Constructive Engagement with Youth

I have been working with youth in Chicago for over ten years and have found that drug use is a significant concern to many youth. Many of the youth I see are homeless and living in the streets. Others live successfully at home with their families, are employed and attend school. As with adults, youth experience a range of drug-using patterns between chaos and stability.

At the Chicago Recovery Alliance, youth ages 14-24 have initiated and developed a peer education program since 2000 in which they provide harm reduction outreach with syringe exchange. This program has shown that young people are aware of problems associated with their own and others' drug use, and that young people can and do constructively contribute to and engage in positive ideas and changes in their own and others' lives. These positive changes differ among individuals and range between avoiding disease transmission, moderating use to maintain stability, utilizing drug substitution therapy, and abstinence.

In other words, youth, like adults, are experts regarding their own lives, which includes drug use. When engaged constructively rather than in a punitive and/or condescending manner, youth will reduce or moderate drug use and even abstain. Abstinence cannot be demanded of anyone, including youth. Constructive engagement keeps people alive and encourages positive change.

Karen Stanczykiewicz
Youth Outreach Coordinator
Chicago Recovery Alliance

Harm Reduction is a Cop Out

I have been in the substance abuse field for over 25 years. I am a recovering addict and I was the Drug Czar for Baltimore County, Maryland for 23 years.

I have been around long enough to see many different approaches to help our youth stay away from alcohol, tobacco and other drugs. While no approach has been proven to work every time for every group of young people, I believe that the one approach that cannot work with teens and with active addicts is the "Harm Reduction" model.

To me this is a manipulation by the pro-legalization movement to justify their ultimate goal. The worst thing we can do to our youth is give a mixed message about alcohol, tobacco and drugs by saying that experimentation and limited use is not bad and dangerous. That's the message I received in 1968, and it was a green light to use.

Now, many baby boomers who used pot (and in some cases still do) think the harm reduction message is more realistic. They are wrong. While we all laughed and made fun of the "just say no" campaign, it worked. School-aged drug use went down, and the entire nation was focused on giving one clear simple message that drugs were bad.

You cannot give kids a mixed message and expect them to make the right decision. They are kids, and they look to adults to help guide them in the right direction. It is clear that the pro-legalization movement has manipulated many in this country to believe that we need a harm reduction approach because it will help sick patients, clear out our jails, reduce crime, and allow us to treat the problem as a medical condition.

This will never be true, and all we need to do is look at the use of tobacco and alcohol in this country to see how easily this nation can and will abuse legal drugs. More people die from alcohol and tobacco -- our legal drugs -- than from all illegal drugs combined. Do we really want other drugs added to this list?

Michael Gimbel
Director of Substance Abuse Prevention
Sheppard Pratt Health System
Baltimore, MD

Methadone is Treatment, Not Harm Reduction

One of the examples of harm reduction mentioned in the article is "methadone treatment for heroin addicts." I am writing to correct a common misunderstanding that methadone and other opiate replacement therapies are "harm reduction."

To say that methadone is merely a harm reduction measure gives credibility to the argument that methadone treatment "is the same as giving drugs to drug addicts." Scientific evidence supporting the use of methadone to treat heroin addiction is overwhelming. Compared to other major drug treatment modalities, methadone is the most rigorously studied and has yielded the best results.

Opiate dependence is not a failure of willpower, nor is it a voluntary decision. While the decision to use drugs in the absence of addiction is to a large extent voluntary or "conscious", research demonstrates that after repeated drug exposure the structure and functioning of the brain is altered. This alteration is a disease process, and uncontrollable craving for drugs is a common sign of this chronic illness. Methadone stabilizes the brain and reduces cravings, often to manageable levels.

Many, many people live long and productive, drug-free lives with the help of this medication. Methadone is treatment, not harm reduction.

Sandra C. Lapham, M.D., M.P.H
Director
Behavioral Health Research Center of the Southwest
Albuquerque, NM

Health Care Now Dictated by Politics, not Science

The Bush Administration, led by Attorney General John Ashcroft, continues to try to keep evidence-based, scientifically sound interventions from the substance abuse treatment community. This effort, most clearly demonstrated in the resistance to the harm reduction approach to substance abuse treatment, substitutes approaches that have been certified "politically correct" by the far right in this country.

As the situation stands now, we are unable to use federal funding to suggest to someone that they might benefit from reducing their alcohol or other drug use. Instead, we must insist that they quit immediately. Again, this flies in the face of what science has led us to know regarding behavioral change.

Researchers and treatment providers have an ethical obligation to resist this politicization of the health care system.

Anthony J. Alberta, Ph.D.
Sonoran Research Group
Phoenix, AZ