Why Harm Reduction Makes Sense: These Three Things I Know are True

Harm reduction is the concept of reducing the dangers of drug and other substance use, including the damage due to addiction. While this seems perilously radical -- opponents claim it encourages drug use by "sending the wrong message" -- it is simply a recognition of undeniable truths about Americans and the entire human species. Here are three things about human beings that nobody can deny.

People will always use psychoactive substances. While the drug czar applauds small drops in teen drug use in the United States, there is no question that a sizable minority of American youth take illicit drugs and, by the time they are 20, a majority drink. Moreover, illicit use of legally-produced pharmaceuticals is the fastest growing form of drug abuse.

The 2008 Monitoring the Future survey of high school seniors found that marijuana remains the most popular drug (a third have smoked marijuana in the last year), but that illicit use of prescription drugs -- pain killers, tranquilizers, ADHD drugs, and others -- continues to grow rapidly.

Where do they find these drugs? Forty percent extend prescriptions they obtained legitimately. Other of these drugs come from family medicine cabinets. It is impossible to cut off these sources.

Of course, young people mainly drink for pleasure -- 43% of seniors drank in the last month. What is most frightening is that much of this comprises binge drinking, and these figures increase substantially as young people approach the age of 21, when about half binge drinking monthly or more frequently.

What are the chances of stamping out illicit drugs? What are the chances of reducing the growing illicit use of pharmaceuticals? What are the chances of eliminating underage drinking and bingeing? None of these things will ever happen. And chances are we will never see all three even decline at one time.

By the way, aiming at reducing underage binge drinking is not the same thing as reducing underage drinking. The first would be called harm reduction, because it recognizes that continued drinking will occur, while trying to reduce the amount of alcohol consumed and the danger that results from young people's bingeing.

Most addicts, alcoholics, and substance abusers will not quit using. Some of these young drinkers and drug users actually have a clinical condition called "substance abuse" or "substance dependence" (a quarter of 21-year-olds). Of course, young people should quit using these substances before reaching this point, or certainly after they achieve it.

But how many adult substance abusers abstain? By now, we are inured to the frequent visits to rehab by problem drinking and drug abusing entertainment figures (fill in your own favorites). There are even more prominent examples -- like the president of the United States, who still occasionally smokes after giving up his regular habit.

Obviously, the father of small daughters shouldn't be smoking at all. Just as obviously, the president of the United States, a role model for millions, should never be seen puffing on a cigarette. On the other hand, president elect Obama claims that he has drastically cut back his smoking, and this has made him healthier.

And, you know, he's right. Everybody should be perfect, but all of us fail at that goal, and people addicted to substances trying to go straight fail more often than average at perfection. But they can still do better by reducing their use, reducing their problematic use (like binge drinking), and staying safer while continuing to use (say, by avoiding drunk driving or using clean needles or taking drugs without injecting them). For the time being, that is probably the best that most can hope for.

The Platonic goal of eliminating all substance use is not only zany, it is unhealthy. Drinking alcohol is good for people at risk for heart disease - it makes them live longer on average. And, of course, we certainly aren't prepared to eliminate all pharmaceuticals -- they were invented to help people. Trying to ban all substance use, like the prohibition of alcohol in the United States, also creates its own problems -- crime, disregard for law, surreptitious and binge drinking, unregulated alcohol supplies and as a result alcohol poisonings, etc.

Where does all of this leave us? Zero tolerance goals -- having everyone join and stick to Alcoholics Anonymous, making all kids totally clean, eliminating all illicit drug supplies -- are each more unrealizable than the other. And we all know it.

Let's just hope that the harm reducer in chief and whomever he selects to be his drug czar are two such people living in the real world we all occupy.

Comments

[Kenneth Anderson]

Dear Stanton

Thanks for all you have done to increase the public's awareness of harm reduction as an option. I realize that 12 step models can be helpful for some people--but they are also harmful for others. My involvement with 12 step approaches to alcohol led me to drink more and almost killed me. Thankfully some of your books and an exposure to the principles of harm reduction which I gained by volunteering in a needle exchange saved my life. These experiences are what inspired me to try to bring the principles of harm reduction to other drinkers by founding The HAMS Harm Reduction Network http://hamsnetwork.org a support group for people who practice harm reduction for alcohol.

