Right into my veins, please. Stigmatizing conduct (the conduct impugned in this column in particular being a great example of conduct requiring just that) is a great tool to assist in discouraging behaviour. The cigarette example is a great one. Take it from someone who was there, back in the 80s when the movement to ban smoking in public buildings was gathering steam there was no shortage of, “ooh, smoking is gross - nobody wants to kiss a smoker, it is disgusting to have to breathe that air, your clothes and hair end up stinking if you go to a bar for the night, smokers’ fingers get yellow etc.” You rarely hear that degree of passion today but that is likely due at least in part to the fact that *the stigma worked* with the result that personal usage no longer impacts public spaces. One lesson here may be that you can stigmatize away (or at least reduce) the need to use stigma. Drunk driving is another example where I think stigma has helped – you no longer hear jokes like “of course I drove home, I was too drunk to walk”.
A problem with addressing rampant public drug use is that too often people miss the fact that there are more than two options. It’s not an either-or, a choice between the gallows for someone caught with a joint and a hedonistic free-for-all. I happen to think all drugs should be “legal” for adults but the conduct itself should remain highly stigmatized. Yes, I know, it is easier to introduce stigma where there was virtually none before (see cigarettes) than it is to maintain stigma when you remove the greatest possible stigma (criminalization). But surely it can be done, “Reefer Madness” and Nancy Reagan’s simplistic “Just Say No” campaign notwithstanding. You start by having clear prohibitions on specific use (location, for example) despite the fact there is no longer a total prohibition on personal use. So, snorting cocaine on a street corner or at the local pub and shooting up on the street are both completely out of the question and resorting to the criminal code or Provincial Offences codes and mandatory treatment for those who won’t/can’t stop themselves from doing this has to be in play.
I also love the point that we now have Human Rights commissars wailing about stigma on this issue when (completely unwarranted) stigma is the cornerstone of the entire woke agenda. These fucking misplaced “empathy” fanatics are gonna’ be the downfall of our civilization.
My first desire for people struggling with addiction is easy access to fully funded treatment. Absent that, I'm fine with people managing their addictions in prosocial ways -- ie; in private and not harming anyone else. There's a role for things like needle exchanges and drug testing kits in this context. Maybe even a heavily restricted and well monitored safe supply in some cases. (Provided the actual facilities are properly run and heavily policed.)
But once we get into public use and public misconduct well, then, you've made your private addiction a public problem and the public now has an obligation to step in with some combination of criminal punishment or mandatory treatment. We shouldn't tolerate tent encampments. Nor should we be tolerating people passed out on the street, nor doing drugs in public. Nor making a menace of themselves on public transit. These are actions that fundamentally undermine public space, and the rights of non drug users to function appropriately in society. JG
When my father came home from WW2 he went to work as an orderly in our Provincial psychiatric hospital. It was referred to as the mental hospital, actually a beautiful rural setting of gardens, fields, a manicured golf course, decorative stone walls, all maintained by the patients, supervised by staff.
Of course we all know what happened to these facilities: Govts and special interests deemed them inhumane and stigmatising ( there's that word).
The result? Over decades these people were left to survive in a system that no longer provided care and protection and now many live on the streets and drugs are their solace.
My believe is that if you can fix the mental health crisis you will make a huge dent in the drug crisis.
When politicians pretend that these policies are working out well when we can see the results in our streets—that’s the definition of ‘gaslight’ (another overused term, but here it fits). It also seems cynical to say this is the best we can envision, i.e. providing safe supply until those accessing it eventually die from their addiction. Wab Kinew sounds like he is onto some common sense.
I agree it is worth walking back policy that is not working but advocating for shame through stigma conveniently ignores that we know much more about addiction and how many maybe most who deal with addiction self-medicate to deal with trauma or mental illness. Recovery is a misnomer for addiction when the root causes are ignored and stigmatizing the individuals by extension is a step I wouldn’t take. Who am I to judge and am I not my ‘brother’s keeper’? Suggesting stigma is the way forward neglects how complex and complicated this issue is and the solution should not be one that allows me to walk anywhere in Vancouver. YVR has always had areas where it is less safe to walk as with any big city.
If you get to the bottom of the piece, I deal with this point. It's one thing to not shame an individual who is struggling with addiction. It's another thing to try to totally eliminate the stigma of anti-social behavior on a societal level - while failing to address the actual harms of that behaviour. We can deal with individual circumstances with compassion and empathy while still imposing certain standards of conduct and behaviour for people in public.
