Feature

Why giving ‘facts’ isn’t enough

A morality-free approach to drugs education doesn’t sit easily with a desire for healthy cities, argues Robin Burgess

Drugs are an important and controversial issue facing health professionals, and will become no less so in the wake of the government white paper Tackling Drugs Together.¹

But a quick look at any broadsheet newspaper, or practice in drugs policy, particularly in relation to prevention, tells a story of confused and deeply divided aims and purposes. Many believe that young people will use drugs whatever education tells them, and that society must tell young people how they can avoid killing themselves rather than just to say ‘no’. Traditional drug education is often portrayed as offering an anachronistic and simplistic moral line, out of touch with modern youth culture in which taking drugs is rapidly becoming the norm.

There is no doubt that drug use is increasing considerably. There are many involved in creating drug policy, such as Keith Popple and Chris Ford, who feel that drugs prevention is a waste of time.^{2 3} They see poverty and lack of achievement as powerful factors that stimulate drug taking, and that drug policy must accept this situation. It would be foolish to disregard the real evidence of the link between poverty, under-achievement, marginalisation and drug taking.

But the reality of drug-related harm demands we find solutions in treatment and education at an individual and a societal level. Ford and many others argue that all we can do is help users to stay healthy even when their choice is to use drugs. But Ford concentrates on how we can respond to the chronic problems of individuals rather than look at mass recreational use.

Ambivalence about purpose in relation to the phenomenon of mass use has profound effects on delivery of prevention activity. In practice, what frequently happens in drug prevention at a local level is presentation of selected ‘facts’ about drugs, with no clear message about use.

There is a great reliance in UK drug education on ‘facts’, on their own, being given to help the user to make an ‘informed choice’. The problem is that the ‘facts’ are not necessarily agreed, are marshalled selectively, are selective by omission, and on their own will not change behaviour. Choices, because they are affected by class, power, economics, and psychology, are not truly informed. Such harm as may result is not equally distributed.

If you live on a poor estate, and feel fairly bad about yourself and your future, your drug use is likely to have much worse effects upon you than on a rich person with a secure family and a rosy future, even where the drug and the level of use is the same. The supposedly objective toxicological ‘facts’ given in drug education about the physiological effects are secondary to what the drug does to you in terms of the community you live in, and the kind of person you are.

In Irvine Welsh’s Trainspotting,⁴ a novel about young users in Edinburgh, we have a clear picture of how, alongside physical harms, drug use is corrosive of people’s abilities to escape economic and social disadvantage. Real opportunities to make choices are shaped and restricted by environment and political, personal and social power. The choice made to use drugs, informed or not, will have different implications depending on all these factors.

The response to this social environment that says that all we can do is to mop up the casualties seems to be politically and economically short-sighted. Although harm-reduction clearly has measurable health benefits, as Ford argues, not all the harms that result from drugs can be prevented by safer use. Nor can we be sure that this approach is infallible. For example, what safe method of use is there for crack cocaine?

It is this problem which illustrates that drug prevention policy is at a crossroads. On the one side is the traditional warning that using drugs will kill you. On the other is the message that drug use is here to stay, and all we can do is prevent a few tragedies with some pragmatic policies.

An alternative is to broaden the concept of harm that is attached to drugs. This requires that we acknowledge, like Ford and Popple, that drugs must be seen within broader environmental, cultural, and economic frameworks. But we must also see drug use (including alcohol), as something which itself will further weaken the social and economic fabric of poor communities and damage the individuals within them.

Drug education designed to reduce drug use, coupled with effective treatment services and appropriate harm-reduction, can redefine itself as part of the attempt to create health for all —as concerned with social justice as with personal and community health. Mass drug use will not make for ‘healthy cities’.

This conclusion call for a clear prescriptive line. Many health professionals are reluctant to link drugs use to any moral or directive framework. But if we accept the political urgency of drugs prevention at a community as well as personal level, we can reclaim the concept of ‘just say no’. Along the way this will save a lot of individual casualties too.