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Family-Based Addiction Prevention: Q&A with the UN's Dr. Gilberto Gerra

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dr-gilberto-gerra-UN-chief-drug-preventionAccording to recent statistics from the National Institute on Drug Abuse, substance abuse costs the United States over $600 billion annually. And while effective treatment certainly lessens these costs, addiction prevention has the power to reduce them even more.

Dr. Gilberto Gerra, an addiction expert who runs the Drug Prevention and Health Branch for the UN Office of Drug and Crime (UNODC), advocates a strong family-based addiction prevention approach.

The age-old proverb, “An ounce of prevention is worth a pound of cure” certainly holds true when it comes to addiction!

One promising approach is family-based addiction prevention. In this drug addiction prevention approach, family members receive help dealing with problems in addition to substance abuse, such as interpersonal conflict, communication issues, and other mental health issues.

To learn more about this vital topic, we spoke with one of the world’s foremost experts on family-based addiction prevention, Dr. Gilberto Gerra.

About Dr. Gilberto Gerra

gilberto-gerra-UN-substance-abuse-preventionDr. Gilberto Gerra is the Chief of Drug Prevention and Health Branch of the United Nations Office on Drugs and Crime in Vienna, Austria.

He has filled that post at the United Nations since 2007, and prior to that he served as a member of International Narcotics Control Board at the United Nations.

Dr. Gerra is a practitioner and researcher in neuroendocrinology and addiction medicine. 

He holds a medical degree from the University of Parma (Italy), and has served as specialist in Internal Medicine and then as specialist in Endocrinology.

He is a professor at numerous universities in Italy, on Neurology and Addiction Medicine and serves as a consultant to the ministries (Ministry of Health, Ministry of Interior, and Ministry of Social Affairs) in the field of substance use disorders treatment in Italy.

He is also the author of many scientific journal articles on the psychobiology of substance abuse, psychoneuroendocrinology, and clinical pharmacology.

In our interview, we discussed ...

  • The nature of dual diagnosis and which mental health conditions often fuel drug abuse
  • The psychological and behavioral issues that drive substance abuse
  • What effective, evidence-based addiction treatment really looks like
  • The most common risk factors and protective factors for addiction
  • The vital importance of family-based addiction prevention, and how you can start today in your own home

Caroline McGraw: Let's start by talking about dual diagnosis, or co-occurring disorders. For our listeners, that's when you have a substance abuse issue coupled with another mental health concern. In a 2013 interview with the World Federation Against Drugs, you're quoted as saying that the majority of drug users are affected by serious psychological and behavioral problems preexisting to drug abuse. Can you tell us about some of those pre-existing issues that increase the likelihood of drug abuse?

Dr. Gerra: We can first of all look to the data about the rate of co-occurring mental disorders. Depending on the study, between 45, 48, 47% of the patients affected by substance abuse disorder have a mental disorder associated with the addictive behavior. A few years ago, this was dismissed as a very simple thing. Because people say, "Yes, for sure they are taking drugs and drugs are provoking a mental disorder. They are making the mental disorder emerge from the subclinical field to the clinical feature."

It in a very simplistic way, the mental disorder was considered a simple consequence of drugs. Starting in the beginning of the 90's ... we were looking to the fact that most these mental problems - psychological problems or personality disorders or real major mental disorders - were coming out in the clinical history of the patient … sometimes pre-existing the addictive behavior.

So, one of my crazy questions when I worked as a practitioner and was seeing someone affected by terrible heroin addiction. They would ... go up and down from prison, twice a year sometimes because of bad crimes, and I’d ask him or her, "When did you steal the first bicycle?"

And most of the times this was at 12 or 13. Two years or one year before they starting drugs. There was this vulnerability of committing small crimes.

Then we'd talk about it. "I was suspended from the school, and then I had major damage from the school because they suspended me." So, things emerge, sometimes many years before. And now we have very clear evidence about the effect of conduct disorder for example.

It's predictive of addiction if it is untreated, developing addictive behavior and substance abuse disorder. And it’s the same for a certain portion of attention deficit hyperactivity disorder (ADHD) and depressed children.

Also, depressed children are less [present] in the scientific literature, do you know why? Because they don't disturb anyone.

If you are antisocial or have a conduct disorder you create a lot of mess. A lot of trouble.