You're completely correct that drug abuse is correlated with trauma. What I don't understand is what version of compassion and empathy makes it ok to do nothing while traumatized individuals effectively commit slow motion suicide in public via drugs? Is allowing a homeless individual who was abused as a child continue to self medicate until he inevitably dies in the cold a thing a compassionate society actually does? Or is there a point at which we acknowledge there's a role for both criminal justice and mandatory treatment to step in, here? When you realize the incredible life circumstances of many drug addicts, the conditions we've normalized via "harm reduction" only seem even more horrific to me, not less. JG
Why I was "self-medicating", meaning ingesting harmful drugs and alcohol, turned out to be less than useless information in the project of trying to stop. This is the point missed by compassionate people. The "why" quickly became fodder for my infinite capacity for justification after-the-fact. Even when it wasn't, the "why's" are a pernicious distraction.
What's missed is to distinguish the person from the behaviour. You can and should say to me, "I'm very sorry for what happened to you, and it was wrong. Your current behaviour is also wrong."
At the point of possible positive change, the "why" is irrelevant. At the point of change, the only question to focus on is "what are you going to do about it right now?"
Drug abusing/enabling programs are built around a moral obligation of society to protect each other from harm. I can follow the logic of that to a point, but in real time how are things working out?
Public safety concerns are valid, as are concerns about public littering, loss of public spaces by normalization of encampments and a looming threat of public health as drug abusers turn urban areas into open sewer systems harkening back to the 18 hundreds.
The worst failure of all is refuting the need to get people off hard drugs NOW to save themselves. To save their brains and bodies from the ravages of drugs that will inevitably destroy any concept of leading a productive life in society, free of constraints.
The public wants a stop to the normalization of drug addled zombies in our midst and being coddled along by authority figures who are well meaning but misguided. Let's get a restorative approach going that saves drug users before it's too late and give public spaces back to the general public.
Well, I've repeated many times in the last 8 years, situated as I am in the smoking hole of Victoria BC drug policy, stigma saved my life. If, instead of the shame I felt at my behaviour, I was told to feel satisfied, confident (even encouraged?), I'd be dead.
Walking down Portage Ave, a teenager circa 1979, my cousin turns to me, pointing to a lump of filthy clothes in a doorway that we knew to be a person, "that's you in a few years." He and I were close and did everything together, so he might have known. I was blind with rage... and used a lot of drugs and alcohol that night, because I did every night. His comment was unfiltered, spontaneous, and brutal because of it's truth. It hurt a lot and I never forgot it.
Our HR Watchdog, Govender, needs to go back to watchdog training school, or just shut up. They know nothing but their feels, but their certainty is causing death and suffering. Even the most ignorant parent learns to love the child and condemn the behaviour, and this... this is the moral crime: to say otherwise is cruel and condescending. Its an utter failure to expect, hope for, work for, better among the humans.
They deserve that hope, that expectation, that effort because this is where the potential lies, the possibility, out of all the possibilities, and with free will, that a positive change might take place. Instead Govender consigns those suffering to "unstigmatized" behaviours that shame themselves, degrade the quality of life, treading fantanyl poisoned waters until they slip below.
Jen is right. The correct, life-affirming, positive, foundation for these suffering humans looks like this: For you who are ready, who will try with an honest effort, even with little chance of success each time... the help should be unlimited, and available at that very moment. If it's not available it is nearly pointless. For the rest, bad behaviour is stigmatized in the same way rotten food that will make us sick makes us feel disgust. It's not good for the corpus (the cells in the individual, the community around them, the city in which that community lives, the human race.... for fuck's sake.)
Absolute truth. Manipulation of language is part of it, too. You mention "safety", the meaning of which has been turned inside out. But also "hate", which has been diluted so much that it demonizes anyone on this or other issues who speaks up for common sense (i.e. Rowling). Today, the NDP calls drug addicts squatting in. parks "residents". (Homelessness is a real and serious issue, but having lived opposite a massive encampment for several years, what I've seen isn't so much that as cop-free zones resulting in centres for open drug dealing, untreated addicts, and people mentally unwell and off their meds.
Jen, some of your best work comes when you name our insanity. Well done. This piece is great. You have a deft hand balancing reality with compassion. We need more of this.
Exactly right. Our society has lost the plot with its drive to rampant permissiveness. A society exists because of social cohesion that is created by positive role models and standards combined with negative stigmatization for lack of adherence. Sometimes a little bit of "intolerance" goes a long way.
