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Where it all began….
I qualified as a doctor 20 years ago. I trained as a physician, before becoming a psychiatrist. I currently work in London as a Consultant Psychiatrist and drug and alcohol specialist. I am based in a community drug and alcohol team and a prison. The people I see are commonly dependent upon heroin, crack cocaine and alcohol, although I see other people who have problems with their use of cannabis, amphetamines or other drugs such as ketamine, GHB or mephedrone.
Frequently, the people I see also suffer from mental health issues and concurrent physical health problems. The people who I try and help often have numerous other challenges, both in their past and present. However, those people who are dependent on drugs and/or are in treatment represent the minority (perhaps 10%) of people who use or have used drugs or alcohol. Almost all of them started using drugs in a way that did not cause them serious harm. The journey to problematic drug use for many took several years, and there may have been countless signals along the way that might have flagged up the fact that their use of drugs was no longer without the risk of harm.
The truth is that for most people, for most of the time, their use of substances is primarily a source of pleasure and does not incur serious harms to either themselves or other people. Many people are able to self-regulate their use; they dabble for a while and stop. Many people who start running into problems with their use of drugs are able to pull back: they take a break, or change the way they use or what they do when they use. Often a friend might suggest they take a break. But some people, I don’t how many, don’t spot that their drug use is causing them problems, or they can’t slow down.
Some people whose drug use does cause them and others serious harm simply do not recognize it. Some people who use a lot of drugs think everyone uses a lot- they look at their mates who also may use a lot of drugs or are always getting smashed and think ‘well, that’s normal’. If they see adverts warning them of the risks of using drugs they think those adverts are talking about risks to other people, not them.
When we hear a health message that tells us that what we do might be causing us harm, most of us use the simple defense of saying ‘I’m different – I will be OK, I’m protected’. What we rarely consider is that actually we might be at higher risk of harm. None of us are average. When it suits us we are above average – have you ever met a person who thinks they are not a better than average driver? When its suits us we are below average – for example, smokers who think they are less at risk of lung cancer than everyone else!
So how does this lead to the drugs meter? Well, I realised that although most people who don’t use drugs won’t ever need to seek treatment, many people who use drugs would like to use less, use safely and most importantly don’t want to harm themselves or other people. In order to make informed choices around drug use people need information – personally relevant, objective information – about their use of drugs. But the reality is that there is no guidance for people who use most drugs about what constitutes safe levels of drug use. Why? Because there are no safe levels – but risk exists on a spectrum.
However, because most drugs are illegal, most governments take the stance that all drug use is bad and harmful. The only way to avoid drug-related harm is not to use them. Of course, they are right and although many governments embrace the concept of harm reduction most of this is aimed at preventing harm encountered by the minority of people who use drugs – those people who use heroin or inject. What is typically ignored is drug use by the masses. People from all walks of life, all backgrounds, cultures and countries that choose to use drugs as one of a number of lifestyle choices. But for these people there are few places to go to get some rapid, objective and hopefully useful feedback on their use of drugs. I hope that drugs meter can be that place. I hope that the feedback people get is useful and moves them in the direction where harm is less likely to be part of their lives.
The drugs meter is designed to allow people to think about their use and compare themselves to other people like them. It aims to nudge people to be safer and wiser, and to provide them with some simple tools to reduce the risk of harms related to their use and flag up when their use might be causing them problems. It places no judgment. It does not tell a person what to do. It reflects back to them what they have shared with drugs meter. It reinterprets that information based on the way I think about drug use and the way it affects different people. Drugs meter is not a doctor. It is not an exact science. But I have based it on the things I have learned and the ways I think about people and their drug use in my work. I want drugs meter to be a safe place where people can think about their use of drugs, and somewhere they can point others that they care for towards.