BELGIUM - Psychiatrist with the Brugmann Hospital in Brussels, was the head of the Crises Centre of its Psychiatric Institute, she is presently the co-ordinator in Belgium of the review "Psychotrope".

ABSTRACT: The growth of the drug dependency phenomenon is not caused by the great availability of certain psycho-active drugs but by the impact of disastrous socio-economic conditions on particularly vulnerable individuals.

("THE COST OF PROHIBITION ON DRUGS", Papers of the International

Anti-prohibitionism Forum, Brussels 28th september - 1st october 1988; Ed. Radical Party)

Has the criminalisation of drugs proved in any way to be clinically or epidemiologically advantageous?

Although it is fairly certain that practically every Belgian has consumed alcohol at least once in his life, and that a good number of Belgians are habitual drinkers, it is equally certain that only a fraction of the population "takes to the drink", to the extent that - whatever the cause - that consumption could be termed problematical.

We could extrapolate from this onto a multitude of substances - from the coca leaf, which is consumed without problems for the most part by the Bolivian peasants, to the frequent use of cocaine in Montreal, which only rarely results in uncontrollable problems of addiction, and from the apparent ease with which the large majority of individuals who have undergone operations "go off" the drugs administered to them during the post-operative phase, to recent experiences with American G.I.s returning from Vietnam, only some of whom experienced difficulty in giving up the heroin which they had previously been taking in large quantities.

This brief introductory statement illustrates the importance of keeping in mind the relevance of personal factors in acquiring an understanding of the real nature of drug addiction.

And, by personal factors we intend factors of personality only - at least in the initial phases.

Whatever the choice of theory to be applied to, or considered feasible for, the case at hand, it is clear that some of those characteristics of the individual must be considered when considering any consumption - be it casual or habitual - of any potentially habit-forming substance.

Here as well, we are not suggesting that any individual with certain characteristics is inevitably doomed to drug addiction at some point in his life. Other factors - essentially of a social nature - intervene at the onset of addition. Also, that supposition would fail to take into account the capacity of some individuals to utilise other means of defence, and would necessitate a "rational training" inevitably leading to the conviction that the differences between the abstainer, the militant of abstinence and the drug-addict are minimal.

We might say that the majority of writers on the subject, as well as physicians, sustain that the problems which could predispose an individual to addiction are related to narcissism.

Whether it is a case of the unbearable Lacanian "lack", or the Anglo-saxon narcissistic fault, or Ollivenstein's theory of the shattered mirror, there is no end to the unbearable narcissistic flaws and wounds that an individual one day could possibly attempt to medicate with a certain product. Anxiolytics and their effects of well-being will obviously encourage the individual to continue with that form of self-administered medication.

We should remember, however, that in a similar situation - despite the initial apparent contradiction between psychoanalytical theory and approaches such as that of Andrew Weil, which define drug-addiction as the psychological incapacity (an access of anxiety?) of some to naturally accede to altered states of consciousness, or the theory of Georges Greaves, which cites the addict's incapacity to experience sensorial pleasure is just that - only apparent. The narcissistic fault, in fact, leads to conditions of insatiable need which lead to anxiety and a closing off.

Going back to our original thesis, a certain personality structure would thus appear to be a necessary pre-condition - which, for the sake of brevity, we will call narcissistic faults - for the development of drug addiction. The others, who are not in a condition in which anxiolysis or a state of well-being is only possible with the use of substances, will use those substances only sporadically, and will take into consideration the negative aspects of a too-frequent use and the dangers of addiction, to the extent to which their anxiety allows them to disregard similar considerations.

These premises necessitate pointing out that, if we are to resolve the problems of drug addiction in the world, the entire range of psychological problems related to the imperilled personality must be "resolved", or to put it more simply, the "adverting" of the narcissistic faults of all and sundry - which is hardly a realistic proposition.

One alternative would be the pure and simple abolition of all products which provide sensations of well-being which are habit-forming.

