History of Harm Reduction - Provenance and Politics, Part 3
Peter Stoker C. Eng. – Director, National Drug Prevention Alliance, UK

Abstract:

The history of ‘so-called harm reduction’ - starting with its conception in and dissemination from the Liverpool area of Britain in the 1980s - is described in comparison with American liberalisers’ ‘Responsible Use’ stratagem in the 1970s and with subsequent so-called Harm Reduction initiatives in various countries. The text takes extracts from or synopses of papers presented by various writers on both sides of the argument. As the scope of a historical review of Harm Reduction - over several decades and across several countries - is necessarily large, this paper is presented in 3 parts. Part 1 examines the developments in the USA; whilst Part 2 looks at Britain, Canada, and Australia. Part 3 considers mainland Europe, and then goes on to explore reasons why the package called ‘Harm Reduction’ has fared better than ‘Responsible Use’ as well as some possible reasons why the present, Harm-Reduction-biased situation has come about. The paper concludes by suggesting possible ways forward for those advocating a prevention-focused approach – learning from history.

Keywords: harm reduction, drug prevention, strategy, policy, politics

7. Europe
Because much of the public’s debate about harm reduction and liberalisation is centred on the USA, UK, Canada and Australia, one could be forgiven for thinking that mainland Europe is not engaged with this struggle. Far from it.

Of course Holland and Switzerland have had their share of the spotlight, but other countries can show much from which to learn. Baltic country Lithuania is unique in Europe in refusing to use the term ‘Harm Reduction’ in its documents; it has an excellent support network for problem users and helps them limit harms from their use, but Lithuania does not want to embrace any notion or terminology continuing the hidden agenda of drug liberalisation. Neighbouring country Latvia has a prevention centre in its capital Riga that would be the envy of any country.

But of all the countries in this region it is Sweden that has the most admirable prevention-based strategy. Having actually tried an acquiescent policy after World War II focused on a growing amphetamine problem, Sweden found the Harm Reduction cure to be worse than the disease and switched to a restrictive approach thereafter. Today, Sweden has the lowest prevalence of drug use in Europe and has several commendable prevention programmes in its array. Treatment centres are either voluntary or mandatory, and results are roughly the same from both.

To be Seen as ‘Normal’ is All We Ask
British pro-drug activists were never slow to promote their wares in the export marketplace; the European Movement for the Normalisation of Drug Policy (EMNDP) had its first meeting in Swindon, England, in 1989, but the Merseyside dope disciples (O'Hare and company) were more ambitious (or perhaps more encouraged) to head for the USA the year before that. They found themselves feted by libertarians ‘in the street and on the Hill’. Amongst those on this promotional trip was Pat O’Hare, now Director of the International Harm Reduction Association. O’Hare and colleagues presented a paper with the innocuous title of ‘Drug Education, a Basis for Reform’ to a Maryland conference convened by a relatively new organisation called the Drug Policy Foundation, about which we now know a little more! Thanks to the late, great Otto Moulton whose vast library is now established in Drug Free America Foundation, there is a library tape of what was actually said by O’Hare and his companion Ian Clements at that conference; it bears little relationship to the written paper. O’Hare told his largely American audience that ‘England has absolutely nothing to learn from America’ and added that ‘…this 12-step rubbish is absolute cr*p’. One member of the audience made so bold as to ask O’Hare, ‘What are the 12-steps?’ ‘I don’t know,’ he responded (but he did know they were ‘absolute cr*p’). He then invited his audience to consider the notion that:

If kids can’t have fun with drugs when they’re kids, when can they have fun with them?

O’Hare was demonstrating that when it comes to radicalism, we Brits can show the former colonies a thing or two.

One milestone on the Harm Reduction road was the establishment of European Cities on Drug Policy (ECDP). Their first International Conference was held in 1990 in the German city of Frankfurt andproduced the so-called Frankfurt Resolution, calling for heroin distribution to addicts, decriminalisation of cannabis and the provision of shooting galleries. It initiated a recruiting drive, and one of its first disciples was Scotland, much to the disgust of Scottish prevention colleagues. According to Glasgow’s Families For Change organiser Maxie Richards, “…harm reduction has become a vested interest of the Social Service industry, and with only one purpose: keeping social peace at the cost of dispensing drugs”.

