Compassion Not Contempt: Interview with Maia Szalavitz

“We have to recognize that people who use drugs need compassion not contempt” – Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction

March is Women’s History Month and what better way to celebrate it here on the blog today than interviewing Maia Szalavitz a longstanding advocate of Harm Reduction policies. I have known Maia for nearly a decade and greatly admire her work and her contribution to the harm reduction movement, which really highlights the many positive things those in the harm reduction universe are doing for addictions.

Maia Szalavitz is a journalist and author who has made groundbreaking contributions on addiction, drug policy, and neuroscience through her writing and advocacy in the past thirty years. Her latest book, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, is a New York Times bestseller.

Welcome Maia. Many working in Harm Reduction have struggled with addiction or mental health issues personally. Can you tell me a bit about your history working in harm reduction? How did you first get involved?

I am a journalist and a person who suffered from addiction. I first got involved with harm reduction, because it saved my life. When I was injecting cocaine and heroin, there was a harm reduction campaign in San Francisco that taught people how to use bleach to clean our needles. An outreach worker from that group happened by sheer coincidence to visit a friend of mine in New York where I lived, and I met her in 1986 and she taught me about cleaning needles. I’m convinced that I did not get infected with HIV because of this campaign. This was at a time when 50% of IV users were infected with HIV. I didn’t even know AIDS affected IV drug users. I continued using until 1988 and then got into recovery.

I was furious that no one seemed to be taking action to prevent HIV among IV drug users in my own city. I tried to raise attention surrounding some of the myths about addiction, such as the myth that people love to share needles or that they won’t change their behavior because they love sharing needles. The truth is that the vast majority of needle sharing occurs because of economic reasons, they can’t afford clean needles or they don’t have access to them. I started to learn more about needle exchange and harm reduction programs.

In the early 1990s, I was in Liverpool, United Kingdom. Liverpool was one of the first cities that was making harm reduction a priority. I saw it start with a few hundred people and then spread into a national movement.

Who were your mentors early on? How does their work continue to impact you today?

There are way too many to name! You’ll have to wait for my book to hear them all, but some of the harm reduction supporters that influenced me early on were:

● ACT UP – A coalition that aims to end the AIDS crisis.

● Dave Purchase – He was a national leader of the needle-exchange movement.

● Alan Marlatt – He brought harm reduction into mainstream addiction treatment.

● Dan Bigg – The Chicago man who brought Naloxone, the opioid antidote, out of hospitals and onto the streets, saving thousands of lives

● Peter McDermott

● Edith Springer – She spread ideas through social work and training people. Edith is known as the goddess of harm reduction.

● Imani Woods – Imani was one of the great pioneers of harm reduction

● Alan Clear – Known for the Lower East Side needle exchange in NYC and harm reduction coalition

● Yolanda Serano – Known for bleach distribution early on and helping make needle exchange happen

● Howard Josepher – Created a pioneering harm reduction program in New York

What is your opinion on how/why addiction happens?

I actually wrote a book on this, called Unbroken Brain: A Revolutionary New Way of Understanding Addiction. My view is that addiction is a learning disorder, similar to ADHD, that grows over the course of development.

There are genetic and temperamental predispositions that we all have and then we encounter various experiences—such as the way we are nurtured, any trauma, our culture—then our brain and cells develop. Combine all these factors together and you create a risk of experiencing addiction. Point being: Addiction is not caused by any one thing. It’s not caused by a drug. Not caused by a gene alone. Not caused by culture alone. All of these are factors that can contribute. Your temperament, worldview, also contribute. Therefore, it’s a developmental disorder. It's more closely analogous to ADHD than anything else. Like that condition, there are genetic components, sure, but you can grow out of it. And sometimes people need medication to manage it.

Do you think abstinence-only programs are effective? Why or why not?

