The Behavioral Corner 
Hi, and welcome. I'm Steve Martorano. And this is the Behavioral Corner; you're invited to hang with us, as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and wellbeing. So you're on the corner, the Behavioral Corner, please hang around a while

Steve Martorano 
Hello, everybody, and welcome again to the Behavioral Corner. My name is Steve Martorano -- right where you left me hanging here on the Corner. Real quick for those of you who might not understand the conceit here -- we think if you stay in one place long enough, all the interesting people in the world will wind up crossing your path. And so that's what we're dedicated to doing on the Corner, we, we try to run into interesting people, we know they have lots of great information for us and that's certainly the case today. So that's the Behavioral Corner. It's a podcast about everything. As a matter of fact, that affects our physical, psychological, emotional, spiritual well being, we're going to take a look at a topic that is, has been foremost in our mind here for a very long time, because we first heard about harm reduction a very long time ago. And I'll tell you the context of that in a second. But to shed a lot of light on this topic, we welcome to the corner, our guest, Maia Szalavitz. Maia is a journalist, and she is a New York Times bestselling author. Her book, which brings her to us today is entitled -- her latest book -- is entitled Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction. Maia, thanks so much for joining us.

Maia Szalavitz 
Thanks for having me.

Steve Martorano 
And thanks for writing the book. It's absolutely timely and absolutely necessary that people understand this. Okay, let's begin with the definition of terms here. We'll start...we'll start at the very beginning. Harm reduction is a term that is so clearly beneficial, that one wonders how it has become the source of controversy when it is associated with the issue of substance abuse. I mean, as you point out in your book, as a society, we go to great lengths to reduce harm across all kinds of activities, from seat belts in cars to helmets in football, although one wonders whether that's enough harm reduction in any way, you know, do no harm goes to the essence of the Hippocratic Oath, which first does no harm. Nevertheless, when people started to talk about harm reduction, and we'll find out about when that started, it automatically pushed a lot of strange buttons. So let's begin at the beginning. How did harm...where did harm reduction begin? And how did he get to be so controversial?

Maia Szalavitz 
Sure. So in drug policy, harm reduction is the idea that we should try to stop people from getting hurt, rather than try to stop them from getting high. And that is enormously controversial because the War on Drugs has as its goal to induce harm in drug users so that they will supposedly realize that they have a problem and quit. And so if you reduce the harm, the fear is that they would never quit and they'll just be having so much fun being addicted, that it will make the drug problem much worse. The reality, of course, is that addiction is defined as compulsive drug use that continues in the face of negative consequences. So if negative consequences, we're going to fix it, by definition, it wouldn't exist. And yet we have this whole apparatus of enforcing the idea that if we can just make the consequences bad enough, and make people hit bottom, and be tough to them, we will solve this problem. And so anything that gets in the way of being tough and being cruel, and making everything as bad as possible for people who use drugs, as an example for kids, so this is why you shouldn't do them. That is why harm reduction is controversial because it's saying that the drug war idea is fundamentally flawed.

Steve Martorano 
Yes, it's the antithesis of Just Say No.

Maia Szalavitz 
Exactly. And it's really saying that you know, just as with any other medical condition, the way to help is to treat people with dignity and respect and empathy and not try to grind them into the ground because you think you know what's better for them.

Steve Martorano 
There are some fascinating reasons why that's the case. We probably won't have time to go into but as you know, substance abuse and treat...treatment of substance abuse grew up outside of the medical establishment. It was never really a medicine. It was never really a therapeutic field. It was in fact a spiritual goal -- put your faith in God and God will deliver you from this plight. But that has some bearing on the way it has been approached. And when you talk about the war on drugs, being set up to make it more difficult for people to get help, I wonder whether that means you don't accept the idea that they are suffering from a disease? And maybe I'm wrong about this. Do you believe that? Addiction is a brain disease? 

Maia Szalavitz 
Okay, so it depends on what you mean by brain disease. If you mean by brain disease, Alzheimer's, or progressive neurological damage, then no, it is not. The research is pretty clear that drug addiction is a learning disorder. And what that means is, in order to get addicted, you have to learn that the drug fixes something for you, and then that has to become ingrained in your behavior in a similar way to how people fall in love or get preoccupied, quite rightly, with their new baby.