European Cities Work in Harmony
In 1994 Stockholm, Sweden, saw the first meeting of what was to become a major vehicle in harmonising European drug policy at the city level, promoting good practice in prevention and resisting the pressures from those who favoured legalisation. ECAD (European Cities Against Drugs) membership comprises mayors of European cities, and to date more than 250 cities have joined. The organisation runs regular international conferences as well as projects involving member countries in cooperative ventures. ECAD has an Advisory Board with members from Turkey, Russia, Lithuania, Poland, Sweden, Finland, Iceland, Ireland, Bulgaria and Norway. Until his death in 2003, London city alderman Peter Rigby was a key activist.

In 2003 Dr. Kerstin Kall, Chief Medical Officer of the addiction clinic at Linkoping University Hospital in Sweden, produced a very useful, dispassionate appraisal of Harm Reduction in comparison with other interventions.(23) She noted that Estonia has the fastest spread rate for HIV, with other former Soviet states not far behind. In the face of thisconcern, WHO and UNAIDS have rated work against HIV above work against drugs. Current suggestions by some that drug penalties should be relaxed in order to ‘solicit’ attendance at HIV clinics are dubious, Kall feels. Needle exchanges did partly slow HIV spread – but greater effect could be observed from other medical interventions, coupled with public health education on the themes of ‘Don’t inject/don’t share/boil your works/use condoms’. Needle exchanges are not observed to be as effective as testing and counselling. The idea that illegality of a drug deters visits to clinics is a myth. Equally, downgrading policy as a scheme to elicit greater use of Harm Reduction is seen to be extremely debateable – the ‘road paved with good intentions’ leads to its usual destination.

A Threat or a Promise?
At an ECAD conference in Reykjavik, Iceland, in April 2002, former Swedish MEP MaLou Lindholm gave a most perceptive paper (24) on the workings of the EU. Her theme was, ‘Is EU a threat to or a possibility for a restrictive drug policy?’ The following is an extract from her paper:

All the member states of the European Union (EU) have signed the UN conventions on drugs and doing so have committed themselves to act for a humane restrictive drug policy in accordance with these conventions. Drug policy is not a competence area for the EU since it is a part of the third pillar, where EU has no right to formulate any binding laws or directives. Every country is independent and the national parliaments are to decide in democratic order. But the EU has big indirect impact on drug policies in its member states through recommendations, agreements, financial support, through laws and directives in other political areas.

If the EU and its bodies (the European Parliament (EP), the Commission (Com), the Council of Ministers and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) strongly supported and worked to implement the UN conventions and the UNGASS declaration, the EU could play a positive role for a restrictive drug policy in Europe and in the world.

Sadly, this is not the case! It is almost impossible to find any written or pronounced support from the EU Commission, the EP or the EMCDDA for the UN conventions on drugs. On the contrary, direct and indirect support is given to the Harm Reduction policy and projects. By this the EU helps to undermine the UN conventions and a restrictive drug policy.

A look at the political groups in the EP shows the same pattern as in most member states. The most drug liberal political groups are the Radicals followed by the Social Democrats (Labour), the Greens, the Leftwing and the Liberals. The Conservatives and the Christian Democrats support a restrictive drug policy. However, it is important to notice that there is no consensus in any political group, except from the Radicals who are all in favour of the liberalisation of drugs.

The main body of Radicals in EP consists of members of the Italian TransNational Radical Party (TRP) which focuses on the liberalisation of illicit drugs. The TRP as well as other drug liberal MEPs takes every opportunity in the EP to write drug liberal amendments to reports from different committees. The amendments and speeches support efforts for decriminalisation and liberalisation of cannabis and reconsideration of the UN conventions on illicit drugs.

The drug liberal organisation CORA (Radical Antiprohibitionist Coordination) associated with the TRP has, thanks to some MEPs, its office inside the building of the EU Parliament. This makes it possible for CORA and its members to operate and lobby the politicians directly and also to be updated on what is the agenda in the different committees. They can, and do, organise meetings and conferences inside the Parliament. They can, without any charges, use the phone, fax and internet of the Parliament. The EU taxpayers pay the bill!

A major problem in the EU, as well as in national parliaments, is that politicians in general have almost no drug-political knowledge. Their ignorance can be partly excused since it is mostly due to the fact that they are dealing with other political areas. But too often it is also a result of lacking interest, which is worrying; as a result they easily fall victim to drug liberal or harm reduction lobbyists.

