Dr Gabor Maté is currently writing a book about addiction (In the Realm of Hungry Ghosts: Close Encounters with Addiction, forthcoming Spring 2008), based on his long-standing experience as a physician to residents in the Downtown Eastside, including many patients with addictions. In a presentation to the staff of the Carnegie Centre, Maté provided a definition of addiction, which helped me to better understand Harm Reduction work: Addiction involves behaviour that is repetitious, has negative consequences, and that you continue in spite of dire consequences in your life. It is not the object that characterizes addiction, but the relationship to the object. According to Bruce Alexander, the original meaning of addiction was “voluntary slavery” and it was only 100 years ago that it became associated with drugs.
As Johnny Knox says in the introduction to this report (page 4) we all have addiction issues, and both Alexander and Maté support this statement, citing examples of addiction to gambling, money, power and consumerism. In his 2005 seminar, Alexander observed that “there would still be an addiction problem if there were no drugs.”
Alexander argues that one important factor contributing to addiction is dislocation, and failure to achieve psychosocial integration — something he claims is endemic in our free-market society, in which workers are expected to be “independent economic actors”, moving where the jobs are irrespective of commitments to family, friends, community, cultural traditions, values, religion, ethnic group or nation (Alexander, 2001: 4). He also says that dislocation is particularly rife in Vancouver, “the most addicted city in Canada” (p. 8) and that Harm Reduction as a social policy is not adequate, although it is the best we have right now. What we really need is a society where people have other choices, where life is good enough that people don’t enslave themselves to drugs:
Although the four pillars are compassionate and useful in combination, society cannot “prevent,” “treat,” or “harm reduce” its way out of addiction any more than it can “police” its way out of it… The key to controlling addiction is maintaining a society in which psychosocial integration is attainable by the great majority of people. People need to belong within their society, not just trade in its markets. (Alexander, 2001: 20)
This seems to be in line with Graham’s critique (see previous section) but it is offered in a way that supports the spirit of Harm Reduction.