World Conference on Drugs

Visby, Sweden – May 3rd to 6th, 2001

‘The History of Harm Reduction’
Paper by Peter Stoker: Director, National Drug Prevention Alliance (UK).

1. Introduction

With a title like ‘the history of …’ you might reasonably expect a historian to be standing here, but I’m not one. Nevertheless I can apply my experience to analysing this situation, and much of that experience, until I moved into the drugs field 15 years ago, was as a construction engineer. Part of my training then was to explore when things collapse, and find out why. Our society has not yet totally collapsed, but it is showing signs of severe stress. Cracks are appearing, and we need to shore the whole structure up quickly, if we are not to be crushed. What is causing this? Basically, our foundations are being undermined.

In this paper I will try to give you my ‘structural analysis’ of the Harm Reduction movement, and some indications for avoiding future collapse.

When Torgny Peterson first asked me to deliver this paper, I misheard him. I thought he asked me to write not about the History, but about the Mystery of Harm Reduction. It seemed a sensible request, but in checking my dictionary I found that a more appropriate word than “Mystery” would be “Mysticism” – which the dictionary defines as:

‘A belief characterised by self-delusion or dreamy confusion of thought, especially when based on mysterious agencies’.

How true that is! And some of the agencies are more mysterious than others.

2. Historical Perspective

Harm Reduction has always been around. In the Garden of Eden, when Eve ignored the advice to “Just Say No to Snakes” and then peer-pressured Adam into biting that apple, it dawned on them that they were naked and they cried out “What shall we do?”. Well, Walmarts hadn’t been invented at that time, so the best they could come up with by way of Harm Reduction was a fig-leaf.

And ever since then, we have been using the “fig-leaf” approach to society’s drug problems.

John Stuart Mill, considered by many to be the father of Liberty, was born in London in 1806. A prodigiously intelligent man, the culmination of his career came in the celebrated essays he published between 1859 and 1865; in particular his classic work “On Liberty”1. Many of those who wish to legalise or liberalise drugs employ philosophic arguments, quoting from this treatise to justify their position. But in doing so they are making a fundamental strategic error. Their favourite quote is:

‘Over himself, and over his own mind and body, the individual is sovereign’

However this is but one sentence in thousands which speak quite the opposite, which emphasise that the individual has an obligation to society, and that the rights of society outweigh those of the individual. On my copy of Mills classic text ‘On Liberty’, the dust jacket gives a more apposite quote:

‘the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others…’

And therein lies the key phrase. Harm to others. For the driving force in the thinking of a drug aficionado is that the individual is sovereign, and the only harm that is significant is harm to that individual – harm to others can be dismissed as the deluded invention of prohibitionists. Mill rejects this, taking direct issue with those who abuse substances and making it clear that, because of the harm caused to others by this individual action, such abuse should be repressed by law. This was particularly far-sighted, given that he wrote it in l859, when drug availability was low and its abuse was virtually non-existent in enlightened democratic nations.

In the context of morality, law and punishment, Mill says ‘Whenever , in short there is definite damage, or definite risk of damage, either to an individual or to the public, the case is taken out of the province of Liberty and placed in that of morality or law’. Punishment is seen to be right ….’for such actions as are prejudicial to the interests of others …the individual is accountable [to society] and may be subjected either to social or legal punishment if society is of the opinion that the one or the other is requisite for its protection.’

False reliance on Mill is not the only example of drug liberalisers wishing to live in another time. One of the studies frequently cited as ‘evidence’ of the innocuous nature of cannabis is the 1896 Indian Hemp Commission report. A premier libertarian in my country, Dr. Colin Brewer, who is a senior member of the International Anti-Prohibition League, frequently eulogises Victorian times as an example of how we might have ‘drug peace’ instead of ‘drug war’.

Those who are more familiar with Mill’s work can take a more objective view. Gertrude Himmelfarb, editor of ‘On Liberty’ makes the point that ‘Mill’s principle of liberty is less applicable than before, given that our social reality today is infinitely more complicated.’ For those of us who are familiar with the drug culture, Himmelfarb might be accused of missing the point. The main purpose of ingesting drugs is precisely to depart from ‘our social reality today’. It follows that anything which facilitates or excuses this departure, including ‘cherry picking’ useful phrases from 150 year-old documents, is fair game.