The EU funds many projects in the field of drugs. A majority are projects promoting Harm Reduction, very few promoting a restrictive drug policy. For instance, ECAD (European Cities Against Drugs), a network of more than 260 European cities who support the UN conventions and work for a restrictive drug policy, has twice applied for funding – and twice been rejected. In contrast, the organisation ECDP (European Cities on Drug Policy), consisting of only approximately 30 cities which have signed the Frankfurt Declaration and work for harm reduction and decriminalisation of cannabis, has received funding for many years from the EU. To summarise: the EU is probably one of the main threats to a humane, restrictive drug policy.

It is quite possible that a new drug-liberal Resolution might be proposed to the EP. It would have a heavy political impact if the EP nations supported a ‘European Cannabis Policy’ and a review of the UN conventions on illicit drugs in a more ‘pragmatic’ way.

In the Council of Europe (COE) with its 43 member states, an attempt was made in January 2002 to have the drug liberal report by British MP Paul Flynn adopted. If it had been adopted, it would have had big political impact – and it almost was. But just before voting, the majority of politicians were convinced that adopting the Flynn report would be a huge mistake, contravening as it did both the UN conventions and the international agreements which their countries had signed. The Flynn report was rejected.

In fact, it is now known that a Harm Reduction Convention is being drawn up (2006/7) for submission to the European Parliament – and it has already achieved some sympathy with some key players.

Semantics in Drug Policy
One outcome of the much greater funding which libertarian entities enjoy is their greater output of writing/s embracing their beliefs. Several professed ‘overviewers’ speak of the ‘great weight of argument for Harm Reduction’ – without acknowledging that this greater weight derives from much greater disposable income allowing a greater tonnage of paper to be churned out.

Frequent allegations are made against Prevention-based entities, accusing them of flowery language, whilst turning a blind eye to their own. Giancarlo Arnao, founder member of the IAL (International Antiprohibition League), has even gone so far as to publish a paper on the topic. (25) He directs his fire against the UN, accusing them of having ‘a semantic system which evinces a tautology’. Say no more!

He starts by criticising people for using the word ‘narcotics’ when they mean drugs in general – and he has a point there. He then objects to the word ‘abuse’ as too stigmatising for use of illegal drugs and the word ‘addiction’ similarly stigmatising compared to ‘dependence’. Arnao concludes by examining what he calls ‘The Semantics of the Single Convention’, asserting that the UN has been willfully drafted in perjorative terms – but he produces no evidence of the ‘dirty work at the crossroads’ he alleges.

In truth, the greater credit for ‘semantics skills’ management must be awarded to the libertarian tendency; they have consistently outmaneuvred the opposition by clever use of words. For instance:

Soft Drugs – a brilliant nomenclature implanting the notion of relative harmlessness

Medical Use – better defined as ‘medical excuse’ when speaking of raw (as-grown) cannabis ingested by smoking; two respects in which medical authorities reject the notion (not to be confused with pharmaceutically prepared cannabinoid extracts which are ingested by oral sprays or similar and for which there is emerging promise of medicinal use)

Recreational Use – a term normally applied to healthy hobbies and interests and having no relevance to the use of illegal substances

Ecstasy – one of several slick marketing names by suppliers

Harm Reduction – replacing the earlier term ‘Responsible Use’ which was more open to criticism by non-users (Who can gainsay ‘reducing harm’? Many do gainsay it when the definition of ‘harm’ is narrow and self-serving.)

Prohibition – a mental trigger term implanting the idea that prevention of the use of illegal drugs is equal to the US alcohol policy in the 1920s (This term conjures up an image of a policy that was doubly ‘bad’ – firstly, because it denied folk a drink, and secondly and worse, it was American and thus useful for libertarians who frequently use anti-American slurs to discredit any prevention-based approach.)

