Peter Slattery

Working with young people means working with substance use. This doesn’t mean that I expect every young person I encounter to be using drugs. It does mean though that I find it just tends to go with the territory. Most young people are going to be exposed to all sorts of substances and often at times when they are under all the stress, distress and excitement of trying to grow up.

Last week I ran a workshop about drug use for a mixture of young people who are, for various reasons, not living in homes with their families. A totally lovely group of young people. The focus of the workshop was not on drugs at all but on people and why any of us do what we do, what might encourage us to take risks, for better or for worse, and ideas about looking after self and others. And so the following is timely. On the Harm Reduction Journal website
is a review of Alexander Brucek’s book ‘The Globalisation Of Addiction: A Study In Poverty Of The Spirit.’ One of the quotes is this:

“People can endure dislocation for a time. However, severe, prolonged dislocation eventually leads to unbearable despair, shame, emotional anguish, boredom and bewilderment. It regularly precipitates suicide and less direct forms of self-destruction. This is why forced dislocation, in the form of ostracism, excommunication, exile, and solitary confinement, has been a dreaded punishment from ancient times until the present….”

“Material poverty frequently accompanies dislocation, but they are definitely not the same thing. Although material poverty can crush the spirit of isolated individuals and families, it can be borne with dignity by people who face it together as an integrated society. On the other hand, people who have lost their psychosocial integration are demoralized and degraded even if they are not materially poor. Neither food, nor shelter, nor the attainment of wealth can restore them to well-being. Only psychosocial integration itself can do that. In contrast to material poverty, dislocation could be called ‘poverty of the spirit’.”

And here, for someone who is ‘demoralized and degraded’ and experiencing a ‘poverty of the spirit’ is the creation of a receptive audience for dangerous substance use. Which tells me something about where our efforts should be if we are interested in making a real difference to people harming themselves with drugs.

 The Sun-Herald on 18th October 2009 ran a front page story and the opening paragraph went like this:

‘Cold and flu remedies containing pseudoephedrine would be available by prescription only if authorities adopt a radical plan aimed at tackling Australia’s growing ice epidemic.’

It’s the bit about ‘Australia’s growing ice epidemic’ which is kind of interesting, because if you go to the website of The National Drug and Alcohol Research Centre, which is an Australian Institution, you will find the following which I have simply cut and pasted:

“ICE” USE FALLS; COCAINE USE IN NSW INCREASES

 

 Use of crystal methamphetamine, ’ice’, fell across Australia in 2009, with the steepest drop being recorded in NSW, according to research of emerging drug trends collated by the National Drug and Alcohol Research Centre (NDARC) at the University of NSW.

On ABC’s ‘Life Matters’, Associate Professor Steve Allsop Director of Curtin University’s National Drug Research Institute talks about trends in drug use. And there is good and bad news. ‘Dabbling’ use seems to be going down. And Buck Reed (on the same show) a first aid provider with UniMed says that on the ‘party scene’ drug-related problems/incidents have dropped over the past 3 to 4 years to about half what they were. All good news. On the other hand, those who are seriously enmeshed don’t seem to be doing as well with not as significant drops. And so we do what? Here it is again. The theme which just keeps popping up. Steve says that:

‘There is good evidence about the best way to protect people from drug-related problems is through connectedness; connectedness to adults, connectedness to schools, connectedness to recreational and cultural activities.’

He says that improving social and economic competence makes a difference. And he says this is equally true of remote communities. That enriched lives tends to reduce drug-related problems.

This theme I reckon, continues to be good news.

Each year Mission Australia does a survey of young Australians (aged 11 – 24) and what seems to be concerning them. It’s always interesting to have a look at and usually it’s pretty encouraging too.

Toby Hall, chief executive officer of Mission Australia, makes some comments on their website about this report. Here is some of what stood out for me in what he had to say:

‘More than 45,000 young people, aged between 11 and 24, took part in the poll this year. The results show that while young Australians are facing a range of serious issues, when it comes to their priorities and values, they are also incredibly well-balanced.