Thank you, Stanton, for being an inspiration.

[Frunobulax57]

You are right Stanton - we cannot make everyone join Alcoholics Anonymous. But the reason is far from the reason you imagine. We cannot make everyone with an alcohol or drug problem join because not all of them will qualify for membership. Only alcoholics can become members. Even drug addicts must be alcoholcis to qualify. So must coin collectors, Patrolmen and ventriloquists. They ALL can join IF they are alcoholcic.

So how does a ventriloquist - perhaps one who is also a crack addict - determine that he fits AA's "description of the alcoholic". Do they have a description that aids in diagnosing for membership purposes? Yes they do. It is in the first 43 pages of their "Big Book" called "Alcoholics Anonymous". AA's "description of the alcoholic" in that book requires that the prospect for membership have two conditions present - (i) Obsession of the mind and (ii) psychical craving once any alcohol whatever enter the body. Both conditions must be present. Otherwise they aren't alcoholic and are not members - even if they think they are. Even if they "keep coming back" .

So I know that you think that ANYONE - any court - doctor - spouse - or whim can just "send" someone to AA and they can become a members but that isn't correct. And it is right because only alcoholics can recover from alcoholism. No one has ever recovered from a malady that they didn't actually have - not as as far I know.

[QueenOfViolets]

The problem is, Obama does live in the real world. And in the real world, it's the law enforcement lobbies, not the voters or the scientists or the bloggers, who are in control of our drug policy.

Law enforcement lobbies don't want harm reduction. They don't care how anyone else feels about the issue. The law enforcement lobbies are extremely wealthy and they are 100% unaccountable to voters.

Obama can't resist these powerful organizations. Nobody can resist them.

So there's basically zero hope that anything about our national drug policy will ever change.

[2sleepy]

Queen- you got that right! And it's not only law enforcement lobbies, it is all the ancillary prison contractors, privateers, drug rehab corporations, even telecom companies making billions off of overpriced collect calls from prisons and jails. All of them will make sure that there is no rational drug reform, and their huge donations to lawmakers come with a quid pro quo. I worked in law enforcement for 22 years and saw the huge waste that was wrought by the 'war on drugs'. Both in terms of money and to drug users who became permanent second class citizens by being labeled 'felon' and sent to prison for simple possession of a substance that the government has decided is illegal. It is tragic and unstoppable, just look at California 176,000 people in prison- over 1/2 for non-violent (mostly drug related) crimes and the idiotic 'bought and paid for' legislature will do nothing to stop the insanity, even though they are facing a 40 billion dollar budget deficit and their shameful prison system costs over 11 billion a year.

[Paradym]

Mr. Peele, you've directly zeroed in on what is the most rational way of addressing the substance use/abuse issue. The fairy tale of being a drug free country in a world where tobacco, alcohol, sugar, and caffeine - all mind-altering substances - are completely legal and highly consumed, and all are dangerous if taken in enough quantities, has caused more harm and corruption than the substances themselves. Odd how the one substance that is non-toxic, has never caused a single death in recorded history from its consumption, and is being shown more and more to have medicinal benefits is still treated as a "hard" narcotic and completely illegal. Not to mention that the industrial version, hemp, which does not contain any meaningful amount of the "dangerous" psychoactive compound, as being illegal simply because it's related to cannabis.

I do hope that with voices like your own the information starts to seep into mainstream consciousness that 1.) there is a difference between substance use and abuse, and 2.) substance abuse should be seen as a health issue, not a criminal issue. We have the largest percentage of our fellow citizens in prison, mostly on drug related charges, than any other industrialized country. The War On Drugs is an epic and embarrassing failure. The country needs the billions spent on prohibition used elsewhere. How many times do we need to keep running into the same wall before we stop running and figure out a safe way around it?

[Arithrianos]

Hemp is not illeagle because it is related to cannibis, that was just an excuse. The turth is that is was a classic case of killing the competion, in this case two products were competing with hemp, and losing badly, because they are so inferior, and those are paper made from trees and dow chemical arificial material made from oil. The people who wanted to make paper from trees knew they could never ever compete fairly, given how crappy paper made from trees is compared to hemp paper. There is a reason hundreds of years old hemp manuscripts are still around while peperbacks made from trees in a few decades ago disinigrate.