The field of psychology has taken the important insight - that drug addictions are strongly correlated with adverse childhood experiences (ACE) like physical and sexual abuse - and argued that stigmatizing drug abuse re-stigmatizes a population that have already been profoundly victimized. I have a world of empathy for that point of view.
However, in taking the ‘trauma-informed’ position that society has a responsibility of care and compassion for high ACE individuals addicted to drugs, they neglected to study the social consequences of normalizing substance use.
There are a number of important questions that, to my knowledge, have not received research funding or even significant interest with the addictions treatment community. Are there a fixed number of hard drug users? Does use increase with normalization? Why do some high ACE individuals use and others don’t? What influence does normalization of drugs have on high ACE individuals? Are a higher percentage of these individuals using now?
My suspicion is, of course, that ‘destigmatization’ has helped increase the size of the pool of high ACE individuals vulnerable to drug abuse. That in addition to the social disorder associated with tolerance of hard drug user, we are actively harming the same individuals we want so badly to help. And finally, that as our social scientists increasingly engage in advocacy rather than in research that looks for disconfirming evidence, that social science will see its findings increasingly rejected by a skeptical public, causing profound harm to all of us.
It's absolutely true that drug abuse correlates with high ACE scores. Which is why empathy and compassion do have to guide our decision making.
What I don't understand is the logic that letting people who have been severely abused die on the streets of drug addiction is somehow a humane or moral answer to that reality. If an abused individual is standing on the side of a bridge threatening to jump, we understand our obligation to forcibly wrestle him off the bridge and get him some help. Yet letting people kill themselves slowly on a sidewalk is, what, fine? Respecting his autonomy?
My opinions on "trauma informed" therapy are...considerable and a column for another day. JG
Empathy and compassion for people with "high ACE scores" is love and kindness.
For the person who, today, might ask themselves if they can stop drugs and alcohol, the right question is, "so what?... now?", "so what?... next?"
The worst feeling I can remember is a day I sought a social worker for my addiction and behaviour. He listened to my story, looked a bit aghast, and said it was all quite understandable and this felt like the worst kind of ontological shock: There is no help, no hope. The professionals have no idea what to do. It was terrifying and I continued for another 8 years.
What I needed was some version of, "Jesus christ man, you need to stop!!! This is insane and you will die, and likely hurt many along the way! Your behaviour is unacceptable and this community will not tolerate it, for good reasons. You have one life and THIS is how you'd like to spend it? Get some fucking help or get out of my office."
This would not be the right response for many people, but it was exactly the right response for me.
I’m no expert in what the treatment community believes, but to me there’s a number of muddled and contradictory understandings and rules underlying their paradigm:
- The drug abusing population have decision making capacity, in the sense that when they are sober they can answer the questions normally associated with capacity assessment in ways that suggest decision making capacity. Even though they act in ways that are self-evidently self harming, these people understand and can articulate the consequences of their actions. This is a significant part of our current, muddled criteria for decision making capacity.
- Involuntary confinement is not appropriate for the drug abusing population. Even though their decision making capacity is probably absent when they’re using drugs, they often do not face sufficient ‘imminent risk’ to justify involuntary confinement. For example, we can’t confine a diabetic who is not adequately regulating their insulin levels until a) their life is at imminent risk and b) they have medically decompensated to the point where they no longer possess decision-making capacity.
These rules around decision making capacity work pretty well for elderly people and kiddos who are developmentally disabled. The rules relating to ‘imminent harm’ work reasonably well for most suicidal people. Where they don’t work well is for people who, through their behaviours, little by little undermine their decision making capacity permanently. And - my view - the understanding of the treatment community that people are best kept as safe as possible until their brains develop to the point where they are either able to abstain or manage their use safely doesn’t account for the power of substances on the market to cause brain damage. It also doesn’t account for the effects of normalizing substance use and the enduring preference of drug users for ‘unsafe’ drugs over the safer drugs we might like them to take instead.
Thanks for your excellent article. I’m super-interested in your maybe future article on trauma informed therapies.
Completely agree. It’s bonkers to think of enabling drug addicts not just to do drugs but to do it in front of children - normalization of drugs makes it more likely for teens to use drugs and that goes nowhere good. Just look at the cannabis induced psychosis showing up in teens because they think pot is no big deal. Then they have a lifetime of antipsychotics and fail to launc into independent living
I was completely in favour of marijuana legalization, and indeed voted Liberal in 2015 to my great eventual regret largely on that issue.
