Shots Across the Bow

One of the things I've been thinking about a lot recently is how to approach a problem as complex as drug abuse among children. As you have pointed out, there are a lot of different factors at work, social, psychological, genetic, behavioral, and probably some more that we haven't come up with yet. So how do we formulate a strategy to deal with all of these various factors?

The traditional approach has been to treat the problem following an economic model, breaking it down into supply and demand. On the supply side, we have the war on drugs, with all of it's heavy handed tactics and bureaucratic excesses. On the demand side, we get "Just Say No."

I think we can all agree that this approach has yielded less than acceptable results.

So I'm thinking of a different approach, one that has worked exceptionally well in another frame of reference.

Health and safety professionals in an industrial setting have to keep workers safe from all sorts of industrial hazards. Moving machinery, hazardous chemicals, toxic wastes, airborne contaminants are just a few of the hazards they have to defend against. To handle all of these varied threats, they've developed a three tiered approach that is flexible enough to adapt to any hazard, while allowing specific measures to be designed that effectively protect the employees.

This is exactly the kind of approach we need, flexible enough to account for all the different risk factors while specific enough to effectively protect our kids from the dangers of drug abuse.

The approach breaks down into three tiers of protection.

Tier one is called Engineered Controls. This is the first line of defense, and our primary tool for industrial safety. Engineered controls are those which are built into a system that function automatically to keep hazards away from the employee. Examples would be machine guards installed over moving equipment that prevent an employee from being entangled, crushed. or otherwise harmed. Other examples would be pressure relief valves, directed ventilation, or automated alarm systems. Engineered controls are divided into two classes, active and passive. Passive controls require no actions on the part of the employee. They function automatically. For example, a pressure relief valve that releases overpressure automatically is a passive control. A ventilation hood used in chemistry labs, on the other hand. is an active control. The employee must do the work under the hood to receive the benefits. The two defining characteristics of an engineered control, active or passive, is that they operate without requiring protective actions on the part of the employee, and they generally aim to keep the hazard away from the employee.

Tier two is called administrative controls. At this level, our engineered controls have not completely isolated the hazard, so now we institute policies and procedures, rules of behavior that are intended to keep the employees away from the hazards. Examples include setting up exclusion areas, stay times, and work restrictions. The focus of an administrative control is to prevent the employee from coming into contact with the hazard and their effectiveness relies on the compliance of the employee.

Tier three is work practices and protective gear. This is the lowest tier, and the last resort. At this level, the employee must, for whatever reason, be exposed to the hazard. Since we can no longer isolate the employee from the hazard, we must give him or her the tools necessary to work safely in or around the hazard. Those tools include specialized training, protective equipment, task specific work practices, environmental monitoring, and safety oversight, just to name a few.

Now, in order to determine which tier to use, and what method we can use to implement that tier, we have to understand the hazards we face. We do a Job Hazard Analysis, or JHA. In the JHA, we break each job down into it's individual tasks, then we analyze each task for the risks associated with that task. For each risk, we assign a priority based on two criteria, the severity of the risk, and the probability of it actually happening. For example, a risk with a low severity and low likelihood would be assigned to Tier three. High severity and highly likely would be Tier 1, or possibly a combination of Tiers 1 and 2.

The combination of the JHA plus the three tiers of industrial safety gives us a flexible tool to thoroughly analyze a job, determine the risks and to mitigate those risks long before an employee every clocks in for his first shift.

So, how well will this work when we apply it to drug abuse?

I think it fits very well. we're talking about hazardous substances, with multiple effects, multiple routes of entry, and dozens of secondary hazards associated with them. We've got a bunch of external factors that affect the amount of risk, all of which creates a very complex situation, but one whose parameters are right in line with this approach. For the JHA, we'll look not just at the risk of overdose and addiction, but all the other risks that go along with drug use. We'll look at each step along the path to addiction and death by overdose, and assign priorities just like we would with a JHA, by severity and likelihood. Then we'll look at all three tiers of controls and see what we can put into action to mitigate the risks. The First tier is the trickiest to adapt, since there aren't many mechanical systems we can put into place, but remember that the emphasis on the first tier is to keep the hazard away from the employee, or in this case, to keep drugs away from our kids. Tier two would then become keeping our kids away from drugs, while tier three would be the last resort, what to do when our kids have already fallen prey to drug abuse.

This approach hits the problem from all angles and all stages and I think if we work at it, we'll come up with a comprehensive plan for dealing with the dangers drug use represents for our kids.

Let me know what you think in the comments, and let's start brainstorming. For Thursday, break down drug abuse into each step, from acquiring the drugs through taking them, the high, and then the crash afterward. Build a list of the hazards involved in each step. I'll post my list on Thursday, and we'll put all of them together to put together the first step of out JHA. Please take this seriously, as the results will only be as good as the effort you put into it.

OK, I'll go first. I'm not sure how to do this so be gentle!