3. America in the Seventies and later

Although the Office of Substance Abuse Prevention now rejects the term ‘responsible use’, back in the Seventies many people were more gullible. A rash of deaths from huffing (solvent sniffing abuse) produced a proposal to give guidance on less risky methods of sniffing. This followed on recommendations drafted in the early 1970s for education on ‘responsible use’ of alcohol, including recommendations for drinking and driving (as distinct from ‘not drinking and driving’). David Duncan (et al), writing in 1994 in the Journal of Drug Education2, identified this as the start of a paradigm shift; and he remarked that such shifts can often be huge but equally are often incremental, and so creep up on society unawares. Given that Duncan and colleagues were offering an unabashed argument in favour of harm reduction, he would presumably have wished for society to stay unawares – at least of the moves by his school of thought.

Society may have been unawares but some people certainly were not. One of those who read ‘Harm Reduction – a New Paradigm for Drug Education’ was Dr. Robert DuPont, a drug specialist who had earlier publicly recanted his support for permissive approaches to drugs – especially cannabis. DuPont sent a stiff letter to the editor of the Journal, saying that Duncan’s article was a regurgitation of the failed ‘ responsible use initiative of 20 years ago’ , and commenting that whilst there might be a place for harm reduction in tertiary prevention, to mitigate the effects on hard core users, harm reduction was a disastrous idea in primary prevention in schools., in that it would undercut the important goal of non-use. Typical of the ‘pearls of wisdom’ in the article was the proposition that ‘Harm reduction is consistent with the human experience …’ and ‘Prevention often increases harm’. Particularly fascinating were the ‘findings’ that moderate users of drugs were healthier psychologically and enjoyed higher life satisfaction than either abusers or non-users. You may also be intrigued to learn that marijuana users enjoy better social skills, a broader range of interests and more concern for the feelings of others than non-users. DuPont reacted emphatically. He was in a strong position to make criticism, since up to that point he had been a member of the Journal’s board of directors – but not any more; he resigned so that his name could ‘no longer be associated with this dangerous message’.

Others have – perhaps wishfully – perceived a paradigm shift in drug policy. In a retrospective paper entitled ‘A Kinder War’ the high priest of drug liberalisation, Arnold Trebach3 spoke of a change being in the air. There was, he perceived, greater understanding of ‘…[the] enduring reality of drug use, the absurdity of even attempting to create a drug-free society, and the need to treat drug users and abusers as basically decent human beings’. In l980 an organisation called the Drug Abuse Council spent $10 million , most of it from the Ford Foundation, to produce a 300 page report entitled ‘Facts About Drugs’. It included such gems as the statement that users are no threat to society, only abusers are; it supported the idea of giving heroin to heroin addicts and – not surprisingly – it proposed, as a Harm Reduction expedient, the decriminalisation of cannabis. It suggested that there should be a distinction between what it called ‘recreational use’ and ‘misuse that harms society’. It went on to say that ‘by adhering to an unrealistic goal of total abstinence from the use of illicit drugs, opportunities to encourage responsible drug using behaviour are missed’. The Drug Abuse Council comforted itself in the supposed validity of its recommendations by predicting that ‘…heavy use would prevail for the next few years….’. In fact from the year of their report’s publication and for the succeeding 11 years, America brought about an astonishing public health success which yielded an overall reduction in the use of all substances by all ages of 60%, removing 13 million drug-users from the slate. In this as in everything else the Drug Abuse Council had got it wrong.

Unfortunately, expression of Harm Reduction philosophy was not confined to the private sector. In 1996 at Emory College in Atlanta, Georgia, the first South Eastern Harm Reduction Conference4 was – appallingly – co-hosted by America’s prestigious Centre for Disease Control. Some of the very well known libertarian groups with which CDC rubbed shoulders included the Drug Policy Foundation, the Lindesmith Foundation and Eric Sterling’s Criminal Justice Policy Foundation. A specimen statement from this bizarre grouping was ‘In allowing users access to the tools needed to become healthier, we recognise the competency of their efforts to protect themselves, their loved ones, and their communities’. The notion that one way of becoming healthier might be to stop or indeed never start being drug users would presumably have been lost on this gathering.

