Around the U.S., overdose rates have spiked, much of this being propelled by the introduction of illicit fentanyl — which is up to 100 times more potent than morphine — into the nation’s drug supply. Fentanyl quickly has become the bogeyman that "bath salts" were a decade ago and that marijuana was some 80 years ago, with many puzzled at the frequency in which it is used and implicated in deaths.
In the 1950s, sociologist Howard Becker conducted a series of interviews with marijuana users, seeking to unpack the panic around the drug and those who used it. Becker’s work in this space has become an important way of understanding a basic, but still perplexing, question among substance use researchers like us: Why do people use drugs, particularly when the potential negative consequences can be so deep and well-known?
As Becker explained it, drug use was something of an acquired taste that one had to grow into. Specifically, first, one had to learn how to properly use the drug. Second, they had to perceive the drug as being responsible for producing some kind of effect, like relaxation or joy. Third, the person had to then come to enjoy that effect.
While this is a really mechanical way of considering how we “experience” drug use, Becker’s classic model provokes a larger series of existential questions that touch on dense, philosophical topics like free will. It doesn’t fully address them, but it does stimulate a fairly intuitive observation: Any answer to the question of whether we have the free will to do (or not do) drugs depends on who stands in the way — or who’s there to facilitate it.
In recent years, forced drug use has become a growing risk factor for the development and worsening of substance use disorders and social stress. Forced substance use is a transactional dynamic where an individual compels someone into using a substance, such as alcohol or heroin, to induce a particular outcome — like getting sex, money, domestic favors or other acts of subservience from the victim. Domestic violence forums on platforms like Reddit are teeming with tales of these harrowing, unpredictable experiences, with many of the victims just learning that this is a “thing” and one experienced by many others.
Most of us go through multiple forms of quid pro quo like this at some point in our lives. As kids, our parents probably told us to eat all of our dinner or risk not being able to go outside and play, or maybe a high school teacher temporarily let us off the hook for skipping class if we agreed to do an extra make-up assignment. These are generally innocuous and well-intentioned efforts meant to get us to do something that’s objectively good for us. However, when forced drug use occurs, it’s neither innocuous nor well-intentioned. And it often occurs parallel to what’s referred to as substance use coercion.
Like forced drug use or sexual assault, substance use coercion is less about the act and more about the gratification that comes from domination, which is a tool for manipulation, not a “tough love” approach to imparting life lessons. Substance use coercion is a pattern of tactics used by an abusive partner to weaponize their partner’s substance use — or the stigma or illicit nature of many substances — against them to maintain power and control.
In 2014, pop artist Kesha alleged that her superstar producer, Dr. Luke, had sexually assaulted and bullied her into taking drugs for nearly a decade, a claim which many at the time scoffed at, framing her as an artist who couldn’t handle the rigors of the music industry and was ultimately clout-chasing. It wasn’t until just this past summer that Kesha and Luke’s rape and defamation cases were settled.
Kesha’s alleged experience illustrates a common tactic of substance use coercion: forcing or pressuring a partner to use substances, to use more than they had wanted or to use new and more addictive substances. A substance use counselor in southern Illinois, Diana, who we interviewed for one of our studies, explained the following: “Each and every one of them if you really sit with them, they have a story. And why they started, it’s either a girlfriend that was forced into using by her boyfriend, or it would be basically because of peer pressure and depression. So, I feel sorry for a lot of those people; but it’s very rare when you find someone that wants to use just because they want to use.”
Substance use coercion can also be counter-intuitive: In some cases, a person may threaten to disclose their partner’s drug use if that partner stops using the drug, as a means of keeping the victim under their thrall. One survivor we spoke with described how this happened to her: “I had got 10 years clean. So in the midst of that, I was trying to do things right.” This is when he partner’s subversion came. “‘I’ll call [Child Protective Services] and get these kids taken away from you’” she says, mirroring the language of her ex. “Just because I was trying to walk the straight-and-narrow.”
There are also cases of abusers withholding means of accessing drug use treatment and other resources. In his kinetic defamation trial in the U.K. with his ex-wife, actress Amber Heard, actor Johnny Depp, who Heard alleged had psychologically and emotionally abused her, alleged that Heard withheld his withdrawal medications as he detoxed, describing it as the lowest point in his life.
A 2012 survey conducted by The National Domestic Violence Hotline and The National Center on Domestic Violence, Trauma, and Mental Health found that 37.5% of a general sample of callers reported that their abusive partner threatened to report their substance use to the authorities to keep them from getting something that they want or need, including custody of children, a job, benefits or a protective order, and virtually anything else of emotional or material value that you can imagine. Abusive partners are hip to the thin margin of error that their drug-using partners have.
