First, Don't Lose: An Argument for a Radical New Model of Addiction Treatment

Ars talks to author Maya Zalavitz about her book Undoing Drugs. He had just discovered a mixture of cocaine and heroin known as speedball and had no intention of quitting, despite HIV spreading rapidly in society thanks to the common practice of dirty needles. But he might have saved his life by accidentally bumping into an apartment in the East Village.

There is rarely time to write about any interesting science fiction that comes to us. So this year, we're once again launching a twelve-day Christmas series, highlighting a vanished sci-fi story in 2020 every day from December 25 to January 5. Today: Why should we replace the punitive approach? The "war on drugs" with a radical New paradigm for Addiction treatment. A woman who visited California taught Salawitz how to protect herself with bleach through a common syringe at least twice, then rinsed twice with water and also washed the injection site. This was Salawitz's first encounter with so-called "harm reduction," an approach to Addiction treatment that focuses on ways to reduce the risks and negative consequences associated with drug use — not only the risk of Addiction and disease, but also social stigma, poverty and imprisonment for example, the availability of Needle-replacement programs Free clean syringes for addicts, reducing the spread of HIV.

Salavez is finally finding his way through his 12-step, 28-day abstinence program. He graduated from college and became a respected science writer with a focus on science, public policy, and Addiction treatment. But he never forgot the California woman's compassionate approach and wondered if there was a better alternative. His personal experience and many years spent researching the science of Addiction and harm reduction have led to the publication of two books: The Indomitable Brain 2017: A Revolutionary New Way to Understand Addiction, his latest book Undoing Drugs: The Untold Story of Harm Reduction and his latest book, Undoing Drugs: The untold story of harm reduction and the future of addiction, published in July.

And he was able to thank him personally. “Our story was the story of how change happens, and how the smallest things we do can sometimes be very different,” Slewitz wrote in his book Undoing Drugs. "He also stated Talmudic wisdom that saving lives is equivalent to saving the entire world. These ideas are at the heart of harm reduction, which takes into account the view that every life is worth saving." /p>

Ars spoke with Salawitz for more information. Needle exchange programs were one of the first harm reduction strategies to obtain support.Enlargement/Needle Replacement programs were among the first harm reduction strategies supported. Robert Nickelsberg/Getty Images

Ars Technica: In his previous book, Invincible Brain (2017), You support a different view of addiction, we tend to either have the view that it is morally bad and addicts are weak, or that it is a disease and addicts are somehow broken.Maia Szalavitz: I see Addiction as a disorder of learning and development, and there are a lot of Evidence to support this view, as it tends to occur in particular brain development D:Adolescence and young adulthood Ninety percent of all addictions start in the teens and twenties. That doesn't mean you don't see them in older adults. This is very rare.

< p> Addiction requires learning because if you don't learn that this drug works for you, you won't be able to find it and crave it. You have to learn that it does something for you. This learning mechanism is very similar to the process you go through, for example, when you fall in love with someone or when New parents fall in love with their child. It completely changes your priorities. Addiction changes your priorities in a way that may force you to do things you wouldn't normally do.

Ars Technica: The traditional focus of the "war on drugs" has been on disrupting supply lines.. Reducing demand by avoiding use Why is this tactic a failure? If you tell them "don't do this". So the most sensible way is to say, "Well, we really don't want you to do this. But if you do, let's make sure it doesn't kill you."

Scare kids drugs don't work. The truth is that if you are a child, injured or starting to develop a mental illness such as depression, or those who cannot communicate for any reason, medications help. We don't want to accept this. People don't know what happens when they take drugs. they think. This is just a rebellion and it should only be suppressed. Or that hedonism is just what should be suppressed. Advertising

It doesn't work that way. People who end up addicted are addicted people. Something prevents them from feeling comfortable on their own skin. At least in the beginning, the drugs work for him. It will be very inviting when you finally find something that makes you feel comfortable, warm, secure and relaxed. e.

Oxycodone is a narcotic pain reliever.Enlargement/Oxycodone is a narcotic analgesic. Among the opioids in the medical system, he admitted, “You know, I've done Oxycantine for a few surgeries, and that was the best thing.” And I knew I wasn't going to give up because I didn't want to lose my job, my marriage, or my kids. The irresistible. In fact, it's the most common experience. It's irresistible when you have no alternative, when the rest of your life is dark. Over the past 100 years, we've tried to use negative outcomes to correct one thing defined by resisting it. It's time to do something else. You see, We are hurting and not really helping, and you have a very powerful moral weapon against taboos, because their biggest goal is to stop evil drugs. Your biggest goal is to save lives.

