What the fight against COVID and the fight against drug addiction have in common


the Jazz Age Lawn Party, which usually takes place twice a summer on Governor’s Island, New York, has become a delicious tradition. Typically, it features live music, social dancing, dance performances, and plenty of elegant 1920s-style dresses and costumes for two weekends in June and August. This year, it has become an unintended example of why we need better communication and better health policy on COVID-19.

Because it was canceled last year, many people attending this year’s June event were especially eager to make the Charleston, the Peabody and make their way into the 2020s, which are already echoing the 1920s in a strange way.

Unfortunately, the demands of the health department meant that there was no dance floor allowed on the spacious lawn. And, even though proof of vaccination or recent negative COVID tests were required, the masks were meant to be worn at all times, except when sitting, eating, or drinking. While the music was, in fact, grand, I almost expected there would be a rule that trumpets and trombones must use mutes.

Perhaps these limitations can be seen as a reconstruction of Precautions related to the 1918 flu. But to me, they represented yet another public health communication failure. Despite the fact that we know much more about situations with a high risk of infection than we did last year, clear direction from the government remains scarce.

Now, however, more than ever, this is exactly what we need. Overly cautious rules, like forcing vaccinated people to wear masks at an outdoor party, don’t make sense at a time when pandemic fatigue affects nearly everyone. Instead, we need to apply the principles of “harm reduction,” which is a public health philosophy that recognizes this reality and has gained ground in recent years.

The idea of ​​harm reduction was born in the fight against AIDS. In the mid-80s it was already clear that cracking down on drugs and syringe possession has not prevented HIV infections. In fact, the places that had the strictest laws and the greatest shortage of needles actually had the highest rates of AIDS.

Essentially, not accepting that a needle ban wouldn’t eliminate intravenous drug use meant needle shortages guaranteed sharing – and with it, the spread of HIV. (Unfortunately, some states are now rerunning this experiment by cutting off access to syringes, and they can expect the same results seen in Edinburgh, new York and Charleston, W. Va., under such restrictions.)

So people who inject drugs got together with public health officials and researchers to devise an alternative. Rather than insisting that we must fight drug use at all costs, policy should focus on reducing injuries to individuals and to public health in general, they argued. Saving lives was more important than trying to stop behavior that some consider immoral.

In other words, the best way to slow the spread of the disease is not to make unrealistic requests for total abstinence, but to work to reduce the greater harm. This idea was quickly picked up by gay men who injected drugs and was applied to sexual behavior as well.

In the mid-1980s, addiction counselor Luis Palacios-Jimenez realized that he sometimes saw the same pattern of behavior in his gay colleagues that he had seen in his drug addict clients. They would heroically try to maintain abstinence or celibacy for months, then slip away and make no attempt to protect themselves during a binge or madness. To counter this, he co-founded the now highly regarded Safer Sex Erotica Workshop and wrote a report delivered.

Psychologist Alan Marlatt observed similar behavior in cigarette smokers and drinkers, calling it an “abstinence-violation effect”. Basically, if the only acceptable goal is continued abstinence, even a minor slip can quickly snowball. When people believe they have already “blown up” they think they might as well just go ahead and dismiss any prior warnings. This problem also affects dieters and just about anyone who is trying to change their behavior. With extremely high risk activities, it can be fatal, and addiction research shows it can make relapses both more likely and more frequent. worst.

Nowadays, we also see it with COVID measures: if we are to be careful 100% 100% of the time, we will tend to abandon other attempts at risk mitigation when we fail, at least in the short term.

But harm reduction — and the many articles now showing its efficiency in everything from reducing the spread of HIV to moderating alcohol consumption, offers a better way. As new variations can make existing vaccines less effective, it is more crucial than ever to focus on prevention measures primarily when they could do the greatest good so that they have the greatest impact.

That means no, don’t demand masks outside at events when people have demonstrated their immunization status. But recommend them to everyone in narrow, crowded indoor spaces where air circulation is limited, vaccination status is unknown, and distancing is not possible.

Don’t fall for the “hygienic theater” trap of constantly washing surfaces that show little sign of driving transmission, but help people maintain better handwashing habits and avoid unnecessary touching of surfaces. high contact like elevator buttons in the lobby.

Rather than aiming to never take a risk, instead help people recognize which situations are really risky and, most importantly, explain why.

In the drug world, advocates of harm reduction have found that treating people as though they have power and with self-respect help reduce risk-taking, possibly by making people feel wanted and needed.

The same applies here: Talking contemptuously to people or assuming that they can’t or won’t make good decisions about risk to themselves only amplifies mistrust. On the other hand, when you provide accurate information, including data relating to uncertainties– people are much more likely to take it into account.

Essentially, when people feel that their choices matter not only to themselves but also to their community, they are more likely to do the right thing. And, when they trust the authorities are on par with them, they are again more likely to reduce risky behavior. In fact, a study on reducing the risk of COVID-19 found that in countries with the highest public trust, adherence to the strictest restrictions was double.

As we emerge from the pandemic in the United States, we must learn from the mistakes made early on, such as the masking communications that were aimed at protecting the supply of healthcare workers, but rather discouraged a preventative measure. effective and increased mistrust.

On June 15, New York Governor Andrew Cuomo lifted most of the state’s remaining pandemic restrictions, citing the fact that 70 percent of adults in the state are now at least partially vaccinated. But people remain confused, and many are afraid to let their guard down, especially with disturbing reports of variants making regular headlines. Clear, honest and accurate risk communication is essential.

Harm reduction research shows that even the most unlikely of people, those who are actively addicted to drugs like methamphetamine and heroin, will act to protect themselves and others if they have accurate information and knowledge. access to resources such as clean needles and overdose antidotes.

You have to respect the general public to be able to do at least as well with COVID. (And it looks like the Lawn Party will be back in the middle of August).

This is an opinion and analysis article; the opinions expressed by the author or authors are not necessarily those of American scientist.


About Rhonda Lee

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