I didn’t give Kentucky its due on the trip, riding only about 45 miles from the bridge at Markland, IN to Covington. Still, Kentucky felt different from any other state and my mind took particular turns while I was there. Unfortunately, so did my bike.
The corn that I saw everywhere in Illinois and Indiana disappeared in Kentucky. Tobacco is king of the fields here. For all of the problems that tobacco causes, it is a beautiful plant. Spread out over a field, the broad leaves catch sunlight in a distinctive way, creating variegated bands of succulent greens. Tobacco is planted in wide, clear rows that created dazzling diagonal shadow lines as I wheeled past. The plants are shoulder high before harvest, and they sprout a delicate crown of seed atop their head.
Unfortunately, the benefits of tobacco end with its aesthetics. Yet Kentucky grows it, processes it, and sells it, and the people of Kentucky are big boosters of their own economy. According to the 2010 CDC State Highlights Report, more than 25% of the adults in Kentuckysmoke, ranking it the second highest rate of smoking in the country. When I stopped to photograph the beautiful Gallatin County Courthouse, I could not help notice how many people milling outside were smoking; everywhere I looked in KentuckyI saw smokers. All of this tobacco, in the ground and in the lungs, got me thinking about the challenges of addiction. How much should we limit an individual’s choice to ingest substances we know are harmful? Should we allow easier access to addictive substances to shatter their allure, or should we have stricter prohibitions? How do we determine when a social habit becomes an addiction? At what point should society intervene in an addictive person’s life?
Let’s consider addictive substances in three broad categories, tobacco, alcohol, and drugs. Our approach to tobacco and alcohol is, we can’t have any until a certain age, and then we can have unfettered access. Our approach to drugs is, we can never have access, though medical marijuana is beginning to bend that prohibition. Once citizens reach the legal age, we can buy tobacco and alcohol at will, and each is taxed quite a bit more than most other products. In theory the taxes act as a deterrent to consumption and also provide revenue to offset the societal costs of these substances. We do not allow commercial sales of drugs, buying and selling them is always a crime for both parties, and the entire economic burden of enforcing the legal and social costs of drug addiction is born without any revenue from the drugs themselves.
Of the three broad groups, tobacco causes the most deaths. In fact, tobacco use is linked to 1 in 5 deaths in the United States (160 per 100,000), more than drugs, alcohol, HIV, suicide, murder and motor vehicle accidents combined. Yet, when a person is over 21, they can buy and smoke as many cigarettes as they want. Since about 20% of teenagers admit to smoking, it appears that even folks under 21 have little trouble obtaining cigarettes. Alcoholism accounts for about 4.0 deaths per 100,000, and alcohol is easy to obtain over the age of 21, while drugs account for 1.6 deaths per 100,000 and are risky to obtain at any age.
The obvious question to these statistics is, if making drugs so hard to obtain helps push down the death rate, why don’t we make it harder to get tobacco and alcohol? Or, the flip question is, if so many fewer people die from drugs than other abusive substances, why do we expend so many resources on the judicial and penal costs of drugs?
Tobacco and alcohol are entrenched in our social fabric; they are big businesses within our economy and these days few would argue to prohibit them. We tried that with alcohol in the 1930’s to disastrous results. Instead, over the past fifty years, we have eaten away at the demand for alcohol and tobacco through education and evolving norms that have shifted our perception of smoking and excessive drinking from acceptable and even cool, to unacceptable. Smoker’s feel under assault, cessation programs abound, and as a result, smoking rates in this country have dropped by more than half since the Surgeon General’s report of 1964. Still, the current rate of 20% adult smoker’s is not budging, and the pressure against smokers varies by state. Not surprisingly, the CDC’s State Report on activities to curb smoking shows that Kentucky allocates fewer resources to help people quit than states with lower smoking rates. Similarly, alcohol consumption is trending down, especially binge drinking, yet as just over 50% of Americans enjoying alcohol in moderation; there is no mandate to make drastic changes in how we handle alcohol.
Drugs are another matter. Since drugs are illegal, they don’t count as business; there are no tax revenues to be garnered or lobbyists to contribute to reelection campaigns. Of course, drugs are a huge underground business, but since they don’t contribute ‘above the line’ to our national economy, their economic value does not get counted the same way.
Regarding the flip question, we are not disposed to loosen the reins on drug access or penalties because we perceive tobacco and alcohol as victimless addictions, while we consider drugs addiction to have serious repercussions to others. In our collective mind, a smoker is just hurting themselves and whoever is breathing downwind from him, while a drunk is pretty harmless as long she doesn’t get behind the wheel, but we think a drug addict is likely to rob and steal to get money for his habit and is capable of even more heinous crimes while under the influence. Each of these scenarios is only partly right, yet they are powerful conceptions that guide our tobacco, alcohol and drug policies.
Substance abuse and addiction puts us right back to our first guiding principle, ‘Life, Liberty and the Pursuit of Happiness’. Whether someone abuses substances is a personal decision, and we lean towards allowing people maximum personal freedom. Limitations on access are limitations on liberty. But this bumps against the conundrum that one element of our triad is working against another, since the poison taken in the name of pursuing happiness almost always shortens life.
