Have You Ever Stepped on a Nail?

Written by Geoff Kane, MD, MPH. Posted on
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Ask people if they’ve ever stepped on a nail and most will say yes. It can happen to anyone, although the odds go up when lots of boards with nails in them are lying around and people are not paying attention. No one wants or expects to step on a nail. It’s a no-fault wound.

Addiction is more likely to develop when lots of addictive substances are within easy reach and people are not paying attention. Some people are more susceptible than others, but it can happen to anyone. No one wants or expects to develop addiction. It’s another no-fault wound.

Concern and individualized assistance are appropriate responses to no-fault wounds. Blame and judgment are not.

Our responses to people with addiction ought to be like our responses to people who step on a nail. We might begin by expressing concern for the injured person and then proceed to administer the equivalent of first aid. If needed we might follow up with more extensive assistance; for example, a tetanus shot and shoe repair after a nail wound, or medication and rehab in the case of addiction.

Wounds heal best in a no-fault atmosphere.

We can avoid nail wounds by cleaning up as many nails as possible, wearing sturdy boots, and reminding each other to pay attention. We can avoid addiction by making addictive substances less attractive and less accessible—and by reminding one another to pay attention.

For individuals with underlying vascular disease, diabetes, or compromised immune systems, the medical complications of stepping on a nail can be especially frightful—severe infection, loss of leg, loss of life. That’s why it makes good sense for them to recognize and manage their medical problems and steer clear of nails.

When individuals are predisposed by genetics and/or adverse childhood experiences, addiction can start and progress rapidly. That’s why it makes good sense for parents, schools, healthcare providers, and others to identify children at increased risk, make sure they have adequate emotional supports and attractive alternatives to substance use, and let them know how important it can be for them to steer clear of addictive substances.