As behavioral health professionals, a big part of our training is learning about the negative impacts drugs can have on a client’s life. We learn about addiction, withdrawal, and the collateral damage associated with problematic substance use: domestic violence, crime, child abuse and the eventual degradation of the human spirit.
For many of us, this education builds on personal experience. A great many behavioral health professionals, including me, have had complicated relationships with substances in our own lives - growing up with an alcoholic parent, losing a friend to overdose, or finding ourselves dependent on a substance, regardless of the havoc it causes in our lives. These personal experiences, which make us empathic and successful professionals in this field, are also the source of the confirmation bias around substance use that so many of us experience during our training.
Confirmation bias is the human tendency to seek out information that confirms our own experiences. This can happen consciously, such as when we look for negative reviews on the internet about that restaurant we went to and hated, or subconsciously, as we select articles to read from a skim of the daily news. The point is, when you have a population of people who have had negative experiences with substance use, they are primed to enter a training situation where that experience is validated.
Unfortunately, confirmation bias is just that, a bias against objective information. In the helping professions, so many people are driven by their personal experiences that training and education become prime places for confirmation bias to occur. This cognitive shortcut is designed to prevent cognitive dissonance, which happens when what is placed in front of us does not jive with our past experiences, and it is not a pleasant feeling. Think about a vacation you took when you had an amazing time. The location, the people, the service were all stellar in your mind. You return and tell your friends about your amazing experience, and one of them relays that they took the same trip and had a horrible time. It feels strange and a bit anger-provoking. How could your friend not see what you saw? What is wrong with that person?
Now consider the same situation, but this time, your friend agrees with your assessment, stating that she too had an amazing time. Neither reaction takes away from your experience, but the negative reaction definitely elicits a different feeling within you.
The framing of all illicit drugs as harmful usually starts during childhood drug education. Kids are taught to stay away from all drugs because they are dangerous.
There is little differentiation made between cocaine, cannabis and LSD, except to say that all are illegal, all can cause harm, and all can lead to addiction. Alcohol is framed differently, based on the assumption that young people will need to learn to drink responsibly. So, we introduce the concept of drink sizes (1 oz. liquor, 4 oz. wine, 12 oz. beer) and we teach people that characteristics such as gender and weight play a role in how intoxicated you become.
We do no such education around the illicit drugs. When young people move into adolescence, the dichotomy of ‘good drug/bad drug’ is intensified both through their own experimentation with tobacco and alcohol, and because many of them are now also on prescription medications, such as Ritalin, Adderall, or Zoloft. At this point, confirmation bias starts to kick in as a cognitive short cut to assessing a situation and its potential harm. It’s a way for young people to start to make sense of their world.
As behavioral health care professionals, we are also trying to make sense of our world. And, occasionally, we are faced with new information that threatens our world view, information that just drips with cognitive dissonance. This is the case with cannabis. Consider the following:
1) Cannabis has been widely used as a medication across the world for over 5000 years. In fact, its history as a dangerous, illicit substance is dwarfed by its history as a medicine.
2) The change in American attitudes about cannabis came not as a result of new research, but as a reaction to Mexican immigration. Fearful of newcomers and their customs, citizens in San Antonio, Texas passed the first anti-cannabis law in the early 1900s. The goal of the law was to gain the ability to legally detain and search Mexican immigrants. This process was not new, similar laws were passed against opium smoking in San Francisco in an effort to control Chinese immigrants. Fear over these new populations fueled media stories of Mexicans chopping up their families, assaulting white women and generally wreaking havoc on communities, all due to their use of cannabis. Cannabis’ illicit status has everything to do with Xenophobia and nothing to do with the actual plant itself.
3) Numerous government-commissioned reports, produced since the time that cannabis was made illegal in 1937, have questioned the need to assign criminal sanctions to the use of the plant, which was found to be fairly benign. However, due in part to the confirmation bias set by fictitious reports of cannabis’ effects, the new information was discarded and cannabis remained not only illegal, but a Schedule 1 substance. Schedule 1 substances are, by definition, substances having no medical use and a high potential for abuse and addiction. The classification of cannabis as a Schedule 1 substance, an action taken 40 years ago during the Nixon Administration, created the basis for much of the confirmation bias that prevents cannabis policy and research from evolving further today.
So, why should all of this matter to behavioral health professionals?