Ars Technica: There seems to be a strong belief in our culture that people should be treated for whatever out-of-norm behavior. And bearing the consequences. So what you call "radical empathy" is something quite foreign to many people.

Maya Slawitz: People with Addiction are often homeless, rejected and marginalized. Many of them already struggle From mental problems. No one wants to see them. So when someone approaches them with love and without Judging and saying, "Hey, I don't care if you do drugs, I just want you to live" - ​​that changes everything. When people feel appreciated, they may value themselves more.

Sometimes they find that medications have prevented them from doing so, and they stop using the drug. Sometimes they reduce it, and sometimes they are so damaged that they still can't get out. But at least they don't die. For me, this is a spiritual thing. I don't generally categorize my experiences this way, but harm reduction is very different from the way addicts are usually treated: "You have to hit rock bottom" or "We have to break your character in order." "To fix you." Damage reduction is the antidote.

There are programs where heroin is prescribed to addicts. I mean, heroin is free. You think these people will never get better because they get exactly what they got. The truth is that when you get free heroin and aren't looking for the next solution, you're not chasing, and you don't have all that drama, suddenly your life falls into this big hole. This is where recovery can happen. Because you are actually bored. People with a history of trauma may have to take drugs for a while and learn ways to deal with trauma before they can stop using drugs.

Nothing remarkable. Nothing answers every time. This is why it is called damage reduction. We want people to change in an instant. It makes us great TV, but it's not like the change most people make. If you meet addicts wherever they are, if you meet them. Listen to them and listen to their concerns. This is the only way you can influence them.. Are we trying to change people who have heart disease or diabetes and need to change their diet? We definitely don't jail them for high blood sugar.

Maya Salaviz is the author of <em>Undoing Drugs</em> Gold artist and harm reduction activist at a demonstration in White Plains, <b>New</b> York. Zoom / Nan Golden An artist and harm reduction activist at a demonstration in White Plains, New York. Eric McGregor / LightRocket / Getty Images

Ars Technica: The United States is currently in the midst of an "opioid epidemic" in which increased drug use has led to widespread drug abuse. I know you have strong opinions about how public health policy makers in the United States manage crises.

Maia Szalavitz: 80% of people who have problems with prescription medications did not have a prescription for the first drug they used. They entered someone's trash. This is a sign that opioids are not addictive: between 40 and 60 percent of people who are prescribed opioids end up on opioids. We had an overdose problem as the people who became addicted weren't sick. They were friends and relatives of patients. There were also people who made painkillers and there were pill factories. So, what did we do? We decided to monitor all prescriptions and start reducing the doses and cutting people off.

This happens to hundreds of thousands of people. Doctors were told, "You can't prescribe more than X, and if you do, law enforcement will be with you." There is even a decrease in opioid prescriptions for terminal cancer patients. What does this mean? Denying people who have used opiates access to a drug is often the only thing that works for them that doesn't help anyone. That person is more likely to force suicide or turn to street drugs than to help him. We have forgotten all we know about how to use these drugs effectively.

Ars Technica: So what's the solution?

Maia Szalavitz: The solution is complex. First, even if you think people are addicted, don't take painkillers. It should be legal for doctors to hold people's prescriptions, unless they are forced to take street drugs. Simply stopping them does not "cure" the addiction. Second, stop locking them up, which also kills them. And third, find ways to provide a safe resource without marketing it.

Ideally, we pay for a treatment that is easy to use, enjoyable and evidence-based, and acknowledge that Addiction is strictly individual. If you come in and my problem is depression and loneliness, and I use medications for self-medication, and we have to find a way out of it that gives me a New sense of meaning, purpose, and peace in life. This will be different for different people. I may hate what helps you.

We need to humanize the entire system again. I actually hope so, because two-thirds of people now support decriminalizing property. You would never have imagined such a thing in the '90s. I've seen the damage reduction caused by supporting two people in Liverpool turn into an international movement against ban aggression. There is still controversy over needle exchange programs, but now the Centers for Disease Control and Prevention says states should get them, not the federal government saying, "We're blocking funding because it sends the wrong message." And I have high hopes for medical students and young doctors who really understand the idea of ​​harm reduction and are trying to change their admissions systems. Learn the secrets of dark matter with Ars and Dr. Paul Satter

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