At about the same time a much more negative assessment of Harm Reduction came from body called the Family Research Council. In the council’s magazine ‘Insight’ writer Rob Maginnis5 produced an exemplary analysis of Harm Reduction; he noted the support from William F Buckley and the ACLU (American Civil Liberties Union) which he cited as ‘a leading promoter of Harm Reduction’. ( I have been advised by one of my gurus – the marvellous Otto Moulton – to constantly watch out for the ACLU; they have always been a major player in drug liberalisation, yet they are rarely seen or mentioned in this context. A possible explanation for this protected position may be the high percentage of ACLU members or supporters amongst the media). Maginnis gives an early example of Harm Reduction in Holland in the l970s, when they were handing out needles in an attempt to limit the spread of hepatitis – this was before the AIDS epidemic had become apparent.

ACLU are quoted as asserting that ‘Harm Reduction assumes drug-users civil rights and individual autonomy should be respected, it treats drug users as important participants in the process of gaining and maintaining control over their drug use, and makes no moral judgement based solely upon an individuals’ use of drugs’.

American drug policy experts, Sue Rusche and Stephanie Haynes, whose assistance with this paper I gratefully acknowledge, both define the Seventies as a period in which responsible use was the lubricant that allowed a whole generation to slide down the slope into drug abuse. Rusche cites use prevalence figures which are stark and inescapable. In 1962, less than two per cent of the American population had had any encounter with any illegal drug. But by 1979, 34 per cent of adolescents, 65 per cent of high-school seniors and 70 per cent of young adults had tried drugs. It was responsible use policies which fuelled this escalation. Between 1973 and 1978, 11 American states decriminalised marijuana. Some 30,000 ‘head shops’ sprang up to supply a curious population with drug paraphernalia. At the same time schools drug education materials taught children how to ‘use drugs responsibly’.

At first, parents were unwitting collaborators in this unfortunate process, in that they were blind to what was going on. But when their eyes were opened, they reacted strongly and assertively. Parent groups, such as Sue Rusche’s National Families in Action, PRIDE – the Parents Resource Institute for Drug Education, and the National Federation of Parents for Drug-Free Youth sprang up all over America, until at one time there were more than 8000 such groups. The parent movement hammered the professionals who had swallowed the Harm Reduction notion, and the parents were extremely successful in producing a paradigm shift of their own, back to prevention. The parent movement defined ‘Drugs’ as any and all illegal drugs, plus any legal drugs (such as alcohol and tobacco) used illegally – for example by those who were under age. Simple strategy goals were defined:

– Prevent use before it starts.
– Persuade users to stop.
– Help those who can’t stop to find treatment so that they can.

Parent campaigns closed the Head shops and put a stop to any decriminalisation. Several states have more recently succumbed to expensive PR campaigns and have swallowed the notion of using raw cannabis as ‘snake oil’ medicine, which just goes to show that you can fool the people some of the time, if your advertising budget is big enough. But in terms of non-medical use, no state has decriminalised marijuana since 1978, and several have actually re-criminalised it. Under the sterling work of the Parent movement in the Seventies and later, the “responsible use” message went into the garbage can, to be replaced by the “no use” message.

Would that it were that straight forward today! How was it that the American parent and family movement, consisting almost entirely of volunteers, managed to intercept and prevent this collapse? I plan to give you an explanation later.

4. Britain in the Eighties and early Nineties

When my wife and I first became workers in the drugs field, for the first seven or eight years we worked in “Street agencies” – face-to-face with addicts, alcoholics, and others at various points along the continuum of substance abuse. We also worked to assist the families and significant others around the user, and we worked as specialist advisers to the teachers in more than 100 schools. We were blissfully ignorant of the storm clouds gathering in the Liverpool area, and we pursued our duties on exactly the same strategic basis as the American parent movement had eventually developed, that is:

Stop it starting. If it’s started, stop it.
If it’s still not stopped then help it to stop. Full stop!
The first signs of trouble came when we, in concert with other Drug Education Advisers across England and Wales started attending National drug education conferences. We might have expected a few radical statements in an arena populated by teachers, but we were unprepared for the virulence of what we heard. It quickly became apparent to us (but sadly not to enough of our contemporaries) that the Drug Education Advisers were being hijacked by a small but well-organised bunch of libertarians. The radicals all sounded like the Beatles, with their nasal Merseyside accents. Liverpool was COOL, so you listened to anyone who came from there – whether they were carrying a guitar or not.
One of these exponents of Scouse charisma was former teacher and Sociology/Criminology graduate Pat O’Hare, now better known as the Director of the International Harm Reduction Association. O’Hare and colleagues were well enough resourced to be able to run a glossy magazine – “the Mersey Drugs Journal” which in due course became the even more glossy “International Journal of Drug Policy” (IJDP). The list of contributing editors to in the IJDP read like a “Who’s Who” of drug libertarianism.

Liverpool in the eighties was a swirling pool of powerful undercurrents. Anger at its social and economic situation compared to the affluent south-east had flared up into serious riots in the Toxteth area of the city, in 1981. Although these eventually subsided, a sharp antagonism remained. Dislike for the Establishment as a species translated into identification with subculture – including drugs. Whether jealous comparison of economies was at the root of the next factor or not, the fact is that there was also antipathy towards all things American amongst the so-called ‘caring professions’ – not reflected in the general population – and out of this came a striving for new directions. The up-swelling of libertarian philosophies at this same time seemed to fuse naturally into the process. One specific outcome was a vigorous seeding of the idea of Harm Reduction; a seeding which took root not just in Liverpool but also – through energetic propagation – across the rest of Britain and internationally.

Whilst other British cities with a high incidence of drug use were obvious places for the Harm Reduction gospel to be spread, it was by no means limited to these centres. Obviously the onset of AIDS, at the start of the Eighties, was a catalyst in the development of Harm Reduction; as a drug agency worker at that time I can vividly remember that we were all deeply concerned at this new major health hazard, and we were invited to regard AIDS as a greater threat to society than drug abuse, a notion which helped to undermine the significance of drug abuse as something to be arrested or prevented. With hindsight it is clear that though AIDS is a terrible disease it is also preventable – as is drug use, and that of the two, widespread drug use is in fact a much bigger threat to society at large. Prevent drug use and you are well on the way to preventing AIDS.

Liverpool was one of the areas where AIDS was a particular threat, largely due to the already high prevalence of drug abuse. But what is not widely known is that this drug use, and in particular heroin use, did not generally involve injecting; ‘chasing the dragon’ (‘smoking’) was the preferred method. It was then that the Liverpool Harm Reduction activists entered the arena. . What happened next was related to me by the mother of two heroin addicts, who later became one of our leading Parent campaigners. In the words of one of the Harm Reduction crusaders, International Journal editor Peter McDermott6:

‘As a member of the Liverpool cabal who hijacked the term Harm Reduction and used it aggressively to advocate change during the late 1980s, I am able to say what we meant when we used the term. Its real value lay in its ability to signify a break with the style and substance of existing policies and practice. Harm Reduction implied a break with the old unworkable dogmas – the philosophy that placed a premium on seeking to achieve abstinence…’

McDermot goes on to talk about the importance of the ‘availability of a legal supply of clean drugs and good supplies of sterile injecting equipment’. Note that he incorporates legalisation and needles as part of the Harm Reduction package; note too that he talks about ‘supply’ – not ‘exchange’ of injecting equipment.

What McDermott and his colleagues meant by good supplies was more than just a rejection of the idea of needle exchange, a process which was supposed to be associated with dialogue between the drug worker and the user, with the aim of encouraging transition to a healthier lifestyle. McDermott & Co. had much more in mind than handing out a pack of needles without dialogue. The reality was, as the Liverpool mother told me, giving out needles by the bag full, and even giving out needles to known drug dealers, whom the police had agreed they would overlook if they found them carrying bagfuls of injecting equipment, to be given out with the drugs they sold. The net effect of this policy was that over a period, Liverpool moved from being an area with a low incidence of injecting drug users to one of a high incidence of injecting.

What the ‘Liverpool cabal’ had as their driving force may be judged from McDermott’s editorial of the time, that said:

‘…we must continue to guard Harm Reduction’s original radical kernel, without which it loses almost all of its political power.’

