Great article! I love the analogy to the poem. One of my favorite If-Then phrases is: "If wishes were fishes, then we'd all cast nets". As a retired practitioner who used to treat addictions as a fairly large chunk of my practice, I could see first hand that the conventional models of addiction weren't working. As a consequence of this I created a harm reduction manual that goes over each of the most commonly used substances, and how to effectively USE them if that is the desire, and how to reduce or quit them if they have begun to get out of control. Here is the link to my substack where I am making it available to everyone. Enjoy (2nd most enjoyed quote that isn't an if-then statement: First the man takes a drink, then the drink takes and drink, then the drink takes the man). https://open.substack.com/pub/alexaudette/p/the-intelligent-self-abuse-manual?r=1z6cwm&utm_campaign=post&utm_medium=web
I've been feeling much as you do for many years now, probably since reading Marc Lewis's *The Biology of Desire: Why Addiction is Not a Disease* in 2016. Lewis is (I believe) a neuroscientist who was addicted to heroin during his med school years.
I'm hoping one of your articles might tackle the question of why we have turned so vehemently against one pillar -- prevention -- especially where young people in schools are concerned. It does appear in a diminished form in what is now being called "upstream prevention," which doesn't really discourage uptake (because that would stigmatize users and prevent them from being open about their drug use, or seeking help, hence more of them would die), but rather seeks to lessen harms from "PROBLEMATIC substance use" (use in general being assumed to be a given, i.e. unavoidable; perhaps true, but really, in 14-year-olds?).
In the context of adults, prevention is now framed as “demand reduction,” which I guess is meant to avoid putting any responsibility on users as individuals.
Edit: BTW, the link that was in the Globe and Mail comment thread was a dud, but the URL provided enough info that I was able to track down your Substack.
Thanks for the comment and feedback. The bit about the link not working is helpful - I’m on a learning curve with such things! As for prevention, that is an interesting question and something I’ve wondered about, so I will look into it.
I have found it interesting that the Public Health folks, who are so involved with the whole addictions “epidemic”, fail to use so many of the tools in their public health toolkit, primary prevention (stopping the problem BEFORE it starts) being one of them. They basically look at the addicts as being a fact of life and set about preventing the complications, while ignoring the side-effects they are having on the non-addicted (like increased supply increasing the rate of people trying drugs and then getting addicted). The analogy is an example I’ve heard at multiple training sessions, in which you can choose between standing downriver and fishing drowning people out of the river as they float by, or you can go upstream and see why they are falling into the river in the first place. Public Health should be doing more of the latter.
Similarly, the other day I read a report about a city in Ontario where they had multiple overdoses within an hour, so the city declared an emergency about the drug crisis. It seems pretty obvious that the problem in that case was a bad batch of drugs hitting the street, not a mass outbreak of existential despair among addicts. The classic public health response to an outbreak would be to track down the source while cautioning people to avoid the risky “products”, ie an outbreak of food poisoning involves looking for the commonalities in what people ate, while cautioning people to avoid said product. Public Health could do likewise with a bad batch of drugs, but they don’t.
"The bottom line is to stay cautious and know what your body needs to feel healthy! No one but you can decide what it means to live your own good life, and there are ways to follow your substance-using desires while keeping yourself safe." – Willa Holt
(The heck with those loser users, or the rest of society!)
Another point I appreciated was your sentence, “Even though addiction prevents addicts from making certain decisions effectively (such as whether or not to use substances, or when and where to take them), clinicians must respect the autonomous choices of the patient.” Here’s where the buzzphrase “nothing about us, without us” muscles in. Most people (I would guess) are unaware of just how much the advocacy groups, which usually include current and former users, are driving substance use policy, especially in BC (DULF, VanDu, KISS, even the Canadian Drug Policy Coalition, as sophisticated as the latter sounds : ) They definitely seem to be nudging the model away from one of understanding and compassion towards one of human rights and entitlement. Check out, for example:
There’s a whole industry, a whole metier, being built around substance use “management” and harm reduction. People have livelihoods to protect, and "lived experience" with drug use is now – hallelujah! – a qualification for many of those jobs.