They’re not just “generation Y with iPods”. Their close connection with family and friends, the people they admire (entertainers with consciences such as Angelina Jolie) and their high level of volunteering, flies in the face of media stereotypes of young people as shallow and materialistic.’

Pete’s comment: I love hearing this. And I’ve gota say I’m not surprised. Over and over again this is what young people tell me.

‘While body image, drugs and family conflict are the biggest worries for 11- to 24-year-olds – with one-in-four regarding each as of major concern – it’s drugs that are increasingly weighing on their minds. Concern about drugs was not a top-three issue in 2007.’

Pete’s comment: I find it Interesting that ‘drugs’ are a worry. Drugs aren’t like climate change where it is happening to us, (and yes we can change it but it take time), …drugs require our active participation at any given moment, drug use is an action on our part. Sometimes a choice, always a response; a person’s response to their own needs and desires intersecting with the pressures and influences of the world.

‘The other standout result from the survey this year is the degree to which young people are worried about their personal safety…

…If you’re afraid of your community, how do you get involved in local activities?’

Pete’s comment: This, I think, is important stuff. And for me, a reason why we need to continue to look at ways of helping people feel part of something…family, community, neighbourhood…ESPECIALLY the guys doing some of the more annoying (at times destructive) stuff. People are either inside WITH us or outside AGAINST us. Inside always seems like a better option to me.

‘The final take-out of the survey is that overall young Australians are well placed to tackle the issues affecting their transition from youth to adulthood.’

Pete’s comment: Good to hear. Onward and upward.

I think the BIG BIG issue of alcohol consumption is finally starting to get some air time in Australia. And so I am weighing in with an opinion or two.

There have been some ads on TV aimed at binge drinking teenagers. They are two part ads, one aimed at under 18 year olds and the other at over 18 year olds. I have no doubt that the ads are well-intended and probably well researched. And I still have some concerns about them. So let me take a bit of a tour through human behaviour and advertising. And I am happy to hear other opinions about all this, and I am happy to hear about any research in this area too which might help us get this right.

My starting framework is the following. If we are going to try to persuade (and that’s what TV ads aim to do)…if we going to try to persuade people to act well either for themselves, for others, or both…then certain ingredients need to be present. Let me quote directly, and it’s only one source of course. In this case it happens to be from Bruce Berger, Ph.D.
Alumni Professor of Pharmacy Care Systems. But there are many other sources which seem to agree:

‘Communication that is persuasive is directed toward changing or altering another person’s beliefs, attitudes, and, ultimately, behaviours. Generally speaking, attitudes are composed of three components:
1. Cognitive…the manner in which the attitude object is perceived,
2. Affective…feelings of like or dislike toward the object, and
3. Behavioural…action tendencies toward the attitude object.1 The cognitive component is the person’s belief about the attitude object. The idea is that beliefs affect attitudes, which affect behaviours. Change a person’s beliefs or attitudes, and you change their behaviours. However, while there are relationships between beliefs, attitudes and behaviours, these relationships are not always straightforward.’

So we have three factors that need to be addressed:
1. Beliefs
2. Attitudes
3. Behaviour

The above comment above about the relationship between these three not being ’straightforward’ is indeed true. If someone believes that they are person of no worth, of no value, it’s not hard to see how this might lead to all sorts of ways of behaving which is damaging for the person. Putting a question mark over this belief is a good idea. Creating an opportunity for the person to experience themselves as worthwhile is certainly a very good idea. However, challenging a person’s belief for instance that children should do as their parents suggest, or that there is without question a creator, or that people are free to choose their own destinies, is likely to lead to a person simply resisting. Certainly not listening to what is being offered. In various forms of therapy (including narrative, solution-focussed and motivational interviewing to name a few), attempts are often not made to change beliefs, but to work with them and to find ways for them to be expressed in behavioural terms more constructively, compassionately. Banging up against people’s beliefs often just results in them pushing back.

