Tuesday 17 August 2010


There are both obvious and also disputed connections between the use of “recreational” drugs and serious mental illness.

Alcohol can cause psychosis and permanent, severe mental illness though this is normally associated with extreme abuse. More insidiously alcohol can exacerbate a serious mental illness and inhibit recovery – a very common experience.

Class A drugs like heroine and cocaine can also cause severe mental illness - permanently in some cases - and certainly these drugs can also exacerbate a serious mental illness and inhibit recovery.

In recent years cannabis has increasingly been identified as a potential cause of schizophrenia, though there is dispute over this with views ranging from (i) a direct causal effect, through (ii) a trigger for the illness among those already vulnerable, to (iii) scepticism about any link. Hafal’s view is that it is commonsense to avoid mind–altering recreational drugs if you already have a mental illness and other people should judge the evidence for themselves – cannabis has certainly not been proved to be safe.

I rehearse all this because of the news today (link here) that the outgoing President of the Royal College of Physicians, Sir Ian Gilmore, has called for decriminalisation of drugs and controlled legal supply. He points to the organised and petty crime associated with illegal supply and use as well as the health hazards arising from contaminated drugs, needles, etc.

Most reasonable people can see that prosecuting users of Class A drugs is something of a distraction from helping people to recover. In practice most users are not prosecuted anyway and if they are it does nothing to prevent their continuing use of drugs. However, not prosecuting users will not remove the uncontrolled criminal supply of drugs. The only plausible way to do this is for the government to permit supply of Class A drugs in a regulated but relatively free way – because if users can’t get what they want from an over–controlled legal supply then the illegal trade will continue to flourish alongside.

The respectable legalisation lobby (as distinct from the ghouls who celebrate drug use) points to the widely acknowledged failure of the law-enforcement approach and indeed nobody can pretend the law has made great progress in suppressing the supply and use of drugs.

But, consider, there are less that 0.5% of people in the U.K addicted to Class A drugs. Does anybody seriously believe that the percentage would not rise dramatically if such drugs were available legally? In common with most of my contemporaries when I was a student I smoked cannabis occasionally but never really found out where to buy it and so did not form a habit. I do not doubt that if Class A drugs had been available legally I and most of my friends would have at least experimented with them and no doubt some of us would have developed problems. I am pretty sure I would not do that now but that's because as the years go by you can better calculate the poor return for the risks taken.

A libertarian might argue that this is a matter for individual choice but in fact there is an established tradition of the state protecting citizens from dangerous choices; and society is entitled to make decisions based on the wider good and to protect the vulnerable, not least people with a mental illness. I like to think myself liberal and open to new ways of thinking but all I see in legalisation is misery for many more vulnerable people and a marked deterioration in the quality of life for all society.

So, hard though it may be, success lies not in freeing up the supply but in giving excellent support to those who have been overwhelmed by drugs. Most addicts have insight into their predicament either most of the time or sporadically. If they knew that there was a humane source of practical and personal support then they would be likely to seek out that help – this of course is not just speculation because good quality support arrangements have a track record of getting people clean. On the supply side I do not claim any great understanding of the policing problems but I feel sympathy with those citizens who want to challenge the fatalistic attitude of some law-enforcement agencies in respect of drug-dealing in their neighbourhood. How indeed can it be right that many people in a community know who is supplying drugs but no action is taken?

If you've got a problem talk to your GP or take a look here.