31/10/2012 13:28 GMT | Updated 31/12/2012 05:12 GMT

Addiction Beat: Learning From the Red Cross

In October of last year, I wrote an article for the Huffington Post titled Tough Love is a Joke - Let's Start Enabling Drug Addicts Everywhere. Unsurprisingly, not everyone liked the piece. In the article, I explained that most (maybe all) harm reduction efforts could fall under the heading 'enabling', given that the going line is that anything that makes a using addict's life more 'manageable' is enabling.

Needle exchange, for example, does save lives and helps to curtail infections throughout society at large. Yet some argue that such efforts only help addicts to keep using, rather than allowing them to hit the 'bottom' (an HIV virus?) that will motivate them to change. I have said enough in these pages about how that view is inconsistent with all the solid evidence out there: people are more likely to continue in their addictions (e.g., smoking) during hard and degrading times, and more likely to change their behaviors when things get better and they actually feel as though they might have something to lose - and more to live for. So I rip the entire 'tough love' culture because it does more harm than good, and also because the mindset is just plain malicious.

Still, ingrained beliefs die hard. Today, I thought I'd make an appeal to medical tradition, and a highly respected tradition at that. Jerry Costley, an addiction worker whom I happen to admire, responded to my article by pointing out that my views (and his) are consistent with what the Red Cross has been doing for some time. Rather than talk nonsense about how harm and damage will actually benefit someone, the right move must involve protecting oneself: if keeping that person in your life is too dangerous, harmful in some way or just too expensive, then letting go might be the right decision.

"My advice to parents and others close to someone with an addiction is to apply the Red Cross lifesaving principles, which are that you do everything you can to rescue someone who is dying or going under, but if you find they are pulling you under and you are in danger of dying with them then it is time to kick yourself free. You may have to let them go under at that point. This is probably the toughest decision anyone will ever have to make, but I agree it has to be made honestly on the basis of self preservation and not that we let them drown because we loved them and felt it was best for them. I think the Red Cross probably put a lot of thought into these principles of live saving before they published them, and I believe they are excellent guides. One such guide is don't jump into the water to save someone unless you are sure you are an excellent swimmer and can handle the water."

The principle is profound, and beautiful in its simplicity. The right reason for refraining from helping someone is self-regarding: no one has a right to suggest that you engage in enabling, or a harm reduction initiative, if doing so would cause harm either to you or to your loved ones. On this basis, honest decisions can be made. For too long, people have been told that harm reduction - offering help of any kind - is in fact bad for the problem substance user. This one preachy bit of tripe is something our civilization can do without. Then, finally, more and more honest and practical decisions will be made.