Posts Tagged ‘addiction’

If I tried venting about every part of Peter Hitchens’s output of the last couple of months which has bothered me, I wouldn’t get to bed until it was 4am and I couldn’t feel my fingers any more. “Addiction” doesn’t exist, apparently. No, I’m not explaining what he seems to mean by that. I’ll let you extrapolate from there. (The case of Mark Duggan also demonstrates why we should bring back hanging. Somehow. Oh god, I’m losing myself down a spiralling pit of inanity. Break away, break away.)

There’s one thing he said that I do want to touch on, though, if I can do so without getting carried away. In talking about the effects of illegal drugs, he uses the phrase “unearned chemical exaltation”.

Of specific interest is the word “unearned”.

Peter Hitchens has a great moral objection to the use of drugs. That itself isn’t so bizarre or insupportable, but what’s interesting is that the “unearned” nature of the high they provide seems to be a significant part of his complaint.

He’s not alone in this; it’s an attitude I’ve seen before. Part of what some people find unacceptable and morally abhorrent about this particular form of artificial manipulation of one’s brain state is that it’s unearned. You haven’t worked for your right to feel good. You just took some drugs.

Never mind any damaging side effects that drug use might have on yourself and society; the bottom line is, you don’t deserve any chemical alteration of your mood.

You think you can just shortcut your way to physical pleasure or mental stimulation, without undergoing the toil and pain associated with the traditional ways of achieving such states? That’s cheating.

And so on.

And then this is used to justify laws against such cheating. And thus a staid, parochial attitude becomes global tyranny.

If you believe the outcomes of a liberal approach to certain intoxicants are so negative that a centralised authority needs to step in and crack down on their usage, that’s an argument to be made. But don’t just sweepingly decide that nobody deserves to feel good until they’ve earned it by suffering enough first.

Classroom discussion questions

1. If a hypothetical drug provided the “chemical exaltation” of, say, cocaine, but without the addictive nature or risk of harmful overdose, is there any reasonable grounds on which it could be outlawed? Could its use even be considered immoral?

2. How little attention does someone have to be paying if they really think that caffeine does not “in any way alter consciousness or perception”?

3. Why is Peter Hitchens?

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– I observed recently that a number of Conservapedia‘s editors seem to be deliberately turning it into a parody site, and it’s deranged proprietor is entirely failing to notice. Not quite to the same extent, but Fox News sometimes seem to be doing a similar thing, and doesn’t even need to be ridiculed.

– You might be letting your religion turn you into an inhumane wanktard if… You don’t want other people to get any help with their addiction problems unless it’s on your terms.

– Bank of America. Fuck yeah.

PZ Myers argues with Islamic fundamentalists for our sins. What does Jesus know about self-sacrifice?

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I’m still on something of an annoying journalism kick.

That’s a kick against annoying journalism, I mean. It’s not annoying that I’m blogging about journalism more these days. At least, I’m not annoyed about that.

Stories like this one, however, do annoy me somewhat, because it’s about something I feel like I know just enough about to be able to comment on. Specifically, it’s about people taking drugs while in prison.

(Yeah, how gangsta does that make my life sound? Probably quite a lot less now that I’ve just attempted to use the word ‘gangsta’ so casually. Sigh. I am so white.)

The gist seems to be that a Conservative think-tank disapproves of drug addicted patients being given opiate substitutes like methadone while in prison. But they don’t seem to have a clear idea on what should be done instead.

One of the things I learned pretty soon in my time working in an addictions centre is that most heroin users really don’t want to be heroin users. Whatever you might think of the war on drugs, and the campaign to scare people out of taking them, one thing that’s true is that heroin can seriously fuck you up. And a lot of addicts know this, even as they start shoplifting or selling sex or breaking into cars to get money to buy more heroin.

Heroin’s really quite moreish, you see.

But methadone is pretty handy stuff, because for a lot of people a small regular dose of it will dramatically reduce the intense, uncontrollable craving that heroin leaves you with.

This is useful, because getting physically or psychologically dependent on heroin is very easy. And there are reasons why so few addicts choose to just voluntarily not have any more of it. These reasons include tremors, sweats, cravings, nausea, vomiting, hallucinations, fits, blackouts, and delirium tremens, among others.

None of which is much fun. This is why people who have started using heroin are often inclined to use more heroin. And this is why there exist structured treatment programmes to help these people.

So criticising the system which “maintains rather than halts” prisoners’ drug habits rather seems to be missing the point. Providing a substitute prescription means people can stop having to acquire heroin through their own means to deal with their addiction, and can start engaging in a more complete treatment programme, which includes things like counselling sessions and psychological advice on how to stay clean.

Most of this think-tank’s “Coming Clean” report (PDF link) seems to be focused on the problem of illegal drugs being smuggled into prisons, rather than the approach to substitute prescribing. This is obviously a significant issue, and I don’t feel equipped to tackle it in much depth, but I wonder if getting prisons completely drug-free isn’t essentially as doomed an ideal as the rest of the “war on drugs”.

In the bits that do focus on substitution, they seem mainly concerned that patients aren’t being mandated to detoxify from all drugs fast enough. But it’s not clear why reducing their doses of medication in a substantially reduced timeframe is always going to be a good thing.

There should certainly be emphasis on reduction with an eventual goal of abstinence, but the fact is that this might not always be clinically indicated, and bringing down someone’s dose of methadone with the aim of having them clean within two weeks could end up being counter-productive. If it’s too fast for them to handle the change, their cravings will flare up, and they’ll go back to taking heroin. (I hear that’s not hard to do, in prison.)