This movement, piously promoted in the name of treating drug users with respect, was in fact an exercise in radical politics. At least one of the ‘cabal’ was known to be a Stalinist.

The political angle was generally masked by rhetoric around the prevention of disease (and in particular AIDS) and the dignity of the user, but their preaching across Britain was both energetic and rapid. The message was promoted to drug workers, teachers, health workers and – not least – to police forces. In 1988 I sat in on a presentation to a regional health authority given by Alan Parry, another leading light in the Liverpool cabal. Parry outlined their policy: money would be moved from Abstinence and Detoxification into Harm Reduction. Prevention was dismissed as ineffective and they would therefore block any drug education scheme unless it could be proved to be innovative and with evaluation built in. When a questioner from the floor asked Parry what evaluation they were doing on their Harm Reduction work, he answered that there was very little funding available and so they would not be evaluating what they were doing – but they did feel it was ‘working well’.

[In this context, it is enlightening to hear the comment made a decade later to one of our member groups by Anna Bradley, at that time Director of Britain’s Institute for the Study of Drug Dependence. Pushed back from her opening gambit, which was to allege a lack of evidence for Prevention, Bradley was forced to concede that ‘… there is no research base for harm reduction’. She has now left ISDD.]

At the time that I took on additional work as an education advisor, assisting our local schools with their drug education work – if any – the whole of England and Wales, a population of some 50 million people, had its drug education coordinated by just over 100 people like myself. Most of these were teachers who had moved sideways into becoming Drug Education Coordinators. They had little or no knowledge of drugs and they were therefore eagerly looking for guidance from those they considered to be more experienced. One hundred is a very small number for a group of determined radicals to penetrate and persuade, and I saw this taking place at drug education conferences and training sessions at the time, without realising how wide-reaching and profound it was to become.

The British Harm Reduction movement did not content itself with staying in Britain – it soon established links elsewhere. We knew that those involved were using electronic means of communication globally long before e-mails were common. One of the ‘travelling salesmen’ was Julian Cohen, co-author of the ambiguously-titled ‘Taking Drugs Seriously’. Cohen7 argues for the ‘plusses of drug taking’; a typical item in Julian’s carpetbag is:

‘The primary prevention approach ignores the fun, the pleasure, the benefits of drug use … drug use is purposeful, drug use is fun for young people and drug use brings benefits to them.’

The European Movement for the Normalisation of Drug Policy (EMNDP) had its first meeting in Swindon, England in 1989. The Merseyside campaigners soon found themselves off to America [1988] where they were feted by libertarians, ‘in the street and on the Hill’. Amongst those on this promotional trip was Pat O’Hare, now Director of the International Harm Reduction Association. O’Hare and colleagues presented a paper8 with the innocuous title of ‘Drug Education, a Basis for Reform’ to a Maryland conference, convened by a relatively new organisation called the Drug Policy Foundation, about which we now know a little more! Thanks to Otto Moulton I have a tape of what was actually said by O’Hare and his companion Ian Clements at that conference; it bears little relationship to the written paper. O’Hare told his largely American audience that ‘England has absolutely nothing to learn from America’ and added that ‘…this 12-step rubbish is absolute cr*p’. One member of the audience made so bold as to ask O’Hare ‘What are the 12-steps ?’ . ‘I don’t know’ he responded. (but he did know they were ‘cr*p’). He then invited his audience to consider the notion that:

‘If kid’s can’t have fun with drugs when they’re kids when can they have fun with them?’

O’Hare was demonstrating that when it comes to radicalism, we Brits can show the former colonies a thing or two.

One milestone on the Harm Reduction road was the establishment of European Cities on Drug Policy (ECDP). Their first International Conference, held in 1990, in the German city of Frankfurt, produced the so-called Frankfurt Resolution, calling for heroin distribution to addicts, decriminalisation of cannabis and the provision of shooting galleries. It initiated a recruiting drive, and one of its first disciples was Scotland, much to the disgust of our Scottish prevention colleagues. According to Glasgow’s Families For Change organiser Maxie Richards “…harm reduction has become a vested interest of the Social Service industry, and with only one purpose: keeping social peace at the cost of dispensing drugs”.