1. Why would someone want to use drugs? Their friends are doing it; they've been told that it will make them feel better; it's fun; to relieve pain of some sort; they're bored

2. Where does a person get drugs? the home medicine cabinet; family members have prescriptions; friends; dealers; some guy down the street

3. Where does a person get the money to pay for the drugs? What happens if you don't have the money? Are there other ways to pay for them? Can you pay your normal expenses and still buy drugs? Do you steal from your family?

4. How do you assess the quality of the drugs you are buying and taking? I had a friend many years ago die from taking something that had been mixed with something else that was very bad. There are real dangers from taking an impure product - not that the danger is any less than taking the real thing, just different.

5. There are health risks to taking drugs, some of which are hepatitis and AIDS. There are also risks from being around drugs - like getting beat up. Plus overdosing. . . .

6. There are legal risks to possessing and/or using drugs. You may be arrested and go to prison. This may impact your future ability to get a job.

7. There are social risks to drug use: alienating family and friends, isolation, mental problems (drugs can make you paranoid, for example) Another quick example - I recently heard about a girl taken to the hospital for an overdose. Her "friends" met her family at the hospital and her mother was so glad to see them. "You guys are her only real friends - no one else is here for her." The possible back story is that she ODd in the friend's home and the friend is the dealer.

8. And then there is the struggle to get clean and stay clean. You have to stay away from your druggie friends. How do you do that?

My limited experience has come from knowing family members of addicts and seeing what they go through. I have no idea how these people became addicts. I just know how their addiction has affected their lives and the lives of those who love them. I also firmly believe that there is a genetic component to addiction - just one of many factors, but an important one.

That's an excellent start opus. You're smarter than the average penguin!

Thanks! :D

I forgot about lying - that's a real big problem with family and friends. You say you're going to a friend's house to watch a movie when you're really going there to get high. You lie about where you spent that $50 I just gave you that was supposed to be gas money. You lie when you're asked straight out if you're doing drugs and you say no. I could go on. . .

All this lying leads to mistrust and feelings of betrayal among those who have been lied to and then they don't want you around.

A few other consequences are divorce, job loss and homelessness.

Folks, feel free to chime in here! I may be smarter than the average penguin, but I'm no genius. I'm sure I haven't covered all the bases and we all come at this from different places.

but it doesn't happen in a vacuum. Addiction doesn't happen in a vacuum. we have to be willing to hold a mirror up to ourselves. What's that saying? "take the splinter out of my own eye before I can help you take the splinter out of yours" ?? something like that...we need to take a hard, critical look at ourselves; at our society...at the choices *we* make...

I am very intrigued (obsessed maybe) by this discussion topic. Also, impressed by the extremely insightful and candid posts here. I found this sight through following Henry's story over the past year. Though I don't feel I'm an eloquent writer, I am very passionate in my opinions on addiction. I do believe there is a strong hereditary factor involved in most addicts. As a former nicotine addict/cigarette smoker, I feel my own addiction was triggered due to genetics. I believe the only *cure* to my nicotine addiction was the med's which altered my physiology, thus enabling me to quit smoking. My biggest accomplishment in life is quitting. Not birthing two children, or creating the dreamt-about life I now lead - those were *intuitive* goals I met. Quitting smoking meant depriving my brain/body of what felt great - very *counter-intuitive*. As a smoker I didn't necessarily want to quit, I enjoyed the feeling. But I knew of the health risks and history of addiction in my family. I did not want to be defined as an addict with the addiction controlling every aspect of my life. Chantix, along with an anti-depressant, enabled me to overcome the addiction to nicotine. Four and a half years later I still consider myself an addict. I am very much aware of the thin line I try to steer clear of.
I apologize if this is rambling-this the first forum I've felt comfortable to share.
What I keep coming back to is: what if methadone clinics were replaced with chantix/antidepressant clinics? What I understand of methadone is you're just replacing one drug for another, yet both are physically harmful.
Isn't it better to alter the brain's physiology with potentially short-term med's?
I'm interested to hear other's thoughts on this.
Thank you Rick for creating this forum to allow for these necessary discussions!

How my child became addicted. He was 14, a skateboard fanatic. Broke both arms, both collar bones, one wrist, cheekbone and eyesocket. Oh yea, his knee cap. Each time opiates were prescribed and I did not think twice about it. He was in pain, thus pain meds. Then wisdom teeth removed and appendix removed, more pain meds. Carefully doled them out to him as prescribed but over two years he had been on opiates for most of that time. He became addicted and went to rehab, cleaned up started using again. Problem, "frieinds." Rehab, clean again "friends" again. Cleaned up on his own with help from girlfriend and except for small relapses I bellieve he is clean. He wants to be. I say make opiates more difficult to prescribe. Use only in hospitals. Use alternative pain management. Force pharmacutical manufacturers to reduce production by say 90%. That would make it so hard to get because it would not be availabe. This has been done in the past with qualudes and amphitamines. Stop production seek safer methods of pain management. We do no need opiates!

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