The real purpose of using the word ‘prohibition’ is to generate a meme (a mental trigger, as described in the section entitled ‘Dangerous Liaisons’ in this paper). A study by Robert Peterson (1) examines whether the usual mental triggers caused by use of the word ‘prohibition’ are justified. Peterson says:

Did prohibition fail? Surprisingly, from a health and economic perspective, prohibition accomplished its goal, saving America both money and lives. Even though alcohol use was not illegal, prohibition significantly lowered alcohol consumption, whilst cirrhosis deaths were cut by over a third, and alcohol psychosis fell dramatically. Even with gangster killings, the overall murder rate declined. From 1905 to 1990 the murder rate rose 300%; during the prohibition period, l918-1929, it only rose 30%; subsequent to prohibition, the murder rate accelerated again. Arguments against prohibition are clearly based more on public opinion and social consensus than on economic or health data. Since the repeal of prohibition, alcohol consumption has tripled. Alcohol is also strongly linked (together with illicit drugs) to violent and property crimes. The real lesson of prohibition is not whether society should absorb either the heavy cost of legal alcohol or the heavy cost of legal street drugs; it is whether society can tolerate multiplying the cost of legal alcohol by legalising other drugs. From an economic, health or legal perspective no justification for legalisation can be made.

The Pursuit of Happiness, German Style
Bremen, Germany, does not automatically spring to mind in the context of pro-drug campaigning, but it undoubtedly has a dedicated campaigner in Professor Dr. Lorenz Bollinger. In 1994 he was the editor of a book with the cosy little title of ‘De-Americanizing Drug Policy’ (27). The book was a compendium of arguments for liberalisation, and it came out of a conference the previous year which Dr. Bollinger also hosted in Bremen’s Institute of Drug Research (BISDRO). The conference attracted not a few familiar names – Peter Cohen (Amsterdam), Diane Gordon (New York), Mario Lap (Amsterdam), John Morgan (New York), Ethan Nadelmann (New York), Freek Polack (Amsterdam), Craig Reinerman (California) and Lyn Zimmer (New York).

Bollinger’s own contribution to the conference centred on his paranoia that all drug control policies have a hidden agenda. By this premise, they are designed either to give one nation control over another (with the USA fingered as the main blackguards) or to give enforcement agencies the tools to socially control target groups – in effect imposing a ‘police state’. In contrast with such oppressive nations/people, liberalisers are the ‘good guys’. One’s view, as ever, depends upon where one stands.

The conference book opens with a suitably-emoted dedication:

These pages are dedicated to all those who, in the pursuit of happiness, have obtained and consumed certain substances defined as illegal and thereby got miserably entangled, detained and stigmatized by the criminal justice system.

Bollinger Spills the Beans
It is only seldom that the operational system for promoting and advancing Harm Reduction is honestly described. The Hanf-Magazin (Hemp Magazine), which provides grass-roots information, published an article by Dr.Lorenz Bollinger (28) in its August l998 issue. Bollinger is not only co-director of BISDRO, he is also a Professor for Criminal Law and Criminology at Bremen University, a qualified psychologist and psychoanalyst. Faced with a ‘significant change’ in the attitudes amongst the expanding body of drug proponents and protected against prosecution for criminal offences by informal agreements with local and regional criminal authorities, the following article by Bollinger displays an understanding of the law that is more in keeping with that of a dealer than a lawyer.

What Bollinger understands by grass-roots movements is, for instance, the illegal setting up of the ‘shooting gallery’ by ‘aksept eV’ in Bremen. The aim of this deliberate violation of the law was to push for a legal decision at what is seen as an ‘opportune moment’ - because several penologists had already spoken out against taking legal measures against ‘shooting galleries’. Bollinger unmistakably calls a spade a spade:

In my opinion, the only viable strategy is one of slow erosion… by the taking of small steps towards definite decriminalisation; practicable solutions pertaining to administrative law and the law regulating public health need to be found which are unobtrusive because they are unrelated to criminal law. Such examples are the medical prescription of cannabis, models of drug distribution by chemists or heroin rations …, the toleration of ‘Coffee Shops’, shooting galleries or drug-checking, certain permissible violations of the laws, aggressive information campaigns in schools and elsewhere, grass-roots organisations.

Ich Bin ein Frankfurter
US libertarian Ethan Nadelmann clearly has a generous travelling budget; he can be seen around the globe. For example, in l997 he peddled his American-derived, Soros-financed philosophy at a conference in Frankfurt, Germany. (29) Ethan was obviously in rumbustious form. There was disagreement in the US, he said: ‘disagreement as to which aspect of the war on drugs was most disgraceful’. But there was, he said, agreement: that ‘you could blame illegality of drugs for almost all the ills the nation suffers’.