5. Taking stock. Where are we now?

We’re in big trouble, that’s where we are. Through a combination of strong adversaries and weak friends we can see the Harm Reduction Movement approaching critical mass in several countries. In England we have many, perhaps most schools adopting a Harm Reduction approach to their education, and the libertarian elite are well entrenched in the Education ministry’s corridors. A self-appointed and exclusive pressure group of educationists and related disciplines, the Drug Education Forum, seems curiously able to protagonise – with impunity – a philosophy which effectively neuters prevention in our schools. We do our best to alert and galvanise those in control, and we have had several meetings with Keith Hellawell, whom you heard earlier. But even a senior advisor like Keith, with all the experience of being a Chief Constable to stiffen him, is likely to find that changing the direction of our government officials is like boxing with cotton wool. It is small comfort – in fact no comfort at all – for colleagues in Australia to tell me that the situation is even worse there, and has been for at least a decade, with Harm Reduction education being the mandatory norm, and cannabis decriminalisation a fact of life in some areas.

I don’t think I need to take time in this gathering by telling you about Switzerland, since I am reasonably sure that you are familiar with that disaster area. An avalanche of Harm Reduction. When looking for the reasons why Switzerland has gone downhill, one explanation may lie in the fact that the director of the so-called ‘Swiss Experiment’ also happened to be the President of the Swiss branch of the International Anti-prohibition League!

Similarly, I believe you will know a good deal about the Netherlands. Their particular brand of Harm Reduction was visible for many years before drugs became the issue, and cannabis cafes opened. As a young man in the late Fifties, I can remember walking in astonishment along Canal Street in Amsterdam, looking at brightly lit and decorated shop-windows in which the ‘Item for Sale’ was not a washing machine; it was a human being.

6. How did we get into this mess?

In reflecting on the development of Harm Reduction, one stark contrast emerges. How was it that there are two virtually identical philosophies; one from only 20 years ago, operating under the title of ‘Responsible Use’ – was quickly identified as ‘The Emperor’s New Clothes’ and kicked out, and yet here we are now, faced with Harm Reduction deeply embedded, with its tentacles reaching everywhere – even into government ? What caused the difference ?

If I asked all of you here today to come up with one word as an explanation, that word would probably be ‘Soros’. In one sense you would be right; the money that George has injected into the libertarian movement, compared to that which we can marshal, is like us attacking their artillery with our cavalry. We British tried that once, it was heroic but futile.

I would like to offer you the deeper explanation of why Harm Reduction flourished where Responsible Use failed, in the push for liberalisation.

It was in the 1960s both in the UK and in the USA that a sea change in educational approaches really took hold; morals-based education gave way to individual rights. Apparently disparate subjects such as reading, mathematics, history, geography and religious education fell victim to the excesses of an overheated individual rights approach in which some pupils could even decide whether to participate in classes or not. It goes without saying that lifestyles subjects such as sex education, drugs education and personal/social education would be swept along at the front of this wave.

One book you might care to read, if you want to get into this in more depth, called ‘The Great Disruption’ – is by Francis Fukuyama9. Fukuyma concludes that there has been a major paradigm shift. Who created that shift ?

I believe the answer lies in a process known as Values Clarification, also associated with Outcome-Based Education. This originated in Wisconsin, USA in the 1970’s under the leadership of a man whom we regard as one of the fathers of psychotherapy – Carl Rogers, together with Professor Sidney Simon and psychologist William Coulson. Rogers started with a very laudable concept i.e. that pupils should be facilitated to discover, and thus reach consensus on values which are beneficial to society. Sadly, within a short time the concept was diverted into one in which pupils were facilitated to discover values which were beneficial to them as individuals. External constraints were to be viewed as obstacles to the individual’s ‘Self-Actualisation’ – as Abraham Maslow, another contemporary of Rogers termed it. Thus, the notion was advanced that ‘… children should be left to create their own autonomous world, and that adults would be anti-democratic if they tried to pass their values to their children’. This was echoed by co-author Sidney Simon in the statement ‘..the school must not be allowed to continue fostering the immorality of morality. An entirely different set of values must be nourished’.

