Drug use, IFS, and harm reduction
I don’t know about you, but the longer quarantine lasts, the earlier in the day I find myself reaching for a beer. My aim of only smoking pot in the evenings is becoming more unattainable, and I’m vaping with alarming frequency. While I don’t partake in anything else, I do feel my consumption might be moving into unhealthy territories as lockdown continues.
Addiction runs down at least one side of my family, and is something I’ve struggled with since my teenage years. When I started recreationally experimenting with drugs and alcohol in high school, I felt like I had finally found a magic potion to treat my mental health problems and the shortcomings of my personality. While a limited budget and some truly awful come-downs kept my usage of chemical drugs in the recreational category, I developed a habitual weed habit before I turned 17. I liked that it numbed my emotions and the jagged edges of my thoughts, and that I could stay in control when I smoked it. I wouldn’t wake up dehydrated, next to a stranger, blanking on the night before. Worst case, I’d wake up a little bloated from demolishing an entire pizza in one sitting.
Though the rate of my weed consumption has waned and crested over the years, these days, I find myself making excuses to smoke it more often. I suspect it’s a combination of anxiety, boredom, and the fact it remains one of my most ingrained coping mechanisms, but I’d really like to move away from becoming more dependent on it. Additionally, I’ve gone from drinking two to three beers per week to drinking one to two beers per day (which doesn’t combine great with my anti-depressant). I’m starting to get a little anxious about the slippery slope that is addiction, and don’t find abstinence, white-knuckling, or any sort of step-oriented program appropriate for me, so I’ve been using a combination of Internal Family Systems therapy and harm reduction to cope.
Since I’ve discussed Internal Family Systems before, and regular readers will be familiar with the concept, I’m going to dive right in to how I’m using the therapy. I’ve identified a “manager” and a “firefighter” part at the root of this struggle over my consumption. My firefighter part, seeing me grapple with cabin-fever and the limitations on my freedoms, and possibly aware that I’m not currently in a position to tap into the exile behind my consumption habits because I have enough on my plate coping with my day-to-day, has jumped in with an impulsive behaviour to distract me from my anxiety and fear. The manager part, the same part that has effectively managed limits on how much I’ve consumed in the past, is getting really concerned this firefighter part is emerging with such force, and has well-founded fears about the long-term impacts of my use, the toll it will take on my productivity, and the physical and mental impacts of addiction.
In order to overcome this internal conflict, I first have to get these two parts in the same room. By going inward, I can bring both my manager and firefighter part to the same table and thank and acknowledge them for all they have respectively done to keep me safe. The next step is to introduce them to each other and explain the merits of each part’s work. I start with my manager part, first just bringing that part up-to-speed on everything that’s going on as a result of COVID-19, to show my manager why my firefighter part is coming out so much, and how it’s been helpful for me. I reassure my manager part that I’ll keep checking in with it to hear its concerns around my consumption, but ask it, for the foreseeable future, to work with instead of against my firefighter part. I stress to this part that it doesn’t have to like or agree with the firefighter’s tactics, but it can be more effective if it finds a way to collaborate with it.
Since my firefighter part already seems aware of the current circumstances, I focus on showing it the merits of the manager's role: that the manager helps bring a sense of balance to my consumption and takes steps to help the firefighter part from having to jump into action. Again, I stress these two parts don’t have to like each other to work together, and commit to check in on them regularly to hear their concerns.
Harm reduction is a nonjudgemental evidence-based set of strategies aimed at reducing the negative consequences of drug-use. Central to harm reduction is the concept that, for better or worse, illicit (or legal) drugs are a part of our world. Instead of ignoring or condemning addiction or drug-use, it’s far more beneficial to work to minimize the harmful effects of drugs. Harm reduction principles also emphasize that those with lived experience play a large role in creating policies and programs to serve them.
In 2001, Portugal became the first country to decriminalize the possession and consumption of illicit drugs and turn to a national harm-reduction approach to tackle its opioid crisis. The country was able to stabilize its opioid pandemic, rates of overdose-related deaths; its drug-related crime and incarceration rates fell, as did HIV and hepatitis infection rates. It was an incredible and effective turn for a traditionally conservative country.
Fundamental to the harm reduction approach, is the understanding that there’s no one-size-fits-all solution to living with and managing an addiction. It’s about finding a personal balance that works for you, and there are a lot of tips and strategies out there. Below, I’ll outline some of the strategies relevant to weed, alcohol, and nicotine use that I’ve gleaned through attending and participating in webinars around mental health and COVID-19, which have been helpful to me.
