Inequalities: Medicalization, class, race, gender and sexuality

The symbolic inequality in "medicalization efforts" (metaphor) lies in the disadvantages it might levy. 

• Stigma and discrimination could result or persist for those not included in medicalized narratives or patient portrayals.
• More tangibly, resource imbalances could follow and exacerbate health disparities among advantaged and disadvantaged groups in society. 
• Health disparities, a more material form of inequality, have concerned sociologists across numerous medicalization debates (e.g. mental illness, obesity and ADHD). Scholars have noted, for example, racial disparities in health care despite increased medicalization in society
• Given the disparities in access to healthcare that characterize the American medical system, it is surely those who are at greatest risk for disorganizing drug use who will be most likely to be treated in institutional settings where pharmacotherapies are dispensed with minimal adjuncts in the form of counseling, educational or vocational services, or family support. 
• A system that disproportionately triages drug users of color into the criminal justice system instead of the health-care system adds another layer of inequity. And, in a recent study about mental illness and drug abuse among correctional populations, Thompson (2010, p. 116) added: ‘‘If criminal justice decision-makers expect African Americans to be criminals, these decision-makers will not seek alternative (including psychiatric) explanations that might mitigate responsibility’’.

1. Unequal Medicalization
• Are all people suffering a given condition medicalized equally? -----The assumption that all people reporting a set of symptoms, traits or behaviors will be defined with a medicalized narrative and addressed with medical initiatives is problematic, especially given that medical science rose to prominence during the height of the colonialist enterprise
•  Acker (2002) study of Pittsburgh’s Hill District found low income and disproportionately black addicts were treated as criminals (i.e. arrested and incarcerated) while wealthier white addicts – who purchased cocaine in the Hill District – were sent to rehabilitation programs rather than prison. This unequal definition and response to addiction has also been documented over time ("stratified biomedicalization") 
• "racialized regime of representation"
• Media (commercial)
• Documentary films
2. Drug control and the shifting face of addiction
3. The criminalization of opiates and cocaine
4. The Marijuana Tax Act, H. Anslinger and W. R. Hearst
5. Crack cocaine and the war on drugs
6. The modern face of drug addiction
7. The neuroscience narrative and disparate addict representation

Various social, moral and legal factors were commonly offered to explain addict’s experiences with drugs and addiction. 

• Criminal involvement was featured prominently. 
• For example, the most common reasons film subjects gave for beginning drug use included experimentation as a result of curiosity, recreation and leisure, peer pressure (their friends were using), family dysfunction, structural disadvantage and the lure of criminal opportunities or lifestyles. 
• However, it is in these films where ethnic and racial minorities make an appearance, adding support to our symbolic inequality thesis as follows. 
• symbolic inequality by race in addiction media not only because most films feature whites but also because many profiled general addiction, and not simply drug problems disproportionately experienced by whites
•  This comes at a time when medicalization narratives describing addicts as ‘‘patients’’ have flourished across social institutions and in modern media, including documentaries
• Patterns in narratives of drug addiction
• Pattern 1. White middle class addiction to prescription pain medications
•  Pattern 1 shows that suburban, middle class whites – especially teens – addicted to painkillers is a prominent contemporary problem. Their addictions can be explained by forces external to them (parents, peers and trauma) as well as by the neuroscience of opiate use and addiction. While the 10 films comprising this pattern reported engaging in criminal activities, all of these films depicted their subjects sympathetically as patients requiring medical treatment.
• Pattern 2. Heroin use among white suburban teens and young adults
•  Pattern 2 films tended to portray teens as ‘‘model’’ kids who have been corrupted by heroin use and, consequently, estranged from their ‘‘normal’’ lives. As a result, the teens gravitated to crime and encountered law enforcement. They have also repeatedly failed drug treatment programs.
• Pattern 3: lower class white abuse of methamphetamine in West and Mid-west
• methamphetamine addiction is explained as a socio-medical tragedy that leads to individual, family and community destruction. 
• Pattern 3 presents a sort of dual social and medical definition of the problem. Lower class whites are represented both favorably and unfavorably and explained with both social and medical narratives, which could be reflective of a race (white) and class (working class/working poor) interaction effect. They are shown as patients needing treatment for their addictions, while still requiring social control for criminal activities and family neglect. Pattern 3 films cast White meth users as vulnerable, with white quality of life declining, and disproportionately emphasizing harm to self and the erosion of white privilege. 
• Pattern 4: general ATOD (alcohol, tobacco and other drugs) addiction, among mostly white teens and adults
• this pattern shows a medical/social framework because addiction is defined as a medical problem (and treatment is most often discussed in terms of detox and possible medicinal treatments), but treatment centers are also shown to encourage support groups, and cognitive-behavioral therapy. In Pattern 4 films, whites are represented favorably as patients who are suffering from a medical problem, while minorities are invisible. Thirteen films featured this narrative and we noted that while it has had a significant presence recently, it also appeared in the early 1990s.
• Pattern 5: drug courts
• In these films, drug courts are defined as a type of treatment program where addicts ensnared in the CJ system can obtain a second chance to get their lives straightened out. Experts are racially diverse and occupy positions in social services (probation, social work and child welfare), law enforcement and court administration. A few medical personnel are also featured. As a result, there is very little or no discussion of neuroscience research, genetic causes of addiction or medicinal treatments as with the patterns mentioned above. Addiction is portrayed as a criminal justice matter and the population is defined as requiring criminal justice services.
•  in Pattern 5, with whites becoming much less visible. Thus, minorities are defined as a criminal justice population who need access to public-funded treatment programs (which do not focus on neuroscience explanations or solutions to the problem, but often focus on 12-step disease models) in prison or at other criminal justice agencies. 
• Pattern 6: crack and heroin addiction in the inner city
• Pattern 6 coalesced around illegal drug use in the inner city, specifically crack and heroin. Exclusively, black persons were profiled in these films. Both drug use and addiction was defined solely as a criminal matter, with social, moral and legal factors causing it. It is important to note that the neuroscience narrative was in firm place in our society and government institutions during the production of these films. In fact, so were genetic explanations and the 12-step disease model of addiction. Yet, there was no reference to these medical explanations at all. Instead, the focus of these films was on drug dealing and substance use/abuse by blacks, who were tied to the illicit drug trade and other criminal activities.

