Q: The concept of safe injection sites for intravenous drug users has been a hot topic here in Canada. We had a pilot project in Vancouver, which aimed to reduce associated harms, like the spread of HIV or hepatitis. Critics of the concept say it sends the message that drug use is okay. What do you think?
A: I don’t know that free needles will make someone a heroin addict. But would somebody say to themselves, “I don’t need to quit if I can find a place to inject safely”? Yeah, they might.
Q: There’s also the matter of putting the imprimatur of government on something it supposedly disapproves of.
A: Yes, and I think those things can be pretty important. In the U.S., when the surgeon general’s report came out in 1964 saying smoking was bad for your health, it had an impact. Everybody knew it couldn’t begood for you. But when it became official, people actually began to stop smoking. So those are the sorts of things you would have to consider [regarding safe injection sites]; you would have to weigh them against the public health advantages, and I think it would be a very hard decision. It would take a long time to get enough data, and I’m not sure the data would ever be good enough to provide the right answer. That would leave people a moral judgment to make.
Q: You explore issues in this book that are philosophical, almost philological, in nature. The research community, you point out, doesn’t apply words like “involuntary” or “compulsive” with much consistency. Is it time for some common understanding of these ideas?
A: I hope my book teaches my colleagues in research, as well as the public, that we can talk about things like “voluntary” and “involuntary” behaviour in ways that are testable. We can test whether behaviour is modified by its consequences.
Q: How has genetic theory—the idea that behaviours like drug dependence are determined by biology—influenced this debate?
A: There was an initial dark period. The initial impulse was to say that nothing that is disordered in our behaviour is voluntary—that everything is a disease. But we’re gradually discovering that things which are clearly voluntary, like religious beliefs, have a heritability. So people are going to say, aha, it’s not that voluntary behaviours are non-biological and involuntary ones are biological. It’s just that they have a different wiring, and the wiring for voluntary ones are more complicated. The neurons are influenced by consequences as well as by preceding biological conditions. Genetics plays a big role in voluntary behaviour, but our brains are wired so that certain activities can be influenced by rewards and punishments.
Q: You must be expecting some pushback from other addiction researchers.
A: I worry about that immensely. A lot of these are people I know and they’re my friends, so I don’t know how that’s going to play out. But I’ve written some articles that have been published that are very much along this line, and there are behavioural economists and some people who run addiction programs who are very supportive. I think the rest of the addiction world has just ignored it; in academia and science, people just tend to ignore that which they disagree with, unless they’re forced to confront it.
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