While I don't know much about cannabis psychosis among teens, clearly something has gone wrong with how we did legalization. The drug has clearly been over-normalized and is now so cheap and ubiquitous, and easy to use thanks to all the new use vectors (e.g. gummies and vape) that there is essentially no barrier to being perma-buzzed.
And I think a lot of people, including young people whose brains demonstrably aren't supposed to be swimming in substances, have taken society up on the offer. A lot of these would be non-users if there wasn't a cannabis store on every goddamn corner, and yes, no social or legal stigma against using. When I was growing up a lot of people smoked weed, many heavily, but that's not really something we should encourage or celebrate to the extent we ended up doing.
Not sure if it's just me, but I've also noticed an increase in complacency and laziness more generally in our society since weed was legalized, and the connection can't be dismissed. As recently as the 2010's it was not really acceptable for adults to openly use marijuana unless you were part of a seedy or alternative subculture. Maybe there was a good reason for that.
Very good article Jen and well made points on the socalled "progressives" use of stigmas. We've listened to that boring, worn-out excuse here in BC for years.
I luv Jen's descriptive use of people replacing their eyeballs with marbles!!
I feel vindicated finally
Hey Tony! I remember when you first ran during Mike Harris' Common Sense election and you promised to harmonize the GST and Ontario PST.
Did you feel vindicated when the Liberals brought it in 15 years later?
Could you stay on topic and make a point? Dragging up a 30 year old political decision hardly makes a point.
Right into my veins, please. Stigmatizing conduct (the conduct impugned in this column in particular being a great example of conduct requiring just that) is a great tool to assist in discouraging behaviour. The cigarette example is a great one. Take it from someone who was there, back in the 80s when the movement to ban smoking in public buildings was gathering steam there was no shortage of, “ooh, smoking is gross - nobody wants to kiss a smoker, it is disgusting to have to breathe that air, your clothes and hair end up stinking if you go to a bar for the night, smokers’ fingers get yellow etc.” You rarely hear that degree of passion today but that is likely due at least in part to the fact that *the stigma worked* with the result that personal usage no longer impacts public spaces. One lesson here may be that you can stigmatize away (or at least reduce) the need to use stigma. Drunk driving is another example where I think stigma has helped – you no longer hear jokes like “of course I drove home, I was too drunk to walk”.
A problem with addressing rampant public drug use is that too often people miss the fact that there are more than two options. It’s not an either-or, a choice between the gallows for someone caught with a joint and a hedonistic free-for-all. I happen to think all drugs should be “legal” for adults but the conduct itself should remain highly stigmatized. Yes, I know, it is easier to introduce stigma where there was virtually none before (see cigarettes) than it is to maintain stigma when you remove the greatest possible stigma (criminalization). But surely it can be done, “Reefer Madness” and Nancy Reagan’s simplistic “Just Say No” campaign notwithstanding. You start by having clear prohibitions on specific use (location, for example) despite the fact there is no longer a total prohibition on personal use. So, snorting cocaine on a street corner or at the local pub and shooting up on the street are both completely out of the question and resorting to the criminal code or Provincial Offences codes and mandatory treatment for those who won’t/can’t stop themselves from doing this has to be in play.
I also love the point that we now have Human Rights commissars wailing about stigma on this issue when (completely unwarranted) stigma is the cornerstone of the entire woke agenda. These fucking misplaced “empathy” fanatics are gonna’ be the downfall of our civilization.
Fwiw, I think this is basically spot on.
My first desire for people struggling with addiction is easy access to fully funded treatment. Absent that, I'm fine with people managing their addictions in prosocial ways -- ie; in private and not harming anyone else. There's a role for things like needle exchanges and drug testing kits in this context. Maybe even a heavily restricted and well monitored safe supply in some cases. (Provided the actual facilities are properly run and heavily policed.)
But once we get into public use and public misconduct well, then, you've made your private addiction a public problem and the public now has an obligation to step in with some combination of criminal punishment or mandatory treatment. We shouldn't tolerate tent encampments. Nor should we be tolerating people passed out on the street, nor doing drugs in public. Nor making a menace of themselves on public transit. These are actions that fundamentally undermine public space, and the rights of non drug users to function appropriately in society. JG
When my father came home from WW2 he went to work as an orderly in our Provincial psychiatric hospital. It was referred to as the mental hospital, actually a beautiful rural setting of gardens, fields, a manicured golf course, decorative stone walls, all maintained by the patients, supervised by staff.