Wow, that latter example is a real treasure! Apart from hitting every woke buzzword, there’s an amazing sentence about not assuming that people who use drugs can’t do their jobs! Hopefully they aren’t referring to alcoholics piloting passenger jets, or such!
My favorites were "We will value the unique expertise, leadership and perspectives that people who use substances bring to the workforce" and "We will help employees remain in the workplace by accommodating their limitations and facilitating access to OPTIONAL, employee-driven health care services. We will provide access to paid leave for employees who are unable to work due to substance use challenges, or who choose to take time off work to seek support."
You don't necessarily need to be able to test a hypothesis for a good argument - the logic can be valid, without the facts being being true. In science, which uses inductive reasoning, you do need to work from observations to see if the argument is true as well as valid, because it works from facts up to generalizations. In deductive reasoning, like math, that's not necessary, because you are working from first principles.
Whether or not one of these methods was better was one of the early foundational arguments in the emergence of the scientific method. Some felt that working from observations could never be adequate and would end up in endless disagreements and unreliable information being accepted - so science would not be able to command any real authority. Which, several hundred years later, seems to be the direction of travel.
I find this interesting yet somewhat medical when it comes to the assessment of people and addictions. It lacks the understanding of cause and groups together all addiction. Maybe they are all the same, but are they? Is addiction a cause or symptom or both?
Great article! I love the analogy to the poem. One of my favorite If-Then phrases is: "If wishes were fishes, then we'd all cast nets". As a retired practitioner who used to treat addictions as a fairly large chunk of my practice, I could see first hand that the conventional models of addiction weren't working. As a consequence of this I created a harm reduction manual that goes over each of the most commonly used substances, and how to effectively USE them if that is the desire, and how to reduce or quit them if they have begun to get out of control. Here is the link to my substack where I am making it available to everyone. Enjoy (2nd most enjoyed quote that isn't an if-then statement: First the man takes a drink, then the drink takes and drink, then the drink takes the man). https://open.substack.com/pub/alexaudette/p/the-intelligent-self-abuse-manual?r=1z6cwm&utm_campaign=post&utm_medium=web
Excellent -- thank you! I was led here by a link in a comment thread that followed this: https://www.theglobeandmail.com/opinion/editorials/article-an-ethical-opioids-policy-needs-data/ (may be paywalled). Will be watching for your future articles, Dr. Gibson.
I've been feeling much as you do for many years now, probably since reading Marc Lewis's *The Biology of Desire: Why Addiction is Not a Disease* in 2016. Lewis is (I believe) a neuroscientist who was addicted to heroin during his med school years.
I'm hoping one of your articles might tackle the question of why we have turned so vehemently against one pillar -- prevention -- especially where young people in schools are concerned. It does appear in a diminished form in what is now being called "upstream prevention," which doesn't really discourage uptake (because that would stigmatize users and prevent them from being open about their drug use, or seeking help, hence more of them would die), but rather seeks to lessen harms from "PROBLEMATIC substance use" (use in general being assumed to be a given, i.e. unavoidable; perhaps true, but really, in 14-year-olds?).
In the context of adults, prevention is now framed as “demand reduction,” which I guess is meant to avoid putting any responsibility on users as individuals.
Edit: BTW, the link that was in the Globe and Mail comment thread was a dud, but the URL provided enough info that I was able to track down your Substack.
Thanks for the comment and feedback. The bit about the link not working is helpful - I’m on a learning curve with such things! As for prevention, that is an interesting question and something I’ve wondered about, so I will look into it.
I have found it interesting that the Public Health folks, who are so involved with the whole addictions “epidemic”, fail to use so many of the tools in their public health toolkit, primary prevention (stopping the problem BEFORE it starts) being one of them. They basically look at the addicts as being a fact of life and set about preventing the complications, while ignoring the side-effects they are having on the non-addicted (like increased supply increasing the rate of people trying drugs and then getting addicted). The analogy is an example I’ve heard at multiple training sessions, in which you can choose between standing downriver and fishing drowning people out of the river as they float by, or you can go upstream and see why they are falling into the river in the first place. Public Health should be doing more of the latter.