NATIVE AMERICANS: Patterns of alcohol consumption and addiction

• culture and the cultural and sometimes ritual context of drinking and drinking behavior must be considered when considering alcohol and drug abuse in Native American as opposed to white communities in the United States.

THE WAR ON DRUGS:

• Not only has the war on drugs proved a costly failure in addressing drug addiction or use overall, including among young people, it has also caused significant harm to the health and lives of children and young people.
• children often experience a wide range of human rights violations linked to drug control efforts. 
• These include torture and ill treatment by police; 
• extrajudicial killings; arbitrary detention; 
• denial of essential medicines and basic health services. 
• Existing drug control policies, and accompanying enforcement practices, often entrench and exacerbate systematic discrimination against people who use drugs, and impede access to controlled essential medicines for those who need them for therapeutic purposes. 
• In some countries, children are detained in compulsory drug detention centers together with adults, and denied appropriate health, education, and other social services.
• Restrictive drug policies have not only had a pervasive effect on people who use drugs for recreational purposes or have a dependency on them, but also on those who need them for pain management.
•  Children are doubly victimized by government failure to ensure access to pain relief: on the one hand, those who suffer pain cannot access direct relief and, on the other hand, children of parents denied treatment are denied parental support
• Severe drug laws resulting in mass incarceration deprive thousands of children of their parents, and, in some cases, their access to social benefits, including public housing;10 and in some countries, a Foreword ix disproportionate share of those incarcerated are poor racial or ethnic minorities.
• The Rhetoric of “Threat” 
• For many the “war on drugs” is a fitting analogy for the scale of the damage policies have caused, their transnational nature, and the financial and human costs. For some, however, the war is all too real, as some of the chapters in this book illustrate.17 For critics, the war on drugs is used in the pejorative to draw attention to a disastrous, international error, or to highlight a ruse adopted in the pursuit of hidden agendas.18 Children often provide a trump card against such criticisms, justification for whatever policies may be employed in the name of tackling addiction and fighting the drug trade. Children, after all, are our future, “our most precious asset.”19 Nothing less than our very way of life is at stake in combating this “evil. 
• Fears, Preconceptions, and Policy
• The fears and ideas that underlie moral panics relating to drugs and result in instinctive support for crackdowns are understandable. But when unpacked and challenged, they provide important insights into current drug policies. 

QUEER YOUTH AND DRUG ABUSE:

• Suicide is the leading cause of death among gay and lesbian youths. 
• Gay and lesbian youths are 2 to 6 times more likely to attempt suicide than heterosexual youth. 
• Over 30% of all reported teen suicides each year are committed by gay and lesbian youths. . . . 
• Gays and lesbians are at much higher risk than the heterosexual population for alcohol and drug abuse. 
• Approximately 30% of both the lesbian and gay male populations have problems with alcohol. 
• Gay and lesbian youth are at greater risk for school failure than heterosexual children. 
• Substantially higher proportions of homosexual people use alcohol, marijuana or cocaine than is the case in the general population.
• Approximately 28% of gay and lesbian youths drop out of high school because of discomfort (due to verbal and physical abuse) in the school environment.
• Gay and lesbian youths’ discomfort stems from fear of name calling and physical harm.
• “Today’s Gay Youth: The Ugly, Frightening Statistics” (n.d.) reports that one half of LGBT youths are neglected by their parents because of their sexual preference and approximately a quarter of LGBT youths are mandated to leave their homes. 
• Cole (2007) explains that rejected LGBT youths generally do not learn how to build a relationship with peers or families. As a result, it creates a state of loneliness and isolation for them. Some LGBT youths are both verbally and physically abused by parents (“Today’s Gay Youth,” n.d.). 
• In addition, roughly about 40% of youths that are homeless are classified as LGBT youths. The same article shows 27% of male teenagers who classified themselves as gay or bisexual left home due to quarrels with family members over their sexuality. Needless to say, parents and families play a big part in discrimination against LGBT youths and the effects that it has on them.