Of course we all know what happened to these facilities: Govts and special interests deemed them inhumane and stigmatising ( there's that word).
The result? Over decades these people were left to survive in a system that no longer provided care and protection and now many live on the streets and drugs are their solace.
My believe is that if you can fix the mental health crisis you will make a huge dent in the drug crisis.
When politicians pretend that these policies are working out well when we can see the results in our streets—that’s the definition of ‘gaslight’ (another overused term, but here it fits). It also seems cynical to say this is the best we can envision, i.e. providing safe supply until those accessing it eventually die from their addiction. Wab Kinew sounds like he is onto some common sense.
And to the UCP government, who started the wave of sanity that may finally prevail on this subject a big thank you!
And a Amen to all the loved ones lost that helped influence the change.
I agree it is worth walking back policy that is not working but advocating for shame through stigma conveniently ignores that we know much more about addiction and how many maybe most who deal with addiction self-medicate to deal with trauma or mental illness. Recovery is a misnomer for addiction when the root causes are ignored and stigmatizing the individuals by extension is a step I wouldn’t take. Who am I to judge and am I not my ‘brother’s keeper’? Suggesting stigma is the way forward neglects how complex and complicated this issue is and the solution should not be one that allows me to walk anywhere in Vancouver. YVR has always had areas where it is less safe to walk as with any big city.
If you get to the bottom of the piece, I deal with this point. It's one thing to not shame an individual who is struggling with addiction. It's another thing to try to totally eliminate the stigma of anti-social behavior on a societal level - while failing to address the actual harms of that behaviour. We can deal with individual circumstances with compassion and empathy while still imposing certain standards of conduct and behaviour for people in public.
You're completely correct that drug abuse is correlated with trauma. What I don't understand is what version of compassion and empathy makes it ok to do nothing while traumatized individuals effectively commit slow motion suicide in public via drugs? Is allowing a homeless individual who was abused as a child continue to self medicate until he inevitably dies in the cold a thing a compassionate society actually does? Or is there a point at which we acknowledge there's a role for both criminal justice and mandatory treatment to step in, here? When you realize the incredible life circumstances of many drug addicts, the conditions we've normalized via "harm reduction" only seem even more horrific to me, not less. JG
Why I was "self-medicating", meaning ingesting harmful drugs and alcohol, turned out to be less than useless information in the project of trying to stop. This is the point missed by compassionate people. The "why" quickly became fodder for my infinite capacity for justification after-the-fact. Even when it wasn't, the "why's" are a pernicious distraction.
What's missed is to distinguish the person from the behaviour. You can and should say to me, "I'm very sorry for what happened to you, and it was wrong. Your current behaviour is also wrong."
At the point of possible positive change, the "why" is irrelevant. At the point of change, the only question to focus on is "what are you going to do about it right now?"
Thank you for sharing that. JG
Hiding behind " it's a complex issue", is what our politicians and administrators do best, and I'm talking country wide, regardless of the issue.
Drug abusing/enabling programs are built around a moral obligation of society to protect each other from harm. I can follow the logic of that to a point, but in real time how are things working out?
Public safety concerns are valid, as are concerns about public littering, loss of public spaces by normalization of encampments and a looming threat of public health as drug abusers turn urban areas into open sewer systems harkening back to the 18 hundreds.
The worst failure of all is refuting the need to get people off hard drugs NOW to save themselves. To save their brains and bodies from the ravages of drugs that will inevitably destroy any concept of leading a productive life in society, free of constraints.
The public wants a stop to the normalization of drug addled zombies in our midst and being coddled along by authority figures who are well meaning but misguided. Let's get a restorative approach going that saves drug users before it's too late and give public spaces back to the general public.
Exactly!
There are no rights without responsibilities! (Just like the management aphorism of no responsibility without control.)
Well, I've repeated many times in the last 8 years, situated as I am in the smoking hole of Victoria BC drug policy, stigma saved my life. If, instead of the shame I felt at my behaviour, I was told to feel satisfied, confident (even encouraged?), I'd be dead.
Walking down Portage Ave, a teenager circa 1979, my cousin turns to me, pointing to a lump of filthy clothes in a doorway that we knew to be a person, "that's you in a few years." He and I were close and did everything together, so he might have known. I was blind with rage... and used a lot of drugs and alcohol that night, because I did every night. His comment was unfiltered, spontaneous, and brutal because of it's truth. It hurt a lot and I never forgot it.