Similarly, the other day I read a report about a city in Ontario where they had multiple overdoses within an hour, so the city declared an emergency about the drug crisis. It seems pretty obvious that the problem in that case was a bad batch of drugs hitting the street, not a mass outbreak of existential despair among addicts. The classic public health response to an outbreak would be to track down the source while cautioning people to avoid the risky “products”, ie an outbreak of food poisoning involves looking for the commonalities in what people ate, while cautioning people to avoid said product. Public Health could do likewise with a bad batch of drugs, but they don’t.
I loved your brain picture and its caption. There’s a stylized brain graphic in this “expert’s” article – which will, you know, fix everything; like, you won’t have to lose another minute’s sleep or write another word: https://www.msn.com/en-ca/health/medical/5-drug-safety-tips-from-a-montreal-harm-reduction-expert-to-keep-you-the-squad-safe/ar-AA1ebeOV?ocid=msedgntp&pc=U531&cvid=cd7b1cadaab746328181870f1cd8848b&ei=29 Easy peasy!
"The bottom line is to stay cautious and know what your body needs to feel healthy! No one but you can decide what it means to live your own good life, and there are ways to follow your substance-using desires while keeping yourself safe." – Willa Holt
(The heck with those loser users, or the rest of society!)
Another point I appreciated was your sentence, “Even though addiction prevents addicts from making certain decisions effectively (such as whether or not to use substances, or when and where to take them), clinicians must respect the autonomous choices of the patient.” Here’s where the buzzphrase “nothing about us, without us” muscles in. Most people (I would guess) are unaware of just how much the advocacy groups, which usually include current and former users, are driving substance use policy, especially in BC (DULF, VanDu, KISS, even the Canadian Drug Policy Coalition, as sophisticated as the latter sounds : ) They definitely seem to be nudging the model away from one of understanding and compassion towards one of human rights and entitlement. Check out, for example:
https://static1.squarespace.com/static/602d6672675bb40d4f1aa13c/t/6375676d425a50391983f425/1668638575453/Workplace+Substance+Use+Policy+3.0.pdf
There’s a whole industry, a whole metier, being built around substance use “management” and harm reduction. People have livelihoods to protect, and "lived experience" with drug use is now – hallelujah! – a qualification for many of those jobs.
Almost makes you want to be a person who uses drugs, given the workplace benefits…
Wow, that latter example is a real treasure! Apart from hitting every woke buzzword, there’s an amazing sentence about not assuming that people who use drugs can’t do their jobs! Hopefully they aren’t referring to alcoholics piloting passenger jets, or such!
Thanks for sharing these.
My favorites were "We will value the unique expertise, leadership and perspectives that people who use substances bring to the workforce" and "We will help employees remain in the workplace by accommodating their limitations and facilitating access to OPTIONAL, employee-driven health care services. We will provide access to paid leave for employees who are unable to work due to substance use challenges, or who choose to take time off work to seek support."
You don't necessarily need to be able to test a hypothesis for a good argument - the logic can be valid, without the facts being being true. In science, which uses inductive reasoning, you do need to work from observations to see if the argument is true as well as valid, because it works from facts up to generalizations. In deductive reasoning, like math, that's not necessary, because you are working from first principles.
Whether or not one of these methods was better was one of the early foundational arguments in the emergence of the scientific method. Some felt that working from observations could never be adequate and would end up in endless disagreements and unreliable information being accepted - so science would not be able to command any real authority. Which, several hundred years later, seems to be the direction of travel.
I find this interesting yet somewhat medical when it comes to the assessment of people and addictions. It lacks the understanding of cause and groups together all addiction. Maybe they are all the same, but are they? Is addiction a cause or symptom or both?
You’ve anticipated my upcoming posts! Stay tuned!