CBC: White Coat, Black Art host says choice was about harm reduction

Dr. Brian Goldman is opening up about his decision to buy his son a pack of cigarettes as a means of harm reduction. ‘I’m all about breaking barriers that lead to shame,’ he says. (Sebastien Bozon/Getty Images)

On Friday, Dr. Brian Goldman found himself making a difficult decision.

In the interest of harm reduction, he wrote on Twitter, “I bought my first pack of cigarettes. Not for me. For my son.”

Goldman’s son is 17, and he has fetal alcohol spectrum disorder (FASD).

The condition can make learning from past experiences tough, and hinders a person’s ability to make good long-term choices, said Goldman, the host of White Coat, Black Art and an emergency room physician in Toronto.

Goldman spoke with Metro Morning host Matt Galloway about what compelled him to buy those cigarettes for his son, and the challenges of raising a child with FASD.

Here is part of their conversation.

Why did you buy cigarettes for your son?

It’s complicated, for many reasons. My son, a couple years ago, was diagnosed with fetal alcohol spectrum disorder (FASD). We adopted both of our children from orphanages in Russia. It was a highly personal thing. There are many different kinds of harm reduction. I could have bought him a Juul. I could have bought him a vape. But I thought that it would be very easy to turn him into the equivalent of a three-pack-a-day smoker with the nicotine levels that you can acquire, and I didn’t want him to get used to that and comfortable with that, so that if he received vape liquid from other people he would graduate onto other things.

The thing about a cigarette is that you smoke them, there’s a finite amount of nicotine in it, and there’s only so much he can afford. There’s only so much that he’s going to be able to acquire on his own. So there is some limit there. I suppose if he became the equivalent of a pack-and-a-half or a pack-a-day smoker, I might consider switching him, you know, buying him a vape. There are other harms. As an average teenager with fetal alcohol spectrum disorder, he’s got the full range of issues that kids face.

We’ve talked about fetal alcohol spectrum disorder on this program before. But for people who don’t know a lot about it, just quickly tell us a bit about it.

Fetal alcohol spectrum disorder is a brain-based neurodevelopmental disorder that’s caused by prenatal exposure to alcohol. And we won’t ever know about our son’s history except to know that he was given up for adoption and in a country — in Russia — that has a high prevalence of alcohol use disorder, and it can cause facial features that are characteristic. But the most important aspect of fetal alcohol spectrum disorder is that it affects the brain, it causes poor executive function. So that means making choices is very difficult.

How is that exacerbated as a child gets older and becomes a teenager?

You can add to that all of the problems of adolescence, and those parts of the brain aren’t well-developed in a 17-year-old anyway. But in somebody with FASD, they will find it very difficult to learn from experience, to make choices that are in their best long-term interest. They have a tendency to engage in high-risk behaviours — and they can be drugs, they can be sexual, smoking. So smoking and using marijuana and other drugs are often very common. They don’t learn from consequences. You can shame them all you like. You can admonish, punish — whatever you say about what happened today, it can happen tomorrow, next week, bigger, you have no idea. You never know what’s going to come next.

Click here for the full article and to listen to the interview.

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