That is equally unrealistic because, on the one hand, such products also provide incomparable services in other spheres (the analgesics, for example), and on the other, psychotropic substances can be extracted from an infinity of easily-procured products (petrol, for example, which is enthusiastically sniffed in Africa).

If a realistic view of this question leads to the postulation that the elimination of personalities predisposed to drug addiction from society, or the disappearance from the face of the earth of all psychotropic substances, is frankly unthinkable, then the converse must be considered; a certain number of drug addicts will always exist somewhere in the world.

To solve the problem of what to do in order to keep that number as low as possible, and above all to limit to a minimum the harm done to the individual and to society, our present society has proposed repression. Reducing the availability of the products is, however, a deception, in that the consequences of such action would be reducing the availability of some products and favouring that of others, the advantage of which has never been satisfactorily demonstrated.

Furthermore, reducing the availability of certain products - something which would have no effect whatsoever on the overall number of drug addicts - would create more problems than it solved.

To begin with, by making them difficult to obtain, those products would become more attractive to a certain imperilled portion of the population - precisely because of that difficulty. The consumption of illegal products soothes wounded pride to the extent that it implies exceptional status.

In itself, this would not present problems of any importance, if it weren't for the fact that prohibition of a product makes quality control impossible and increases considerably the cost to the consumer.

Thus, since excessive use of a product is relatively unaffected by price or quality, those two aspects cannot but poison the situation of the drug addict - physically through the harmful consequences of imbibing impurities, and psychologically through the direct and indirect consequences of the financial burden of supporting a drug habit.

In the 'best' of cases, the temporary total elimination of these substances from the market through suppression results in the addict's becoming dependent on some legal product, which is often more harmful to him since he is less 'culturally" familiar with its use. It is not rare that a heroin addict suffering from severe withdrawal symptoms will die of an 'overdose' consisting of a combination of alcohol and an excessive quantity of some sedative the effects of which the addict is not familiar with.

Rejected, and often considered a criminal, the addict dependent on illegal drugs, in the long run, cannot avoid experiencing an aggravation of the narcissistic faults and the deep anxiety which caused his addiction in the first place.

Thus, we cannot avoid the conclusion that making drugs illegal does not provide any advantage for the addict, while it has no effect on the total number of drug addicts, since the cause of addiction is to be found in other factors.

We must, however, point out that the illegality of certain products provides only disadvantages for those who use them as a "palliative".

The problem thus to be solved in this phase is ascertaining whether or not the legalisation of these products would have any important effect on the kind of addiction of "imperilled individuals". Another problem is ascertaining whether that influence could prove harmful.

The only valid means we have for finding the answers to these questions is reflection and common sense. Cultural background also seems to have some relevance in the preference of one product over another, when all are available, except in rare occasions, particularly in the case where there is a desire for one effect over another.

The recent decriminalisation of the use of hashish in Amsterdam is an example of the above. Another is the variety of products used in India, the choice of which depends on whether the user is Hindu, Christian or Muslim. Similar examples could be cited ad infinitum, since the choice of a product is often no more than a tribute to its social or progressive status - one example of this being the consumption of alcohol in some Magrebian countries and in India.

We will now approach the question as to how individual problems influence the choice of one product over another, when they are all legal and do not pose any problem, except in cases where dependence on the product has an addiction connotation.

It was precisely the result of that type of individual choice related to the effect desired that, during the period of less severe control on drug prescriptions, some members of the medical profession became dependent on amphetamines, and others on morphine, when alcohol is the most culturally condoned psychotropic substance in Europe. That tolerance did not, however, prevent other physicians from becoming openly alcoholic.

The example of "physician" amphetamine and morphine addicts demonstrates nevertheless that their addiction did not seem to be more destructive or harmful than that of their alcoholic colleagues.

An observation of the use of heroin by consumers and addicts in the producer countries tends to demonstrate that it is not any more mortal than alcoholism is in France.

It is thus not the intrinsic dangers of heroin which constitute the "plague" of the West so much as the effects of its illegal status.

