A CULTURE OF PREVENTION:
rebuilding communities
by
R.Marcus Gaudry
Nov 27 2009

Recently, the necessity to create a culture of prevention has become abundantly clear to me, especially since it is looking more and more like a globalized culture of addiction continues to progress despite any effort to put a stop to it. In order to get a clear idea of what it means to create a culture of prevention, it seems to me to only make sense to define what exactly that means, and in order to do that, it appears essential that we first define certain terms, for example the term "culture". This word alone has several meanings, depending on the context in which it is being used. For the purposes of this paper, we will be applying a social, historical, and a somewhat anthropological context to the term:

cul-ture: [kuhl-cher] n. a particular form or stage of civilization, as that of a certain nation or period: Greek culture. the behaviors and beliefs characteristic of a particular social, ethnic, or age group: the youth culture; the drug culture.
Anthropology. the sum total of ways of living built up by a group of human beings and transmitted from one generation to another.

We should also seek to define the words "addiction" and "prevention":

ad-dic-tion: [uh-dik-shuh n] n. the state of being enslaved to a habit or practice or to something that is psychologically or physically habit-forming, as narcotics, to such an extent that its cessation causes severe trauma.

pre-ven-tion: [pri-ven-shuh n] n. The act of preventing or impeding.effectual hindrance.

Granted, these definitions are at best basic, or even a little bit generalized, but they do serve well enough to grant us some place to begin a hopefully constructive dialogue, as it were, on what it means to use phrases such as 'a culture of addiction' or 'a culture of prevention'. While I'm fairly certain the meaning to these terms will gain depth as this work progresses, the above descriptions provide enough of a foundation for purposes for now.

On November 17, 2009, I and several of my classmates attended a workshop intended to network information at the Roundhouse in Yaletown, Vancouver, BC called "Creating a Culture of Prevention." Among others, a keynote speaker at this workshop was professor emeritus at Simon Fraser University Bruce Alexander, who started the event off with a talk which he called "Great Expectations" (he mentioned that a better title would have been "Great Expectations...with one reservation"). Much of his talk was based around historical research which is illustrated in detail in his book "The Globalization of Addiction", the point being that "Over and over again,you'll find the proof...When culture breaks down, you'll find addictions (Alexander, 2009)." This breakdown of culture in the traditional sense of the word, argues Alexander, tends to leave a person or group of people in a state of dislocation, which can be described as "poverty of the spirit". Thus, addiction can be regarded as an attempt to find a substitute means of belonging in a social structure from which they are otherwise isolated from. In retrospect, I can see this as a means of being part of a subculture or counterculture, which as of late seems to be becoming a global culture of addiction; perhaps due to, in large part, the global free market society. Thus, according to Alexander in this discussion, addiction is neither a criminal nor a medical problem, but a political problem. Also, to call addiction 'a brain disease caused by drugs which is incurable, but manageable' , is apparently a poor doctrine and an unsatisfactory approach to addiction, especially since it rules out most of the nature of addiction, whch extends much farther than simply drug addiction. It is certainly true that addiction, or the state of being enslaved to a habit or vice, encompasses more than just narcotics or substances; other examples could include processes like sex or gambling, or shopping, or relationships (in particular abusive relationships or codependency), or video gaming (one that Alexander repeatedly expressed concern for), or even certain lifestyles. When considering this theory, the real problem is then not addiction by itself, but in actuality cultural fragmentation. "The ultimate problem is that there are a lot of people out there that just don't have much to live for, so they latch onto other things (Alexander, 2009)." So is dislocation the cause of addiction? I personally can't say for sure. What is clear to me is there is an all but undeniable link between dislocation and addiction throughout history.

What was also discussed, of course, was the four pillars approach to addiction and treatment, though it would appear a better term to use would be recovery. The four pillars, as we know, are treatment, harm reduction, enforcement, and prevention.

"Treatment", it can be argued, is something of a misnomer - if you are to discount the disease model of addiction entirely. I do not, personally, but that is something that will be discussed later in this paper. Perhaps a better term for this pillar would be something to the effect "recovery facilitation". Either way, this pillar in the four pillars is essentially about offering access to services designed to help people come to terms with addiction problems and learning to live healthier lives. Speaking from personal experience; recovery, if handled correctly, can be a powerful tool towards generating a sense of belonging, community, and in what can be seen as a culture of addiction, being in recovery is almost like a subculture in and of itself.

Harm Reduction, present, is clearly the pillar that appears to be getting the most publicity, especially since it seems to run in directly the opposite direction of the prohibition style of "war on drugs" which officially originated in the US with President Nixon declaring said war in 1971, when he named drugs as public enemy #1. In light of how arguably dismal the results of this approach has been so far, it only makes sense that an alternate approach would be sought after, and right now, the pillar of harm reduction seems to be the favorite. The idea of harm reduction is to reduce the harm associated with addiction, especially addiction to drugs and alcohol. While this is certainly an important dimension to look into, it is essential that we remember this is one of four pillars, and in order for a four pillars approach to work, all four pillars need to be implemented together, like how a table has four legs, and all four legs are required if the table is going to stand.