Steve Martorano 
Well, again, we can go off on all kinds of tangents here. That's a fascinating take on this now...

Maia Szalavitz 
...and that was my last. 

Steve Martorano 
I mean, that's, you know, it's interesting. I mean, if it's a learned behavior, then...then it can be unlearned.

Maia Szalavitz 
Well, exactly. And also, what I think is that, you know, there's a very specific type of emotional learning, that happens when you fall in love or have a child, and it just resets your whole priorities, towards making sure that you sustain those relationships, and, you know, keep the kid alive and healthy, and all that. And so, you know, when that object gets replaced by a drug, then what you're doing --- it's...it's just like if you think about people who have affairs. They're like, hiding it, they're lying about it. It's not very different from that, like, people will rob things because they're love. It's...it's the same kind of thing. We've just made it super alien.

Steve Martorano 
It rearranges the priorities and directs them in an unhealthy way. All the priorities are staying high. And damn the consequences, which is...

Maia Szalavitz 
Well, I mean, the thing is...the thing about that is that people who are addicted, have a reason to be addicted generally. So it's not like you're happily going along your life, and you just get exposed to this thing. And you just give up everything to become selfish and evil. What generally happens is, you've either been traumatized as a child, you have a mental illness, or you have just severe despair. And, or you may have all three, then you come across something that actually makes life feel bearable. And yeah, you're gonna fall in love with that, and then it's going to be trouble because it will start to interfere with the rest of your life.

Steve Martorano 
Yeah, and I know, you tell that story beautifully in another of your books, The...The Unbroken Brain or The Unbroken Brain. And I'll tell you, I should have mentioned in the beginning, you got my attention with the essay in the New York Times from a few weeks back, which had the brilliant headline in terms of tension getting about opioids or like love.

Maia Szalavitz 
Yeah, I mean, I think like, I'm kind of amazed that more the public doesn't understand that because it's like, fundamental physiology. And when you look at it, like if you block brain opioids, bonding does not happen in other species. And we presume that it's similar in humans, but we, fortunately, don't usually do that.

Steve Martorano 
Yeah, well, I mean, yes, it is another great mystery of this situation. And that is, and I just, I was going with this, but I mean, in terms of why people get high/ Okay? Simply put, I've interviewed so many people now who have gone through horrors and come out the other side. And almost to a person when asked, "Why did you begin getting high?" Beyond what you said about trauma -- there's, there's always a lot of that -- they said they liked it.

Maia Szalavitz 
You're not gonna get addicted if you don't like it. And I mean, one of the things that most people don't know and that I wasn't able to mention in the New York Times essay is only about a third of people who get exposed to opioids feel that sense of love and comfort and warmth. The other two-thirds either it's kind of like a meh experience or they actively aversive, so they like they're made nauseous, they're numb, they just don't like it at all. Now, even among the third that like it, at least half of them, often more than half don't become addicted. And that tends to have to do with the fact of they have a life that they don't want to give up in service to this drug.

Steve Martorano 
You also think some people just are not predisposed genetically,

Maia Szalavitz 
How would a genetic predisposition work? It has to work by you're making you like the drug, or by making you unhappy. So it's like, I think we think these genes are this kind of magical thing that just do things. But the reality is that they have to act or a specific mechanism. And a mechanism by which they act is do you like this stuff or not? And the other mechanism is, are you traumatized, and does has that affected your physiology such that you feel this experience. 

Steve Martorano 
I didn't mean to imply that genes are destiny, but they are a factor. That could be. 

Maia Szalavitz 
Oh, yeah, yeah. Well, I mean, they like, you know, so it's, you know, it's probably about half and half, like how addiction just like any other complex behavioral trait, whether it's intelligence or whatever, it's usually around 50%. So yeah, so it's like, okay, we've got that 50%. And, and this is why addiction is so complicated because it's like the thing that predisposes me to addiction, which for me, was like depression that was kind of brought on by like, being sort of incredibly lonely and outcast due to, as I find out on being on the autism spectrum, somebody else may get addicted, because they're seriously impulsive. And they're not anxious, which I am. They are, bold, and they want to do everything. 