Once a survivor has a criminal record due to substance use coercion, it creates seismic barriers to stabilization. This includes barriers to getting a job, finding stable housing, accessing public benefits, and if the child welfare system has been involved, being unified with their children.
These realities become even more complex when we think about the effects of substance use coercion on families, including the ways that substance use is treated by Child Protective Services. At least 1 out of 8 children live with at least one parent who has a substance use disorder. And roughly 40% of child removals from homes, for example by Child Protective Services, are due to a parent in the home having a substance use disorder. America’s child welfare and criminal legal systems are notoriously hard on women who get caught up in drug-related cases, particularly when they’re Black. These survivors not only have to negotiate and navigate their abusive partner’s threats and abuse, but also the weaponization of systems against them and laws that punish their very survival.
At the heart of substance use coercion is a desire for control and power whereby the abusive partner hijacks their partner’s autonomy to enforce dependency. It’s vindictive, humiliating, and also highly effective, representing a vortex of power that draws a person in, leaving them few options. In this respect, substance use coercion is a mutation of the odious "pickup artist" movement, the point at which the target has been fully undermined and psychologically manipulated into submission. These adjoining ideologies are heavily validated by a public that blames survivors for the violence that abusive partners inflict on them and that stigmatizes and supports the criminalization of drug use.
It's also reinforced by a culture of forced substance use that permeates our world in ways that haven’t been previously understood and appreciated by public health experts. Greek life, for example, is rife with cases of forced drug use — used by fraternity and sorority leaders as a litmus test for the dedication and loyalty of pledges. Similar practices have been seen throughout collegiate sports, too, as the recent Northwestern University football program scandal showed.
This can also be seen in instances of “sextortion,” wherein an abusive person weaponizes sensitive details or intimate images against someone to threaten and control them. Abusive people leverage the threat of disclosure — for example, to the victims’ family members and friends — to shame and control the victim. However, taken together, these cases have historically been written off as the errant acts of immature youth rather than predators, particularly when the perpetrator is white.
During Becker’s time, substance use was something of a cultural oddity, but like today, it was policed and criminalized in wide-ranging ways, and people frequently conceived it as being, first and foremost, a result of peer pressure. The mostly ineffective Reagan-era D.A.R.E. and "Just Say No" campaigns of the 1980s heavily deployed the theory of peer pressure to rally kids away from the seductive power of drugs. To this end, forced substance use is an extension of how we have conventionally thought of peer pressure. But substance use coercion is not restricted to substance use: it has all-encompassing, radiating impacts that invariably affect everyone in the victim’s immediate radius.
From this vantage point, it’s also possible to see substance use coercion as a microcosm of a highly complex history of manipulative geopolitics. In 1839, in response to what it dubiously labeled as unfair trade practices in relation to China’s vast opium cache, the British Empire initiated a four-year war with the Qing dynasty, which had recently banned sales of the drug over concerns about increasing cases of addiction in the ascendant country, an act the British sought to undermine using India-based smugglers. British subversion and battlefield mastery not only effectively ended China’s opium prohibition, but it facilitated the British acquisition of Hong Kong. A second so-called “opium war” between the British and Chinese, again won by the British, followed roughly two decades later as a result of British dissatisfaction with Qing’s concessions, with spoils including greater British influence in the country and region that persists to this day.
To this day, the effort to disrupt substance use coercion remains stymied by both a conceptual and legalistic roadblock, both of which is amplified by economic interests and moral ambiguities tied to the War on Drugs. To this end, there are numerous policies in place, from “failure to report” policies to those that criminalize pregnant women who use substances, that are especially harmful to people experiencing substance use coercion.
What can we do to disrupt the practice of substance use coercion? The first step is to advocate for policies that would contribute to the development of systems that decriminalize substance use and end the War on Drugs, while recognizing that this alone won’t fully dampen the stigma that abusers leverage to coerce their victims. However, one of the things that makes substance use coercion so dangerously effective is the constant threat of entanglement with the criminal legal and carceral systems, and divorcing the legal aspect of drug use from the moral aspect will push the public writ large to reconceptualize their views.
Second, access to healthcare, including supports for those who have substance use disorders, is challenging even in the best of situations. Increased funding, training and support for healthcare systems that serve people who use substances is critical.
Third, we can all be more alert to the experiences of people in our lives with substance use disorders, being mindful of those in their lives who may leverage drugs to suppress them, and supporting and linking these individuals to resources like the National Domestic Violence Hotline when coercive incidents arise. Measures to prevent or mitigate most modern public health crises don’t typically arise until we begin to see cases of it in the local news over and over again. This is a rare emergent epidemic that we can still nip in the bud.