‘Scare tactics’ have been used in the past and they have always been controversial. But it seems there can have impact depending on a number of ingredients. Here is some research about ’scary messages’. They work when (and I am inclined to agree)…
(1) the message provides a strong argument that the recipient will suffer a negative consequence if the recommendations are not accepted; and (2) the message provides strong assurance that adoption of the recommendations will eliminate the negative consequences.

So a little more simply, if we are going to try to scare or unsettle people we need to satisfy two criteria. A person needs to get the messages that:
1. If I keep doing this…it’s going to be awful!
2. If I stop…things will improve

And thirdly, it seems to help if we have:
1. The absence of coercion
2. The presence of compassion and concern

Okay, so with that as the background, let’s start to look at campaigns and ads that aim to help people be happier and healthier. There are a number of scenarios to this. Here are four:

1. How do we get people to do stuff that they believe is good for them and that they want to do? For example, exercise.

4. Okay now how do we get someone to STOP doing something that they believe is good for them, (and ‘good’ might mean, ‘it makes me happy, popular and it’s fun’), that they basically find attractive, and that they want to continue doing? Now this one is getting real tough. But I suspect a large number of the 168,000 young people in Australia who binge drink regularly fall into this group.

Let’s look at each of the above.

And the example I started with is, exercise. So imagine that we are designing an advertising program aimed at encouraging people to do more physical stuff.

To start with, communication theory would tell us that:
a. We say clearly to the person what we want them to do. Not what we DON’T want them to do
b. We give the person an action. And it needs to be something a person is able to do and is likely to do

So we say: ‘Walk 3 or 4 times a week for 40 minutes’. Okay, this all makes sense.

Importantly, the ad, as per ideas about persuasive communication, ideally also needs to :
a. Fit with what most of us believe
b. Fit with what most of us want to do
c. AND, give us clearly an action to follow through with

For example…

These ads have the element of humour. Always powerful.

This is a tougher job. But all of the above applies here too.

Littering isn’t good for the look of our towns and it’s bad for public health. Most people agree. Yet many people litter. Why do people litter? Or what stops people from putting their rubbish in bins or taking it away? Well many reasons for sure, so maybe the ads in the 80’s were aimed at the swinging voters who would do ther right thing if they were able to, or simply more mindful of what they are doing. So the ads say ‘Do the right thing.’ So the communication tells us to DO something rather than NOT do something. Here is a very dated corny ad from 1983 which shows just this.

So:
a. We agree that its a good idea to do…X
b. We (mostly) want to do the right thing
c. We are told just what to do…’The right thing’, put litter in a bin. (In fact in this ad we are actually shown numerous times what to do)

Again, the ad fits with what (most of us) believe, that is, that it’s good to have a clean community, and so we agree that littering is a bad idea, and we agree that we should do something about it and we may well take on board the suggestion as to what to do…put litter in a bin, an action which most people can take up quite easily.

I am not suggesting that ads like this turn us all into model citizens but they at least hang together in terms of what makes sense in encouraging us to act better for ourselves and for others.

Okay let’s look at how we encourage people to STOP doing something. This gets a bit tricky but smoking cigarettes is a good example. The latest ads encourage people to STOP doing something that they know is bad for them and do something that many people who smoke would like to do, which is quit. Okay so we have a fit with the belief but the action is harder. People would LIKE to stop, it’s just hard to do. But again people are given an action…ring this number!

So here too there is a fit with the belief and an action to follow it.