If you are isolated and depressed with low self esteem, sometimes with this state of anxiety, it is difficult to socialize with the other children. You are living in your own world, you don't disturb anyone, and no one cares about you, because you are apparently a good boy or good girl, not creating any problems.

But inside you are suffering because of your depression.

Sometimes you are also suffering because of your low appreciation of your person from the physical point of view. You don't like your body. And this for an adolescent, that is not something light, it's something heavy. I think that many things have come before substance abuse.

And about this I have a very important point to underline: the issue of recreational use of drugs.

The majority of patients - when I came to interview them - I asked, "Why did start to use drugs?"  And their typical response: "Because I like them."

That's a very artificial response, a very superficial reply, but you start to understand that most of them were using drugs because of ... their psychological condition, and because of their perception of a lack of support from their parents, and so on.

Because I've had children in the same condition, with the same availability of drugs, and they are not using them. And they say, "For recreational use, I cannot use something that is illegal and damaging my brain." Because they know better.

…. When you are using for recreation, often it means … you did not receive enough love in your time.

Most of the time, you are not aware of the fact that this makes you vulnerable for drugs. It is because your self-esteem, your condition, has not been well established.

"I don't have the courage to approach my friend or my girlfriend." You are feeling lack of control.

With some drugs, you are taking control, you know? It's been called self-communication, it's something larger than self-communication. People vulnerable for exposing themselves to drugs … are coming from some sort of problematic equation.

It could be a big one, or a small one.

For example, if you have beginning of bipolar disorder, early onset in childhood ending in adolescence. If you have depressive manic stages of neural bipolar disorder, but in adolescence for sure you are at risk of using drugs to reach from depression to mania.

But however, if you are slightly overweight and you are at adolescence … and this is making you a marginal person in your group. You will have perfect fitness in a few years; you will be very beautiful. But she does not believe this. She says, "Now I am marginalized because I am fat. A little fatter than the others." And this will become a very big problem for an adolescent.

It is equally dangerous as any bipolar disorder early onset in the risk of approach to drugs.


The classic objection I receive in many conferences is that friends oblige them to start the first abuse of alcohol. It is not a matter of obliging, it's a matter of how much they're open to this kind of vulnerability. How much you were broken in a condition that was preexisting to your choice and conditioned in your choice?

Clearly, people are not rats. People always have possibility to say no or say yes, but some people have a larger scale of possibility to say no because they have a lot of self esteem, a lot of strong conditioning, more development of their personality.

Other children have a short perspective in saying no.

Caroline McGraw: Yes. That is so well said. That's such a wonderful explanation. Especially that focus on how being teased, being ostracized, feeling like you don't belong, that that can be very traumatic to someone. And that can later lead to choices that they might regret because they are acting from that pain.

So, that brings me to my second question. You talk about how, when people receive effective, affordable, and humane treatment that meets their medical and their social needs, that it prevents drug related crime.

We talk to a lot of people at The Clearing that call us. They want to talk about treatment for themselves or a loved one. So can you talk a little bit about what constitutes compassionate, real treatment? What are some of the key elements of good addiction treatment?

Dr. Gerra: As you mentioned, we probably share this dogma that it's

From Coercion to Cohesion: Treating Drug Dependence Through Health Care, Not Punishment.

.... It is a real change in the perspective of the approach to the world drug problem.

Fortunately, it has been very well represented now in the document produced by the General Assembly Special Session on Drugs and agreed upon in 2016. Such a protection approach has been really confirmed and adopted by members unanimously at the UN.

If I am a parent now coming to your center this afternoon and bringing my son and my daughter to your center, what I would ask you to provide is ... some methodology to obtain the extinction of the conditioned behavior - that is, the compulsive conditioned behavior produced by drugs.

A reduction of craving, a reduction of the conditioned compulsive behavior …. And this is sort of reestablishing the mechanism of effecting the motivational system. And making the motivational system and the reward system completely focused only on drugs …. It says, any other reward is becoming irrelevant.

This is very similar to the conditioned behavior provoking the Pavlovian dogs. Remember when they started to salivate responding to the bell?

The bell was associated with the arrival of food. Any conditioned behavior can go to total extinction or a reduction of the intensity of the conditioned behavior.

So, the first thing is that should be taking place in a treatment center is some methodology - be it psychological, social, or pharmacological - to reduce the intensity of craving and the intensity of this compulsive conditioned behavior, right toward extinction.

Classic method toward extinction is for example, not getting the reward.