Our HR Watchdog, Govender, needs to go back to watchdog training school, or just shut up. They know nothing but their feels, but their certainty is causing death and suffering. Even the most ignorant parent learns to love the child and condemn the behaviour, and this... this is the moral crime: to say otherwise is cruel and condescending. Its an utter failure to expect, hope for, work for, better among the humans.
They deserve that hope, that expectation, that effort because this is where the potential lies, the possibility, out of all the possibilities, and with free will, that a positive change might take place. Instead Govender consigns those suffering to "unstigmatized" behaviours that shame themselves, degrade the quality of life, treading fantanyl poisoned waters until they slip below.
Jen is right. The correct, life-affirming, positive, foundation for these suffering humans looks like this: For you who are ready, who will try with an honest effort, even with little chance of success each time... the help should be unlimited, and available at that very moment. If it's not available it is nearly pointless. For the rest, bad behaviour is stigmatized in the same way rotten food that will make us sick makes us feel disgust. It's not good for the corpus (the cells in the individual, the community around them, the city in which that community lives, the human race.... for fuck's sake.)
Absolute truth. Manipulation of language is part of it, too. You mention "safety", the meaning of which has been turned inside out. But also "hate", which has been diluted so much that it demonizes anyone on this or other issues who speaks up for common sense (i.e. Rowling). Today, the NDP calls drug addicts squatting in. parks "residents". (Homelessness is a real and serious issue, but having lived opposite a massive encampment for several years, what I've seen isn't so much that as cop-free zones resulting in centres for open drug dealing, untreated addicts, and people mentally unwell and off their meds.
That's 2 days in a row. Thank you, Thank you so much.
Reading this was cathartic. Thank you.
Jen, some of your best work comes when you name our insanity. Well done. This piece is great. You have a deft hand balancing reality with compassion. We need more of this.
Keep going! And thanks.
Exactly right. Our society has lost the plot with its drive to rampant permissiveness. A society exists because of social cohesion that is created by positive role models and standards combined with negative stigmatization for lack of adherence. Sometimes a little bit of "intolerance" goes a long way.
It's difficult to stigmatize drug addiction without stigmatizing many other bad behaviours.
Canadians still have the attitude that they would rather destigmatize everything than restigmatize something they personally don't object to.
We live in the era of shamelessness I think.
Hell Yah, Jen!
I would take a bullet for Jen Gerson.
Hopefully, it will not come to that. JG
I'll be right behind you.
She's a genius with a keyboard.
No argument there.
What refreshing, lead-with-the-chin journalism!
I wish the Maple Leafs played the way she comments.
Courage, fury, and magnificent elegance.
The field of psychology has taken the important insight - that drug addictions are strongly correlated with adverse childhood experiences (ACE) like physical and sexual abuse - and argued that stigmatizing drug abuse re-stigmatizes a population that have already been profoundly victimized. I have a world of empathy for that point of view.
However, in taking the ‘trauma-informed’ position that society has a responsibility of care and compassion for high ACE individuals addicted to drugs, they neglected to study the social consequences of normalizing substance use.
There are a number of important questions that, to my knowledge, have not received research funding or even significant interest with the addictions treatment community. Are there a fixed number of hard drug users? Does use increase with normalization? Why do some high ACE individuals use and others don’t? What influence does normalization of drugs have on high ACE individuals? Are a higher percentage of these individuals using now?
My suspicion is, of course, that ‘destigmatization’ has helped increase the size of the pool of high ACE individuals vulnerable to drug abuse. That in addition to the social disorder associated with tolerance of hard drug user, we are actively harming the same individuals we want so badly to help. And finally, that as our social scientists increasingly engage in advocacy rather than in research that looks for disconfirming evidence, that social science will see its findings increasingly rejected by a skeptical public, causing profound harm to all of us.
It's absolutely true that drug abuse correlates with high ACE scores. Which is why empathy and compassion do have to guide our decision making.
What I don't understand is the logic that letting people who have been severely abused die on the streets of drug addiction is somehow a humane or moral answer to that reality. If an abused individual is standing on the side of a bridge threatening to jump, we understand our obligation to forcibly wrestle him off the bridge and get him some help. Yet letting people kill themselves slowly on a sidewalk is, what, fine? Respecting his autonomy?