In the past we decided that scare tactics didn’t work. But we have refined our thinking about this somewhat. If we are not careful we can generate interest where there was none before (with say ads about ICE) but we can also show black horrible lungs, a scary unsettling image and yet hope for a quite different impact. The ad says to someone who smokes:
a. Every cigarette is doing you harm. ( This is scary)
b. You can stop. (This gives hope)
c. Here’s what you do: ring this number (This offers an action a person can do right now)

And this fits with the criteria for a usefully scary ad:
1. If I keep doing this…it’s going to be awful!
2. If I stop..things will improve

Let’s look at another ad specifically targeting adults and in particular, parents.

This ad encourages parents to think about their alcohol consumption and follows the same reasoning. Most of us care about our kids, and being encouraged to think about our drinking and the impact on our kids is a thing most of us would agree is also a good thing. We aren’t told in the ad exactly what action to take, but we are perhaps encouraged to rethink what we do around our kids. So the belief fits for us, and the possible action, a rethink or a mindfulness gives us something to do that fits the belief.

Cognitive dissonance theory states that a feeling of dissonance or distress occurs in people when they do or say something that runs in direct opposition to their beliefs or self-concept. The following ad seems to fit here. Not many parents really want to hurt their children. Yes, some also really do. But this ad is directed at ‘ordinary’ parents who might get it wrong from time to time. And in this case. tragically wrong. It’s a tough ad.

Now this one is getting real tough. But I suspect a large number of the 168,000 young people in Australia who binge drink regularly fall into this group. So we are talking about young people doing something which they think is fine and that they want to continue doing. How do we encourage them to stop? And this is where the anti-binge drinking ads come in. Here is the one aimed at under 18 year olds:

I am aware that that not all ads are aimed at all people, that each have target different groups, and that this one is designed to encourage younger teenagers to look after themselves. I agree with the intention but have some doubts about its effectiveness.

A lot of what is shown is actually attractive to young people. Drinking in parks is not something that I think is fabulous but this is irrelevant. Many quite ordinary otherwise ‘good’ kids do this regularly. So much of what we see in the lead up to the ‘disaster’ is seen as good. No matter what I might think, lots of young people like the idea of getting drunk and do so as quickly as possible. Some of the disasters; the running over by a car, are horrible…but hey…stuff happens doesn’t it? The possibly unwanted sex is not wonderfully attractive…but then again…and it matters not what I think…is this really that unattractive and unwanted…?

The following ad is aimed at over 18 year olds:

The dilemma for each of these ads is that they are in competition with the attraction of getting drunk. And the many many kids who are getting drunk are not for the most part ‘troubled’ kids (to use a bit of shorthand here). They are ordinary kids trying to have a good time. And the dilemma is that while NOT falling over and NOT being hit by a car are reasonably desirable, they are seen as simply part of the way things are, and the attraction of getting drunk I suspect is a much stronger pull than the fear of a possible disaster.

The crash into a table…yes…horrible…but…stuff again…happens doesn’t it? The ‘disaster’ of the fight in the bar is, I would suggest, not seen by many young men as a disaster at all.
Lots of young men don’t think fighting is especially okay but will certainly push back if pushed. And ’stepping up’ like this is seen as a good thing by many young men. So we have a double banger here where both getting drunk, and defending yourself (fighting) are seen as good things. The ad suggests that getting drunk and/or fighting are undesirable and this is simply out of step with what a lot of young people think.

So with these ads what we have is:
a. The message does NOT fit with an existing belief. It clashes
b. The message of what to do does NOT fit with what people want to do
c. The message is DON’T do something rather than DO something and this does not fit with communication principles
d. There is no possible action suggested (whether it fits with belief systems or not)

Elsewhere I have posted the following comments from Professor Christine Griffin of the UK. I will repeat them here. She says that:

‘Adverts that show drunken incidents, such as being thrown out of a nightclub, being carried home or passing out in a doorway, are often seen by young people as being a typical story of a ‘fun’ night out, rather than as a cautionary tale.’

And:

‘Not only does being in a friendship group legitimise being very drunk – being the subject of an extreme drinking story can raise esteem within the group.’

The ads below from the UK seem somewhat different and I have put them here by way of contrast. Take a look at these first two.