Both suboxone and naltrexone go in this direction because they are taking away the possibility to have a full effect of heroin.

In case of the antagonist is because the receptors are completely blocked. In case of agonist because the receptors are occupied by the agonist, that is, not giving the same reward that heroin is giving.

But there are many other methods of abstinence or subtraction …. drugs are stopping the triggering effect. The cue effect produced by the exposure to drugs.

But the other big thing is ….We cannot ignore the history of the patient, his own problematic situation. The history of trauma and abuse and neglect and household dysfunction and so on.

And taking care of these things ... as the psychologists are doing, with Cognitive Behavioral Therapy  (CBT) and Motivational Enhancement Therapy and Motivational Interviewing - in this way this is helping with our conditioning, our double bind.

We cannot ignore the history of the patient, his own problematic situation

We were speaking about the double diagnosis, but this is the double binding. The binding created by drugs with the conditioned response that I mentioned before. And the binding created by this problematic situation is preexisting to drugs that is binding you more and more.

So, taking car of the psychological package, but also, looking into two other things. The lifestyle. Say you start life as a creature of the night, a rat or a cat. Hunting or be hunted during the night. You start to wake up at 1:00 pm.

Caroline McGraw: Yes, yes. You're nocturnal.

Dr. Gerra: Then you stay in the disco club until 4:00 or 5:00 and then you go to sleep when the other people are going to work. But you cannot change this, because the highest level of cortisol is at 8:00 in the morning because we are diurnal animals. ACTH, an adrenocorticotropic hormone that is stimulating cortisol is waking up at 6:00 in the morning, and this is going to push cortisol and cortisol is mobilizing sugar.


This is happening at 8:00, 8:30 in the human species. And if you start to completely dismantle this kind of cycle in your life because of your own lifestyle. If you don't put in order these things in your body, you will be for sure not so well.

This is happening for people who have to work during the night … And now they’re trying to protect the workers from this imbalance created by waking up in the middle of the night.

And then the last one that we have the opportunity to discuss is the issue of creating new interpersonal relationships.

So, during treatment, I’ll summarize:

  1. First, the extinction of the conditioned behavior, to weaken, to reduce the strength of the conditioned behavior.
  2. Second, I said that the psychological problem to be elaborated.
  3. Third, the lifestyle changes; good food, good circadian cycle, and then
  4. The fourth, personal relationships: with the staff, among the patients, with your family.
You rediscover your family in a different perspective.

I think that if I have to choose one, the fourth is the most important.

Caroline McGraw: The relationships.

Dr. Gerra: Interpersonal relationships because they become the food for changing other things.

So, I've got to dismantle my conditioned behavior because I have discovered a new relationship with someone. And as the problematic relationship was sometimes the cause of the problem, it could become the solution of the problem.

And as the problematic relationship was sometimes the cause of the problem, it could become the solution of the problem.

Caroline McGraw: Yes, yes and that's a very good transition because I wanted to ask you about family based prevention and for our listeners, family based prevention means that family members receive help dealing with problems in addition to substance abuse.

So, they learn about how to deal with conflict, they learn about how to communicate. They learn how to function and have healthy relationships. So, can you talk about why these family based prevention approaches are so important?

Dr. Gerra: We have invested a lot in my branch here in the UN; we have family-based addiction prevention in 30 countries around the world.

We've had some important donors - Sweden, France, and the US - and I think that as we've found from the US branch, these approaches are found effective by science.

A lot of consolidated literature is showing a reduction of the rate of people experimenting with drugs and a lot of people delaying their initiation.

That is one other big advantage because if you start to smoke at 19 or 20 rather than doing this at 14 or 16, it makes a difference.

Family-based prevention has been found effective by science.

There is an impressive article written by a psychologist in the United States that is talking about the urgency of early love.

He has a slide showing lions and there is a mother and the offspring, newborn lions. And the methodology of the mother, to make them resilient, to make them grow healthy and happy, is licking and touching.

These kind of things are not for a very long period for the animals. So, if you don't have this section of early love in the first six months of a life … you have these three years, these 36 months that are so crucial. The section of early love.

The bad news - and the good news for prevention - is that the lack of early love, lack of care can make for unhappy situation.

How do babies respond to change like that? The lack of these things are provoking changes in gene expressions.

The genes that you receive from your mother and your father, can be expressed in RNA, the DNA can be copied in the RNA, and the nucleic acid.

