Lifestyle choices

Substance use and even problem substance use are sometimes referred to as lifestyle choices, usually in the context of political or media discussion. The implication is that people make a free choice to use substances and some develop problems and choose to continue to use. This is usually used to leave responsibility for problem drug use solely with the individual and, crucially to diminish or remove any responsibility the state or other stakeholders have to support and assist the person.

This view can be regarded as simplistic and damaging. The vast majority of adults use psychoactive substances of some kind and the use of such substances is a common feature across all human history and culture (see abstinence).

The notion of problem substance use as a lifestyle choice or as a lifestyle choice ‘gone wrong’ also denies the extensive evidence that problem substance use is closely associated to varying degrees with poverty, adverse childhood experiences and trauma. (See poverty; see adverse childhood experiences; see trauma). It denies the science of public health that individuals have limited control over their lives and health behaviours.

Objection may be raised also if people are regarded as self-soothing or self-medicating by using substances or using substances as a coping mechanism for aspects of a life that people find otherwise intolerable (see self-medicating). To what extent is there a choice, particularly if there is limited or no access to other means to achieve these ends?

Objection may also be raised on the grounds that some people have a physical or psychological dependency on a substance and require to use substances to prevent unpleasant and perhaps dangerous, even fatal, withdrawal or to ‘remain normal’ or ‘feel normal’.

Objection may also be raised as this term suggests that people have a range of options while in reality there may be very few or no attractive ‘lifestyles’ available. And if options are available then how free a choice is a person making in the face of other pressures?