, T., Kariminia, A., Kinner, S. A., Law, M., Preen, D. B., & Stoové, M. (2011). Counting the cost: estimating the number of deaths among recently released prisoners in Australia. The Medical Journal of Australia, 195(2), 64-68. Retrieved from: https://www.mja.com.au/journal/2011/195/2/counting-cost-estimating-number-deaths-among-recently-released-prisoners

Australian Institute of Health and Welfare. (2012). Alcohol and other drug treatment services 2011-2012. Canberra: Australian Government

Australian Institute of Health and Welfare. (2011). Drugs in Australia 2010: tobacco, alcohol and other drugs. Canberra: Australian Government.

Baldry, E., McDonnell, D., Maplestone, P. & Peeters, E. (2006). Ex-prisoners, homelessness and the state in Australia. Australian and New Zealand Journal of Criminology, 39(1) 21-33. Retrieved from: http://researchbank.rmit.edu.au/view/rmit:6505

Berridge, K. C., & Robinson, T. E. (2001). Incentive-sensitization and addiction. Addiction, 96(1), 103-14. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/11177523

Bukowski, C. (1998). The captain is out to lunch and the sailors have taken over the ship. Santa Rosa: Black Sparrow

Butler, T., Kinner, S. A., Levy, M., & Streitberg, L. (2012). Prisoner and ex-prisoner health: improving access to primary care. Australian Family Physician, 41(7), 535-537. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/16476156

Carroll, J. (1995). The negative attitudes of some general nurses towards drug misusers. Nursing Standard, 9(34), 17-23. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/7612430

Darke, S., & Ross J. (2002). Suicide among heroin users: rates, risk factors and methods. Addiction, 97(11), 1383-94. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/12410779

Dolan, K., MacDonald, M., Silins, E. & Topp, L. (2005). Needle and syringe programs: A review of the evidence. Canberra: Australian Government Department of Health and Ageing.

Douglas B., Mcdonald D. (2012). The prohibition of illicit drugs is killing and criminalising our children and we are all letting it happen. Australia21 Roundtable Report. Retrieved from: http://www.australia21.org.au/publication-archive/the-prohibition-of-illicit-drugs-is-killing-and-criminalising-our-children-and-we-are-all-letting-it-happen/

Durkheim, E., & Jones, R. A. (1986). An introduction to four major works. Beverly Hills: Sage Publications

Gaffney, A., & Payne, J. (2012). How much crime is drug or alcohol related? Self-reported attributions of police detainees. Trends & Issues in Crime and Criminal Justice. Canberra: Australian Institute of Criminology.

Greenwald, G. (2009).Drug Decriminalisation in Portugal: Lessons for Creating Fair and Successful Drug Policies. Cato Institute. Retrieved from: http://object.cato.org/sites/cato.org/files/pubs/pdf/greenwald_whitepaper.pdf

Hingston, C. (2006). Prisoner health among australia's poorest. Australian Doctor, 4. Retrieved from: http://search.proquest.com.ezp01.library.qut.edu.au/docview/195126415

Kinner, S. A. (2012). Drug use, morbidity and mortality among prisoners and ex-prisoners in Queensland. Burnet Institute. Retrieved from: http://www.dpmp.unsw.edu.au/sites/default/files/dpmp/resources/KINNER.pdf

Krahn, H. J., & Lowe, G. S. (1993). Work, industry, and canadian society (2nd ed,). Nelson Canada: Scarborough

Mcluhan, M. (1964). Understanding media: the extensions of man. London and New York: Mcgraw-Hill.

Makkai, T., & Payne, J. (2003). Key findings from the drug use careers of offenders (DUCO) study. Trends & Issues in Crime and Criminal Justice. Canberra: Australian Institute of Criminology.

Marsh, I., Pilkington, A., Richardson, J., Taylor, P., Trobe, K., & Yeo, A. (1995). Sociology in Focus. Ormskirk: Causeway Press.

Pearson, G. (1983) Hooligan. London: Macmillan.

Stoové, M. (2012). Confronting reality: opportunities to address injecting drug use in correctional settings. Centre for Research Excellence into Injecting Drug Use. Retrieved from: http://creidu.edu.au/policy_briefs_and_submissions/1

Wilkins, L. T., (1964) Social deviance: social policy, action and research. London: Tavistock.

World Health Organisation. (2006). Constitution of the World Health Organisation. Basic Documents. Retrieved from http://www.who.int/governance/eb/who_constitution_en.pdf

World Health Organisation. (2013). Substance Abuse. Retrieved from: http://www.who.int/topics/substance_abuse/en/


Reflection
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