The nucleic acid can guide the production of proteins, hormones, peptides in the brain, neurotransmitters, interceptors, etc. But the RNA expression is not always the same. It is very much influenced by the environment. It's not genetics only, but it's epigenetics …. The expression of the genes can be easily related to lack of early love. So, we have evidence of not getting enough care in this initial stage of your life, is going to make you vulnerable because of the changes in gene expression.

It's not genetics only, but it's epigenetics …. The expression of the genes can be easily related to lack of early love. So, we have evidence of not getting enough care in this initial stage of your life, is going to make you vulnerable because of the changes in gene expression.

So, imagine how much replacing and re-creating this environment of love and care and listening to the children as an expression of care is powerful.

Before you were thinking of prevention as something philosophical. We teach people to do something, we inspire people to do something. Now we can say, "Good prevention is changing the gene expression of people." It’s making them less vulnerable and it is unbelievable.

When you start to handle the classic things that we promote, we promote through family-based prevention … we don't promote through psychologism. It’s not going to work to have the [parent] go home and become a psychologist. A nurse or a single mom full of problems is not to become a psychologist. This is completely absurd.

With family-based prevention we disseminate simple things, which are so powerful because everyone can adapt them.

Imagine, the first main content is undivided time for your child. Spend an afternoon. Joking with the parents, joking with the child. I always say to parents, don't spend two hours with them in the beginning. They never see you and they're going to be sick of you!

I suggest please start with something smaller, then scale up. Play Lego or to play something together or to prepare a homework for tomorrow.

The second issue is supporting and engaging behavior. "I'm afraid of the test in school. What can I do?" Instead of blaming, you can say, "We can exercise together so next time you can do better …. You are not to consider this being defeated. You are not diminished because you failed a test. You can do better next time."

Then, supervision, supervision. Imagine, they were paying money to this center of drug abuse in Lisbon. The strength of supervision is reducing 30% of user-related drugs.

Supervision means, Where are you going? To do what? What time will you come back? With whom will you go?

You don't need a psychologist. My three children - now they are old - but when they were 17 or 16, I cannot repeat in an interview what they said to me when I ask these questions. “I'm already an adult. I don't want to share this information."

But the parents are becoming depressed ... in a certain sense, frustrated. They say, "I received a bad reply from my children. They did not care about me. They did not consider me in authority."

And you know what the parents do? They stop asking next Saturday.

Instead, the asking should continue. When the child is saying to you, "Go to the hell, Daddy. I do not want to reveal to you where I go with whom to do what with at what time." You know? They say this with the cortex, with the conscious brain.

But their amygdala, the storer of emotion and hippocampus and the unconscious brain is saying, "You know why my father and my mother are bothering me so much?”

Caroline McGraw: Because they love me.

Dr. Gerra: Because for them I am of value. I'm not garbage. I'm not something useless. They are very interested in me and taking care of me."

So, I mentioned the importance of continuing to do supervision.

Ask very gently where are they going, to do what with whom. And then another issue which is very important is giving rules for their own life. Imagine, apparently, small things: "Help your mom to prepare the dinner. Go get water in the garage." Give very simple things where you participate in the life of the family because there are roles that everyone has to pay.

Do dinner with daddy, seeing the face of your father. It’s not having a dialog. Having a dialog is too much. Have dinner with your father. Presenting this the first time in a meeting, they told me, "This is completely stupid because no one has lunch with the children because they are in the cafeteria, you are in a coffee shop to have a sandwich. But for dinner everyone is seeing the children.”

And I demonstrated to them that this is not true anymore. People cannot see the children. Why? Because sometimes they work in a construction company. He's going home, he's hungry, he has dinner and the children are in the swimming pool coming back from a course of swimming.

Then each people are going to do [their own thing] and the children are eating at 7:00. And then the parents are eating at 9:00, when they’re together at home at the same time. The children take from the kitchen two different foods, and they go to see the cartoon and the news into different rooms.

Listen when they don't speak. Listen when you don't understand what they say. Listen when they are calling you because you are in trouble because of other things. Listen as a sign that you really care about them.

It’s frightening. Can you imagine? So in reality, people are staying weeks without seeing the face of their children. That is terrible damage. So, restating this idea of supervision, rules, supporting and engaging behavior and undivided times. This is like .... when you protect people from coronary diseases, from cardiovascular diseases. No sedentarity, no smoke, no hypertension, no cholesterol.