My opinions on "trauma informed" therapy are...considerable and a column for another day. JG
Empathy and compassion for people with "high ACE scores" is love and kindness.
For the person who, today, might ask themselves if they can stop drugs and alcohol, the right question is, "so what?... now?", "so what?... next?"
The worst feeling I can remember is a day I sought a social worker for my addiction and behaviour. He listened to my story, looked a bit aghast, and said it was all quite understandable and this felt like the worst kind of ontological shock: There is no help, no hope. The professionals have no idea what to do. It was terrifying and I continued for another 8 years.
What I needed was some version of, "Jesus christ man, you need to stop!!! This is insane and you will die, and likely hurt many along the way! Your behaviour is unacceptable and this community will not tolerate it, for good reasons. You have one life and THIS is how you'd like to spend it? Get some fucking help or get out of my office."
This would not be the right response for many people, but it was exactly the right response for me.
I’m no expert in what the treatment community believes, but to me there’s a number of muddled and contradictory understandings and rules underlying their paradigm:
- The drug abusing population have decision making capacity, in the sense that when they are sober they can answer the questions normally associated with capacity assessment in ways that suggest decision making capacity. Even though they act in ways that are self-evidently self harming, these people understand and can articulate the consequences of their actions. This is a significant part of our current, muddled criteria for decision making capacity.
- Involuntary confinement is not appropriate for the drug abusing population. Even though their decision making capacity is probably absent when they’re using drugs, they often do not face sufficient ‘imminent risk’ to justify involuntary confinement. For example, we can’t confine a diabetic who is not adequately regulating their insulin levels until a) their life is at imminent risk and b) they have medically decompensated to the point where they no longer possess decision-making capacity.
These rules around decision making capacity work pretty well for elderly people and kiddos who are developmentally disabled. The rules relating to ‘imminent harm’ work reasonably well for most suicidal people. Where they don’t work well is for people who, through their behaviours, little by little undermine their decision making capacity permanently. And - my view - the understanding of the treatment community that people are best kept as safe as possible until their brains develop to the point where they are either able to abstain or manage their use safely doesn’t account for the power of substances on the market to cause brain damage. It also doesn’t account for the effects of normalizing substance use and the enduring preference of drug users for ‘unsafe’ drugs over the safer drugs we might like them to take instead.
Thanks for your excellent article. I’m super-interested in your maybe future article on trauma informed therapies.
Excellent points.
Unfortunately, politicians don't do nuance.
But then, beauty contests are no basis for a system of government ...
narcissists with no artistic talent.
If we deny them this, where will they pop up?
Completely agree. It’s bonkers to think of enabling drug addicts not just to do drugs but to do it in front of children - normalization of drugs makes it more likely for teens to use drugs and that goes nowhere good. Just look at the cannabis induced psychosis showing up in teens because they think pot is no big deal. Then they have a lifetime of antipsychotics and fail to launc into independent living
I was completely in favour of marijuana legalization, and indeed voted Liberal in 2015 to my great eventual regret largely on that issue.
While I don't know much about cannabis psychosis among teens, clearly something has gone wrong with how we did legalization. The drug has clearly been over-normalized and is now so cheap and ubiquitous, and easy to use thanks to all the new use vectors (e.g. gummies and vape) that there is essentially no barrier to being perma-buzzed.
And I think a lot of people, including young people whose brains demonstrably aren't supposed to be swimming in substances, have taken society up on the offer. A lot of these would be non-users if there wasn't a cannabis store on every goddamn corner, and yes, no social or legal stigma against using. When I was growing up a lot of people smoked weed, many heavily, but that's not really something we should encourage or celebrate to the extent we ended up doing.
Not sure if it's just me, but I've also noticed an increase in complacency and laziness more generally in our society since weed was legalized, and the connection can't be dismissed. As recently as the 2010's it was not really acceptable for adults to openly use marijuana unless you were part of a seedy or alternative subculture. Maybe there was a good reason for that.
Very good article Jen and well made points on the socalled "progressives" use of stigmas. We've listened to that boring, worn-out excuse here in BC for years.
I luv Jen's descriptive use of people replacing their eyeballs with marbles!!
Ohhhh so true !
It's rampant and like a disease.
Look at me, Look at at me !!!
I can't see and I'm NDP!!
Especially after this weekend vote of
82% for Eby, Leader of the Direction Lost.
Thanks Jen.
Love your rhyme!