Various studies show that the views on the drug problem and appropriate policy responses have undergone profound changes from the 1960s onward. This article is analysing one of these changes, the decriminalisation of drug use, reflecting a fundamental change of view: understanding drug use as a health issue and not as crime. A useful heuristic to understand this type of change is Thomas Kuhn’s paradigm concept. He sees a paradigm as a set of beliefs that are shared by a scientific community and accepted by a wider community. A paradigm change is therefore a socio-psychological process rather than rooted in new scientific or research facts.
The author analyses the change from the dominance of a crime to the dominance of a health paradigm reflecting its social-historic context, starting with the widely shared concerns about substance use related health problems in the 20th century. These concerns translated into two different views on the essence of these problems, a crime and a health paradigm. The first served as fundament of the international drug control efforts, resulting in the still governing drug prohibition. Yet, the health paradigm was also of influence from the start and gradually gained weight. From the 1970s onwards the health paradigm became more important as part of a wider reform movement. It started in the Netherlands and the UK as bottom-up process criticising criminalising the users of illicit drugs as inappropriate, detrimental for their health and inhumane. The health paradigm was seen as more appropriate.
The author reflects on the benefits and disadvantages of the health paradigm. Its primary benefit is that it helps to understand the health problems related to drug use. A key disadvantage is its close relationship with the disease paradigm. The latter fits well with the generally negative view on drugs as dangerous or evil. It is encompassing the risk of ‘pathologising’ all forms of drug use and denying phenomena of unproblematic use for, among other things, recreational or spiritual purposes. Like the crime paradigm it can serve for control purposes. The drug user remains subject of control or disciplining policies and is not in charge of his/her own life. An additional problematic issue is that ‘softening’ the approach towards the users seems to be mirrored by a harder, more punitive approach to the producers and sellers of the substances, which are seen as villains, making available the drugs which deserve harsh punishment for ‘devastating’ the lives of users.
The author concludes with a short discussion of the well-being paradigm as possible alternative for the health paradigm. It covers a broader spectrum than the health paradigm and helps to grasp the negative impact of (problem) drug use, reducing well-being, but is also useful in understanding the positive sides, enhancing well-being.