Participate in hobbies that are hard to do on your drug of choice. For example, I’ve been enjoying playing the guitar, but am at the stage of my learning which requires a level of thought and nimbleness being stoned or drunk doesn’t afford me.
Rely on your support networks. Checking in regularly with family and friends provides me a with a window where I won’t typically use, and helps alleviate some of the boredom and anxiety I’m feeling.
Prepare for disruptions in your supply chain. There’s been a few occasions where I’ve had to wait a little longer than normal to re-up. When I find myself in these situations, I try to limit my daily amount to stretch my supply so I won’t have to contend with some of the mental consequences of going cold turkey. I’m also very lucky to be in a position where I can afford significant quantities of my drugs of choice, which limits contact with others and ensures I have a good amount on hand. Please note: it can be dangerous to have large amounts of drugs on hand for a number of reasons.
Create a safe-use and bad high plan. Since smoking weed can make me a little paranoid, I practice some safe-use principles to diminish my anxiety including not sharing my bong or joints, keeping a clean space where I use, and washing my hands regularly. I don’t really experience bad highs anymore, but, for those that do, it might be helpful to cope ahead.
Be considerate of your mental health when using. If I have a few drinks, I’m more likely to get emotional. I try to consider this before drinking and, if I experience intense emotions while drinking, I try to remind myself my emotions are being amplified because of the alcohol and not necessarily my overall mental health.
According to the World Health Organization, smokers and tobacco users are likely to be more vulnerable to COVID-19. I’ve tried to incorporate edibles into my usage, and transitioned from cigarettes to a Juul last October. Those who feel anxious about this might also consider turning to nicotine patches, nicotine gum, tinctures, or other delivery methods that minimize harm to the lungs.
Of course, strategies around effective harm reduction will vary depending on your drug of choice and your circumstances. For example, if you use drugs where there’s a risk of overdosing, you should identify a support person who can be with you remotely while you’re using. A number of communities, regions, and cities have also launched overdose prevention lines—a phone number you can call where someone will stay on the phone with you while you’re using, and The Lifeguard App automatically connects users to emergency response services if they become unconscious and unresponsive. It can also be helpful to write down what you’re using and how much you’re using each day. Not only will this allow you to be more mindful of your consumption, but, in the event of an emergency, a card with this information will provide valuable insight to first responders. Consider the implications of withdrawal during this time, and stay informed about local harm reduction clinics, as many are operating at a limited capacity during COVID-19. It’s also really important you don’t share supplies (cigarettes, joints, needles, etc.) or, if you must, wipe them down with alcohol.
Again, I’ve just scratched the surface when it comes to harm reduction strategies. But, by incorporating harm reduction strategies into my IFS therapy work, I’ve been able to diminish some of the internal conflict over using during COVID-19, reduce my consumption levels, and be gentler and kinder with myself during a difficult time.
Mad History
This issue: The Keeley Gold Cure
There’s no place quite like the United States when it comes to the commercialization of junk medical science. One early innovator who did quite well in this regard was Leslie Keeley. Keeley, born in 1836 in New York, was a doctor and Union Army surgeon who opened a sanitarium in Illinois in 1880 to treat alcoholism. His treatment centred on a “secret formula” he said contained bichloride of gold, and included regular hypodermic injections—upon analysis, his secret formula was found to be mostly alcohol and ammonium chloride, while the injections he gave to patients contained strychnine and boric acid—both are used in insecticides. Patients who received the Keeley Cure often experienced fear, confusion, vomiting, and dizziness.
Despite all of this, within ten years of opening his Illinois treatment centre, he began selling Keeley Institute franchises. At its height, the Keeley Institute had over 200 branches across North America and Europe. By 1900, the year Keeley died, the Keeley Cure had been administered to over 300,000 patients and had made Leslie Keeley a very wealthy man. Though Keeley was denounced in a 1908 article in the Illinois Medical Journal as, “a common , ordinary quack with a useless remedy which made good by advertising and catching suckers,” his Institute would continue to operate (though the formula would allegedly change and the focus would shift to being a more supportive program) until 1965.
Recommended Listening
CRACKDOWN
By: Garth Mullins and the CRACKDOWN editorial board
Billed as a podcast about the “drug war, covered by drug users as war correspondents,” CRACKDOWN follows stories of communities fighting for their lives, and the community-led activism and solutions that spring from dire circumstances. The latest episode looks at two converging public health crises: COVID-19 and the overdose epidemic, and the series thus far has covered everything from methadone versus Methadose, Portugal’s decriminalization of simple possession, to inequitable housing. The monthly podcast is put together by a team of Vancouver’s veteran drug user activists who bring compassion and insight into complex issues.
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