*Names have been changed to protect the identities of those involved.
James* is two years old. Or three. No-one’s quite sure. Like many kids in the area he doesn’t know how old he is. James is scrawny and stunted. He’s about the same height as a typical one year old. Most of the time, though, he’s running around the streets by himself.
He emerges from a tiny shack made of wood, no bigger than the smallest room of a ‘normal’ house, where his entire family of 15 sleep. He wears a t-shirt that goes past his knees and sometimes trips on it as his bare feet slap against the concrete as he runs down the road. This is actually an improvement as he’s often just completely naked and dirty and running around.
His slightly rounded cheeks betray a stick-thin figure, the result of chronic malnourishment. His physical condition pales in comparison to the mental malnourishment from this combination of poor nutrition, poor hygiene, and constant negativity surrounding him. He learns every day that the only way to get attention – something every child desperately needs and craves – is to break something, to hurt someone, to do something wrong. To a child’s mind, attention is good. And so in the mind of this three year old, he learns from day one that bad is good.
No-one around him sees this is unusual. They know his parents have to work, scavenging through piles of someone else’s trash so they can eat today. A meal of rice with fish sauce, soy sauce, or if they’re lucky a piece of meat they found in the trash discarded by some restaurant or supermarket. Everyone knows why James is dirty, naked, and running round by himself. They know why the other kids like him do too.
So what will happen when James grows up? What happens when James starts to become a man? If we could look into the future we would likely see James as angry, abusive, and addicted. So what do we do about a problem like James? What happens to him and the thousands of children like him? There are answers… it just takes a lot of learning.
Lesson One: The Environment of Poverty is as Toxic as the Trash
One study about Payatas, the home of the largest dumpsite in the Philippines and what Payatas is mostly known for, measured the human development index in the area (Regalario, 2002). The human development index is a rough measure of overall development. It includes life expectancy, education, and income per person. With a score of 0.4179, if Payatas was a country it would rank 180 out of 189 in the world. It is one of the largest and poorest slums in the Philippines.
Living in poverty is stressful. If you haven’t truly lived through poverty you cannot understand how that feels. One study found the stress of living in poverty is the equivalent to losing 13 IQ points. For a better measure that’s the difference between you as you are and as a chronic alcoholic. Or if you went all night without sleeping. Remember the last time you pulled an all-nighter? Remember feeling overwhelmingly tired but needing to finish something? How easily you were annoyed, frustrated, and snapped at other people? How difficult it was to concentrate, the food you craved and ate? And now imagine this is how you feel every day for the rest of your life… Double your workload, go through the day as if you haven’t slept, and do it all while being looked down on and insulted by the rest of society. This is a small glimpse of everyday life.
So here’s the crucial point: if you were in their situation you would almost certainly make the same decisions. It’s not their place in the world, it’s not their destiny, their caste. It’s random luck. “There but for the grace of God go I”. Whoever is born into this physically, emotionally, and intellectually toxic environment will be stunted by it..
And right now, that’s James.
Lesson Two: What Causes Addiction Is Not the Drug Itself, It’s Why People Take the Drug
Imagine you you fall over, maybe down some stairs, or get hit by a car, and you break your leg. You’re rushed to hospital, surgery is performed, and you’re in a cast. You spend a few weeks with your leg raised while painkillers are pumped into your body. What painkillers? Pure, medical grade heroin. The purest kind of heroin (diamorphone) you could ever find. If the drug itself was the biggest factor in addiction, anyone who came out of hospital would walk (or hobble) out as an addict. But we don’t. We take a drug because we’re in pain. And when that pain goes away, we don’t need the painkiller any more. In that way most of us have actually taken illegal drugs in some form or other. And the experience was positive. It helped us because the drugs are meant to be a short-term solution to a problem like a broken bone, surgery, or some other underlying trauma that is being fixed.
People take drugs for many different reasons but they all relate to some sort of pain. Social pain. Emotional pain. Physical pain. What separates the social user from the addict isn’t what they take, it’s why they take it. Street kids often sniff glue, for example, because it dulls hunger pangs and other senses for a time, allowing them to escape their reality. Relieve the root cause of the problem, and the drug use goes away. Solve the pain, and the painkillers (drugs) aren’t needed any more.