Steve Martorano 
They're risk-takers. 

Maia Szalavitz 
Right. And like, you know, I'm scared to drive but I shot heroin. So...

Steve Martorano 
You know, there's...I'm sure you're aware of a terrific book that has been written recently, where they make it seems odd to think about this a correlation between the attitudes and behavior of big wave surfers, and drug addicts. 

Maia Szalavitz 
Well, yeah, of course. But it's like, would I ever be a big wave surfer? It's funny, I just spent hours watching them when I was on a plane, and I love the ocean, I love the waves, I do not like getting wiped out even by a small wave. So no, that is just not going to be my thing. But I understand. And I think that when we look at people who are prone to addiction, we have to see that there are very different traits that can get them there. So it might be one person who's super bold and seeking stimulation, the other person may be retreating from stimulation, and some people have like extremes on both ends. So you know, they kind of swing back and forth. But I think it's really important to recognize that there is no one addictive personality. 

Steve Martorano 
Yeah.

Maia Szalavitz 
There is a whole slew of them. 

Steve Martorano 
Well, Maia Szalavitz is our guest, she is the author of a brand new book called Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction -- which is troubling to think about. Addiction has a past, and apparently, it's going to have a future too. But anyway, very complicated event, people who abused drugs and are caught in that device, we're learning more and more about how to treat that going forward. So let's pivot now to exactly what you're talking about. So this is a complicated thing that we're really not very good at understanding, much less treating, and instead of continuing to hammer away at the silver bullet, that will make you go away. We've got to stop the harm. And the harm, incidentally, cannot be exaggerated. One hundred thousand people now did in the past couple of years -- more than auto accidents and heart disease -- it's a slaughter out there. So tell us about harm reduction, its origins briefly, I know, it's a long story, but it began in the home of The Beatles, right?

Maia Szalavitz 
Exactly. So the idea of harm reduction has been floating around for a long time going back to like hypocrisy...(laugh) Hippocrates, as you say, I do not want to call them a hypocrite. 

Steve Martorano 
No.

Maia Szalavitz 
Anyway, that old doctor dude -- and in Amsterdam, their drug policy had been sort of based on that. What Liverpool did, however, as they took the idea of harm reduction, and they made it into a political movement and a movement within public health, that our goal really has to be to reduce harm, and that if we're trying to harm people in order to help them, that's not really a good idea. Whenever we try to do that we've had terrible bad side effects and oftentimes, you end up making people worse. So what this does, what harm reduction does, and why it has been so scary to prohibitionists and supporters of the drug war is that it says policies should be making things better, not worse for anybody. The idea of a policy that is focused on making someone's life miserable in order to convince their children not to do it. This is using people's instruments, this is not okay. The prohibitionist have taken the moral high ground for so long saying, "Oh, what about the children?" You know, you know, we have to be cruel to people who use drugs so that like children won't take after them? Well, first of all, if I'm dying in a corner somewhere, no kid is gonna see it hopefully. And second of all, shouldn't we be teaching our children that we should be compassionate for people who are ill? And shouldn't we be teaching our children that we want to make life better for people not worse and that disabling people should not be our goal, enabling people to have a productive and happy life as much as possible -- that's what harm reduction is about. And we don't want to disabled people with tough love, or jails or any of that. We want to minimize the harm that is done to them and to people around them. And by doing so, help them actually move towards recovery. And this is the thing that a lot of people really don't get. A lot of people recover, because they have hope, not because they have more despair.

Steve Martorano 
And they recover because they're still alive. 

