Maia Szalavitz calls for radical empathy in her book, "Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction".
It's rare to write about every cool science-y story that comes our way. Each day from December 25 through January 5, we'll post a science story that fell through the cracks in 2020, highlighting it in a special Twelve days of Christmas series. The war on drugs should be replaced with a new paradigm for treating addiction.
Maia Szalavitz was 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 800-273-3217 Even though HIV was spreading through the community thanks to the practice of sharing dirty needles, she had no intention of quitting, even after she discovered the heady mixture of cocaine and heroin known as speedballs. A chance encounter in an East Village apartment likely saved her life.
A woman from California taught Szalavitz how to protect herself by running bleach through a shared needle at least twice, rinsing with water and washing the injection point. It was Szalavitz's first encounter with the idea of "harm reduction," an approach to treating addiction that emphasizes ways to minimize the risks and negative consequences associated with substance abuse. Needle exchange programs give free clean needles to people who need them.
Szalavitz found her way back from addiction through a program. She became a highly respected science writer after finishing college, focusing on science, public policy and addiction treatment. She wondered if there was a better alternative to the California woman's compassionate approach. Her personal experience and research gave birth to two books: Unbroken Brain: A Revolutionary New Way of Understanding Addiction and Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction.
Szalavitz was able to thank the woman who saved her life last year. "Ours was a story of how change happens, and how even the smallest things we do can sometimes make a tremendous difference," Szalavitz writes. The wisdom of the Talmud says that saving one life is equivalent to saving the entire world. The perspective that every life is worth saving is taken by these ideas.
Ars and Szalavitz were able to learn more.
Needle exchange programs were the first harm reduction strategies to get support.
In your previous book, Unbroken Brain, you advocated for a different view of addiction. We tend to think that it's a disease and that the addicts are broken in some way. You think addiction is a learning disorder. Can you tell me more about that?
I see addiction as a learning and developmental disorder. There's a lot of evidence that supports this perspective because it tends to come on at a specific time in brain development: adolescence and young adulthood. The majority of addictions start in the teens and 20s. You can see it in older people. It is much more rare.
If you don't learn that the drug does something for you, you won't find it and you won't crave it. You have to learn that this fixes something for you. The learning process is very similar to when you fall in love with someone, or when a new parent falls in love with their baby. It completely changes your priorities. You may be compelled to do things you wouldn't normally do if you have an addiction.
The focus of the war on drugs has been on disrupting supply lines and reducing demand. Why has this approach failed so badly?
Teenaged brains are wired to try to push away from their family in order to get out of the nest. They are quite likely to do it if you tell them not to. "Okay, we really don't want you to do this," is the most sensible approach. Let's make sure it doesn't kill you.
It doesn't work to scare kids off of drugs. If you are a kid who is starting to develop a mental illness like depression, or who just cannot connect for whatever reason, drugs can help. We don't want to admit it. People don't understand what's happening when people take drugs. They think that it's only a rebellion and that it needs to be crushed. Hedonism needs to be crushed as well.
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It doesn't work that way. The people who end up getting addicted are people who have something that makes them uncomfortable in their own skin. Drugs work for that at first. It is going to be very attractive when you find something that makes you feel okay and warm and safe.
Enlarge / oxycodone is a narcotic pain killer.
I asked people about their experience with the drugs in the medical system and they said it was the best thing they had ever done. I didn't want to lose my job or my marriage, so I wouldn't touch it again. They think they're the only person who's ever been able to resist that irresistible euphoria. That is the most common experience. This drug pleasure is not irresistible to everyone. It's irresistible when you have no other choice.
It's difficult for people to understand. Compulsive drug use is defined as addiction despite negative consequences. We spent the last 100 years trying to change something that is defined by resistance to them. It's time for something else. Reducing harm becomes the goal once you realize that it's not actually helping. The greatest goal of prohibitionists is to stop the evil drugs. Saving lives is your greatest goal.
According to Ars Technica, there seems to be a strong belief in our culture that people must suffer consequences for behavior that is outside the norm. It's quite foreign to many people that you call your idea of radical empathy.
