Substance Abuse

Substance abuse is the sustained use of alcohol or drugs in a pattern that damages the user’s health, work, and obligations to others. Every society that has produced an intoxicant has produced rules about it, and the argument between conservatives and their opponents is not whether addiction is destructive but where responsibility for it sits. Conservatives hold that the person retains moral agency inside addiction, that the family and the congregation recover people more reliably than the state does, and that public order is a precondition of any recovery worth the name.

The disagreement has practical consequences. Between 1999 and 2023 more than a million Americans died of drug overdose, and Canada recorded roughly 50,000 opioid deaths between January 2016 and June 2024.¹ Both figures accumulated while policy moved steadily toward treating addiction as a disease requiring medical management rather than a disorder of conduct requiring moral and social response. Conservatives read that record as evidence that the medical frame, taken alone, is incomplete.

Key Takeaways

• Conservatives treat addiction as a compound problem: physiological dependence coupled with a collapse of habit, obligation, and social attachment.
• The disease model explains the physiology and struggles with the fact that most people who recover do so without clinical treatment.
• Intermediate institutions, principally the family, the congregation, and mutual-aid fellowships, carry the load conservatives assign them.
• Decriminalisation experiments in Oregon (2020–2024) and British Columbia (2023–2024) were reversed by the governments that enacted them.
• Public disorder tolerance and drug policy are treated as one question rather than two.

History And Context

Intoxication became a public policy question in Britain during the gin craze of the 1720s to 1750s, when cheap distilled spirits reached London’s poor in quantity for the first time. Consumption rose sharply, mortality in the capital exceeded births for a stretch of years, and William Hogarth’s Gin Lane (1751) fixed the moral panic in a single image. Parliament responded with a series of Gin Acts, the effective one being that of 1751, which raised duties and restricted retail licences to keepers of substantial premises. The episode set the pattern: supply restriction plus moral suasion, applied together.

American Prohibition ran from January 1920 to December 1933 under the Eighteenth Amendment and the Volstead Act. Alcohol consumption fell, cirrhosis deaths fell, and organised crime grew large enough to become a permanent feature of urban politics. Conservatives draw a two-sided lesson: prohibition changed behaviour, which the libertarian account underrates, and it produced criminal enterprise and contempt for law, which the prohibitionist account underrated.

Alcoholics Anonymous began in Akron, Ohio, in June 1935 when Bill Wilson and Robert Smith met, and published its basic text in 1939. It is not a state programme, charges nothing, keeps no membership rolls, and rests on confession, restitution, sponsorship, and dependence on a higher power. Its structure is precisely the intermediate institution conservatives describe: voluntary, local, morally demanding, and outside both market and state.

Richard Nixon declared drug abuse public enemy number one in June 1971. The Controlled Substances Act of 1970 built the scheduling system still in use. Four decades later the pendulum swung: Portugal decriminalised personal possession in 2001 while expanding treatment and retaining civil dissuasion panels; Oregon’s Measure 110 decriminalised possession in February 2021 and was substantially repealed by legislation passed in March 2024, signed that April and effective 1 September 2024; British Columbia’s exemption began in January 2023 and was curtailed in May 2024 after public drug use in hospitals and parks drew sustained objection.

The Conservative Position

Conservatives begin with agency. The addict’s choices are constrained, not abolished, and treating him as a patient without a will removes the one resource recovery requires. Roger Scruton argued that persons are held to account precisely because accountability is what constitutes them as persons; to excuse a man entirely is to stop treating him as one.² The demand that an addict make restitution to those he has harmed is a form of respect.

Second, conservatives locate the causes upstream of the substance. Addiction concentrates where marriage, steady work, church attendance, and neighbourhood association have thinned. Robert Nisbet’s account of the loss of intermediate associations describes the terrain on which modern addiction spreads.³ Charles Murray documented the divergence in marriage rates, labour-force participation, and civic participation between American communities after 1960, and the addiction map tracks that divergence closely.⁵ On this reading the drug is the symptom of a prior dissolution.

Third, conservatives insist that public order is a condition of recovery rather than an obstacle to it. James Q. Wilson and George Kelling argued in 1982 that visible disorder signals the absence of any governing standard and invites more of the same.⁴ Applied to drug policy, the claim is that open-air markets and public use entrench addiction by normalising it, and that enforcement which clears public space is a service to users as well as to residents. Drug courts, which pair judicial supervision with mandatory treatment and graduated sanctions, are the characteristic conservative instrument: coercion in the service of restoration.

Fourth, conservatives prefer institutions to programmes. Teen Challenge, the Salvation Army, and parish-based recovery ministries are cheaper than public systems and outperform them for the people who enter them, because they demand something. The state can fund such work; it cannot replicate the obligation that makes it effective.

Differing Positions

The medical account holds that repeated exposure alters the brain’s reward and stress systems, that these changes persist for years, and that moral exhortation addressed to a person in withdrawal accomplishes nothing. On this view the conservative emphasis on will describes the endpoint of recovery rather than its mechanism, and stigma keeps people from seeking help.

Harm reduction advocates argue that dead users do not recover. Supervised consumption sites, naloxone distribution, and opioid agonist therapy with methadone or buprenorphine have the strongest evidence base in the field for reducing mortality, and buprenorphine retention roughly halves overdose death in the treated population. Critics of the conservative position note that Portugal’s model, which pairs decriminalisation with substantial treatment investment and civil sanction, has held up better than Oregon’s, which decriminalised without building the treatment capacity first.

A third line argues that criminal enforcement falls unevenly. American crack cocaine sentencing carried a 100-to-1 weight ratio against powder cocaine from 1986 until the Fair Sentencing Act of 2010 reduced it to 18-to-1, with consequences concentrated among black defendants. The objection is not that order matters less but that this instrument was applied unequally.

References

1. Public Health Agency of Canada, Opioid- and Stimulant-related Harms in Canada (Government of Canada, 2024); U.S. Centers for Disease Control and Prevention, Drug Overdose Deaths in the United States (National Center for Health Statistics, 2024).
2. Roger Scruton, On Human Nature (Princeton University Press, 2017).
3. Robert Nisbet, The Quest for Community (Oxford University Press, 1953).
4. James Q. Wilson and George L. Kelling, “Broken Windows,” The Atlantic Monthly (March 1982).
5. Charles Murray, Coming Apart: The State of White America, 1960-2010 (Crown Forum, 2012).