Understanding Harm Minimization
As much as Safety might wish it, the real world is not binary black and white. Sometimes the most caring thing to do in a fallible world with fallible people is simply keep harm to a minimum. Harm minimization is the course of action that puts care at the centre of intelligent ethical decision making. This means that sometimes the lesser of two evils is better than sitting on some sanctimonious horse hoping that it won’t bolt.
The Chief Minister Andrew Barr in the Australian Capital Territory (ACT) came out today and suggested that the Australian states would do well to observe the effectiveness of pill testing in our jurisdiction (https://www.canberratimes.com.au/national/act/andrew-barr-gives-pill-testing-trial-the-green-light-20190218-p50ync.html). This will be the second time that the ACT has undertaking pill testing at a music festival (https://ama.com.au/ausmed/nation-first-pill-testing-trial-canberra-music-festival).
Of course, the binary mindset interprets harm minimization under its binary logic as the approval of substance abuse. The binary view holds to the fact that many substances are declared illegal and so any form of compromise is determined as approval of substance abuse. The same binary logic of ‘what is the only acceptable goal?’ drives Safety to its nonsense language of zero harm.
When humans are faced with highly complex situations where zero actually makes things worse then, harm minimization is the best approach. The Australian Department of Health and all the helping professions take such an approach: (http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front5-fa-toc~drugtreat-pubs-front5-fa-secb~drugtreat-pubs-front5-fa-secb-6~drugtreat-pubs-front5-fa-secb-6-1).
I have witnessed the harm and suffering of substance abuse for many years and have never advocated for any form of substance use. Indeed, I have studied, experienced first hand and researched the issue and all of its suffering. It is not a pretty sector to work in.
There are many problems with the zero view but let me just highlight one. The first and most important delusion of Zero is that it doesn’t understand the nature nor causes of addiction. Standing in front of a locomotive at full boar and wishing it would stop makes just about as much sense. Having worked for years in the areas of addictions, mental health, community services and social work I can tell you, no one in those sectors believes in zero. To better understand addictions I suggest you read Gabor Mate or Johann Hari.
At the foundation of the zero view is the delusion of behaviourism that is, that humans behave according to some mechanical idea according to inputs and outputs. Of course the curse of behaviourism is Safety’s addiction (https://safetyrisk.net/the-curse-of-behaviourism/). When one understands the complexities of human motivation (read Higgins Beyond Pleasure and Pain) one sees how this tired old 1930s theory doesn’t work.
When it comes to harm minimization professions (founded on the principles of helping and care) like the AMA fully support drug injecting rooms and pill testing (https://ama.com.au/gp-network-news/ama-backs-pill-testing-festivals). Anyone who claims the title of ‘professional’ should understand the complexities of human anthropology and the nature of the real world. Real professions would never back zero (https://www.socialworker.com/extras/social-work-month-2015/when-just-say-no-is-not-enough-teaching-harm-reduction/).
The strange thing about all the grandstanding on zero and the pill testing debate is that the greatest level of harm and death in our society doesn’t come from illicit drug use (https://www.aihw.gov.au/getmedia/34569d3a-e8f6-4c20-aa6d-e1554401ff24/aihw-bod-19.pdf.aspx?inline=true ). It comes from a legal source – alcohol. And there is no greater demonstrated failure of zero in history than the efforts made to ban and outlaw alcohol.
Dr Rob Long
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Peter says
I watched the Q&A programme on the ABC last night, a great debate and one of the few areas that encourage open debate and conversation on issues, wish there was more of it. The Police Officer was clearly torn between his organisational history and the enforcement model and what I think he actually believes works. But it is so difficult to swim upstream and hold different views to the establishment. The ex-commissioner was more open as he doesn’t need to worry about what the establishment think. Couldn’t help but think that the drug issue is a genuine “Wicked” problem. We need a multi faceted, harm minimisation approach.
Rob Long. says
Peter, I didn’t see the debate but one thing would have been common between the professionals is that zero doesn’t work. How on earth people keep on peddling this nonsense in denial of fallibility is mind boggling. Those that are stuck inside the binary black hole of orthodoxy seem to be happy to be blind to the extensive suffering that zero fosters. Head in the sand methodology has never worked but always attracts the dumb down fundamentalists who with they were living in Utopia.
Same is true of safety, except the industry is probably 30 years behind because of its addiction to behaviourism. I think in the next 30 years we may see a slight move to harm minimization once the zero delusion has run its course and behaviourism continues to be exposed as antiquated nonsense. Maybe then safety might start to look professional.
Bernard Corden says
Dear Rob,
I detect a hint of mellowness using safety and professional in the same sentence. It must be the encroachment of retirement.
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light
Dylan Thomas
David Skegg says
One issue that is not getting air time at the moment is to have the more destructive substances legalised through the existing medical system. Getting rid of the black market would greatly reduce the profit motive and assure quality control, and leave open the medical profession to utilise diversion therapies
Rob Long. says
Hey Bernard, your imagination must be getting the best of you. The opposite is indeed the case. There can be no profession without care and helping and Safety is not interested in either.
Rob Long. says
David, a sense-able idea and supported by many. I have a friend ex-commissioner of police who believes that 80% of all crime is related to illicit drug use. I would certainly endorse that from my time in social work and corrections. Much of the recreational use is connected to the depressions of poverty and entrapment in societal cycles of victimisation. When life looks crop then medical escape is attractive. The wealthy can hide it but it is just as prevalent.
A little visit to the Wayside Chapel is all one needs to dispose of the stupid ideas of zero and binary simplicity.
Wynand says
Although not quite the same, there are some similarities: because alcohol, or more accurately drunk driving is a big cause of vehicle accidents, the authorities think lowering the legal limit of allowed alcohol in the blood will address the issue. However, they do not assess how many of the accidents happened with people inside the limits, so reducing the limit will not cause less accidents, it will cause more people to break the law. The similarity is that the proposes solution do not address the cause. If the reason for using illicit drugs is removed, the issue will reduce. However, the debate is about drugs already in circulation. I think (and this is not a debate in South Africa, so I know very little on the subject) the amount of drug use will not change at all if pills are tested. Most likely, the person brining in the pill to be tested probably already decided to use it. If the pill tests unsafe, will they not take it, or just find another source?. The same goes for injection rooms and clean needles – the person using it already decided to use anyway. However, the prohibiting approach drives “reporting” underground (sound familiar?). At least with injection rooms, there is some manner of knowledge about the users. With street injections, knowledge is usually only after the fatality.