Very easy to understand, don't need a psychologist. And also the things that I mentioned to you about drugs and the prevention are very easy to understand.

Chaotic families are difficult to reach. The mother affected by depression and intoxicated of benzodiazepines. The father, up and down from prison, anti-social, a con. This is difficult to change.

gilbertogerra-coercion-cohesionThen, on the other side of the curve ... we have families that are perfectly working well. They can teach to us. In the middle, there is a gray area that is 90% or 95% percent of the people, who are not doing the right things with the children.

Simply because of a lack of information about doing the right things. And as before they were eating cholesterol, now they stop eating cholesterol because they know it is dangerous.

They started to go for jogging because they know that sedentarity is dangerous. They can learn what needs to be done with the children. And the family is not colder ... it is not all totalitarian. Not say, do that because father, no. Or it's not less fair. It's a kind of engagement, warm style, support style. At the same time we do a lot of the rules together and care and we have this unbelievable companion.

Don't speak now to your children before listening.

Caroline McGraw: Listen first, yes.

Dr. Gerra: Listen not only with your ears.

Caroline McGraw: With your heart.

Dr. Gerra: Listen when they don't speak. Listen when you don't understand what they say. Listen when they are calling you because you are in trouble because of other things. Listen as a sign that you really care about them.

In reality, it is going to recreate a situation that they tell you they can really revert changes in the genes and also counteract genetic risk.

I publish many articles explicitly about the issue of risk related to the certain gene variance. Gene polymorphism and [inaudible 00:34:03] gene polymorphism affecting your transporter of serotonin and apparently, you become lacking in serotonin and passive. You become irritable, you become always angry … and you are very much at risk of that.

Those of this genotype of the gene variance. There are already many studies, not only my studies. Demonstrating that great parenting is going to counteract … the risk of this genotype. Someone at risk because of his gene - that you cannot do anything because his gene is the personality trait - good parenting is also more effective than what is so called normal. But they don't call it a magic gene. So, the good news is that parenting is more powerful than genetic risk.

And the things is that the fact this protection against genes … there is an unbelievable study that are saying that if you apply this care opportunity to children. The people responding back are the children at risk. Can you imagine?

You should expect the children who are already in good condition, should respond well to good parental care. The best response, the higher level of response, is among the children who are at risk.

Such as, they are in need of love … it’s something that is beautiful for them. The other children are already stable and resilient and already in good condition. Good home, good relation, good interpersonal relation. They don't recognize this as something essential for them. They care relatively. The people caring more are the people in trouble.

Caroline McGraw: The vulnerable ones. Yes. That is so powerful, thank you. You made such a good connection between here are the genetics, here are the epigenetics and here's how you families can make these small changes that can affect your children and that can influence their gene makeup and it's amazing. It's incredible.

Dr. Gerra: If I can add one thing. Understand that in all these scenarios we should let understand the people, that there is no one guilty.

So, someone can say, "Nah, the child is not guilty because he's becoming a user. The parents are guilty because they were unable to provide a good education." Well, the parents did not already give good education to the child simply because they were not provided the tools and the understanding and the information.

A thrombosis of the coronary arteries and myocardial infarction - because you were eating every day salami and ham et cetera - we get high cholesterol then it's not that you are guilty. You are simply not aware of a situation.

What was working before in the nuclear generational family - where you learned from the mother and father and which way to parent - now, it's no longer existing. So, we are in a circumstance where the public has to have an intervention to replace something that was normally in a naturalistic way transmitted to the new parents by the old parents.

Caroline McGraw: Yes. That makes so much sense. That the family structures have changed and so they don't have that transmission that they used to have.

Dr. Gerra: You might have the father and the mother. You don't live with the uncle, you don't live with your aunt, but as children not to show you the mothering. You don’t know which way to move on the first movement and the first activities.

To manage your time, most of the time, the parents are isolated in the nucleus, in the core. A function of the family that is completely isolated. 800 kilometers or 7000 miles from the parents, from your own father and your own mother.

Caroline McGraw: Yes and that's so powerful that no one is to blame. You’re not pointing a finger at anyone it's just, "You didn't have what you needed. You didn't have the tools, you didn't have the support, you needed something."

Dr. Gerra: Exactly.

Caroline McGraw: Okay. I will ask another question. So, when you talked about the vulnerability of adolescents to drugs especially, if they don't have that early nurturing. Maybe someone knows, "Okay, I had a hard childhood. I did not have that consistency, I did not have that expression of love. I have that vulnerability."

