Should Drug Addiction be Considered a Disability?

Date: 07 February 2012

Summary

Hosted by the National University of Ireland in Galway, the second panel debate organized by the International Centre on Human Rights and Drug Policy fleshed out positive strategic outcomes of aligning drug addiction to the United Nations Convention on the Rights of Persons with Disabilities (CRPD), but also highlighted how this might be detrimental to drug users themselves because it reifies traditional judgments made about them. 

In his argument in favour of using the disability framework to protect people with drug dependence, Mr. Richard Elliott, Executive Director of the Canadian HIV/AIDS Legal Network, said ‘People who have problematic drug use experience disability because those people live in a world in which an overarching approach is the prohibition of those drugs through penal law, and in fact, one cannot think of another example more classic example of how to dis-able people than to criminalize them and prohibit their participation subject to the stigmatization and vilification that criminal law represents.’

He argued that drug dependence could fit both the medical and social model of disability. The latter is now enshrined in the 2006 Convention, one of the newest human rights instruments of the United Nations and lauded as a progressive paradigm shift in law because it reaffirms  equal access to rights for persons with disabilities.  This convention marks a shift towards the social model of disability and it requires governments to recognise the legal capacity of persons with disabilities, enshrined in Article 12 of the ICRDP.

Mr. Simon Flacks, Lecturer at the University of Reading, also arguing in favour of the inclusion of drug dependence as disability, said that while the pathologization of difference through mental and bodily behaviour are good arguments against considering drug dependence as disability, the strength of the social model of disability is that it recognizes it as a social construction rather than a moral failure of the individual. He said most people encounter varying mental health problems throughout their life and it is in everyone’s interest not to be discriminated against when that happens.

Mr. Flacks added that the one could make the argument about drug dependence, looking at the CRPD Ad-hoc Drafting Committee proposal to include as causes of disability ‘agents causing malfunction’ that lead to a disorder.

In her rebuttal, Rebecca Shleiffer, Advocacy Director of the  Health and Human Rights Division at Human Rights Watch,  argued there needs to be a ‘stronger statement internationally, to speak about violations and not just focus on one small subset’. The medical model has been adopted in some countries but that has not eliminated human rights violations. The difference of drug dependence and drug addiction might not be so wide yet, because there are still many assumptions about it that are taken to be true.

For example, the United Nations Office of Drugs and Crime (UNODC) understands dependence as an overpowering thing, denying  agency to people with a dependence to a drug, when in fact, one could see that a person injecting regularly  might be addressing their addiction responsibly. She added users should also have a say before being labelled as disabled.

Dr. Eliot Ross Albers, Executive Director of the International Network of People who Use Drugs, rejected the idea of drug users as disabled,  not even in extreme circumstances such as when  undergoing withdrawal syndrome.  He argued that under prohibition, drug users have only been understood in two ways: either as criminals or deviants. The disability proposal is not radical enough because it would reify the status of drug users as deviants.

Between criminalization and medicalization, the latter has been adopted but only for tactical reasons. The disability label, as the medical problem label, is disempowering because people who use drugs don’t see themselves as such.

Prof. Gerard Quinn, Director of the Centre for Disability Law at NUI and moderator of the debate, both the arguments for and against share an absolute rejection of starting off a policy or a law by making the person with drug dependence a ‘problem’.  He said ‘people are not problems they have rights, and these have to be respected’.

He added that in the drafting process of the ICRDP, the ‘disability community rejected stigmatization attributed to the movement because the ethos is that we all have some functional limitation.’ The treaty, Quinn said, expresses something about our ‘universal human condition, and it is the latest iteration of a theory of justice applying to this particular period’.

The majority of participants voted against considering drug dependence as a disability. Although unclear what everyone’s position was, one person in the audience highlighted what Schleiffer considers a recurrent issue that comes up in national debates. That is, the question of agency and responsibility that drug use is seen as a risky choice, but one taken by a conscious person.  She and Richard considered that regardless of the risk, one should not be denied medical attention, which has been the experience of people with drug dependence. Especially poor health uses, are excluded from the universal right to health.