Proponents of restrictive drug policies often cited the 60% reduction in drug use between 1980 and 1992. Nadelmann said you can’t count that because the ‘War on Drugs’ didn’t start until l986 (In fact, it started a good deal sooner with the parent movement rather than the government deserving the credit, having mobilised thousands of parents from the late l970s onwards). Moreover, says Nadelmann, it was a poor outcome because it only affected the middle classes (No evidence is given to support this charge).

Most people don’t harm themselves in using drugs – his next point (But they do harm a lot of other people around them). Drugs won’t go away, he says (But the prevalence can be significantly reduced, evidence shows – both in relation to illegal drugs and, notably, to tobacco).

Methadone, says Nadelmann, is to heroin as nicotine patches are to smokers (The comparison is shaky; no deaths have been reported from use of nicotine patches. And the fact is that patches are used as a stepping stone to cessation of smoking. Far too often these days, methadone is seen as the permanent stopping place for users).

According to Nadelmann, who seemed to stray further from the middle of the road with every step, the government is to blame for crack cocaine through their unwillingness to agree to cocaine legalisation, just as they were guilty of provoking the making of ‘moonshine’ by prohibiting regular booze. In Ethan’s eyes, the Dutch are the true pathfinders of drug policy – a nation where ‘pragmatism’ counts for more than ‘moralism’. This conference was seemingly not the place to whisper the suggestion that a pragmatic policy does not have to axiomatically abandon morality – or vice versa – but then Nadelmann would not have heard it anyway, he was in full flight, heading for his Promised Land.

Some Final Thoughts on European Matters
This paper need not take space in repeating the developments in Switzerland, since most readers will be familiar with that disaster area - an avalanche of Harm Reduction. When looking for the reasons why Switzerland has gone downhill in the avalanche, one explanation may lie in the fact that the director of the so-called ‘Swiss Experiment’ of heroin prescription and assisted injection sites also happened to be the President of the Swiss branch of the International Anti-prohibition League.

Similarly, readers of this Journal can be assumed to know a good deal about the Netherlands. Their particular brand of Harm Reduction was visible for many years before drugs became the issue and cannabis cafes opened. Holland is also liberal in its approach to pornography and to the age at which sexual activity is legal (12 years of age). In the late 50s, this writer can remember walking in astonishment along Canal Street in Amsterdam, looking at brightly lit and decorated shop windows in which the ‘Item for Sale’ was not a washing machine; it was a human being. There were, it was said, ‘Harm Reduction’ procedures in place – condoms on the bedside table, regular health inspections for the ‘service provider’, and so on.

George Soros does not neglect Europe; in recent years Soros has placed some of his support and resources behind new organisations in Europe. The Soros-funded ‘Forward Thinking on Drugs’ group had a familiar figure on the bridge: Mike Trace, the disgraced UK ex-Deputy Drugs Tsar. Subsequently, another international libertarian body was created with Soros support - the Beckley Foundation, based in London. And its head? Mike Trace.

8. Taking Stock: Where Are We Now?
Definitely not where we want to be, that much is certain. Through a ‘combination of strong adversaries and weak friends’ (quoting Emperor Cicero - 106 to 43 BC), one can see the Harm Reduction Movement has already reached critical mass in several countries. Australia has taken Harm Reduction as the touchstone of its education, whilst in England many, perhaps most schools are adopting a Harm Reduction approach within their education, and the libertarian elite are well entrenched in the Education ministry’s corridors. A self-appointed and exclusive pressure group of educationists and related disciplines, the Drug Education Forum (based and serviced for most of its life in the DrugScope’s offices) seems curiously able to protagonise with impunity - a philosophy which effectively neuters prevention in our schools.

Prevention workers did their best to alert and galvanise those in control, and during his term of office they had several meetings with Keith Hellawell. But even a senior advisor like Keith, with all the experience of being a Chief Constable to stiffen him, found that changing the direction of our government officials was like boxing with cotton wool. It is small comfort – in fact no comfort at all - for colleagues such as those in Australia to say that the situation is even worse there and has been for at least a decade, with Harm Reduction education being the mandatory norm and cannabis decriminalisation a fact of life in some areas. This just paints a depressing picture of what the future might hold for other countries if prevention workers continue to be pushed aside.