Maia Szalavitz 
Well, exactly. If you're dead, you can't recover. And that's one of the fundamentals of harm reduction. You know, what's interesting is, if you do the most enabling thing in the world, prescribe heroin, okay, they got the heroin, like, they don't have to chase it anymore. They don't need money, they got the drug, it's all good, right? Well, if you actually do that, people think, Oh, it'll extend the addiction they'll never get well, they'll just like, you know, go along in a haze. In reality, what happens is, when you take away the cops and robbers and all the chasing of the drugs and the money, people have a lot of time. Suddenly they're like, "Okay, maybe I should get a job, maybe I should, you know, see my family more." Also, there's this phenomenon that happens. If you get what you really, really want, and you think is going to fix your life -- it usually doesn't. And there's a sense of like...like, you get this big success, and it's like, everything's gonna be solved now. Everybody loves me, it's all gonna be good. And then it's like, no, you're still you, and you still have all your problems. So that's a similar thing that happens when people who use drugs get all the drugs they want. Once you can sort of open up that space where they see okay like more did not solve this. Then you can start to see, okay, well, you know, what is behind this? Why are you doing this? And the other thing that's essential to harm reduction is treating people kindly. And you know, people who are actively using people will, you know, cross the street to avoid them, people will just, you know, say terrible things about them and to the -- people even commit violence against them -- it's a very acceptable prejudice. And so when somebody says, "Hey, I think you deserve to live, whether you continue using or not. I'm not going to demand abstinence from you, in order to think you deserve to live, I'm going to say your human being, all of us have gifts, please be able to use yours."

Steve Martorano 
To put a fine point on this. There's nothing mutually exclusive, about harm reduction, and getting clean -- ultimately getting clean. In fact, you refer to the other time, as using empathy, which has been lacking and radicalizing, it may get the horse rather than the cart, and get out in front of this from a human standpoint, let me ask you this, because people say, here's the nub of this thing, as you just said, "Wait a minute, you're enabling them, you're making it easier for them to do that." And you don't deny that you are you're making it safer, not so much easier, but safer. But what happens is when they go I and I can sort of intellectually appreciate that notion, where are you going to put the clean needle exchange?

Maia Szalavitz 
Well, right, and I mean...

Steve Martorano 
End of my block right? 

Maia Szalavitz 
Well, you know, ideally, you just go to a pharmacy, like anybody else good and have to, like segregate out to people -- and in fact, in many states, it is legal to just go buy a syringe and some places you can get them cheap enough that that is a viable way of doing it. And similarly, with safe injection sites, and all of that kind of thing. The thing about locating these programs is, first of all, realizing that something like a safe injection site where people can inject under medical supervision, will not work if they're not in an area where there is already intensive public drug use, because people are not going to drive several miles to go to the safe injection site. It's got to be in the neighborhood where they already are. So the question is not should we cite this in this neighborhood? The question is, do you want people shooting up in the street? Or do you want them shooting up in a safer place where they have a better chance of getting recovery? Studies show that people who attend needle exchange and basically safe injection sites or needle exchange for the police to use the needles at five times more likely to get into treatment.

Steve Martorano 
I want to pause there because I've had this explained to me once very, very clearly by a former user who said -- he acknowledged that look, this is about harm reduction -- people don't understand they're just trying to keep the deaths down. He said but the truth of the matter is, "When I was using, I wasn't looking for a safe place to shoot up. I was just looking to score and get high."

Maia Szalavitz 
It's actually much more pleasant to get high in a safe injection site than it is to have to be looking over your shoulder, somebody's gonna rip me off, or somebody's gonna like to punch me or the police gonna come and arrest me. And also, to be fair, most of the people who are going to use a safe injection site are people, you know, without houses.

Steve Martorano 
My point was it -- and want you to answer this so that people might understand it -- you have people engaged, as we've just described, and incredibly self-destructive behavior. And now, technique comes along, that says, we're here to make this safer for you, that might not automatically appeal to someone already engaged in horrible behavior, and can't see any other way than this.

Maia Szalavitz 
People go to these sites. People like these sites. You know, the thing is that, like, yes, there are people that are so severely self-destructive, that they won't take any actions to protect themselves. And they are probably actively suicidal if not consciously so. Interventions for people in that state are going to be different than for people who are just kind of seeking anesthesia. For people who are seeking anesthesia, where you just want to escape. It's so much nicer to be in a warm room with people who care about you, where you can just nod out and do your thing than it is to be on the street and be exposed. It's kind of like, do people want to have sex on the street? No, I mean, there's a kink perhaps. But I'm not saying anything regarding that. But the vast majority of people prefer to have sex in private. Similarly, injection, like doing it in public has the chance of ruining your high.