Similar approaches were observed in Gestalt-based education practices in Switzerland. A typical guiding assertion was that ‘Morals are regarded as obstacles which hinder the development of ‘my authentic self’ and the teacher has no right to impose his sense of values about what is right or wrong’. In Australia, classroom techniques resembling group therapy were deployed to produce changes in children’s attitudes and behaviour and challenge their previously held values.

Carl Rogers eventually expressed his own concern about the monster he had created, referring to it as ‘this damned thing’ and wondering ‘did I start something that is in some fundamental way mistaken, and will lead us off into paths that we will regret?’. But by then the wave had swept things beyond his reach. Britain now has a Journal of Values Education which invites school classes to discuss such questions as ‘Are drugs really bad for you?’, ‘What are the benefits and risks of drug taking?’ and ‘If adults drink alcohol why should I not take Ecstasy ?’

I believe that study10 of the Values Clarification process and related movements helps explain how we have reached where we are today. This is why Harm reduction has taken root, when Responsible Use died off quickly after a first flourish of growth, having fallen on stony ground.

But we cannot blame Rogers for everything that has happened in the last 20 to 30 years, anymore than we can blame George Soros. One is an idealist and the other an opportunist, but they both sowed seeds in grounds which we ourselves have made fertile.

External factors across and within society have, by their confluence, brought about enormous changes. Emancipation of the young, their greater disposable income, disempowerment of traditional authority – including parents and teachers, a more materialistic society and a ‘me first’ outlook, dismantling of ‘community’, the highlighting of ‘personal rights’ at the same time as the downplaying of ‘responsibilities’, effects of structural unemployment and the need for a more mobile workforce – this last factor adding to the breakdown of the nuclear family. The ‘contribution’ of the professions in being part of the problem rather than part of the solution is a major influence, as Professor Norman Dennis11 makes clear. I could say more, but you get the picture …

And the results of this we can now see in our undisciplined classrooms; in a police force which is perceived as sometimes more ready to arrest victims than criminals in order to reduce the harm to the latter; in drug workers campaigning to free colleagues who have apparently allowed drug dealing to be pursued on their premises, and in Education Authorities that will not allow school nurses to issue Aspirin or Paracetamol for fear of a negative reaction, but are receptive to the idea of issuing ‘morning after pills’ to young girls without their parents’ knowledge.

Harm Reduction is no more than an extension of this much deeper and wider paradigm shift. Addressing only Harm Reduction in seeking to strengthen our society against structural collapse is an over-simplification that could prove fatal.

7. What should be our rational response?

This paper is about the history rather than the solution, but I don’t feel I can leave you without at least trying to offer some provocation. Here are a few possibilities:

Option 1 – find another George

Option 2 – react less, act more. Define the ‘Harm’

Option 3 – identify and study the processes that brought us to today, and from this
develop promising corrective strategies

Option 4 – carry on doing what you are doing, but better

Option 5 – save the world, and in doing so

Option 6 – take heart from good news such as this12 .


1. Mill. J.S. ‘On Liberty’ (1985 Penguin Classics)

2. Duncan et al ‘Harm Reduction’ – an emerging new paradigm for Drug Education (1994 Journal of Drug Education)

3. Trebach A. ‘A Kinder War’ (1993 Scientific American)

4. Drug Policy Foundation/Center for Disease Control ‘Southeastern Harm Reduction Conference (1996 Conference Advisory)

5. Maginnis R. ‘Harm Reduction’ – an Alternative to the Drug War ?’ (1996 Family Research Council)

6. McDermott P. ‘Editorial’ (1992 International Journal on Drug Policy)

7. Cohen J. Clements I. Kay L. ‘Taking Drugs Seriously’
(1991 Healthwise)

8. O’Hare P, Cohen J, Clements I. ‘Drug Education – a Basis for Reform’ (1988 Drug Policy Foundation Conference)

9. Fukuyama F. ‘The Great Disruption’ (1999 The Free Press)

10. Stoker P. ‘Moralising….Demoralising: The Fight over Personal and Social Education’ (2000 pre-publication edition)

11. Dennis Prof. N. ‘Social Irresponsibility – How the Social Affairs Intelligentsia have Undermined Morality’ (1997 The Christian Institute)

12. Sullivan Dr. L ‘Drug Policy – a Tale of Two Countries’ (1999 News Weekly)


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