9. How Did We Get Into This Mess?
Are the cuckoos in charge of the nest? It is a known fact of avian life that cuckoos, once in the nest, push everyone else out – hence one English language metaphor derived from the word ‘cuckoo’. The other common metaphor for ‘cuckoo’ is, quite simply, someone who is ‘not too tightly wrapped’.

George Soros seemingly recognises the first metaphor. In advancing his Open Society (which might be more accurately defined as a Half-Open Society), he does his best to see that his half of any argument has the major share of the resources. This determinationeven extended in 2004 to his funding Democrats to ‘cuckoo’ George Bush out of his White House nest.

There is, in truth, no shortage of cuckoos. Many people in a wide variety of fields are currently expressing concerns about the bizarre drift which is carrying Britain along in 2007. For example, over the last 12 months or so, the British national press has reported the following gems in the ‘Human Rights’ sector:

• Police declining to publish pictures of escaped murderers in case this infringed their Human Rights
• Health professionals suggesting self-mutilators should be given clean blades and helped by nursing assistants to cut themselves
• UK drug workers voting in favour of being drug users themselves, if they want
• National Lottery refusal of funding to lifeboats because they were not rescuing enough ethnic minority people
• Forestry Commission launching new recruiting campaign to encourage more gays to become lumberjacks

Prevention workers are always at the mercy of the cuckoos. The opposing forces, given the combined effect of their greater financial and personnel resources plus the majority Libertarian tendency in the media, have made the playing field so tilted and so slippery that ascent by prevention advocates is nigh on impossible.

The media tilt is very significant. It always used to be the case that British Prime Minister Blair, faced with a difficult issue, would ask, “What does the Mail say about this?” The counter-attack by libertarians has therefore been to steadily assassinate the character of the Mail. This contrasts with some years ago when it used to be the Guardian that was the whipping boy. Neither extreme attack was justified; the centre ground is, as ever, where a balanced view is more likely to be found.

A common thread in the libertarian media is to characterise prevention as punitive and oppressive of Human Rights. Neither is true, and the latter is particularly unbalanced in that it speaks only to the Human Rights of the drug user. The Human Rights of all those around the user – up to and including society as a whole – are not even entered, let alone entertained in this rhetoric.

What, then, is needed to produce balance? A much greater exposure of prevention for the health promotion value it embodies, a large reduction in the ‘Human Rights’ hyperbole, a rational approach to harm reduction which has cessation and abstinence as its ultimate goal and a balanced recognition of the Human Rights of all concerned – which of course includes the users. Cuckoos, too, deserve their share - but no more than that.

What Fertilised the Growth of Harm Reduction, the Ebb of Prevention?
In reflecting on the development of Harm Reduction, one stark contrast emerges. How was it that there are two virtually identical philosophies: One from only 20 years ago, operating under the title of ‘Responsible Use’ was quickly identified as ‘The Emperor’s New Clothes’ and kicked out, and yet here we are now, faced with Harm Reduction deeply embedded, its tentacles reaching everywhere – even into government? What caused the difference?

If readers of this Journal were to be asked to come up with one word as an explanation of the difference, that word would probably be ‘Soros’. In one sense they would be right; the money that he has injected into the libertarian movement, compared to that which Prevention workers can marshal, is like attacking their artillery with our cavalry. We British tried that once; it was heroic but futile.

A deeper explanation of why Harm Reduction flourished where Responsible Use failed in the push for liberalisation may lie elsewhere.

It was in the 1960s both in the UK and in the US that a sea change in educational approaches really took hold; morals-based education gave way to individual rights. Apparently disparate subjects such as reading, mathematics, history, geography and religious education fell victim to the excesses of an overheated individual rights approach in which some pupils could even decide whether to participate in classes or not. It goes without saying that lifestyle subjects such as sex education, drugs education and personal/social education would be swept along at the front of this wave.

One book which explores this phenomenon in more depth is called The Great Disruption by Francis Fukuyama. (30) Fukuyama concludes that there has been a major paradigm shift. Who created that shift?

