July 4, 2006

Of Grace, Addictions, and Needle Exchanges

As someone who has worked in mental health for 30 years, including with clients who have been addicted to needle-injected narcotics, I was dumbfounded by the vote by Fresno County Supervisors against legalizing a needle exchange. When I heard the arguments against supporting this program, I realized something else had to be going on because the arguments just did not make sense.

Supervisor Henry Perea said he couldn't back this program because he was for serious treatment - as though the two solutions were somehow opposed to each other. They are not. The existing underground program nets people into treatment all the time. A legitimate needle exchange simply would help prevent people from getting dangerous and expensive (!) illnesses.

Supervisor Judy Case feared the program would attract more drug addicts to the area. People who are addicted are going to stay as close to sources and other contacts as possible. Why leave anywhere for a clean needle and risk missing a fix?

Supervisor Bob Waterson turned the program down because he wanted the City of Fresno to help pay. Why wait? A successful program would be a strong argument for additional support. Plus, Fresno County needs the money it would save on just one HIV-AIDS patient or a handful of hepatitis C patients.

In my business, when an argument doesn't make sense, I go looking for deeper reasons. What I see in this situation is a lot of fear as well as some embarrassment. To get past this present impasse, we need to deal with these issues first.

Part of the fear is about people who seem different from us. Few of us are comfortable with needles, period, let alone with the idea of injecting ourselves in a vein. For many of us, the very thought of this is repulsive. Why would we want to make this "okay" by giving people more needles? This intense emotion tends to override all other rational judgment.

Another part of the fear, a part that holds great power, is that we don't like the idea of being addicted to anything, particularly something as all-consuming as meth or heroin. Being addicted means loss of control and that is embarrassing. This is why, even when people are in therapy, it is often a real challenge to persuade them that they are addicted to something, let alone to get them to seek help. "Oh, I'm not an addict, if that is what you mean. I am not like those scum bums who live on the street!"

Initially, all such comparisons are quickly and angrily denied. Anyone who might dare to remind them they are just as addicted as the "scum bums" is swiftly and heatedly rejected. And therein lies our collective problem. Gerald May, psychiatrist and son of famed Rollo May, published a book years ago entitled Addiction and Grace. One of his main points was that we all are addicted to many things, not just the obvious substances like heroin, meth, crack, alcohol, tobacco, and the like. We can be addicted to possessions, power, wealth, food, sex, gambling, appearance, security, and so on. An addiction is anything that becomes a compulsion (behavior) or an obsession (thoughts) that gets in charge of our psyche, our soul, that becomes more important than anything and everything else.

With people who are focused on shooting heroin or meth into their veins, it is easy to say they are addicted. They clearly have made this the center point of their lives. Those of us who don't do this, however, don't like to think we are in any way like these obvious addicts. Any reminder of this is angrily denied. But this angry denial is driven by fear and embarrassment.

I can hear people saying with indignation that, "I'm not like those people," and I would have to agree. Most of us are not. My point, though, is that we are afraid to see ourselves as even a tiny bit like them, afraid this will somehow degrade us. This makes us want to keep them as far away as possible, even to the point we stop seeing them as human beings. One way we can distance ourselves emotionally from them is to refuse to provide this important but really small amount of help … help that benefits the larger society as well by reducing illness and related costs.

From the perspective of my religious tradition (Christianity), where grace is understood to be God's unconditional love, the needle exchange also makes good sense. Jesus was disproportionately concerned with the people who had the least and who were the least. Providing people with clean needles is an act of love as well as of common sense. Done in that spirit, it also serves as an invitation to seek help. I have seen this work with my own eyes. Let's not be afraid, let's not be embarrassed. Let's move forward with this program.

--David E. Roy, Ph.D.

Copyright 2006 by David E. Roy, All Rights Reserved.

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