I didn’t have to look far to find an example of the Daily Mail being outraged at the “limitless free drugs” available to prison inmates. It’s not an especially raving or offensive article by their standards, but there’s still less of an understanding of substance misuse issues than you might naively hope for from serious journalism. Nobody’s “admitting defeat” here. The goal is still a safe reduction of harmful activities as much as it ever was.

“The new strategy has all the hallmarks of keeping addicts addicted,” they declare, without ever explaining what any of those hallmarks are, probably because it’s bollocks. A two-week detox doesn’t stop you being addicted to heroin, and often it’s simply not the most effective or practical way to achieve abstinence.

According to this same article, “two-thirds of all crime is drug-related”. A staggering proportion of the people who end up in jail are there because of, for instance, “acquisitive crimes”, necessitated entirely by the urgent need to obtain more drugs. I’m not going to get into the argument for legalising everything here, but surely the thing to offer heroin addicts that’s most helpful to everyone is to keep them out of a situation where the best option for them is to use some more heroin.

And sometimes simply detoxifying them safely and giving them a stern talking to about how drugs are bad isn’t the best way to do that. When I said that heroin was moreish, I was using understatement as a comical device. I hope that was clear. Heroin is highly addictive, and helping people to stop taking it any more is difficult. In the centre I work in, there are regular group meetings and one-to-one counselling sessions, and the team regularly liaise with other departments who organise things like social activities, gym memberships, childcare, and safe housing. This is all important if you want it to be worth people’s while staying clear of the stuff they’re addicted to.

This is quite long already, and I don’t quite have the energy to carry on ranting just now, about the popular dehumanising portrayal of all drug users as hardened criminal scum who made their own choices and should have to live with them. Suffice it to say for now that this view is deeply unfair. Maybe I’ll go into that another time.

Okay, I have just noticed one more thing to moan about here though:

Some inmates do try to give up drugs, but prison is the wrong place, from a physical, psychological and practical point of view, for addicts.

If they had somewhere more suitable to go, the prison population would be reduced by almost half.

Hmm. Imagine for a moment that the government actually introduced a scheme to take half of all current inmates out of the prison system, and gave them an inpatient detoxification in some clinical centre especially set up for their treatment.

Can you imagine the response of the Daily Mail and its readers to such outrageous taxpayer-funded coddling?

Anyway. It may not be a traditional unicorn chaser, but the Guardian have an article about prison drug treatment which I found a nice relief after all that.

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Here is an advert pointing out the disparity between the Shell oil company’s recent profits, and the humanitarian results of their recent massive oil spill. Here is a statement from Amnesty expressing disappointment that the Financial Times newspaper decided not to run this advert. Here are Naomi McAuliffe’s thoughts.

– I’ve been hearing about Project Prevention a lot lately. They’re an organisation set up to help children born to drug-addicted mothers. The primary way they do this in the US is by offering addicts $300 to receive “long-term contraception”, which in some cases involves a form of sterilisation.

They’re coming to my attention because the woman behind it all, Barbara Harris, has come to the UK recently. And while I’m sure she’s filled with the best of intentions, I do not support this organisation.

I work in a substance misuse treatment centre. One of the nurses in my building is a Pregnancy Liaison, and works closely with a clinic at a local hospital to deal specifically with clients coming to us for treatment who are also pregnant. There are detailed protocols in place for handling this kind of thing, and I’ve typed up many assessments for substance-addicted women detailing their medical and psychiatric condition in the weeks before and after delivering a baby.

My point is that, in the UK, the NHS is kinda on this one already. It’s not totally escaped everyone’s notice that sometimes drug addicts have babies, and those babies might have problems that need medical support. If there’s good reason to support certain kinds of medical intervention to assist with this – such as long-term contraception – then why should this be done entirely independently by someone like Barbara Harris? Why should it not be integrated into the existing infrastructure?

It’s not at all clear that Project Prevention’s approach is based on good science or in their patients’ best interests. The fact that people have to be paid to submit to these treatments surely counts as a red flag that they’re not always the most healthy and sensible thing to do, otherwise why would they need such coaxing? And consider the first thing stated on their website’s page titled “Objectives”:

The main objective of Project Prevention is to reduce the number of substance exposed births to zero.

Maybe I’m being picky about bad writing more than anything else here, but I’d have thought that the main objective of a charitable medical organisation ought to be more along the lines of providing a high quality of support and care to as many patients as possible, rather than simply attempting to completely eradicate a certain type of behaviour.

It’d be like a family planning centre saying that their main objective was to reduce the number of abortions to zero. Sure, a world with no unwanted pregnancies might be a wonderful idea, but the focus of your activities should surely be to provide care where it’s needed.

So yeah. Not comfortable with this at all. The Northern Doctor is far more scathing.

– Nick Clegg gave a speech today about political reform. I’m cynical enough not to be falling over myself until I see some of this actually happening, and it’s disappointing not to see a repeal of the Digital Economy Act mentioned specifically. But hey, maybe something’ll come of it.

– And lastly, go watch my new favourite TED talk ever. This is so awesome. This is so awesome it almost makes me want to be a maths teacher. Seriously, I just love this guy and cannot fathom why he and people like him aren’t basically in charge of everything. Or at least everything to do with maths textbooks. I need to write about fun maths stuff here more often. So much of its unpopularity among kids is down to the dismal way it’s taught, and it’s tragically unfair.

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