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Russell Brand's Insight Into Addiction Helps Drug Debate

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Russell Brand's take on the drugs debate is refreshing. In a documentary he did for BBC 3 he looked at how we dealt with heroin addiction in the UK and asked some awkward questions.

Although better known as a celebrity, his pragmatic and sympathetic scrutiny of the drug problem deserves praise, even if some question his 'expertise' on the subject and criticise the BBC for giving this platform to a comedian rather than the 'experts' we are used to.

He is a recovered heroin addict himself and brings, with well-reasoned debate, an insider's view into the drug abuser's world. He appreciates the pain and devastation addiction causes that no amount of statistics or expert guidance can ever convey. He doesn't hold back.

Is addiction a 'disease', as he keeps referring to it in his documentary, like cancer, heart failure or diabetes which strikes out of the blue and which we have little or no control over? Or is it a self induced illness brought on by the reckless and selfish behaviour of individuals who chose this path of self destruction?

The answer is important because drug enforcement and treatment decisions can be shaped by easily manipulated public attitudes that range from the punitive and unsympathetic "personal responsibility" model to the tolerant and understanding one, the "it could be me or my child" argument.

Do those who indulge themselves with fry-ups, fast food, exercise not at all, slouch on the couch and imbibe legitimate drugs like wine, lager or cigarettes have a somewhat superior intellectual argument when they get a stroke, heart attack, lung cancer or diabetes in their early forties?

Many heroin addicts start taking drugs of some sort in their teens or early twenties. This is not a time of life one generally associates with the virtues of maturity, insight or responsibility.

Several of today's addicts will have desperate personal backgrounds, being abused and traumatised at an early age or exposed to drugs, often from the womb, through no fault of their own by irresponsible adults.

Others, young, wild or impulsive will have fallen into the habit, beginning with the occasional weekend spliff and, through carelessness, lack of will power and ignorance of how addiction works, gradually progress to more frequent use of harder drugs and lose control before they know it.

In his documentary Brand also questions the UK's drug policy which has been mainly geared towards 'harm reduction' rather than striving for 'complete abstinence'.

A harm reduction strategy, aimed as much at reducing the damage drug addiction does to society through crime as to the individual, derives from the admirable philosophy that it is better get as many addicts off the streets as possible, give them clean needles and syringes to reduce the likelihood of them getting HIV infection or hepatitis when they do inject, and help them reduce or stop their potentially lethal street heroin, replacing it with a less powerful opiate, methadone for example, which can be taken by mouth.

One aim is to reduce exposure to infections like HIV, commoner with intravenous drug use, and also to minimise accidental deaths from contaminated or lethal doses of black market drugs.

But methadone, itself a highly a addictive drug, causes side effects which the addict has to live with while taking this opiate, often for the rest of his life.

Although relatively successful the main problem with this approach is that there is often no end in sight for the addict, save a roundabout of visits to clinics, doctors, pharmacists, supervisors, social security offices and all too frequently their own dealer for even more heroin.

Because harm reduction is the default agenda, and many countries besides the UK use it, there is less of an emphasis on encouraging the challenging goal of complete abstinence-getting the addict off drugs completely and returning him to a normal, drug free, productive life.

Abstinence is what Russell Brand wants and has challenged the experts on. It is what many addicts aspire to and the UK Government is now tending in that direction of prioritising it over a harm reduction policy as well.

This will mean shifting some resources towards methods for achieving total abstinence. Heavily dependent addicts who want to stop completely will require easier access to inpatient facilities while they get over the acute and often distressing phase of stopping suddenly-going cold turkey-, sometimes with the help of short term medication. They may need a period of intensive inpatient rehabilitation with ongoing counselling and psychotherapy by appropriately qualified and motivated staff.

High relapse rates mean that this cannot stop for months, even years, and needs to be done in conjunction with programmes designed to re-educate, train, house and re-employ so the addict has both a goal to aspire to, and less of a reason or excuse to go back on drugs. Relapses are inevitable, however, and should be seen as challenges rather than failures, such is the nature of addiction.

As I stated above most addicts start taking drugs when young. Many know addiction is a possibility but do not really understand what it is. Flirting with the dangerous and the forbidden is something rebellious youngsters do. This is something we have to accept and over legislating can often be counter-productive.

Educating children-drugs are a fact of life- from a very early age, about the warning signs and consequences of addiction could pay dividends, particularly if we have role models like Russell Brand to drive the message home that drugs can be extremely dangerous.

Prioritising 'abstinence' rather than 'harm reduction' as the UK declared drug's policy need not impact one iota on those addicts who do not succeed in stopping. Many never do. Needle exchange mechanisms will always be necessary and clean opiate, including heroin, replacement therapy should be part of the policy, but not the policy itself.

Addicts are little different to anyone else when they are ill. Their affliction is not a moral one. It is a physical and mental one which causes untold suffering and misery. By aiming high and giving them the opportunity to fully recover, not just exist in a netherworld of managed addiction, social welfare dependence and chronic illness we will be doing them, as well as ourselves, a big favour.