What can that person do to address that when they say, "Okay, I know that this is what led me here." How can they begin to heal from that lack of love and to learn how to be in those good relationships?

Dr. Gerra: First of all, let me say it's kind of vulnerability. The Director General of the National Institute of Drug Abuse Nora Volkow and Professor Koob and Professor Mclellan published an article about the condition of this disorder that is addiction to drugs and has been called a complex multifactorial health disorder by the General Assembly … accepted unanimously by the General Assembly in 2016. ("Neurobiologic Advances from the Brain Disease Model of Addiction"). They say, addiction is a multifactorial complex head disorder. The nature is chronic and relapsing so, it was really recognized that we are speaking about a disease.

The article is saying, also the beginning, also it’s not only continuous use of drugs, or the conditioned behavior, but also the first exposure, the first initiation, the first experiment with drugs.

These children can have real changes in their biology. At some point, they can have an alteration of the HPA axis. The hypothalamus, pituitary, adrenal axis. This is as your machine to respond to stress. Your genes are always working; consuming fuel, producing cortisol when it's not necessary. You’re determined and stressed.

With enormous stress that is coming from outside from the normal life, you have in a sense you are unable to cope in acute situation. There is a lot of evidence on this cortisol and ACTH level that are higher in the population … for substance abuse.

They have this kind of change that is ... related to their own history of problematic childhood and first hand experiences and so on. So, you asked about what to do when you are affected by these kinds of things. First of all, you should find someone to accompany you. We’ve measured the progress of this counseling activities in the school. Not speaking on about drugs. They should not speak about drugs or speak about risky situations. They should speak about the self-perception of the people, of the students. I have a colleague who, knowing my previous career, asks, "What's the grade you give to your life?" Not your performance in school, in sports, et cetera, but to your life in general. To you as a person.

And one of the most dramatic and also most aggressive persons, a boy said, "I give one hand in front of the others, I show a face with ten, but in front of the mirror, when I am alone, I give myself less than two."

Caroline McGraw: That's very powerful.

Dr. Gerra: A discrepancy, "I have ten of ten in front of my friends in particular, the girls, but inside less than two."

Consider this situation, case by case. Teach the adults, and create structure and a personal relationship with these children, where they can start to speak with someone. Apparently, in some families they were unable to speak with parents.

The first thing should be getting them on board in a new interpersonal relation, to create a new channel of communication. Where they are able to explain what is their concern, what is the source of their distress or their problematic situation they see for their life, their concern about their future and this kind of thing … it should be open in the school and when possible, in the family.

The family sometimes is difficult because the family cannot change quickly to provide this kind of relationship. This is not only as the first four rules as I described to you before, but they are very easy to apply and apparently they should be applied.

The school then as a second ... should start to offer not specifically with counselors not only, but every teacher. That math teacher teaching math or teaching history or teaching language on Italian or English, should start to ask himself, "What am I doing, through the learning and teaching process, what am I doing to create an interpersonal relationship?"

I am saying that also with the authors of literature for example, I am teaching the children to create a personal relationship with the authors of the literature.

For example, you read the Hemingway. Are you establishing a relationship with Hemingway?

Caroline McGraw: Yes. I studied literature so, I like this.

Dr. Gerra: It changes your perspective. I'm doing this through the interpersonal relationship you have with your teachers and your friends are reading Hemingway with you. So, the material that is shared in the school, has to become an opportunity to create that interpersonal relationship.

Then imagine, you open a door and you find inside; good things, problematic things, et cetera, that can be really a part of the process of ... going to restore the situation ... that we recreated before.

For sure, as you understand, I'm not against providing information about drugs because it is important that schools and parents are informed and they provide good and clear and reliable information on drugs.

But this is a timing issue, it is a 3% issue.

The 97% issue is not related to information on drugs that they are always moved when they are provided in the correct way. But the 97% is the recipient of drugs that have to be considered.

To remain on the example of Hemingway, when they start to see that for example, through this pain, they can start to dream about their lives. They start to adopt values … and when you start to acquire beliefs and values and dreams, I think that is already helping them in coming out from this situation. The vulnerable situation.

Finally, I think that the external environment, the media has a great responsibility. I think that what they are disseminating to the adolescents because it is really says they are proud and not afraid to say this of a business.

