How do you know if you have a problem with drugs?

We are a nation of hypocrites. We expect our politicians to have never used drugs like cannabis or cocaine, despite having used them ourselves. This familiar type of double standard is playing out with the Finnish prime minister, Sanna Marin, forced into taking a drugs test as a result of a video surfacing of her partying with friends, one of whom can be heard talking about cocaine.

Meanwhile, in the race to be the next UK prime minister, Rishi Sunak and Liz Truss try to outdo each other on who will be toughest on punishing people who use drugs. Rishi Sunak is winning hands down with his promise to be “incredibly tough” on drug users and describing drug use as “horrific”.

Although the Finnish prime minister is the one currently facing the heat about drug use, our own politicians have been exposed to the same kind of judgement by the court of public opinion. If these people were unique in having used drugs, such frenzied media attention might make sense – but they are not. A recent YouGov poll suggests one in four of us use illicit drugs such as cannabis or cocaine, and this rises to one in two for those aged between 25 and 55.

Like me, you’ll have come across friends or people at work who smoke or drink and say they can take it or leave it, implying they are in control even though some you suspect might not be. Undoubtedly, there are people who can have an occasional drink or line of cocaine, often described as “social drinkers”. By itself, frequency of substance use isn’t an accurate way of determining whether an individual has a problem with alcohol and other drugs, although the risk of developing a problem is known to be related to frequency and, importantly, the quantity used.

In my experience, useful as amount and frequency of use are, the acid test – forgive the pun – is what happens when the drug is taken away. This provides useful intelligence about the individual’s relationship with a drug. Whether its absence is voluntary or enforced doesn’t really matter, it’s how the person responds that is really telling. How physically and psychologically uncomfortable do they feel? How preoccupied with the substance are they? What impact does it have on their ability to function or maintain relationships?

Then there is money, particularly given the significant squeeze on income due to the cost of living crisis. How much are you spending on your drug of choice? Are you finding that you prioritise purchasing a drug including alcohol over essentials such as food, clothes or utility bills? Again, this is not a foolproof indicator, as this obviously wouldn’t be an issue for those with sufficient resources to maintain their desired level of drug.

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So, while there are a number of factors or questions which can point to a potential problem, with drugs there is no accurate or quick way of telling for certain. Humans are masters of denial, and we can minimise any internal or external voices that threaten our cognitive status quo which permits continued drug use.

Most people I have met in treatment don’t need to be educated about the harms and risks of using drugs – they know this all too well. While they know they have a problem, it’s a case of whether they are willing to admit it to themselves or anyone else. Once that inner quiet voice gets loud and persistent enough, most people respond either by seeking help or, unfortunately, by finding new ways of drowning it out – which invariably increases the risk of harm.

It’s worth remembering that most people don’t develop a problem with drugs like cannabis and cocaine. They can use them recreationally and enjoy the experience without any adverse impact on their lives or the lives of others. The difficulty is that we still are unable to predict with any accuracy who will develop a problematic relationship with drugs.

What we do know is that vilifying people like Marin sends a clear signal that our collective attitude to drugs is still infantile. We need to accept that people use drugs, grow up and ensure people get treatment when they need it.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York