While these ads do not fit snugly with the principle of communication: That is, to say clearly what you want rather than what you don’t want, and they do have the dilemma of competing with the attraction of getting drunk, they also still have things that seem to be useful. They do meet the criteria of an unsettling message:
a. Most people believe if they continue to do this there may well be a disaster
b. Most people believe if they stop doing this, life will be better

The ads are aimed at teenagers and don’t show the attractive stuff about drinking…the actual getting drunk, and the fighting…they show the possible results of drinking that in themselves, many young people may well not want. And while not exactly humorous, they are kind of interesting. A bonus.

The ad that follows also does not fit well with communicating principles in that it does not directly say WHAT to do, but it does fit with what many young people believe. It shows what is likely to be a genuinely unwanted outcome of drinking. In this case, not only unwanted sex but what looks like gang rape. And as something unwanted this does fit with what many young people, female and male, think is a horrible thing.

This last ad below is aimed squarely at parents and fits reasonably well many of the criteria discussed above. The message is a DON’T message and this is perhaps not ideal and finishes by showing an image of what to NOT do…perhaps the ad serves as a reminder for parents who love their kids. that is, most parents, and encourages us to…’think about it…do the right thing.’

None of this is simple. And everyone is trying to get it right. And when we get it wrong, change it and get it right. Let’s keep on trying, experimenting and evaluating…and doing more of what may just help keep our kids well and happy.

Lots of young people are hurting themselves and others through their use of alcohol. Yes we know this. And so our government has decided to have a series of ‘hard-hitting’ ads aimed at young people and drinking. The minister said something along the lines that young people think they are bullet-proof and they need to know they are not. The ads, from what I can see so far, seem to show the violence and agro and all the unpleasant stuff that goes with nasty drinking. And this is supposed to turn young people off getting drunk is it? I really don’t get it. Okay so let’s add up what we know:
1. Young people don’t actually think they are bullet-proof. But they do have strong young bodies which can take a hell of a pasting and bounce back. And they are full of hormones, and their and hearts and minds are full of desires, impulses and a yearning to explore, experiment and push hard.
2. The research around brain development is now pretty clear. The part of the brain that says: ‘Whoa slow down…maybe this is dangerous’ isn’t fully developed until around 25 years old.
3. We used to have clear ways for young people to grow up which helped them go through the transition gradually. In traditional societies this growing up process was marked by rituals of initiation, and changed expectations, and possibly some guidance. And these addressed the brain development issue, even though we didn’t know about it at the time. In more modern times these rituals have been things like the first full-time job, a 21st party, or getting married. I am not advocating we all run out and get married to those we have lived with for years, but I am saying that there has been an erosion of the markers of growing up and young people are both unsure as to how to grow up and when they are grown up.
4. Added to this, at least in Australia, we have this peculiar combination of getting to leave school, go legally into a pub, and get a driver’s license all at about the same time. A strange piece of social organisation.
5. And then we have a society which is awash with alcohol, and alcohol being actively associated with all that is enjoyable in our society including our cherished sports.
6. Now I quite like living in Australia in 2008 but I suspect we have a got a couple of things wrong. You recall the old marching call that goes: ‘What do we want?’ And the old response is: ‘Instant gratification!’ The cry continues: ‘When do we want it?’ And…you know the rest. We have created a society where credit is better than saving up for something, where a job for a couple of years is a long term event. Fast and furious is the way of the day…

Enter alcohol. Made for the moment really.

I suppose we could rethink the way our society works, which might be contributing to the nasty drinking behaviour which might just be an outer response to inner needs and confusions. But sorting out our society and root causes is kind of a big task isn’t it?

Maybe we could look specifically at how alcohol is promoted and advertised; we could look at where it is consumed, how it is consumed, and when it is consumed. And of course, who is consuming. But this is kind of a tough option too.

