ccording to a United Nations report, Pakistan had 7.6 million illicit substance users in 2022. More than 75 percent of those were male and 50 percent were under the age of 30. In a bid to address this situation, the state has been following the conventional Western model – of banning of substances and taking criminal action against users. However, decades of war against drugs in the United States and other Western countries have proven fruitless, indicating that this approach does not reap the desired results. A paradigm shift is needed to successfully address this issue, particularly in resource-constrained and institutionally-weak settings like Pakistan.

There is a common misconception in the society that the root cause of substance abuse is people having access to illicit substances and that by restricting this access – through banning or criminalising the use of such substances – we can address the problem. This misconception was informed by scientific experiments on rats in the early 20^th Century, in which a rat was placed in a cage and offered normal water and water laced with opiates or cocaine. Alone and isolated, the rats always chose the drug laced water, overdosed and died. However, an American psychologist, Dr Bruce Alexander, challenged these findings and developed another experiment in the 1970s. In this experiment, he built a huge park with a community of rats living together, socialising and engaging in various activities. The rats in this park were also given normal water and water laced with opiates. Surprisingly, almost all the rats rejected the drug laced water and chose to consume the normal water and lived happily in the rat park. This showed that it wasn’t simply access to drugs but the psychological state and social environment of the rats that determined whether they got addicted to substances or not.

If we apply this inference to humans, then we can hypothesise that substance abuse is merely an unhealthy way for people to cope with the distress they are experiencing. And if we apply this in Pakistan’s context, it will be easy to see why that substance abuse is increasing in our society – increasing sources of distress in the form of economic problems, unemployment, political disenfranchisement, perceived lack of justice, social oppression, unhealthy parenting and others. While it is not easy to address these issues, stemming from decades of failed sate policies, elite capture and more, criminalisation of substance abuse will also not work. The mere assumption that an emotionally balanced and well-adjusted person will start using heroin if you put it in front of them is illogical and unscientific. Usually, those who gravitate towards substance abuse are suffering from emotional and social problems, which they are unable to cope with through healthier mechanisms.

If you restrict access to one substance, users may resort to alternatives as evidenced by the rise in the use of crystal meth following a clampdown on heroin. In addition, there is a natural human instinct to gravitate towards that which we are told not to pursue, further complicating the situation.

A paradigm shift is required to focus on the root cause of substance abuse. We need to look at the inability to access healthier ways of coping with distress. Instead of banning substances and criminalising substance use, we should focus on treating the affected people with compassion and providing them with healthier alternatives to express troubled thoughts and emotions they are trying to drown out through substance abuse. Instead of sending notices to schools and universities to impose penalties on substance abuse, we should focus on making life skills and resilience building curriculum mandatory in all educational institutions. Engaging the youth in healthier alternatives such as sports and music by developing infrastructure in underprivileged neighbourhoods can also help counter the rising tide of substance abuse. Instead of demonising substance users, we need to encourage the society to provide them with social and emotional support so that they can get the help that they need. We need to fireproof our population against the use of substances instead of engaging in pointless firefighting which is not leading to positive results.

Some scientists even argue that the decriminalisation of certain substances may lead to a reduction of harm. For example, decriminalisation of marijuana is now happening globally after Western nations witnessed the benefits with some arguing that it may reduce use of more harmful substances like heroin and cocaine. Some psychedelics such as LSD and psilocybin are also being used for treatment of certain diseases. So care must be taken not to paint all illicit substances with the same brush. However, these need to be administered under the watchful eyes of trained mental health professionals since these do not yield the same benefits when used recreationally and might cause great harm.

Critics may argue that by decriminalising substance use and not clamping down on those might encourage their use. However, that argument doesn’t hold before the evidence that we have that the war on drugs is failing. Taking a compassionate and well thought out approach may lead to better results.

The writer is a public health practitioner focusing on mental health. He is the founder of Taskeen Health Initiative