Steve Martorano 
Yes. Harshing your mellow. Listen, Maia, I wonder if you would...if you...I'm just talking about some policy prescriptions here that might work. Because again, people resist this notion of harm reduction, because they think it will continue the use. You have a permanently stoned population. So you've made a clear case for no, this is a path to recovery -- harm reduction is a path to recovery. Would it be a wise policy to say, let's use the most extreme example, that it was illegal to get a prescription for heroin? 

Maia Szalavitz 
Yeah, I mean, I think like...

Steve Martorano 
...but wait, would you...my point is, would a wiser policy be yes, for a certain amount of time...

Maia Szalavitz 
First of all, we have two medications that are proven to cut the death rate from opioid addiction by 50% or more. These are buprenorphine and methadone. They're both opioids themselves. So presumably, heroin would have the same effect. But it only works if you continue taking it. It doesn't have a protective effect once you stop. So in order to get that 50% reduction, which is an enormous...enormous savings of life, and if we had cancer drugs like this, we'd be dancing in the street. In order to get that you have to stay on. So the other thing is that dealers don't require you to, you just have to pay, you don't have to jump through all these hoops or piss in a cop or get it for only X amount of time. That is a recipe for failure. We have tried that over and over again. And we're still trying it in the methadone and buprenorphine system, just get people off as fast as possible, we'll know what you're doing is creating a cycle where people just cycle in and out of treatment that way. What you want to do is stabilize people. And yeah, some of them are going to continue to use on top and take other drugs, aside from what's prescribed to them, but they still have a dramatically lower chance of dying. And where there is life, there is hope. So the idea...

Steve Martorano 
Let me stop you. Let me stop you. Hope for what?

Maia Szalavitz 
Hope for getting healthier, getting happier, getting more productive getting to be more there for your family, because the thing that also people fail to understand about being on long term use of opioids is that if you are not using additional drugs, and you are at a stable dose, and you're taking that dose at the same time, every day -- I could be right at this minute on a dose of heroin that would kill you. And you wouldn't be able to tell it from my behavior because you get a complete tolerance to the high. Now maybe I'm getting some like social warmth that you know my body wasn't producing enough endorphins or whatever it is, but I am here I am present I am able to do anything that anybody else can do. And this is not the case for say alcohol, leanness maintenance. Alcohol maintenance can work in some instances, but people remain impaired. Whereas with opioids, you are not impaired if you are in the correct dose and you're taking it the correct way.

Maia Szalavitz 
 So you can be a high-functioning person who is...

Maia Szalavitz 
I'm a high-functioning person on Prozac. Does this make me any lesser than anybody else? No. So I'm a high-functioning person on methadone does that...no. It's like there were many paths to recovery and one of them is staying on medications, whether they're psychiatric medications or opioids or whatever. But it's just like if you only define recovery as abstinence, you know, and I've heard in meetings, it said, sometimes, you know, well, if I didn't drink today, it's a good day doesn't matter if I beat my wife doesn't matter if I stomped on the cat, you know, I'm sober. So it's all good. No, that is really not okay, actually, especially for the wife and the cat. But also, because what people really want from recovery, is quality of life is. You know, Freud said, "We want to be able to live and work." So let's see, how can we best do that? And for some of us, the best way to do that, in my instance, is to stay on antidepressants, because when I'm not on them, I am clingy and needy, and anxious and miserable. You know, again, for some people, that drug might be an opioid, but I'm not going to judge anybody based on the fact that their wiring is such that they need some chemical support. 

Steve Martorano 
Yeah, and Freud said that thing about loving work, and he was high on cocaine most of the time. He certainly could function really well. Let me ask you...

Maia Szalavitz 
And by the way, I'm not a big fan of him in general.

Steve Martorano 
No one is anymore. I mean, anyway, have you had a very serious substance abuse problem? How bad did it get?