So what we have come up with is to leave all this alone and try and change the way young people behave. And the way that is chosen, a series of commercials, is one which research suggests is counterproductive. That is, showing the ‘worst’ outcomes of drinking…which is supposed to deter our young people from dangerous drinking. And yet young people video punch-ups and put them up on YouTube. And getting drunk is what many young people try to do on weekends, as cheaply and quickly as possible. Whether I approve or not is kind of irrelevant. And yes there are those who don’t get drunk. And yes many of those who do, are still decent kids. But there seems little sense to these ads. Who are they aimed at? Those unlikely to get drunk anyway? So if we are aiming at those young people who see getting drunk as a good thing to do, and if we are aiming at those who see getting drunk and fighting as good things to do (rites of passage?), why on earth do we expect that ads showing the very behaviours which are actively sought and admired, is going to encourage them to act any better?

No, I just don’t get it.

Our federal government seems to be concerned about young people binge-drinking. And this is good. Yet how we proceed needs some careful thought. Take a look at the following recent research from the UK. Professor Christine Griffin from the University of Bath, who led the research with colleagues from Royal Holloway, University of London and the University of Birmingham has this to say:

‘Extreme inebriation is often seen as a source of personal esteem and social affirmation amongst young people…’

She goes on to say that:

‘Adverts that show drunken incidents, such as being thrown out of a nightclub, being carried home or passing out in a doorway, are often seen by young people as being a typical story of a ‘fun’ night out, rather than as a cautionary tale.’

And:

‘Not only does being in a friendship group legitimise being very drunk – being the subject of an extreme drinking story can raise esteem within the group.’

I think something important is being said here. Behaviour perceived as a problem by adults or the wider society is not necessarily seen that way by the young people involved in it. And so how we tackle it needs some serious thinking.

The following ad, on the other hand, shows I think, a well-thought-out response. It reminds those of us who drink…er…and we are in considerable numbers…to be mindful of what we do, where we do it, and just and who is noticing. It seeks the best in us and reminds us to be the decent human beings that most people are most of the time.

This ad isn’t really directed at young people. But it’s not bad. Now we need to start getting it right with young people too.

The following article appeared in the Sydney Morning Herald August 11, 2008, and I thought it had something to say and was worth reproducing here so I contacted the author Raymond Seidler Addiction medicine specialist, Potts Point and asked him if if that was alright. He said ‘yes’ and so here it is. One of his titles on his website is ‘Street GP’. I knid of like that. Thanks for the borrow of the article Raymond.

‘ECSTASY JUST ANOTHER IN LONG LINE OF NATIONAL PASTIMES

World record hauls of ecstasy have occurred in Australia since 2004 but nothing approaches the 4.4 tonnes detected in tomato cans in June in Melbourne with a street value of $440 million. It seems that despite extensive education and interdiction, Australia’s youth have embraced this drug like no other. The market remains buoyant.
As a GP in Kings Cross, I have seen hundreds of ecstasy users over the past decade, and despite horror stories in the press most take this drug with impunity. The phenomenon of “Eckie Monday” (the weekend “come-down” from a binge requiring a medical certificate for work absence) is common. So, too, is the weight loss and lack of vitality in habitual users who dance themselves into exhaustion and grind their teeth in clubs all over Sydney.
Early mornings in the Cross provide a cavalcade of burnt-out E users heading home after an all-nighter. But for the most part they do not suffer serious medical problems. A few may develop overheating or hyperthermia and require a short admission for hydration with a litre of fluid or two intravenously in an emergency department. Seizures and drug-induced psychosis do happen, but at a very low rate. Even this outcome does little to dissuade users to quit their drug of choice.
Sure there are horror stories of PMA (para methoxy amphetamine), a cheaper, dangerous substitute for ecstasy causing sudden death, but this is so rare as to not affect demand. Ecstasy testing kits are now available over the internet. These testing kits are common in Europe outside clubs and should be encouraged here.
Young people are educated on the risks and dangers of all illicit drugs. Most schools now have excellent drug education programs covering all illicit drugs in Australia. Children use the internet to plug holes in their knowledge and successive government programs portraying ecstasy as a danger have done little to reduce ecstasy use in Australia.
Most young users have observed their friends taking the drug without adverse effects. Combine this with the boundless optimism of youth and an unshakeable belief that they are bulletproof and you have a recipe for an explosion in demand.
Drug use follows fashion cycles, and in many ways governments’ demonisation, with their horrific video footage, entrenches the inevitable generational warfare between the young and their parent’s generation. It is unusual in my experience for a young person to request treatment for ecstasy abuse unless they are dragged kicking and screaming by a concerned parent. They do not want treatment if their recreational use is limited to weekend recreation, and will show a therapist bored disinterest
Price is a keen indicator of availability and none of my patients ever complain of difficulty obtaining ecstasy. So we can conclude that despite these huge hauls by federal police and the national crime authority, significant stockpiling must occur around the country.
Drug trafficking will go on as long as there is demand. Australia has always been at the forefront of illicit drug use worldwide. In 1936 we had the highest use per capita in the Western world of cocaine and heroin. And now we appear to have won a gold medal for ecstasy. Very little has changed.