The libertarian notion that the individual can do whatever she likes runs into a number of obstacles when it comes to substance abuse. These obstacles become the parameters that refine the overarching principle. First, we need to acknowledge that substance abuse is almost always the symptom of something else. Smoking, drinking, and drugs are manifestations of something gone wrong, whether social, psychological or physiological. From a Five Why’s perspective, substance abuse is not a root cause. Second, we need to acknowledge that substance abuse is not a victimless condition; addiction detracts from our ability to be fully engaged and contribute to society at the highest level. Third, we need to recognize that whenever substance abuse affects others, spouses, children, victims of abuse related accidents or crimes; the individual’s right to do as he pleases is superseded by society’s obligation to protect the affected. Fourth, we need to acknowledge the true cost of addictive behaviors and lay that cost squarely on the abusers. There is no reason why society should shoulder the burden of anyone who smokes or drinks or drugs himself beyond function.
If substance abuse is not a root cause, than we need to approach substance abuse through education that aims at the root. We have already seen great success in this approach by shifting the perception of cigarette smokers from glamorous to undesirable and in the process cutting cigarette smoking in half in fifty years. Our educational initiatives should help people not only understand the biological and chemical effects of various substances, but also their emotional and psychological impact. Some people will use this knowledge to modify behavior, but not everyone will. Regardless, in a society where we will hold people responsible for their actions, society is obliged to help people make informed choices.
Any behavior that arises from the substance abuse that affects others should be curtailed. We see many examples of this already in place; states with stringent drinking and driving laws and widespread prohibition of smoking in public places to reduce exposure to second hand smoke. There are ways we could take these approaches further; ban drive-through liquor stores, tie car ignition to breathalyzer tests, ban smoking in homes with children, but each of these cuts deeper into our civil liberties. The discussion of where the rights of the individual are trumped by the desire to protect the innocent must underpin any such decisions.
In The Price of Smoking, Frank Sloan argues that the real cost of a pack of cigarettes, including the personal, family and social costs, is about $40. Other studies vary, but all agree that the real cost of smoking is much more than the taxes added to a pack of cigarettes. With an average pack of cigarettes costing around five dollars in Kentucky, but over ten dollars in New York City, we are nowhere near recouping the costs of cigarette smoking from those who inhale them. Cigarettes should cost more. Alcohol too.
Any holistic view of how our society addresses substance abuse has to ask why do we treat drugs so differently from tobacco and alcohol? We are making better progress reducing alcohol and tobacco demand and we are recouping at least some of the costs by having these substances integrated in our economy. Wouldn’t we be better off to find some way to integrate drugs into our economy as well? This would not be easy. The system would have to be carefully regulated; the potential for corruption is great, and we run the risk that more readily available drugs would increase demand. But given that our current approach to drugs, in which we harp on Mexico and other countries for creating supply instead of addressing our internal problem of demand, is not working. Perhaps it is time to try something different. We have a model for bringing a prohibited substance into our mainstream economy with fairly good success – we did it with alcohol after the fall of Prohibition. If we believe individuals have the right to ingest harmful substances, our track record shows we do better as society structuring some form of legality to the substance and controlling it publicly, as we do with tobacco and alcohol, than we do covertly, as we try to do with drugs.
Our approach to abusive substances should be to educate people about their dangers, tax them to a level that reflects their true social costs, yet make them available in a regulated manner. The same approach could apply to other forms of addictive behavior and the so called ‘victimless crimes’ of gambling, overeating, and prostitution as well. None of these conditions are victimless, yet each will be easier to address if we are forthright in acknowledging that they exist, and determine how our society can offer individuals the right to participate in them while guarding the safety and well-being of those affected. There is a reason why Nevada has the highest standards of health among prostitutes – it is legal and it is regulated.
If we consider the full spectrum of smoking, drinking, drug use, prostitution, gambling, or overeating, almost all of us are appalled by one or more of them, yet almost all of us participate in one or more of the others. We have to recognize that these are human activities, they are going to transpire, and they will happen with more safety to the user and less collateral damage to others if we recognize them and permit them to occur in a sanctioned manner.
As my mind considered all the destructive behaviors that humans have concocted, I managed to take a right turn too soon and got lost along a lovely rural road of hills and large farms just south of Coventry. I should have turned around as soon as I realized my mistake, but turning around is not in my DNA, and so I sallied forth with a general idea that I needed to go north and east. That strategy works fine in a city with a grid, but is tricky on a winding road with the sun directly overhead. I noticed the mailbox numbers descending; I would eventually hit a cross road, though it turned out to be miles away. It was hot. I needed lunch. I wondered if I should retrace, but the hills behind me were forbidding. I kept forward and finally the country road dead ended into the frontage road of I-75. I traded shady swales for brutal concrete inclines as I made towards a water tower signed Walton. I rocked my bike side to side as I climbed; my head light from the sun, my stomach needing food and my psyche needing bearing. I stopped at the intersection and looked around. I took a sip of water. The knot of disorientation in my stomach craved satisfaction. This is how it feels to be adrift. This is what it is like to grasp for something to ground you, to make the world around you align in some meaningful way. This is where some folks need a smoke, a drink, or a hit; a bag of chips or a roll of the dice. This is where I needed a sign, which I found on the far side of the overpass, US 25 heading north. I followed the sign, glad to have some bearing, but I did not feel fully confident again until three miles later, where I reconnected with the road I missed and knew where I was once more.