8 things film and TV get wrong about drug and alcohol treatment

Nicole Lee, Curtin University; Jarryd Bartle, RMIT University, and Paula Ross, Australian Catholic University

Drug use and addiction are popular themes in movies and television, but they often get things very wrong. Here are eight common myths about drugs you'll see on the silver screen.

1. Rehab goes for 28 days

In the movie 28 Days, Sandra Bullock is given a choice between prison and 28 days in a rehab centre.

The 28-day program, popular in the United States, actually has nothing to do with the optimum treatment period.

Health insurance companies in the US are only prepared to fund 28 days in rehab. So the 28-day rehab model was developed around funding, not effectiveness.

We now think about three months of treatment is optimal. Treatment completion may be as important as treatment length. So completing a shorter treatment is better than dropping out of a longer one.

Confronting the reality of mass drug seizures.

The seizure of 416kg of cocaine off the Yorke Peninsula dominated mainstream media headlines last week. Journalists around the country brainlessly regurgitated the glowing press release spoon-fed to them by the Australian Federal Police’s public relations department.

Reporting diligently lauded the 21st of March operation as the largest illicit drug seizure in the history of South Australia, aggrandising the bust as an apparently monumental win against crime. Yet such coverage only obscures the reality of drug policing in Australia.

The global "War on Drugs" is one of the single-most catastrophic public policy failures in history. 

Now one Victorian MP has put forward a bill to decriminalise the personal possession and use of prohibited drugs.

The private member's bill doesn't have the support of the government or opposition, so it's highly likely to fail, but it's started an important conversation about how our drug laws are harming people, and how we can improve them.

The whole point of prohibition was to reduce drug use and drug-related harms. Not only has it failed to do so, it's had the opposite effect.

Prohibition has expanded drug markets and created a more dangerous drug supply. Drug-related deaths increased 60% worldwide between 2000 and 2015. Illicit drugs now account for 1.3% of the global disease burden.

On December 2, a motion in the ACT Legislative Assembly made consideration of the passage of a bill to decriminalise possessing small quantities of illicit drugs dependent on the government coming up with a plan for effective treatment of co-occurring mental health and substance dependency problems.

This was probably not the first time that the Assembly has resolved on a course that will undermine and delay the outcome that it seeks.

The continued subjection of people who use certain substances to the non-therapeutic, stressful processes of criminal law compounds the underlying problems that may have led to their drug use. It can also exacerbate, and even initiate, any mental health problems that they may have.

The criminalisation of drugs is a notorious driver of stigma and is one of the main reasons people who use drugs are reluctant to seek treatment, as well as being behind the crisis in the Australian mental health system. Criminalisation and the associated stigma that goes hand in hand with illicit drug use disinclines many mental health professionals from having anything to do with people in trouble with drugs.

The select committee that considered the territory's decriminalisation bill heard witnesses describe the failure of the mental health system to provide help when it was needed. Mental health services were stretched to breaking point. For example, speaking on behalf of the AMA, Professor Jeffrey Looi, the head of psychiatry and addiction medicine at the ANU Medical School, observed that mainstream health services "frequently struggled to meet levels of demand that they face, because of unsustainable under-resourcing, understaffing and lack of infrastructure". He added that there were "constant problems with the level of capacity in relation to bed flows; having sufficient beds to care for people with acuity of conditions, with a substantial overlap of addiction medicine problems, including substance abuse ..." The committee also heard from parents at their wits' end. Mental health services, to whom parents had reached out for help, left them to handle their child's challenging conditions without meaningful support.

It is of inestimable sadness that the intolerance of some parents to the drug use of their children pushes the recovery they yearn for more and more out of reach.

The picture painted by witnesses speaking on behalf of drug treatment services was more optimistic, whereby even those who displayed florid co-occurring mental health and substance dependency problems were successfully engaged, retained and stabilised in a treatment service. Those services were also struggling with funding sufficient for only half the estimated demand, but, in responding to people with co-occurring conditions, they were clearly in a far less dysfunctional state than hospital emergency and mental health services. They all articulated the need for services that are accessible, effective and non-stigmatising. No wonder they solidly supported decriminalisation.

It is vitally important that those services co-operate with one another so that the best outcomes can be achieved for those seeking help.

Services like the King's Cross and Canadian medically supervised injecting centres have documented improvement in the mental health of patients. Heroin-assisted treatment now available in six or seven European and North American jurisdictions has also produced better mental health outcomes.

A primary goal of drug services is to stabilise people so they are in a position to make better choices, rather than insisting on them being drug-free. Certainly everyone wants their loved one to be free of addiction, but if the choice is between continuing drug use and the higher risk of death from enforced abstinence, life should win.

The Beginning of the End of Drug Prohibition: An interview with Greg Chipp

The US-led the push for global drug prohibition early last century. On the domestic side, this commenced with the 1914 Harrison Act, while, internationally, Washington pressed for the first international drug control treaty, the 1925 Geneva Convention, which it refused to be a signatory to.

Over the following decades, a series of international drug control treaties were negotiated. These were eventually consolidated under the 1961 United Nations Single Convention on Narcotic Drugs: which is the key document of the prohibition era.

US President Richard Nixon then launched his official war on drugs in June 1971, marking an intensification of the law enforcement arm of prohibition. His administration did so with the aim of criminalising and controlling African American communities and the rising antiwar movement.

Forty years later, the former heads of state and leading intellectuals that comprised the Global Commission on Drug Policy condemned the drug war as a failure, which has increased drug use, led to mass incarceration and caused the development of a huge transnational criminal network.

There is nothing simple about drug use and it is essential to have a sense of perspective.

Drug use is widely considered to be an overpowering social ill, a perennial threat. Yet in truth, the picture is ambiguous in the extreme. As the historian, Lucy Inglis comments in Milk of Paradise: a History of Opium, many of us will end our lives being given morphine to dull pain. 

A growing number of Australians support the legalisation of cannabis, while almost three in five back the idea of pill testing, according to a new national survey.

The 2019 National Drug Strategy Household Survey also shows Australians are drinking and smoking less, but some illicit drug use is on the rise.

Importantly, this national snapshot, released on Thursday, shows the Australian community is becoming more open to less punitive measures around drug use.

Between 2017 and 2018, 62% of the 130,000 individuals presenting to drug and alcohol treatment were there because of problems relating to either alcohol or methamphetamine (‘ice’) use. Unfortunately, relapse after treatment remains the norm, with a national study showing that only 52% of treatment-seekers substantially reducing or quitting their substance use a year later.

When I started writing about the war on drugs many years ago, I soon realised its connection to the other bogus war in the last decades, the war on terror. Both conflicts are unwinnable and yet countless governments around the world invest billions of dollars annually into a militarised battle that’s done nothing to address the reasons so many people consume drugs.

Instead, drug use and abuse are soaring around the world, including in Australia, and the results are clear to see; overdoses, dirty and untested pills consumed at music festivals and ever-present stigmatisation around anybody who uses illicit substances.