Clearly, they are not effective for everybody. For opioid addiction, we have two treatments that reduce the death rate by 50% or more—buprenorphine and morphine. That's in comparison with abstinence-only programs: Using medication cuts the death rate by at least half. Some people do benefit from 12-step programs, but in reality, there are different ways into addiction and therefore there will be different ways out. It’s a grave error that 90% of the treatment in the U.S. is focused on the 12-steps, especially since it means we pay millions of dollars for rehabs that teach what people can learn for free in self-help groups. 12-step programs are great self-help for some people but the problem is when we treat addiction as a moral problem. It’s not helpful that the medical system says addiction is a disease, but then recommends treating it with confession, meeting, and prayer.

What does the word "sobriety" mean to you?

I’m not a big fan of the word sobriety, though I think it’s 1000 times better than the word “clean.” Clean implies that people who are using drugs/alcohol are inherently “dirty” which is not the case. Clean is a terrible word to use. I prefer people to use the phrase “in recovery.” Sobriety sounds dull and boring, and not very much fun, much like the word “sober” does. When you want to attract people into a new way of living, using the word sober isn’t the best way to do that.

Recovery can be a lot of fun, far more than addiction is! It really put me off when I went to meetings and people would tell me to give up people, places, and things. I already gave up drugs, why should I have to give up sex and rock and roll too? The people who inspired me when I was in recovery told me I could potentially meet the love of my life, have a dream career, have a good group of friends. It was less about giving things up. Recovery needs a serious re-branding so that it highlights the things you gain, not the things you have to give up.

I speak a lot about shame and stigma and how they prevent people from seeking help for addiction or mental health issues. In your experience, what are some of the main barriers preventing people from getting help?

The number one cause of addiction stigma is the fact that drugs are criminalized. Criminalization is a huge problem. We don’t lock people up with diabetes when they eat a donut, or lock depressed people up when they are sad, therefore we cannot criminalize people for having an addiction.

Other barriers include people being afraid of addiction. Why do I think people are afraid of addiction? Because people are afraid of losing control. This is the same reason why there is a stigma against obese people, because we stigmatize what we fear. We fear that we could become a slave to drinking or drugs. We all have a natural human tendency to stigmatize people that are different. It’s not as easy to stigmatize people when we are not criminalizing them.

What has been the proudest moment in your career?

My proudest moments are more of a process, not a singular event. I was proud when my book made the New York Times bestseller list and when I received an award from the National Institute on Drug Abuse for my book. My less personal sense of pride is around the increase in safe injection facilities and harm reduction policies in general but of course, that's hardly in any way my work alone, that’s a collective success.

If you could design a Harm Reduction plan for the U.S. (or the world for that matter) what ideas would you like to bring to fruition?

● Decriminalize possession of substances

● Legalize marijuana

● Model effective ways of non-commercial distribution of other substances like psychedelics in order to guide better policy

● Expunge all the criminal records of people who have been affected by the war on drugs

● Use the money being spent to criminalize drug offenders to pay for actual evidence-based treatment that is voluntary, compassionate, caring, and supportive

● Extend Harm Reduction services like needle exchange and safe injection sites

● Implement universal health care

● And while we are at it…let’s implement a universal basic income, because ultimately, the things that level inequality will fight addiction in the long term, but addiction is more than just a response to inequality. We must identify and be compassionate towards people who are addicted. People who become addicted feel like outsiders for various reasons: because they are poor, have suffered from traumatic experiences, etc. They feel they are fundamentally different than others. If we become generally more accepting of difference, we will have a better world.

We need to take care of ourselves and each other in this chaotic moment. We have to recognize that people who use drugs need compassion, not contempt. We need to take care of each other instead of condemning others. We need to empathize and understand others’ perspective—then we will be better equipped to address addiction and mental health disabilities. Drug policy needs to focus on reducing harm instead of focusing on reducing the number of people getting high.

Thank you so much for taking the time to chat with me today, Maia.

You can pick up a copy of Maia’s book Unbroken Brain: A Revolutionary New Way of Understanding Addiction at her website. Also, keep an eye out for her upcoming book called Undoing Drugs (working title), which will likely come out after the election in 2021.

To find out more about my views on addiction and sobriety, read The Abstinence Myth.