“Really… You think you’re the only one who had a hard time?”

There’s a lot of academic and advocacy energy around harm reduction, legalization, and assertions that drugs and drug use carry relatively few innate harms–the real problems are puritanical and often racist attempts at social control.

These discussions give the impression that people with addiction and society would be ok if we assured a legal, unadulterated supply, safe and unfettered spaces to use and live, sterile equipment, along with access to first aid and treatment meds.

I’ve said many times, since the beginning of this blog, there is no ideal or problem-free drug policy. The real questions are: What problems are intolerable? What problems are we most willing to tolerate? How do we minimize/eliminate what’s intolerable and mitigate the harm from the problems we’re willing to tolerate?

That we’re deciding mass incarceration is intolerable is a good thing. Same for the role of racism and disparate and heavy-handed impact experienced by communities of color.

Source: nomatterone

Those should be deemed intolerable. And, drug policy, like many other things, involves trade-offs.

Our failure to acknowledge these trade-offs and attempt to earnestly mitigate the harms associated with the priorities we choose to enshrine in policy/practice has resulted in immeasurable damage and prevented us from changing course in a responsible manner.

The current focus on individual liberties and harms, along with the conflation of addiction with lower severity substance problems often gives the impression that the only serious harms associated with substance use disorders are results of legal status and adulterated drug supply, obscuring many harms experienced by people with addiction and those close to them.


A recent Keith Humphreys tweet speaks to this and touches upon the amends process associated with 12 step recovery.

The Washington Post has a paywall that might prevent you from accessing the story, but a friend shared this video, which the story is based upon.


Humphreys refers to a cringe factor in this story. I also sense considerable hesitancy to acknowledge and create space for the harm experienced by people around the addict. Note Humphreys’ nuance. He says, “Addiction typically inflicts harm on others.” … addiction inflicts harm.

Preslee’s description of her dad (Casey) threads an important needle too. She alludes to him as two different people — a sober-self and an addicted-self.

“For as long as I can remember, my dad has been an alcoholic… I knew how my dad would be one person when we showed up to the party, and a completely different person when we left.”

“Seeing him in rehab, he was so different from before,”

I sense that this hesitancy emanates from destigmatization efforts. There’s an effort to frame them as non-threatening, which aligns with framing them as victims of social failures and harmful policies. It also aligns with impulses to downplay impaired control and the risk that presents to others.

So… this gets complicated. Are people with addiction frequently victims of bad policy? Yes. Definitely. But there’s much more to it than that.

Note that while there might be a lot wrong with alcohol policy, it’s not criminalized yet alcohol causes plenty of harm.

I think it’s important to note that people with addiction are often harmed by bad policy, but they are also harmed by the illness of addiction, and they are often perpetrators of harm to others around them.

A former colleague who worked in juvenile justice said, “People see my kids as victims or perpetrators. When they reduce them to a victim or a perpetrator, it makes it hard to see them as a resource.”

Note the importance of looking beyond his victimization in healing the relationship with his daughter:

“One day, we were all sitting in the living room for a family meeting,” wrote Preslee. “My dad said, ‘I’ve been through alot and gone through it, kids, and we will be okay.’ This made me angry and I responded with, ‘Really, Dad? You think you’re the only one who had a hard time throughout this?’ ”


The questions around moral responsibility in active addiction are complex and difficult to answer and will inevitably involve acknowledging seemingly incompatible truths. Similarly, finding the best policies (which, if we’re honest, might more accurately be described as the least bad policies) requires acknowledging the tradeoffs involved and the harms we’re choosing to tolerate.

  • How do our alcohol policies protect, neglect, or harm Casey?
  • How do they protect, neglect, or harm Preslee?
  • How do they protect, neglect, or harm others?
  • Who do these policies place responsibility upon? For what?
  • If Casey’s problem was heroin rather than alcohol, how would that change?
  • If Casey’s social/environmental circumstances were different, how would our answers change?

Whether we’re talking about policy or moral responsibility, the answers are not easy, but we can’t find them by avoiding, ignoring, minimizing, or obfuscating inconvenient truths.