What Should Prevention Look Like?

I recently attended a presentation by the phenomenal Ira Chasnoff, MD. (You can find out more about him at NTI Upstream.) Dr. Chasnoff was doing research in the field of drug-affected neonates in the early 1990s, when I first started my career in the field of addiction. I had to wait about 30 years to see him in person, until 2023, when he presented at the Indiana Perinatal Substance Use Conference. Thankfully, they brought him back in 2024, and I was front and center again.

This year’s topic was on prevention and what good prevention looks like, but first, let’s talk about what bad prevention looks like. Al(most) all of us remember the bad prevention messaging of “This is your brain on drugs.” Other bad messaging is any of the scare tactics we’ve recently experienced, such as law enforcement showing overdoses with NARCAN saves or the photographic trajectories of those who use methamphetamines. There’s not a single person using substances who believes ze will trade places with one of those examples.

So, what makes a good and ethical campaign? Dr. Chasnoff pointed out four concepts:

• Therapeutic intent: the policies need to be in the best interest of the receivers.
• Justice: access to appropriate care must be assured.
• Do no harm: the environments of delivery must be safe and nurturing for the receivers.
• Respect for autonomy: policies must demonstrate that the individual’s choices will be respected.

Consider urine testing for those in the criminal justice or child protective systems. Is that actually prevention when there’s a negative outcome to a positive test? The therapeutic intent is non-existent if a positive test causes a sanction of any kind. A positive test should cause an intervention and referral to help that individual receive care. As an aside, this is why nail testing is so good! The lack of immediacy removes the desire for immediate sanctions, replacing it with a true intention to provide supportive care. See USDTL.com for more information about nail testing.

Next, let’s take recording overdoses or showing pictures of people in the depths of their addictions as a warning to the rest of us. Is there justice in that? I contend there is not, and the tenet of doing no harm is also missing, particularly with regards to the general public. We have become so inured to seeing traumatic events that we think that they don’t affect us, but they do! According to Butler Hospital, “Exposure to negative or distressing content on social media, such as news about violence, disasters, or graphic imagery – can lead to stress, anxiety, or trauma” (Butler). There is harm in seeing people overdose or seeing people at their worse. We shouldn’t accept this messaging as a means to help others.

And how does respect for autonomy come in? Think Reefer Madness. We see it now as completely ridiculous, but there was a time when people bought into that schtick, and if you didn’t, YOU, my friend, were part of the problem. Addiction is a disease, and misusing mood-altering substances – including alcohol and cannabis – can lead to that disease. But sometimes it doesn’t. Autonomy comes in when we present facts and let people make up their minds. Autonomy isn’t the use of shame, stigma, or disregarding information.

Addiction is a chronic, progressive, and lethal disease…one that nearly 15% of the population in the United States has (Shatterproof). Those numbers are going up and up, and that increase is negatively affecting all of us. One in three people is affected by a loved one’s addiction. But we cannot treat nor incarcerate our way out of this problem. Prevention – good prevention – is the only way we’ll be saved.

Resources

https://www.butler.org/blog/7-ways-social-media-can-affect-mental-health

https://www.ntiupstream.com/who-we-are

https://www.shatterproof.org/learn/addiction-basics/addiction-in-america

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