Enforcement, or "policing", is another pillar that receives a lot of attention, and understandably so. The general paradigm socially certainly would appear to demand something be done to reduce the volume of criminal activity that is so often associated with addiction, both with drugs (use and distribution) and in the more general sense of the term - for example gambling and pornography (prostitution, child porn, etc.). In the case of drugs, of course, there is the passing of bill C-14, which is designed to enforce strict sentencing for drug related crimes. Again, this is certainly an important factor to recognize, as it addresses the very real need for public order, safety, and peace. However, we would do well also to note that more policing alone has not yeilded much in the way of positive results, and that once again there is a clear need to acknowledge all four pillars in this approach.

Prevention, ironically enough, seems to be the one pillar that few, if any, really want to touch. Perhaps because to do so would involve a great deal of sticky politics, and many have difficulty getting past the idea that prevention means 'telling people what to do and how to live'. The primary goals of prevention are to promote healthy families and communities, protecting child and youth development, improve the health of the general population, and to reduce the differences in health between groups of people. Obviously, one aspect of prevention is education. What we discussed at the workshop in this regard is that while it is important to educate about the dangers of drugs and addiction, to do this alone is actually a deficit based approach to prevention. What cannot be overlooked is the importance to also provide education towards positive alternatives to addictive behaviour. What came up often in discussion was that rather than working and speaking against addiction, we should speak and work in such a manner that encourages a healthy lifestyle, and that encourages community growth. This attitude of "for" something over an attitude of "against" something else would hopefully be the genesis of an important paradigm shift, which would, ideally, begin some real recovery on a community level.



Which again brings us to the importance of thinking in terms of community rather than a bunch of individuals or individual groups. We also came to a consensus on was the necessity to build up a stronger networking among ourselves, to the effect of basically becoming a community of prevention advocates ourselves. This is, part, the reason I am hesitant to name names in this assignment, the idea for this assignment is present the idea of 'we' rather than 'I' or "they'. I'll admit as well that the other part of the reason is because I take terrible notes and carelessly neglected to include names when I took my notes for this assignment.

One of the largest concerns that came up, repeatedly, was the apparent lack of political will towards creating a culture of prevention. This was expressed by a number of different people in a number of different ways, such as the absence of any political figures at the workshop and was described by more than one person as 'shameful'. One possible way to create political will could be to make noise about the need for more effective prevention. Also noted was a need for advocacy, and leadership - or direction. All of these things, it was proposed in general, would be a great asset in improving connectivity with one another. What was also brought to our attention was the idea of promoting the concept of a culture of prevention, perhaps starting off with some kind of advertising or slogan campaign. Possible themes bounced around were "You are at the centre of 'community'" or "You Belong" This second one holds a great deal of potential, as one could design billboards depicting a family at a dinner table (etc) with a cutout person with the word "you" in the cutout.

Overall, what has become readily apparent throughout this course, and in particular after attending the "creating a culture of prevention" workshop, is that in order to yield any truly tangible results in addressing the problem of addiction, we will have to re-evaluate our approach to the problem. Fortunately, that has already begun with the development of workshops like the one on Nov 17, 2009. Such events are an essential first step, albeit a small first step, in what will likely be a long process. Of course, it has been said that a journey of a thousand miles always begins with a single step. What is apparent to me right now, is that we are very much living in a culture of addiction, especially with the ever growing globalizing of free market society. In order to make strong recovery a plausible goal, efforts are required to create a culture in which the damages caused by dislocation are reduced as greatly as possible, in the hope of developing a cultural shift towards prevention. To be clear, "dislocation" can be and has been defined by some as "poverty of the spirit", and history reveals that where dislocation (poverty of the spirit) is prevalent, so to will we find the problem of addiction. Does this evidence necessarily eliminate the concept of the disease model of addiction? I don't think so. What is also fairly common is that where you find poverty, you will find disease. Therefore it can be said that addiction is to disease what dislocation is to poverty. In this thread of thought, addiction can be thought of, or defined as a disease (or dis-ease) of the spirit. If then it is a disease (dis-ease) of the spirit, then the spirit can be healed. To create a culture of prevention, there is a clear need to limit the extent of dislocation. To limit the extent of dislocation, it is imperative that we make every effort to rebuild solid, inclusive, and diverse communities.

Also, I reiterate there may very well be a foundation towards creating a culture of prevention already in place. Within this current culture we live in, which I sometimes playfully refer to as the "fast food" culture of addiction, there is at present something of a subculture, or maybe what can be called a counterculture of recovery. Many of those who are enjoying a life in successful recovery will likely tell you that indeed, a part of the reason why they so readily took on their addiction lifestyles was very much about trying to find a niche in which they belonged, and that niche is certainly a part of the reason they stayed in their addiction for as long as they did. It was how they identified themselves. In recovery, and especially in a supportive recovery environment, they found a new niche, a new identity (or more accurately perhaps their true identity), and found themselves in what could easily be described as a whole new community.


References:
Alexander, Bruce K. great expectations Nov 17, 2009
"Creating a Culture of Prevention" workshop, Nov 17, 2009
http://dictionary.reference.com/
vancouver.ca/fourpillars/index/htm