People with addiction are often homeless. Many people have mental issues. Nobody wants to see them. That changes everything when someone approaches them with love and no judgement and says, "Hey, I don't care if you're using drugs, I just want you to stay alive." People value themselves more when they feel valued.
They stop the drugs when they discover that drugs are getting in the way. Sometimes they cut back and sometimes they are so traumatised they can't get out of it. They're not dying. It's a spiritual thing to me. I don't think harm reduction is the same thing as addiction treatment, but it is different. Reduction of harm is the antidote to that.
There are programs where heroin is prescribed. It is free heroin. You would think those people wouldn't get into recovery because they're getting what they want. When you get free heroin and you don't have any drama, your life suddenly has a huge hole. Recovery can come in because you get bored. People with traumatic histories might have to be on drugs for a while and learn how to deal with their trauma before they can stop the drugs.
Nothing is perfect. Nothing will work. This is why harm reduction is called. We want people to change quickly. That makes for great TV, but it's not how most people change. If you listen to the concerns of the addicts and meet them where they are, you will be able to affect them. How can we change people with heart disease or diabetes to eat better? We don't put people in jail for having high blood sugar.
Maia Szalavitz is the author of Undoing Drugs.
Ars Technica: Radical empathy is counter to the worst of human nature.
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Maia Szalavitz is absolutely correct. I feel that radical empathy is the core of all religions. When you see harm reduction in action, it is almost like Christ. You are giving something to someone with no hope of them paying you back for it.
Trying to practice that is the focus of harm reduction. Maybe we can help this person avoid an overdose or give them medication when they're released from prison. The goal is to move beyond that. We can save these lives now. I realize when I talk to people who are addicted that they have something to give. Every single one of them. We throw them away.
Many people struggle with helping and enabling when dealing with addicted loved ones.
Maia Szalavitz thinks we should get rid of the word enabling. The idea that addiction can be cured by hitting bottom is what inspired the concept of enabling. If you enable an addiction, you're preventing them from recovering. The idea of hitting bottom is ridiculous for a lot of people. It's a narrative device. You want to help the person to stay alive until they are able to find their way.
You have to decide what you're comfortable with for friends or family. Don't just think, "I should just throw them in the street and they'll get better." They could get better or die. If you want to throw someone out of your house because they are stealing from you or harming your children, that's fine. It's okay not to be abused. Do that for you. Don't do it for them.
The artist and harm reduction activist is in White Plains, NY.
The US is currently in the midst of an "opioid epidemic" in which increased prescription of opioid medications led to their widespread misuse. I know you have strong opinions on how the US handled the crisis.
Eighty percent of people who develop problems with prescription opioids did not have a prescription for the first drug they used. They got into someone's food. The majority of people who are prescribed non-addictive opioids end up with leftovers. They were the friends and relatives of the patients. There were also people who were faking pain to get prescriptions. What did we do? We decided to cut people off and monitor all prescriptions.
It's happening to a lot of people. Doctors are being told that they can't prescribe over X amount and that law enforcement will be on them. Patients with terminal cancer have a reduction in the number of prescriptions for narcotics. How does that make sense? Denying people who have gotten benefit from access to the medication that is often the only thing that works for them does not help anyone. It's more likely to make someone commit suicide if they use a street drug than if they use a medication.
So what is the solution?
Maia Szalavitz said the solution was complicated. If you think people are addicted to pain medications, stop cutting them off. Doctors should be allowed to keep people's prescriptions if they want to avoid using street drugs. Cutting them off doesn't cure the addiction. It is also killing them if two stop locking them up. There are ways to provide a safe supply without marketing it.
If I come in and my problem is depression and loneliness, and I'm using drugs to self-medicate that, we need to find a treatment center that is user-friendly and welcoming. It will be different for different people.
The whole system needs to be re-humanized. Two-thirds of the public now supports decriminalization of possession. I have seen harm reduction go from being championed by two people in a small town to being an international movement that is making inroads against prohibition. The CDC is saying that states should have needle exchange programs, rather than the federal government, because it sends the wrong message. I'm very hopeful that medical students and young doctors are grasping the idea of harm reduction and are trying to change systems to adopt it.