Summing what we have stated up to this point, it is clear that:

l- A certain type of personality will be predisposed to the development of drug addiction;

2- We have little hope of having any direct effect on the number of predisposed individuals in the world;

3- We have no hope at all of eliminating the psychotropic substances which cause dependence;

4- The illegal status of certain products is negative for those dependent on them;

5- The choice of consumer products is cultural, while the choice of the product of addiction, while it is also determined by cultural factors, also responds to individual needs;

6- One product compared to another does not appear "intrinsically" more dangerous, always considering the degree of consciousness of those effects.

We must thus conclude that, if the legalisation of all psychotropic substances results in an increase in the consumers of products recently legalised (which in itself should not present problems), it would cause only a relative increase in the number of addicts dependent on those products, without however necessarily producing an increase in the total number of drug addicts.

Given that, in conditions of legality, dependence on one or another psychotropic substance is more or less the same (with the exception of tobacco), the results, both to the individual as well as to society, could only be beneficial. And the above confutes one of the most widely accepted theories that there is a connection between the increase in drug addiction today in the (Western) world and the increase in the offer.

No one would hazard to say that in a similar culture, the fact that the 'Martini' because it is the object of publicity and offer, will be the cause of a larger number of persons preferring Martini in preference to Saint Raphael, until the fashion is changed, at which time they will drink Bitter or Port.

Drawing the conclusion that Martini is to blame for a greater number of persons becoming dependent on it than the number of those risking becoming dependent on Saint Raphael is intellectually dishonest.

However, it is possible that, in a society in which the level of stress in the race to "succeed" constantly increases, a growing number of individuals will develop narcissistic faults, in which case the number of addicts could increase.

It is certainly easier for those with good reason for denying the economic and social aspects of the spread of addiction to put the blame on Martini. And if that incrimination leads to the outlawing of Martini, then - inexorably - more and more reasons will surface for its banishment. However, those new-found reasons will not include any conclusive proof of its real harmfulness.

The increase of alcoholism in the area of Charleroi - which was hard hit by the economic crisis - is not traceable to an increase in the offer of beer. If heroin were introduced, it is quite possible that a higher number of people would become dependent on it there than all in the rest of Belgium. That dependence, however, would not have been caused by the offer of the product, and if it were legal, one might hope that in the long run, it would not be more harmful than alcohol. If it were illegal, however, you can be sure that it would cause other problems which would make it a scourge far worse than alcohol, and the complexity of the problems created by those new heroin addicts for medicine would be of such proportion as to constitute an argument in favour of outlawing heroin.

Of course, we cannot contradict those who argue that if the market in the Charleroi area remained closed to illegal heroin - thus, totally eliminating the offer - the situation would be exclusively "alcoholic"-related (and thus less complex, as it would constitute a more well-known social phenomenon).

However, this in all probability would never occur and, for reasons of an "other" economic order, it is equally as unrealistic as the proposition of eliminating all narcissistic faults.

In concluding this brief presentation in favour of the legalisation of drugs and against the concept of the impact of availability on the spread of addiction (as that phenomenon would appear above all to affect some of the more fragile individuals in disastrous social and economic conditions), it is necessary - in the interests of real and not merely rhetorical precautions - to place that legalisation in a context of health education.

Although the Belgian population has, after generations, learned to handle its alcohol consumption (with the exception obviously of the occasional alcoholic), the situation as regards psychotropic substances and illegal drugs is quite another story.

The legalisation of psychotropic substances does not necessarily imply that heroin, cocaine and hashish will be put on sale everywhere.

On the contrary, it means that everyone will be called upon to become informed as to the effects of those substances, their advantages, limits and risks.

Although experience teaches us that generations are needed before a population learns to intelligently use a product (demonstrating once more that, whatever the type of culture predominating, the choice of products remains dependent on individual factors, which are themselves tributary of the social and the economic), generations of controlling limitations will be required before that management will be mastered.

Only in conditions of regulated legality can a health education programme be conducted with any hope of success. Weren't the dangers of barbiturates and the limits to be applied for their successful administration learned in a generation? A "clandestine barbiturate addiction" would never have provided the subject of a convincing health education programme.