Another study explains this well. Rats were put in tiny cages (left) and given access to a bottle of water and a bottle of water laced with whatever drug was being studied. The rats would try the drugged water, get addicted, overdose, and die.
Other researchers, however, saw the rats were crammed in a tiny cage with nothing else to do. So they created a better environment, Rat Park, where rats could run around, eat well, and socialise. They placed the normal water and drugged water there too. But the rats didn’t take to the drugs. Most never touched it, and none did compulsively (addiction). When they placed previously addicted rats from tiny cages into rat park, they showed withdrawal symptoms but then weaned themselves off.
Sound ridiculous? That’s for rats, right? People are different. But there is a kind of natural experiment for this too. During the Vietnam War nearly 20% of US soldiers became addicted to heroin. It’s not difficult to figure out why people under the stress of war, in a foreign country with people shooting at them, would want to escape.
So the USA was naturally worried about hundreds of thousands of heroin addicts returning (about 400,000 addicts according to the estimates). So what happened when they came home? Ninety five percent stopped using drugs overnight. Why? For them, the pain had gone, the trauma they faced in Vietnam, and so the need for pain relief went with it. You can read more about that here.
Many of these examples are in this great TED talk.
Here Johann Hari also shares about the solution. Portugal, for example, became tough on drugs and ended up with 1% of the population becomes addicts. Eventually Portugal shifted the huge amount of money it took to police the issue and imprison drug offenders into development, rehabilitation, and support mechanisms. Instead of addiction being treated as a crime, it was treated as a health issue.
Soon after, overdoses, violent crime, and HIV all rapidly dropped. The country saved a lot of money too. But a key part of the solution was a better minimum wage and other social and economic measures which improved the quality of life. When the pain people felt was eased, the need for pain relief (drugs) did too. For more on the example of Portugal (and others) read here.
Addiction is a symptom of a desperate and basic need in the lives of addicts that has not been fulfilled. Addiction is caused when someone is in pain and cannot find relief elsewhere. Usually we turn to our family, friends, and community to deal with this need. If we can’t do that, if the pain continues, then we are likely to depend on drugs for that relief. This is why two people can take the same amount of a drug and one will be a social drinker and the other an alcoholic. Physical factors do matter, of course, but the largest part of addiction is in the cage someone lives in. It’s also why wealthier areas have problems with addiction too. Poor communities suffer more pain, especially economic pain leading to hunger and similar trauma. But emotional, social, and psychological pain and trauma must also be addressed.
Tackling the issue of drugs means understanding the cause of addiction. It means understanding the pain someone is feeling and finding pain relief for the trauma they face. It means building healthy relationships, where people can feel supported, and creating a world where a hard-working family can satisfy all their basic needs.
A Better Way…
If 95% of US soldiers addicted to heroin stopped using overnight because they changed their environment, we must endeavour to improve the places where most addicts live. Blaming and punishing the addict, as we’ve seen, only makes things worse. Solving the problem of drugs in our society doesn’t mean fighting the drug itself, it means easing the pain the addict feels. It doesn’t mean anti-drugs, it means being pro-compassion. If you somehow removed all the drugs from the world, people would still be in pain and still looking for an outlet for it. The problem is not solved.
The good news is a better way is possible. It’s also more effective and even cheaper! Throwing a person in jail is far more expensive than solving the social problems in communities that create addiction. Not just because of the costs of imprisoning someone, but also because of the family and community left behind when they were taken.
Solving these issues requires empathy first. It requires us to understand the pain a person feels, to understand why they may take a certain drug, and to solve that problem. We have a chance to build something better.
We can prevent the future that awaits James right now. We can prevent the pain that will lead a generation of young people to seek pain relief through drugs. It takes effort, patience, and understanding.
Is it easy? No. Is it the right thing to do? Absolutely.
Meanwhile, we’ll see James next week…**
**James now regularly comes to the Fairplay School, a safe space where he can play, bathe, rest, and learn. He is part of the community and while he has a long way to go his situation is getting better. Baby steps.