You can’t stop deaths of despair without addressing despair

The latest quarterly drug death statistics were released yesterday. They do not make for comfortable reading and so have prompted an election campaign spat, with Scottish Labour accusing the SNP/Scottish Government of trying to address the issue via 'gimmicks'.

The headline figure is stark; Scotland's drug deaths appear to have increased by 31 per cent since the previous quarter to be 16 per cent higher than at the same point the previous year, cementing Scotland's position as the drug death capital of Europe.

If there is a difference between the Labour and SNP positions, it is not enormous. As the Scottish Government, the SNP has tended towards a harm reduction approach, undertaking initiatives which reduce the likelihood of drug users dying as a result. The Labour approach is more abstinence-based with an emphasis on recovery.

But neither is proposing to do something the other isn't, other than in terms of degree. Most starkly, Labour claims that the problem is that there are not enough opportunities for recovering addicts to get their lives in order by finding stable housing and work.

The problem is that the Labour solution is to invest in “skills, in employment and also in housing”. That was the Blair mission in 1997, Salmond's in 2007, Cameron's initial mission in 2010, Sturgeon's in 2015, Theresa May's in 2017, Boris Johnstone's in 2019, and is currently the priority of both Keir Starmer and John Swinney.

This analysis does at least have the merit of beginning to identify the actual problem; in social theory, drug deaths are in a category with suicide and alcohol-related deaths. They are known as Deaths of Despair, and they are generally a response to a lack of hope and a failure to feel control over one’s own life.

These are all 'self-destructive' behaviours. They are about a desire to no longer feel like you exist. They begin when someone's current circumstances feel unlivable to them, often driven by past trauma, almost always exacerbated by current living conditions such as being subject to violent crime, living in substandard housing, and being unable to feed and cloth yourself.

They then intensify when the person comes to feel there is no way out of this situation, no future they can identify where this feeling of inability to suffer life as experienced will ever be left behind. Neither a regime of methadone/naloxone (risk management) nor periods of recovery and 'just say no' (abstinence) change that fundamental underlying dynamic.

And nor does pursuing precisely the economic non-strategy that allowed this situation to develop make any sense as a response to it. Most people in poverty are in work, and 40 per cent of those who receive benefits are employed. We don't have a labour market which is really capable of producing the outcomes Labour implies from skills training.

Or look at housing; last year in Scotland about three thousand people died deaths of despair – suicide, alcohol or drugs. That happens to be almost the same as the number of social houses built in Scotland last year. The dead could have filled every new home.

To repeat, often the difference between someone under significant financial duress and someone who is self-destructive comes down to prior lived experience and trauma. Neither party has a serious offer on tackling the mental health crisis.

But more fundamentally, it is an enormous mistake to see these as issues of narcotic use. It is widely recorded that we face an epidemic of despair in Western society. We must never forget that nearly one in three people in Glasgow is or has been on medication for depression, anxiety or other mental health conditions.

Drug deaths are neither a failure of risk management nor a failure of abstinence but a failure of economics. Our economic system has created a low-pay, high-stress, exploitative economy, which creates severe ill health via a system of promoting addiction and pushing people to eat unhealthy food and live sedentary lifestyles which revolve around screens.

Deaths of despair are and always will be the ultimate indicator of a wider fundamental social failure. Managing those deaths without addressing that wider failure is a losing game, as the Scottish Government is finding out.

Common Weal has set out a full model for a National Care Service, a fundamental revolution in housing and a different economic strategy which might actually reduce despair. That will not be achieved through drug injection rooms or recovery beds alone.