In 1982, President Ronald Reagan declared a “war on drugs” (a term previously used by President Richard Nixon in 1971). From that moment on, the peddlers of illicit drugs were vilified and so, too, were the human beings who used them. In the 1970s and 1980s, the government presumably did not have a thorough understanding of the brain and developmental science we now have at our disposal. From that perspective, one can comprehend why addiction became a legal issue rather than a public health crisis. Today, however, it is alarming to observe that substance use disorder continues to be a legal issue, and the question of how to prevent drug addiction is still met with the notion that “just saying no” will deter young people from substance use. This approach is ineffective and not scientifically supported.
The U.S. Attorney General, Jeff Sessions, addressed law enforcement officials in March of 2017. He said: “I think we have too much of a tolerance for drug use ─ psychologically, politically, morally…We need to say, as Nancy Reagan said, ‘Just say no.’…Educating people and telling them the terrible truth about drugs and addiction will result in better choices by more people”.
One might be inclined to ask: “If we have access to the science, why is it not widely understood and implemented in practice?” The answer to this question is complex, ideological, and beyond the scope of what we are trying to achieve; namely, awareness. Our responsibility as treatment providers is to explain why “just say no” is an ineffective means of prevention, and to identify how to prevent drug addiction in an appropriate, evidence based way.
Why Say ‘No’ to ‘Just Say No’?
Dr. Gabor Maté, author of the book In The Realm of Hungry Ghosts, close encounters with addiction, spoke at Dartmouth in April of 2017, not long after Attorney General Session’s comments. Dr. Maté illuminated the success of so-called prevention programs: “Every day, between 130-140 people die of overdoses, which means that every month you have the equivalent of a 9/11 happening…Welcome to the Middle Ages”.
While Dr. Maté’s delivery was harsh, one must admit he has a point. Our prevention programs aren’t working. But why?
“The first thing we have to realize is that when we’re talking about addiction, we’re not just talking about drugs,” Dr. Maté said. “It can apply to cigarettes, eating, shopping, gambling, work, sex, compulsive internet [use], compulsive video-gaming. The issue is not the behavior…the issue is does it provide temporary relief at the cost of long-term consequences?”
Addiction is “an attempt to solve a problem,” Dr. Maté asserts. “Why was it that you weren’t able to be with the pain?”
“We have to look at people’s lives in the context of their psychological and social relationships,” Dr. Maté noted. Addiction is “an attempt to somehow control your life experience”. Addictions are also “very often about self-medication. If that’s the case, we’ve got to be dealing with what [people are] self medicating…All addictions distract from pain”.
According to Dr. Maté, the “brain develops in interaction with the environment…The environment triggers the genes.” What he is saying, in essence, is that the disease model only partially explains the biology, and fails to address the psychological and sociological factors. These factors include lack of healthy attachment, stress, trauma, and adverse childhood experiences. “Trauma does not have to be big ’T’ trauma,” Dr. Maté explained. In other words, it can be a simple but not insubstantial matter of inattentiveness or emotional unavailability. For each adverse childhood experience, the “risk of addiction increases exponentially”.
In considering failed drug policy and the question of how to prevent drug addiction, Dr. Maté said: “You fail to protect young children, you stress their parents, we don’t deal with trauma – and then their brains develop in a certain way, and they turn to substances we’ve arbitrarily declared to be criminal activities…We’ve permitted them socially to be abused and then we punish them for running away from their pain”.
The so-called war on drugs, then, is responding to stressed, traumatized people with more stress. Furthermore, if vulnerable populations tend to be stressed or traumatized, how will they have the developmental capacity to “just say no”? Society cannot begin to address the problem of how to prevent drug addiction while simultaneously ignoring or perpetuating trauma.
“You don’t prevent addiction by going into schools and telling kids how bad drugs are,” Dr. Maté said. “You just don’t. And the reason you don’t is because the kids who will listen to adults are not at risk”.
How to Prevent Drug Addiction (Really.)
It’s critical to pause and note that education should not be undervalued. Young people should know the risks of drug use and have limited access to medication with the potential for dependency and misuse. The public should also be aware of the risks and consequences of addiction. On the other hand, strong caregiving and community relationships, healthy coping skills, stress reduction, self-care, and early intervention for adverse childhood (and adult) experiences are equally – if not more – important.
“Trauma is not a word that’s mentioned in medical schools,” Dr. Maté gravely observed.
“The good news is the brain can develop even later. People can heal. That’s a capacity inside all of us. But we don’t need to be punished. We don’t need to be ostracized. We need to be dealt with compassion and understanding, and we need to heal the trauma that underlies the addiction”.
Answering the question of how to prevent drug addiction isn’t a matter of prevention per se, it’s a matter of intervention. It’s unreasonable to expect that any human will skate through life without experiencing adverse events or stress. The problem is what one does with the stress. How do we deal with life’s challenges? As adults, we can intervene by modeling and teaching healthy coping skills, and by providing swift support when traumatic events occur. We can also intervene by assessing our personal and societal attitudes toward stress. Are we using external things to provide temporary relief without regard to the long-term consequences? What message does this send to young people?
Above all, Dr. Maté advocates for safe environments. “Nothing grows when it’s not vulnerable…you want people to grow? Make it safe for them to be vulnerable”. If safety and vulnerability are necessary for healing, it stands to reason our culture could benefit from more tolerance…not less of it.
If you are seeking a safe place to heal, please call (888) 649-1149 or contact us here.
Autumn Khavari is the Process Recovery Center’s in-house writer. She received an education in Substance Use Counseling from Beal College in Bangor, Maine.
Maté, G. (2017). The Hungry Ghost: A Biopsychosocial Perspective on Addiction, from Heroin to Workaholism [Video]. Retrieved from https://www.youtube.com/watch?v=NC5dp9q0Tg0&feature=youtu.be