It could be that the answer lies in a process known as Values Clarification, also associated with Outcome-Based Education. This concept originated in Wisconsin, USA, in the 1970s under the leadership of a man whom most people regard as one of the fathers of psychotherapy – Carl Rogers, together with Professor Sidney Simon and psychologist William Coulson. Rogers started with a very laudable concept, i.e., that pupils should be facilitated to discover and thus reach consensus on values which are beneficial to society. Sadly, within a short time the concept was diverted into one in which pupils were facilitated to discover values which were beneficial to them as individuals. External constraints were to be viewed as obstacles to the individual’s ‘Self-Actualisation’ - as Abraham Maslow, a contemporary of Rogers, termed it. Thus, the notion was advanced that:

… children should be left to create their own autonomous world, and that adults would be anti-democratic if they tried to pass their values to their children.

This was echoed by co-author Sidney Simon in the statement:

...the school must not be allowed to continue fostering the immorality of morality. An entirely different set of values must be nourished.

Similar approaches were observed in Gestalt-based education practices in Switzerland. A typical guiding assertion was that “Morals are regarded as obstacles which hinder the development of ‘my authentic self’, and the teacher has no right to impose his sense of values about what is right or wrong”. In Australia, classroom techniques resembling group therapy were deployed to produce changes in children’s attitudes and behaviour and challenge their previously held values.

Carl Rogers eventually expressed his own concern about the monster he had created, referring to it as ‘this damned thing’ and wondering, ‘Did I start something that is in some fundamental way mistaken, and will lead us off into paths that we will regret?’ But by then the wave had swept things beyond his reach. Britain now has a Journal of Values Education which invites school classes to discuss such questions as ‘Are drugs really bad for you?’, ‘What are the benefits and risks of drug taking?’ and ‘If adults drink alcohol why should I not take Ecstasy?’

Study of the Values Clarification process (31) and related movements helps explain how we have reached where we are today and why Harm Reduction has taken root when Responsible Use died off quickly after a first flourish of growth, having fallen on stony ground.

But one cannot blame Carl Rogers for everything that has happened in the last 20 to 30 years, anymore than one can blame George Soros. One is an idealist and the other an opportunist, but they both sowed seeds in grounds which we ourselves have made fertile.

External factors across and within society have, by their confluence, are some of the causal forces creating fertile ground for societal change. Emancipation of the young, their greater disposable income, disempowerment of traditional authority (including parents and teachers), a more materialistic society and a ‘me first’ outlook, dismantling of ‘community’, the highlighting of ‘personal rights’ at the same time as the downplaying of ‘responsibilities’, effects of structural unemployment and the need for a more mobile workforce (this last factor adding to the breakdown of the nuclear family) are some of the causal forces creating a ripeness for such societal change. The ‘contribution’ of the professions in being part of the problem rather than part of the solution is a major influence, as Professor Norman Dennis (32) makes clear. One could say more, but the picture is already clear…

The results can now be seen in undisciplined classrooms, in a police force which is perceived as sometimes more ready to arrest victims than criminals in order to reduce the harm to the latter, in drug workers campaigning to free colleagues who have apparently allowed drug dealing to be pursued on their premises and in Education Authorities that will not allow school nurses to issue Aspirin or Paracetamol for fear of a negative reaction but are receptive to the idea of issuing ‘morning after pills’ to young girls without their parents’ knowledge.

Harm Reduction is no more than an extension of this much deeper and wider cultural shift. Addressing only Harm Reduction in seeking to strengthen our society against structural collapse is an over-simplification that could prove disastrous.

10. What Should Be Our Rational Response?
This paper is focused on history - on yesterday and today rather than tomorrow – nevertheless, some indication of possible future options learnt from history may be in order. Sample initiatives include the following:

• Become more pro-active, more guided by structural planning, less preoccupied with responding to what ‘the Other Side’ does

• Continue doing what you are doing, but get better at it

• Improve your international networking and cooperation (How many hundreds of signatures have you collected in support of the ITFSDP Resolution, first tabled at the conference in Brussels in February 2005 and addressing what is known as ‘so-called Harm Reduction’?)

• Find the prevention-funding equivalent of George Soros

• Study and learn from the processes that have brought us to where we are today (This paperattempts to contribute to that understanding.) In this context, a studious read of the full paper by Michael J Ard (13) could be a good use of your time.

• Keep up with the changes – this arena is volatile, not static. For example, even as this paper was being put to bed, a British national newspaper (Independent, 10 April 2007) ran a feature arguing that Afghanistan’s poppy crop should be purchased outright by Western nations such as Britain and the US which, they argued, would cut off the opium flow to Europe at a stroke, undermine the Taliban and correct a current shortfall in supply of opium for Western nations’ medical purposes. (A broadly similar proposal a few weeks before this by SENLIS was enough to provoke the Afghan government into closing the SENLIS office in Kabul) This writer suggests thatan appropriate name for such a project would be ‘Poppycock’.