Maia Szalavitz 
I was shooting up like, you know, 40 times a day. I was doing cocaine and heroin, I was really, really sick. For me. As it turned out, I needed abstinence-plus antidepressants. I got there by luck. And despite the fact that I had legal issues, I had all kinds of things, I was thrown out of school. The idea that putting me in jail would have fixed that. It wouldn't. It would have just made it worse because then I come out...

Steve Martorano 
Yeah.

Maia Szalavitz 
You know, so the thing here is that like, what do we really care about? The chemicals in my bloodstream? Or am I a happy, productive, functional, loving person?

Steve Martorano 
I'll tell you right now, I'm interested in that way of sport, okay. But I'm interested at how you got there, the moment you're not using heroin anymore. 

Maia Szalavitz 
No. No.

Steve Martorano 
Okay. So but you so at some point, you were able to say it's luck, I get that we want to expand that opportunity for many other people, for them to arrive at the same point you did, where you were.

Maia Szalavitz 
So what first would happen is somebody taught me to use bleach to clean my needles so I did not get infected with HIV. And 50% of the people that I would have been sharing with were already positive, including the guy I was about to share a needle with when I was taught to protect myself. So first of all, that bit of harm reduction, most likely saved my life. It also sort of started a political passion in me because I was like, why do people just want to let us die? Gay men are out there fighting for their lives, like why are we just not getting this information out to people? And why are politicians saying no, we can't give them that information, because that'll encourage the kids to shoot up. And it's like, really, I don't think anybody looking at me is gonna want to be like me, at that point. So, you know, it was just ridiculous. I'm not saying that nobody ever needs abstinence. What I am saying is that what we should care about is not whether the person is abstinent. But whether the person is happy and loving and productive and able to, you know, be the best person they can be for themselves.

Steve Martorano 
And find their way to sobriety if that's what they want. By the way to the chilling story, Maia tells in her book about that moment when the total complete stranger says, "Don't know, don't use that needle, you'll get sick." That's amazing. Let me ask you here and then we're to wrap up as I know, you're probably busy. Our guest Maia Szalavitz, author of the book Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction. The relationship between harm reduction getting some traction, and the shift from criminalizing this behavior, to addressing it as a health issue coincided with race. Did it not? There was a time where we know people were doing all the bad stuff, you said it dying in proportion to the same kinds of numbers, but those neighborhoods were unseen. They were people who are brown and black, and so let them die.

Maia Szalavitz 
This is my whole work here. Our drug policy is not based on these drugs being more dangerous, so they're illegal. Our policy is based on these drugs are used by people or we associate them with people who we have prejudices against, and therefore they should be illegal, but the drugs we like are fine, even if they're more dangerous. For example, tobacco is way more dangerous than marijuana. You cannot have a scientific risk-based assessment that says, "Yeah, we should have tobacco legal and marijuana illegal.' So our whole drug war has really been about racism and about using the idea of drugs to target certain groups of people, because frankly if jail was such a great way of stopping the addiction, why don't we put the billionaire addicted people in there? You know, why did the white people get off?

Steve Martorano 
Or at least the billionaire people who are profiting from this?

Maia Szalavitz 
I don't even care! The thing for me really is just that like, No, we don't send rich people to jail for drug possession, because we recognize the treatment is a way to treat a health condition. You know, if jail and mass incarceration was such a good technique for stopping the addiction, we should have seen it by now we've gone from spending a few million a year on it to over a trillion, you know, not trillion per year, but multi-billions per year and collectively a trillion. This does not work.

Steve Martorano 
It's undeniable, though, that looking at just the recent epidemic of opioid use, once it spilled over into white neighborhoods, I don't mean, just the poor Appalachian areas. I'm talking about the Gold Coast suburbs of American cities, once it spilled into there, suddenly, everybody, "Oh, wait, these people are sick, these people need help. We can't be locking them up." 

Maia Szalavitz 
Well, and this is why people will say like, "How come you're for this?" Okay, I've been for this since 1986, when we were cracking down on crack and locking up tons of black people. So we're still doing badly on all of that. But I am not saying there's no way you can say, "Oh, well, she's supporting it, because she's white." I'm supporting it. Because I've seen the injustice to people of color because I feel very passionately that you know, the answer isn't? Well, now let's crackdown on white people and do the same terrible things we've done to black people who are equal. If I was a black person, I might feel like that because like, you know, I rightfully would be very pissed. I think that what we need is harm reduction for everybody.

