Consider food. Most of eat several times a day. Every day. It’s not a problem because most people keep it under control and don’t overeat.

Some of us (me included) have a slightly disordered eating pattern. I binge eat occasionally followed by a period of restrictive eating punctuated by microbinges etc. Is it a problem? I’m 25 pounds overweight, but I hold a job, maintain an active social life, and even play a couple sports (badly) in rec leagues. My eating doesn’t affect my household finances so it’s all good.

If you watch one of those tv shows focused on very large people (and I don’t intend to body shame here) you will see something different. There are people who’s excessive eating negatively impacts their health and mobility. In many of the cases portrayed they are unable to hold a job, and much of a shows drama will focus on deteriorating personal relationships as people “choose” compulsive eating over the people in their life.

This range of behavior is true for all addictions. Many people can handle dabbling in the drug or activity. Many will occasionally wander over the line into problematic behavior but wander back. And some spiral in a pattern of misuse that is self destructive. It’s not the attraction of cocaine or Molly or Twinkies that’s the problem. It’s the continuation of use despite the negative impacts on the users life.

Policy makers struggle with this too. The basis of “harm reduction” as an approach is that we don’t judge the use, only the impact on the users life. If we give people access to safe regulated supplies, safe injection sites etc. many people can maintain jobs and keep their families together etc. Much of the negative impacts come not from use itself, but from the way we force people to behave in order to meet their needs.