The business is making money on the skin of these people. Big pharma and big alcohol and big tobacco and big drugs in the future, but all of these things are in a circumstance in part, orchestrated and facilitated by the media

Bring on board the media to facilitate an environment outside, to establish an interpersonal relationship between adults and children and making this relationship full of inspiring content. That’s development in the right direction and not in the wrong one.

Caroline McGraw: Yes, exactly. It's that you as a person, you have the power to choose. You can choose whether or not to take drugs, but you are influenced. You're influenced by the media, you're influenced by your family relationships like, these all affect you. You're not separate from these, your environment really matters, for sure.

Dr. Gerra: You know? I want to share an example. I've done a request in a school. I like to bet with the teachers. It was secondary school, the second year of secondary school and I said, "Let me go in and take in the books."

At that time, in the classroom and I was not aware of which kind of topic they were studying that moment. I said, "Starting from where it is, any method, any topic, I’ll start to speak about the future of the students."

They said, "No, it's impossible Gerra, you can't find technical method." It was a technical institute.

So, I went back in the class room with class mates. With what they were studying, I was not lucky. Topography. So, I told you I see these lines. These round lines, the mountains, are connecting all the points at the same altitude. I said, "These are showing the depth and these are showing the altitude of the mountain."

So, I asked one of the child that was there, because it was in Sardinia, this experiment, this boy was working with the father as a shepherd. He was helping the father in the afternoon as a shepherd. I asked, “If your donkey has to walk on that mountain, can you predict how much he has to work? How much he has to sweat?”

He said, "The donkey is completely unaware because he is a beast. He is an animal." And I said to him, "Can you predict on this mountain that is written here on the map of topography, can you predict that you have to work and be tired, you have to sweat to go to the mound of this mountain?”

"Yes, I can predict because I read the lines connecting points, showing the meters at which meter you are. I can predict how much is the effort that I have to do." So, this map of topography give me a possibility in my life, to predict the consequence of my actions.

We speak about what is the capacity of humans … to predict what was the consequence of the situation.

We speak about what is the capacity of humans … to predict what was the consequence of the situation. And then we spoke about their lives, not about topography.

Caroline McGraw: That was wonderful. The elevation change and you can see the effort. It's going to take this much effort to get up that much elevation. That is such a great example that you can see the consequences.

Dr. Gerra: I would conclude that the donkey was not looking to the map.

Caroline McGraw: Right. Only we're looking at the map. The donkey doesn't know. Well thank you so much for your time. You've been so generous and so kind and it's been wonderful to talk with you.

Dr. Gerra: Good to hear. It was a pleasure for me.


More Information About Dr. Gilberto Gerra

Dr Gilberto Gerra (AT)

Chief of Drug Prevention and Health Branch, Division for Operations, United Nations Office on Drugs and Crime, Vienna.

Dr Gerra is the Chief of Drug Prevention and Health Branch, Division for Operations, United Nations Office on Drugs and Crime, Vienna. He holds a medical degree from the University of Parma, was a specialist in Internal Medicine and then a specialist in Endocrinology.

He is a Professor at numerous universities in Italy, on Neurology and Addiction Medicine and serves as a consultant to the ministries (Ministry of Health, Ministry of Interior, and Ministry of Social Affairs) in the field of substance use disorders treatment in Italy.

1995-2002: Director of the Drug Addiction Treatment Centre in Parma.

1993-2002 Director of the Addiction Research Centre of Parma.

2003-2006: Director of the National Observatory on Drugs, at the Prime Minister Office, Rome, Italy.

2004-2007: Member of International Narcotics Control Board (INCB) at the United Nations, Vienna.

Member of the College on Problem of Drug Dependence (CPDD), Member of the International Society of Psychoneuroendocrinology (ISPNE), Member of the Board of the Italian Society on Drug Addiction (SITD) and Member of the scientific committee of the Federation of Dependence Treatment professionals in Italy (Feder.Ser.D)

He is author and/or co-author of many articles in the field of psychobiology of substance abuse, psychoneuroendocrinology and clinical pharmacology (120 articles on scientific peer reviewed journals).

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Caroline McGraw

This post was written by Caroline McGraw

In addition to her work as "the voice of The Clearing", Caroline Garnet McGraw writes about trading perfectionism for possibility at A Wish Come Clear. Visit and receive your free Perfectionist Recovery Toolkit today!

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