• Recognise that there is a place for some methods of reducing harms from drug use, but that place is downstream of onset of use – a part of the treatment process, always open to assessment and practice review and always with the eventual goal of abstinence.

• Learn from the comparisons between preventive policies and Harm Reduction. Dr Lucy Sullivan gives an exemplary report (33) of the comparison between Sweden and Australia.

• Understand that the Media are not just passive observers – they contribute to social and cultural change through what they choose to write in their columns and editorials, what the adverts show, what they say on TV, radio and movies and what they write in their blogs and websites. It is incumbent on all of us to make relationships with the media and make them not just listen to our views, but use them.
  
  You will not like every media contact you make, but that is less important than their liking your story. In the early days of the New York Times, they posted a motto ‘All the news that’s fit to print’. In our present age the rock mag Rolling Stone parodies this by offering ‘All the news that fits’ – i.e., if it doesn’t fit with their prejudices, it won’t get onto the page. Don’t be put off – try them anyway and all the others.

• Create your own memes!

It has been said that those who do not learn from history are condemned to repeat it. American judge and educationalist Robert H. Bork might have been thinking about the history of so-called Harm Reduction when he wrote:

One of the uses of history is to free us from a falsely imagined past. The less we know of how ideas actually took root and grew, the more apt we are to accept them unquestioningly, as inevitable features of the world in which we move.

11. And in Conclusion …
Society exists and expands through the building of structures. Some structures are physical – the concern of architects and engineers. Others are organisational or behavioural – the concern of a very diverse range of people. Structures are known to sometimes overstress or even collapse if the stress is great enough. In the case of drug misuse (or abuse), our society today can be seen to be severely stressed – but there is no structural unity in our remedial works. For some participants this is quite intentional, whilst for others it is no more than ‘unintended consequence’.

By studying the provenance and practice of harm reduction, as encouraged by this paper, it is possible to identify more clearly what best to do to achieve more unity in our response and to generate consequences that are ‘intended’ rather than accidental.
Perhaps the single most seminal point this writer can offer in concluding this paper is that all behaviours – including abuse of drugs – are influenced by the ‘culture’ that surrounds them. This is, in effect, the confluence of the many and varied factors around drug abuse and misuse.

Some cultural factors like health awareness and morality are society-wide. Others are mostly confined to specific groups – youth, adult, employers, leisure, sports, arts, advertising, music and so on. This writer took an earlier ‘sounding’ of these cultural aspects in his paper (34) to the Fifth International Drug Prevention Conference in Rome (2003).

Clearly, many of these factors range widely and are independent of specific behaviours like drug abuse/misuse. It is therefore essential that anyone seeking to influence drug policy is alive to these important external factors.

The topic of this paper was the ‘history’ of Harm Reduction. In exploring the subject, it became apparent that there was as much ‘mystery’ as ‘history’ – or perhaps, more appropriately, ‘mysticism’ which the dictionary defines as:

A belief characterised by self-delusion or dreamy confusion of thought, especially when based on mysterious agencies
How true that seems of Harm Reduction. And some of the agencies are more mysterious than others.

Biography
Mr. Stoker is Director of the National Drug Prevention Alliance (NDPA), which he helped form. He has completed more than 20 years in this field and has helped three other charities to form, all running well. His first 7 years in the field were as a drugs/alcohol counsellor in a London drug agency; he also created and delivered a wide range of trainings and was a Government ‘Drug Education Advisor’ to some 100 primary and secondary schools. In 1987 he completed a one-month study tour throughout America, under the auspices of the US State Department. He has delivered workshops at more than 10 PRIDE conferences, and in 2004 he received the PRIDE International Award for services to prevention. He has completed technology transfer trainings in Poland, Germany, Portugal and Bulgaria. In 2001 he was awarded a First Prize in the Stockholm Challenge contest for websites with a health-promotion value. Mr. Stoker is often to be seen or heard on TV, radio or in national/regional newspapers and has authored many articles and papers. For 30 years prior to this career he was a professional Civil Engineer, running projects up to £5,000 million at present-day values.

References
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