Steve Martorano 
And again, we were fully back to the beginning of this where you talk about this is a very old and natural attitude among people, that you help someone who is in crisis, you don't kick them when they're down, you pick them up. And by whatever means we are getting that point more fully now, good for all of us.

Maia Szalavitz 
It's sad that we needed white people getting sick for this for us to get to understand why this is essential that those of us who have been fighting for it since way back sort of recognizing that it's always been essential.

Steve Martorano 
Yeah, incidentally, just one last point about the polarization of drug policy. Yes, it was targeted because it was a drug of minorities, these were behaviors of minorities. But when the student movement rose up, in reaction to both civil rights and the war in Vietnam, it's pretty clear that the Nixon administration's policy, he's the one that launched the War on Drugs said, Hey, here's a chance to target our regular victims, that people of color, and all these damn kids, and all those drugs became classified as a Schedule One narcotics and, and the war went on and on. Well, it's time to not so much call an end to the war on drugs, but to change our tactics. I think that's what you're trying to say, I think this is a valuable book...

Maia Szalavitz 
The war on drugs is really a war on people. There are many ways of helping people feel better so that they don't end up becoming addicted. We need to do things in terms of prevention, that we don't do, such as making the world a better place for the people on the bottom. We could do an extraordinary amount of prevention, by reducing child trauma and by working with kids who are traumatized before they start self-medicating. 

Steve Martorano 
Yeah, yeah. 

Maia Szalavitz 
And by also identifying mental illness early before it becomes a disaster. Like I mean, I was pre-depressive for a very long time, and ruminating on how horrible I was. If I had been able to sort of have cognitive skills to deal with that I might not have ever had the problems that I ended up having, because they were so directly related to self-medicating the self-hate.

Steve Martorano 
It's the tragedy, the additional tragedy of substance abuse is that the co-occurring problems that are probably at the source of the behavior are not looked at or treated until you know the problem is manifest. Then they go oh, there's all the things going on here.

Maia Szalavitz 
Right well then we see the drug is the problem and then we have policies we're like okay, the drugs the problem we'll just take this prescription opioid away and then look "Oh, everybody be fine. There is nobody...illegal market won't develop. Fentanyl won't happen. It'll be just fine. We just take away the drugs. We don't care if you have pain. We don't care if you have an addiction. This will you know, save the children or something." And what do we end up with but a much, much, much worse situation?

Steve Martorano 
Yeah, slaughter isn't that in fact. The book Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction. Its author, Maia Szalavitz has been our guest on this program, you're invited to come back, you know, once a month, if you like. You're terrific. The books are important. Thanks so much for your time. Have a great holiday. And maybe we'll see you sometime in the New Year. I hope so.

Maia Szalavitz 
Cool. All right. Thanks so much. And let me give you one tiny critique. Please don't use the word "substance abuse," because it implies child abuse, sexual abuse, emotional abuse, and it's really stigmatizing. And that's why it got taken out of the DSM in 2013. "Misuse" is really good. "Substance use disorder" is cool, but like you're not abusing a poor little drug like you're abusing yourself, but we call self-abuse a different thing. So that's my little critique, anyway...

Steve Martorano 
No, thanks for that. You know, staying ahead of the DSM, as you know, can be challenging. Thanks, Maya. Thanks so much. 

Maia Szalavitz 
Thank you.

Steve Martorano 
And again, (you're) always welcome to join us on the Behavioral Corner, as are the rest of you. Thanks, and see you next time on the Behavioral Corner.

Retreat Behavioral Health 
Retreat Behavioral Health has proudly been serving the community for over ten years. Here at Retreat, we believe in the power of connection and quality care. We offer a comprehensive holistic and compassionate treatment from industry-leading experts. Call 855-802-6600 or visit us at www.retreatbehavioralhealth.com to begin your journey today. 

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