Raymond Seidler Addiction medicine specialist, Potts Point’

This is a bit of a development from the last thing I put up. The camp where most of us were young-ish…and some of us somewhat older. And good things happened:

And as our 5 day camp together came to a close I asked a question of a bunch of people of various ages ranging across 35 years. This is what I asked: What is the best thing in the world? And this is what they said:
Life
Music
Friends
Children
Life
Music
People
Life
Love
My daughters

So…how would you answer the question? What do you think is the best thing in the world?

This is the stuff that always worries me. The article in a widely read daily newspaper is called ‘Heaven and Hell’ and is about ‘Ice’, the crystalline form of methamphetamine. And I will assume the best of the journalist, that they were trying, in the course of doing what journalists do – which is to write articles – to be responsible in alerting us to the dangers of something in our society.

Yet I worry. One person talking of their use of ice said: ‘…you were instantly much, much higher. It’s hard to describe.’

The article goes on to say that a couple who had used found ‘…there was no hangover, no crash, no anxious-depressive speed comedown. It was the best of all worlds.’

The article also has a section which looked at the downside and this was called ‘The chilling facts.’
Chronic depression
Agitation
Severe paranoia
Proneness to acts of violence
The acceleration of apoptosis, or natural cell death…which…can result in…premature ageing.

So are we scaring people here, or just making them thoughtful? Would someone reading this reconsider using this or other drugs? What stands out for people as they read? Do we say to ourselves, as most of us do who get into cars, that (with considerable evidence to support our belief by the way) we will make it home safely?

I continue to worry about WARNINGS. Yes, we need to know what could await us if we do…X. And yes, we really do need information…and yet still people enter into relationships knowing that there is something like a 40% chance of that relationship ending up on the rocks. We continue in the hope that we will be happy, that our hearts will not be broken. That tragedy will befall us. That we are in the other group, the 60% who are make it. Or we tell ourselves that the risk is worth it.

Here is a footballer…with just a little damage…..

Concussion
Chipped tooth
Separation of joint in shoulder
Cracked ribs
Torn pectoral muscle
Externally rotated hip
Abdominal hernia
Shattered bone in finger
Snapped bone in finger
Cracked thumb
Bruised femur and tibia
Torn ligament
Hamstring sprains
Sprains
Bone erosion in ankle
Bone spurs in ankle

If we told him when he was younger that this would happen to him would he have continued? Well what do you think? I suppose we could point out this example to young players and they would ….do what? Stop playing? Or would they say to themselves…’it won’t happen to me.’ Or will they say: ‘It might happen…but it’s worth it!’

We really do need to be thoughtful about what we think might be useful.