This book is basically an indictment of NHS addiction services, but most people in the States probably have a very different view. For one thing, more middle class people are likely to know opiate addicts, but Vicodin or Oxycontin rather than heroin. And far more of these people are high functioning, partly because the Romantic view of opium/heroin didn’t really cross over to synthetic or derived painkillers. And there’s no comparable support net for chronically unemployed, er, chavs. Or whatever.
Anyway there are certainly some similarities between say the inner-city heroin addict in America and in Edinburough, but the good doctors viewpoints are highly colored by working in a prison. The “addict” in his viewpoint is someone who was already a criminal – Britain is more lenient than the US in incarcerating people – and then does anything he can to get more heroin and commit more crime. He seemed to have almost no experience with the upper or middle class drug or alcohol addict, or perhaps found them statistically insignificant.
Most of his scientific points are perfectly legitimate – heroin withdrawal is not that big of a deal and certainly doesn’t cause TRAINSPOTTING BABIES ON THE CEILING. But anyone who’s actually known opiate addicts knew this too. The condemnation of the addict is certainly full on, but with some sympathy, compared to the condemnation of the medical apparatus in place for the addict. “If you get on methadone and tell your dealer, he will not throw his supply away. He will find a new client.” Kind of an interesting viewpoint.
I do agree that legalization won’t work without some limitations, like alcohol has now. He argues that any limitations will provide a black market, which isn’t exactly the case with alcohol. But, then, I think legalization of alcohol is super hypocritical coupled with illegalization of other drugs. And it’s true that I personally do lots of research about drugs, which almost no other user does. Taking a test before getting a “drugs license” doesn’t seem too far out of line. Again, this wouldn’t kill the black market, but it would decrease people just trying hard drugs because they happen to be legal.
But in general the good doctor is condemning the lack of viable alternatives to the so-called “spirituality” of drugs, and states that western culture is sick. He doesn’t outright say religion is the answer, but there’s no other provided. The more immediate problem is the complete giving-in of doctors to the disease model of addiction. Again, I don’t see this to be as big a deal in the US, where only rich people can afford addiction treatment, or some poor people in those few cities with free/cheap methadone clinics. But it does sound like the British underclass is seriously fucked up.