While medical attention is a right, persons with disabilities have been historically denied the choice to take it. Thus, Prof. Quinn added that any health provisions should be underpinned by recognition of full exercise of agency, as it was lobbied by the non-governmental organizations in the process of drafting the ICRDP.

The debate series organized by the ICHRDP- University of Essex in collaboration with other universities is a project funded by the Open Society Institute. The ICHRDP research directive is to find and understand the intersections between human rights and drug control. Rick Lines, Co-Director and Founder of the debates aim to understand  ‘what that structure of social control means or doesn't mean for fulfillment of human rights, not only for people who use drugs, people who produce drugs, or the criminal justice system that exist that impact on right to health considerations, among others’.

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The Panel

• Richard Elliott is Executive Director of the Canadian HIV/AIDS Legal Network.Richard joined the Legal Network staff in January 1999 as Director of Policy and Research, following an 18-month term on its board of directors. He became Deputy Director in 2005 and Executive Director in 2007. Previously, he worked as a civil litigator in private practice. He has appeared before all levels of Ontario courts and the Supreme Court of Canada, and has helped guide the Legal Network’s litigation in key HIV-related court cases in Canada and internationally.Richard holds an undergraduate degree in economics and philosophy from Queen's University in Kingston, Ontario, and obtained his LL.B. and LL.M. from the Osgoode Hall Law School of York University in Toronto.  He was called to the bar in Ontario in 1997.  He has authored numerous reports, papers and articles on a range of legal and human rights issues related to HIV/AIDS, appeared before legislative committees, taught or lectured at several law schools, and presented extensively on HIV-related human rights issues across the country and internationally. For a more complete profile, see the the website of the HIV/AIDS Legal Network.

• Rebecca Schleiffer is the advocacy director for the Health and Human Rights Division at Human Rights Watch. She has authored reports and advocacy documents on HIV/AIDS in Africa, Asia, Central and Eastern Europe, and North America, focusing on the human rights of people living with and at highest risk of HIV/AIDS. Her research and advocacy has covered the role of criminal law in addressing (or impeding) the response to HIV/AIDS, government restrictions on HIV/AIDS information to youth, and to HIV and harm reduction services to injection drug users and to prisoners. Rebecca has a bachelor’s degree from Harvard-Radcliffe College, and a law degree and a masters in public health from the University of California, Berkeley. See her complete profile on HRW website.

• Simon Flacks is a lecturer in the Department of Law at the University of Reading. He recently submitted his PhD, undertaken at the University of Vienna, on the subject of drug treatment for under-18s. He wrote a paper concerning the exclusion of drug and alcohol addiction from equality legislation in the UK, which was published in the journal Social and Legal Studies in September 2012. 

• Dr. Eliot Ross Albers has a PhD in philosophy and  has been an activist in the movement for drug users' rights for more than a decade. He is Executive Director of the International Network of People who Use Drugs, an international peer led advocacy network, which is recognised in the harm reduction, HIV, and drug policy reform worlds, as well as by the relevant UN agencies, as the leading representative network of this community. Follow his work on Academia.edu and of the INPUD.

Moderator

• Professor Gerard Quinn is a leading authority on international and comparative disability law and policy and is a professor of law at NUI Galway. ‌He directs the Centre for Disability Law and Policy at the School of Law, which was established by a grant from Atlantic Philanthropies in 2008.  The Centre is a founding member of the Lifecourse Policy Research Institute at the University.  He was called to the Irish Bar in 1983, and holds a masters (LL.M) and doctorate in law (SJD) from Harvard Law School as well as a BA (Political Science) and LL.B from NUI Galway. See his complete profile and publications.

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Video

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Further questions

• What is the difference between the social model in the ICRDP and the medical model of drug dependence (World Health Organization Definition)? How does that apply to drug use/dependence?

• Is the political cost of adopting the disability model for drug users to high? Should activists push rather for formally recognising the equality of drug users and protection of human rights? Which ones would be more applicable?

• Does the adoption of the medical perspective for drug dependence pave the way for the recognition of rights of drug users?

• How do we move away from normative assumptions about ‘deserving and undeserving’ drug users? What are the concepts creating these two categories (i.e. agency, moral responsibility, harm, pleasure?)

• What are considered ‘social barriers’ in the ICRDP? Would ‘Prohibition’ qualify?

• Richard Elliot and Rebecca Schleiffer discussed how in the US, drug dependence recognised as disability only after the person decides to address the addition. However, this would be a technical rebuttal of disability. How reasonable or counter-intuitive is the law? How much is morality a problem that, even if accepting the benefits of the social model of disability, drug users, in their difference, will have to deal one by one and from different corners (recreational drug users, problematic drug users, etc.)

• Would Article 12 (legal capacity) of the ICRPD be a safeguard against coercion to treatment for people with drug dependence?

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Further Reading

Albers, Eliot Ross, ‘Civil Society Intervention: International Network of People who Use Drugs’ (Statement at 31st UNAIDS PCB under agenda item 1.3 Report of the Executive Director Dr Eliot Ross Albers, PhD 2012) <http://unaidspcbngo.org/?p=19625 > accessed on 01 August 2013

Adlaf, Edward M, Hayley A Hamilton, Fei Wu, and Samuel Noh, ‘Adolescent stigma towards drug addiction: effects of age and drug use behaviour.’ (2009) 34 Addictive behaviors, 360.  Available in the e-library

Bruce, R Douglas, and Rebecca A Schleifer, ‘Ethical and human rights imperatives to ensure medication-assisted treatment for opioid dependence in prisons and pre-trial detention.’ (2008) 19 The International Journal of Drug Policy, 17.  Available in the e-library

Centre for Addiction and Mental Health (CAMH), 'The Stigma of Substance Use: A Review of the Literature' <www.camh.ca/en/education/...net/.../stigma_subabuse_litreview99.pdf> accessed on 3 July 2013. 

Corrigan, Patrick W., Sachiko. A . Kuwabara, and John O’Shaughnessy, ‘The Public Stigma of Mental Illness and Drug Addiction: Findings from a Stratified Random Sample’ (2009) 9 Journal of Social Work, 139.  Available in the e-library

Flacks, Simon, ‘Deviant Disabilities: The Exclusion of Drug and Alcohol Addiction from the Equality Act 2010’ (2012) 21 Social & Legal Studies, 395.

Foddy, Bennett, and Julian Savulescu, ‘Addiction and Autonomy: Can Addicted People Consent to the Prescription of their Drug of Addiction?’ (2006) 20 Bioethics, 1.  Available in the e-library

Harpur, Paul, ‘Embracing the new disability rights paradigm: the importance of the Convention on the Rights of Persons with Disabilities’ (2012) 27 Disability & Society, 1.  Available in the e-library

Ontario Human Rights Commission, 'Minds that matter: Report on the consultation on human rights, mental health and addictions,' (2012) Available online.

O’Mahony, Charles, ‘Legal capacity and detention: implications of the UN disability convention for the inspection standards of human rights monitoring bodies’ (2012) 16 The International Journal of Human Rights, 883.  Available in the e-library

Quinn, Gerard, Theresia Degener, and Anna Bruce, Human Rights and Disability: The Current Use and Future Potential of United Nations Human Rights Instruments in the Context of Disability (United Nations Publications 2002), 184. Available online.  

Nowak, Manfred, ‘When detainees have a disability: Their rights and fundamental freedoms’ (2009) 5 International Journal of Prisoner Health, 113.  Available in the e-library.

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